In March of 2014, the New England Journal of Medicine published a study on healthcare-associated infections. Two of the board members of the Vitamin D Council, Dr. Sadeq Quraishi and Dr. William Grant, wrote a letter to the editor indicating research that shows vitamin D’s role in healthcare-associated infections. The New England Journal of Medicine did not publish their comments. We’ve included their letter below as well as a link to the abstract of the original paper. Please give them both a read and share your thoughts in the comments section below.
The link to the abstract of the original paper can be found here: http://www.nejm.org/doi/full/10.1056/NEJMoa1306801
To the Editor:
Magill et al. estimate 650,000 patients developed healthcare-associated infections (HAIs) in 20111. Vitamin D supplementation is safe, inexpensive, and a potential mechanism to reduce the risk of HAIs. Mechanisms by which vitamin D metabolites may reduce infections include regulating innate immune responses and inducing production of endogenous peptides (cathelicidin and defensins), which have modest antimicrobial as well as potent antiendotoxin properties2. Observational studies suggest that vitamin D status is a modifiable risk factor for surgical site3, blood stream4, and Clostridium difficile infections5. Randomized, controlled trials (RCTs) regarding vitamin D supplementation and prevention of community-acquired infections have been less convincing, with three major factors likely contributing to such findings: 1) the use of conservative dosing strategies; 2) non-uniformity in the use of supplements (ergocalciferol vs. cholecalciferol); and 3) the inclusion of subjects with near-optimal vitamin D status at baseline. Carefully designed, adequately dosed, RCTs of truly “at-risk” individuals (e.g. hospitalized patients) are greatly needed to determine whether vitamin D supplementation may be a low-cost/high-yield strategy for the prevention of HAIs.
2. Youssef DA, Ranasinghe T, Grant WB, Peiris AN. The potential of vitamin D to reduce the risk of hospital-acquired infections, Dermatoendocrinology. 2012;4(2):167-75.
3. Quraishi SA, Bittner EA, Blum L, Hutter MM, Camargo CA Jr. Association Between Preoperative 25-Hydroxyvitamin D Level and Hospital-Acquired Infections Following Roux-en-Y Gastric Bypass Surgery. JAMA Surg. 2014;149(2):112-8.
4. Quraishi SA, Litonjua AA, Moromizato T, Gibbons FK, Camargo CA Jr, Giovannucci E, Christopher KB. Association between prehospital vitamin D status and hospital-acquired bloodstream infections. Am J Clin Nutr. 2013;98(4):952-9.
5. Quraishi SA, Litonjua AA, Moromizato T, Gibbons FK, Camargo CA Jr, Giovannucci E, Christopher KB. Association Between Prehospital Vitamin D Status and Hospital-Acquired Clostridium difficile Infections. JPEN J Parenter Enteral Nutr. 2014 Feb 3. [Epub ahead of print]