Association Between Prehospital Vitamin D Status and Hospital‐Acquired Clostridium difficile Infections |
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Authors: | Sadeq A Quraishi MD MMSc Augusto A Litonjua MD MPH Takuhiro Moromizato MD Fiona K Gibbons MD Carlos A Camargo MD DrPH Jr Edward Giovannucci MD ScD Kenneth B Christopher MD |
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Institution: | 1. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston;2. Channing Division of Network Medicine and Pulmonary and Critical Care Division Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts;3. The Nathan E. Hellman Memorial Laboratory, Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts;4. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston;5. Department of Emergency Medicine, Massachusetts General Hospital, Boston;6. Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, Massachusetts |
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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. |
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Keywords: | vitamin D 25‐hydroxyvitamin D Clostridium difficile hospital‐acquired infection nosocomial infection |
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