title: Baseline hypovitaminosis D is not associated with poor clinical outcomes in osteoarticular infections.
abstract: OBJECTIVE
  Although vitamin D is recognized as an important factor in bone health, its role in osteoarticular infections is unclear. We hypothesized that low vitamin D (25-hydroxycholecalciferol) levels are associated with a lower likelihood of treatment success in osteoarticular infections.
  
  
  METHODS
  This was a retrospective cohort study of patients with orthopedic infections who had a 25-hydroxycholecalciferol level drawn when their infection was diagnosed. Outcomes were determined at early (3-6 months) and late (≥ 6 months) follow-up after completing intravenous antibiotics.
  
  
  RESULTS
  We included 223 patients seen during an 11-month period with osteoarticular infections and baseline 25-hydroxycholecalciferol levels. During the initial inpatient management of the infection, hypovitaminosis D was identified and treated. The mean 25-hydroxycholecalciferol level was 23 ± 14 ng/ml; 167 (75%) patients had levels <30 ng/ml. Overall, infection treatment success was 91% (159/174) at early follow-up and 88% (145/164) at late follow-up. 25-Hydroxycholecalciferol baseline levels were similar in those with and without successful clinical outcomes, both at early (25 ± 15 vs. 21 ± 9 ng/ml; p=0.3) and late follow-up (25 ± 15 vs. 23 ± 16 ng/ml; p=0.6).
  
  
  CONCLUSIONS
  To our knowledge this is the first report on hypovitaminosis D and its impact on outcomes of osteoarticular infections. Hypovitaminosis D was frequent in this cohort. With vitamin D repletion, there was no difference in treatment success whether patients had baseline hypovitaminosis or not.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, 660 S. Euclid, St. Louis, MO 63110, USA; Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland. Electronic address: jonas.marschall@insel.ch.
authors.forename: J
authors.initials: J
authors.lastname: Marschall
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, 660 S. Euclid, St. Louis, MO 63110, USA.
authors.forename: J W S
authors.initials: JW
authors.lastname: Lewis
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, 660 S. Euclid, St. Louis, MO 63110, USA.
authors.forename: D K
authors.initials: DK
authors.lastname: Warren
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, 660 S. Euclid, St. Louis, MO 63110, USA.
authors.forename: H M
authors.initials: HM
authors.lastname: Babcock
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Barrack
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, 660 S. Euclid, St. Louis, MO 63110, USA.
authors.forename: V J
authors.initials: VJ
authors.lastname: Fraser
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000150:complications / Q000188:drug therapy*; D002112:Calcifediol / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014807:Vitamin D / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications*
chemical_list: D000900:Anti-Bacterial Agents; D014807:Vitamin D; D002112:Calcifediol
keywords: Cholecalciferol; Joint infection; Osteomyelitis; Outcome; Vitamin D