Association between prehospital vitamin D status and hospital-acquired Clostridium difficile infections.
OBJECTIVE
To investigate whether preadmission 25-hydroxyvitamin D (25(OH)D) levels are associated with the risk of hospital-acquired Clostridium difficile infection (HACDI).


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.
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston.
Sadeq A
SA
Quraishi
Channing Division of Network Medicine and Pulmonary and Critical Care Division Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Augusto A
AA
Litonjua
The Nathan E. Hellman Memorial Laboratory, Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Takuhiro
T
Moromizato
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston.
Fiona K
FK
Gibbons
Department of Emergency Medicine, Massachusetts General Hospital, Boston.
Carlos A
CA
Camargo
Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
Edward
E
Giovannucci
The Nathan E. Hellman Memorial Laboratory, Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts kbchristopher@partners.org.
Kenneth B
KB
Christopher
D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000302:isolation & purification; D003015:Clostridium Infections / Q000097:blood* / Q000453:epidemiology; D003428:Cross Infection / Q000097:blood* / Q000453:epidemiology / Q000382:microbiology; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014807:Vitamin D / Q000097:blood*; D014808:Vitamin D Deficiency / Q000097:blood* / Q000453:epidemiology
D014807:Vitamin D
25-hydroxyvitamin D; Clostridium difficile; hospital-acquired infection; nosocomial infection; vitamin D