A paper recently published in Dermato-Endocrinology (Youssef et al., 2012) indicates that raising vitamin D concentrations among hospital patients has the potential to greatly reduce the risk of hospital-acquired infections. Hospital-acquired infections (HAIs) are a leading cause of death in the U.S. healthcare arena, with an overall estimated annual incidence of 1.7 million cases and 100,000 deaths. HAIs in U.S. hospitals generate an estimated $28.4 billion to $45 billion in excess healthcare costs annually. Patients are often vitamin D deficient since many diseases such as cancer, cardiovascular disease, and respiratory infections are linked to low vitamin D concentrations.
Pneumonia is the most likely HAI, followed by bacteremias, urinary tract infections, surgical site infections, sepsis, and others.
Vitamin D plays an important antimicrobial role. Among the antimicrobial actions are reducing local and systemic inflammatory responses as a result of modulating cytokine responses and reducing Toll-like receptor activation and stimulating the expression of potent antimicrobial peptides, such as cathelicidin and ß-defensin 2. Cathelicidins are a family of peptides thought to provide an innate defensive barrier against a variety of potential microbial pathogens, such as gram-positive and gram-negative bacteria, fungi, and mycobacteria, at multiple entry sites, including skin and mucosal linings of the respiratory and gastrointestinal systems, as well as some viruses.
One of the advantages of vitamin D in combating HAIs is that it strengthens the innate immune response, thus overcoming the antibiotic resistance of many bacteria encountered in hospitals.
Optimal vitamin D concentrations are at least 30-40 ng/ml (75-100 nmol/l). The average white American has a concentration of 26 ng/ml, while the average African-American has only 16 ng/ml. Vitamin D concentrations have fallen in the past 20 years, in part due to spending less time out-of-doors. About half of those admitted to hospitals have concentrations below 20 ng/ml, thus making them more susceptible to HAIs. Raising vitamin D concentrations would reduce the rate of diseases such as many types of cancer, cardiovascular disease, hip fractures, and respiratory infections, thereby reducing the rate of hospital admissions as well as HAIs once admitted.
In an accompanying editorial, David McCarthy, MD, outlined what hospitals could do to overcome vitamin D deficiency among hospital patients. Among these recommendations is making high-dose vitamin D3 (5,000 and 50,000 IU) capsules available to the patients.
In a related paper in Dermato-Endocrinology (Bailey et al., 2012), it was reported that Veterans Medical Centers in the southeastern United States that had more vitamin D testing had lower per patient costs.
Bailey BA, Manning T, Peiris AN. Vitamin D testing patterns among six Veterans Medical Centers in the southeastern United States: links with medical costs. Mil Med. 2012;177:70-6.
McCarthy D. Youssef et al. make a strong case for addressing 25(OH)D concentration (vitamin D status) in hospitalized patients with infections. Dermato-Endocrinology. 2012;4(2):84.
Youssef DA, Miller CW, El-Abbassi AM, Cutchins DC, Cutchins C, Grant WB, Peiris AN. Antimicrobial implications of vitamin D. Dermato-Endocrinology. 2011;3(4):220-9.
Youssef DA, Ranasinghe T, Grant WB. Peiris AN. Vitamin D’s potential to reduce the risk of hospital-acquired infections. Dermato-Endocrinology. 2012;4(2):167-75