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Letter to the editor: Vitamin D and healthcare-associated infections

Posted on: May 7, 2014   by  Sadeq A. Quraishi, MD, MHA

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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.

 

References

1. Magill S. S., Edwards J.R., Bamberg W., et al. Multistate Point-Prevalence Survey of Health Care-Associated Infections. N Engl J Med 2014:370(13):1198-208.

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]

6 Responses to Letter to the editor: Vitamin D and healthcare-associated infections

  1. Rita and Misty

    Community-acquired infections (CAIs) are not the same as healthcare-associated infections (HAIs).

    Community-acquired infections are acquired anywhere other than in a healthcare facility, in settings such as schools, exercise facilities, or any place you come in contact with other people or with surfaces that have been contaminated.

    I would venture to say that healthcare-associated infections usually happen in concurrence with a surgery or illness or some other major assault to the body.

    I wonder if major trauma to the body would result in a quick drop in the 25(OH)D level, and if so, would this quick drop in the 25(OH)D level coupled with an overall deficient state cause the body to be very susceptible to HAIs?

    Also:

    Is it possible that the greatest immediate benefit from vitamin D supplementation would be when very severely deficient folks are brought up to an optimal 25(OH)D quickly? This might partially answer why there is little evidence with respect to vitamin D supplementation being helpful in preventing CAIs.

    If it is correct that major trauma would cause the body to utilize massive amounts of vitamin D, I wonder then how ethical it would be to perform a vitamin D study on patients entering the hospital.

    In other words: If trauma uses up D, wouldn’t the most ethical thing be to supplement everyone entering the hospital for surgery or major illness with a bolus dose of D in an attempt to prevent HAIs?

    I am not a scientific researcher. Nor am I a physician. I apologize for any incorrect usage of terminology.

  2. IAW

    To: Dr. Sadeq Quraishi OR the VDC

    The above story gives me information and then asks me to “share your thoughts in the comments section below”. I waited to see how others might respond and would like to respond but I was not exactly sure what kind of comment you were looking for.

    I think you and Dr. Grant’s response was appropriate and do not know why it was not published. Does the New England Journal get overwhelmed with responses and can’t deal with them all? Are they just being stubborn and will not print it? Did someone buy them off? Are they just inept? Is this what you meant by “comment”? Should the members of the VDC send emails or letters to someone at the New England Journal?
    Ivy

  3. Rita and Misty

    Hi Ivy-I too found Dr Grants comments to be on spot. Why did the journal refuse to publish these comments? I think Dr Quraishi may agree that vitamin D is still very much a controversial topic in the mainstream world. I think if scientific folks approach the journal it might have some small impact. But honestly mainstream is an obtuse world. My first response now reads a bit disenchanted to me. And this would accurately describe my mood towards mainstream at the moment. Yet we have responsibility to press forward here. This includes lay folks as well as scientific folks. So if VDC provides contact data I will submit a complaint. Science requires a voice. Censorship is unethical. I hope I still have the heart of an activist. I am typing on a cell phone and I have fat fingers so I apologize for typing errors. <3

  4. Rita and Misty

    To our readership: Let us think outside normal logic today. Please today would you consider that in this world it is best to keep giving all you’ve got–certainly in general, but more specifically, pertaining to vitamin D. Give all you’ve got, even to those who appear not to notice you. Because the reality is that we never really do know who we touch, and lack of response on the other person’s part is not an appropriate gauge.

    So VDC, please do post contact data with respect to the N.E.J.M.

  5. Mary Pittaway

    The church put Galileo under house arrest and demanded that he retract his assertions that the earth revolved around the sun to avoid being burned at the stake for being a heretic.

  6. Rita and Misty

    Yet science did finally prevail. 🙂 And so it will be with vitamin D.

    I hope the Vitamin D Council is okay with my posting here the following information:

    If you are reading the VDC members’ blog, it’s most likely because you are vitamin D savvy! Has vitamin D improved your health and well being? Would you be willing to help others get healthier by sharing your vitamin D story? If so, please consider sending me (Rita Celone Umile) a brief video clip sharing how vitamin D has changed your life. I’m putting together a video collage so that others may learn and benefit from our vitamin D journeys towards good health. Please consider your participation in this video to be a gift of compassion towards ending what is perhaps the #1 public health issue of our century. Thank you! I can be reached at umileritac@aol.com

    PS~The video clips can be short. Your first name and how vitamin D has improved your life will be just great. 30 seconds to one minute of your time, and then just email me your video clip. This is a project that is near and dear to my heart. If you are reading me here, mostly likely it is because vitamin D has improved your life. Let’s work together to change the world’s view of vitamin D. Thank you!

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