title: Healthcare costs of Staphylococcus aureus and Clostridium difficile infections in veterans: role of vitamin D deficiency.
abstract: Clostridium difficile and staphylococcal infections are associated with increased morbidity, mortality and healthcare costs. Vitamin D deficiency may also contribute to increased healthcare costs. There is increasing evidence that vitamin D may have an antimicrobial role. We examined the relationship of serum 25(OH)D levels to staphylococcal and C. difficile infections to determine if vitamin D deficiency was associated with adverse outcomes. In the outpatient setting, vitamin D deficiency in patients with C. difficile and staphylococcal infections were associated with significantly increased total outpatients costs and fee-based consultation. Laboratory expenses had a trend towards higher costs in the vitamin D-deficient group but did not reach statistical significance. The differences were most clearly seen in the in-patient group with enhanced laboratory, pharmacy and radiology costs. These differences resulted in vitamin D-deficient patients with C. difficile or staphylococcal infections having costs more than five times higher than the non-deficient patients. The total length of hospital stay was four times greater in the vitamin D-deficient group. In addition, the total number of hospitalizations was also significantly greater in the vitamin D-deficient group. Surgery costs demonstrated a tendency to be higher in the vitamin D-deficient group but failed to reach statistical significance. Vitamin D deficiency is intimately linked to adverse health outcomes and costs in Veterans with staphylococcal and C. difficile infections in North East Tennessee. We recommend that vitamin D status be checked in patients with these infections and appropriate therapy be instituted to restore vitamin D level to normal in an expeditious manner.
authors.affiliation: Mountain Home VAMC Medicine Service, East Tennessee State University, Johnson City, TN, USA.
authors.forename: D
authors.initials: D
authors.lastname: Youssef
authors.forename: B
authors.initials: B
authors.lastname: Bailey
authors.forename: A
authors.initials: A
authors.lastname: El Abbassi
authors.forename: R
authors.initials: R
authors.lastname: Copeland
authors.forename: L
authors.initials: L
authors.lastname: Adebonojo
authors.forename: T
authors.initials: T
authors.lastname: Manning
authors.forename: A N
authors.initials: AN
authors.lastname: Peiris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D013211:Staphylococcus aureus; D013714:Tennessee / Q000453:epidemiology; D014728:Veterans; D014808:Vitamin D Deficiency / Q000191:economics* / Q000453:epidemiology / Q000628:therapy