Association Between Prehospital Vitamin D Status and Hospital-Acquired Clostridium difficile Infections. (January 2015)

• Record Type: Journal Article
• Authors: Quraishi, Sadeq A.; Litonjua, Augusto A.; Moromizato, Takuhiro; Gibbons, Fiona K.; Camargo, Carlos A.; Giovannucci, Edward; Christopher, Kenneth B.
• Is Part Of: JPEN, Journal of parenteral and enteral nutrition. Volume 39:Number 1(2015)
• Page Start: 47
• Page End: 55
• Publication Date: 2015-01
• Subjects: vitamin D -- 25-hydroxyvitamin D -- Clostridium difficile -- hospital-acquired infection -- nosocomial infection; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; 615.85484
• DOI: 10.1177/0148607113511991
• Languages: English
• ISSNs: 0148-6071

Abstract

Objective : To investigate whether preadmission 25-hydroxyvitamin D (25(OH)D) levels are associated with the risk of hospital-acquired Clostridium difficile infection (HACDI). Materials and Methods : Our retrospective cohort study focused on 568 adult patients from 2 Boston teaching hospitals between August 1993 and November 2006. All patients had 25(OH)D levels measured before hospitalization and were at risk for HACDI (defined as the presence of C difficile toxin A or B in stool samples obtained >48 hours after hospitalization). We performed multivariable regression analyses to test the association of prehospital 25(OH)D levels with HACDI while adjusting for clinically relevant covariates. Results : In these 568 patients, mean (SD) 25(OH)D level was 19 (12) ng/mL, and 11% of patients met criteria for incident HACDI. Following adjustment for age, sex, race (nonwhite vs white), patient type (medical vs surgical), and Deyo-Charlson index, patients with 25(OH)D levels <10 ng/mL had higher odds of HACDI (odds ratio [OR], 2.90; 95% confidence interval [CI], 1.01–8.34) compared with patients with 25(OH)D levels ≥30 ng/mL. When patients with HACDI were analyzed relative to a larger patient cohort without HACDI (n = 5047), those with 25(OH)D levels <10 ng/mL (OR, 4.96; 95% CI, 1.84–13.38) and 10–19.9 ng/mL (OR, 3.36; 95% CI, 1.28–8.85) had higher adjusted odds of HACDI compared with patients with 25(OH)D levels ≥30 ng/mL. Conclusions : In our cohort of adult patients, vitamin D status before hospital admission was inversely associated with the risk of developing HACDI. These data support the need for randomized, controlled trials to test the role of vitamin D supplementation to prevent HACDI.