title: Interrelations of immunological parameters, nutrition, and healthcare-associated infections: prospective study in elderly in-patients.
abstract: OBJECTIVE
  Healthcare-associated infections [HAI] are common in elderly individuals and may be related to both nutritional deficiencies and immunosenescence. Here, we assessed whether overall malnutrition and/or specific nutrient deficiencies were associated with HAI via alterations in immune parameters.
  
  
  METHODS
  Prospective observational cohort study in patients aged ≥ 70 years admitted to the geriatric rehabilitation unit of a teaching hospital in France between July 2006 and November 2008. Clinical and laboratory parameters reflecting nutritional status and immune function were collected at baseline. Flow cytometry was used to assess blood lymphocyte subsets including the naive CD4 T-cell count, naive and memory CD8 T-cell counts, effector CD8 T-cell count, and CD4/CD8 ratio. Patients were monitored for HAI for 3 months or until discharge from the geriatric unit or death.
  
  
  RESULTS
  Of 252 consecutive in-patients aged ≥ 70 years [mean age, 85 ± 6.2 years], 181 [72%] met French National Authority for Health criteria for malnutrition and 97 [38%] experienced one or more HAI. Patients who subsequently experienced HAI had significantly lower baseline values for energy intake [odds ratio (OR), 0.76; 95% confidence interval (95%CI), 0.59-0.99], serum albumin [OR, 0.43; 95%CI, 0.32-0.58], serum zinc [OR, 0.77; 95%CI, 0.62-0.97], selenium [OR, 0.76; 95%CI, 0.61-0.95], and vitamin C [OR, 0.71; 95%CI, 0.54-0.93]. Associations linking these five variables to HAI were not significantly changed by adjusting for flow cytometry T-cell subset values.
  
  
  CONCLUSIONS
  Our results suggest a direct effect of nutritional parameters on HAI rather than an indirect effect mediated by immune parameters.
authors: Université Paris Est (UPEC), Faculté de Médecine, LIC EA 4393, Creteil F 94010, France; Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Albert-Chenevier - Henri-Mondor, Département de Médecine Interne et Gériatrie, Creteil F 94010, France. Electronic address: marie.laurent@ach.aphp.fr.
authors: M
authors: M
authors: Laurent
authors: Université Paris Est (UPEC), Faculté de Médecine, LIC EA 4393, Creteil F 94010, France; Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Henri-Mondor, Santé Publique, Creteil F 94010, France; Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Henri-Mondor, Unité de Recherche Clinique, Creteil F 94010, France. Electronic address: sylvie.bastuji-garin@hmn.aphp.fr.
authors: S
authors: S
authors: Bastuji-Garin
authors: Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Henri-Mondor, Departement d'immunologie, Creteil F 94010, France. Electronic address: anne.plonquet@hmn.aphp.fr.
authors: A
authors: A
authors: Plonquet
authors: Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Cochin, Service de Biochimie inter-hospitalier Cochin-Hôtel-Dieu, Paris F 75014, France. Electronic address: phuong-nhi.bories@cch.aphp.fr.
authors: P N
authors: PN
authors: Bories
authors: Université Paris Est (UPEC), Faculté de Médecine, LIC EA 4393, Creteil F 94010, France; Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Henri-Mondor, Santé Publique, Creteil F 94010, France; Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Henri-Mondor, Unité de Recherche Clinique, Creteil F 94010, France. Electronic address: aurelie.le-thuaut@hmn.aphp.fr.
authors: A
authors: A
authors: Le Thuaut
authors: Université Paris Est (UPEC), Faculté de Médecine, LIC EA 4393, Creteil F 94010, France; Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Henri-Mondor, Santé Publique, Creteil F 94010, France. Electronic address: etienne.audureau@hmn.aphp.fr.
authors: E
authors: E
authors: Audureau
authors: Nescens Centre of Preventive Medicine, c/o Clinique of Genolier, Rue du Muids, 3, CH-1272 Genolier, Switzerland. Electronic address: polang@nescens.com.
authors: P O
authors: PO
authors: Lang
authors: Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Cochin, Service de Biochimie inter-hospitalier Cochin-Hôtel-Dieu, Paris F 75014, France. Electronic address: samir.nakib@cch.aphp.fr.
authors: S
authors: S
authors: Nakib
authors: Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Albert-Chenevier - Henri-Mondor, Département de Médecine Interne et Gériatrie, Creteil F 94010, France. Electronic address: evelyne.liuu@hmn.aphp.fr.
authors: E
authors: E
authors: Liuu
authors: Université Paris Est (UPEC), Faculté de Médecine, LIC EA 4393, Creteil F 94010, France; Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Henri-Mondor, Santé Publique, Creteil F 94010, France. Electronic address: florence.canoui-poitrine@hmn.aphp.fr.
authors: F
authors: F
authors: Canoui-Poitrine
authors: Université Paris Est (UPEC), Faculté de Médecine, LIC EA 4393, Creteil F 94010, France; Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Albert-Chenevier - Henri-Mondor, Département de Médecine Interne et Gériatrie, Creteil F 94010, France. Electronic address: elena.paillaud@hmn.aphp.fr.
authors: E
authors: E
authors: Paillaud
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology; D005260:Female; D005602:France; D005853:Geriatrics; D006784:Hospitals, Teaching; D006801:Humans; D007109:Immunity; D018655:Lymphocyte Count; D008297:Male; D044342:Malnutrition / Q000150:complications; D015596:Nutrition Assessment; D009752:Nutritional Status; D011446:Prospective Studies
keywords: Aging; Immunosenescence; Infections; Malnutrition; Micronutrients