Journal of Critical Care 28 (2013) 1104
Contents lists available at ScienceDirect
Journal of Critical Care journal homepage: www.jccjournal.org
More nutritional research needed to prevent and treat Acinetobacter infections
To the Editor: I read with interest your recent article by Turkoglu et al [1], which reports that among 201 critically ill hospitalized patients, Acinetobacter infections were significantly more common in vitamin D–deficient patients as compared with those with normal vitamin D levels (25% vs 10%; P = .012). This article also cited a number of important articles, which report that vitamin D deficiency is common in both the general and hospitalized populations and that vitamin D levels are associated with significantly higher rates of infection and mortality. Many hospitalized patients are deficient in many nutrients including vitamin D. A 2007 review of 110 published articles reported that 13% to 78% of all hospitalized patients had protein-calorie malnutrition [2]. Protein-calorie malnutrition ranged from 42% to 91% in elderly hospitalized patients [2]. Malnutrition is associated with higher rates of hospital-acquired infections in general. A French study of 630 hospitalized patients reported that hospital-acquired infections were 4.98 times as common in severely malnourished patients as compared with well-nourished patients (95% confidence interval, 4.6-6.4) [3]. Several articles have reported that low albumin and other indicators of malnutrition are associated with significantly higher mortality rates from Acinetobacter infection. A Taiwan study reported that low albumin levels (below 2.5 g/dL) were associated with significantly higher rates of mortality among hospitalized patients with antibiotic-resistant Acinetobacter baumannii (80% vs 28%; P = .0102) [4]. A second Taiwan study of 149 hospitalized patients with Acinetobacter baumannii infections reported that serum albumin
0883-9441/$ – see front matter © 2013 Elsevier Inc. All rights reserved.
levels were significantly lower among mortality patients vs survivors (2.9 ± 0.5 vs 3.2 ± 0.5 g/dL; P = .005) [5]. Vitamin D and many other nutrients (such as water, protein, calories, omega-3 fats, vitamins A, B complex and C, zinc, iron, and copper) play a critical role in preventing and fighting off infections [6]. Much more research and clinical attention are needed to prevent and treat hospital-acquired infections of Acinetobacter and other pathogens. I hope the Journal of Critical Care will continue to publish articles that examine the relationships between nutrition and infection. Luke Curtis MD, MS Forest Hills, NY 11375 E-mail address: [email protected] http://dx.doi.org/10.1016/j.jcrc.2013.09.010 References [1] Turkoglu M, Aygencel G, Dizbay M, et al. Is Vitamin D deficiency associated with development of Acinetobacter baumannii infections in critically ill patients? J Crit Care 2013;28:735–40. [2] Kubrak C, Jensen L. Malnutrition in acute care patients: a narrative review. Int J Nurs Stud 2007;44:1036–54. [3] Schneider SM, Veyres P, Pivot X, et al. Malnutrition is an independent risk factor associated with nosocomial infections. Br J Nutr 2004;92:105–11. [4] Tseng YC, Wang JT, Wu FLL, et al. Prognosis of adult patients with bacteremia caused by extensively resistant Acinetobacter baumannii. Diagn Microbiol Infect Dis 2007;59:181–90. [5] Chen HP, Chen TL, Lai CH, et al. Predictors of mortality in Acinetobacter baumanni bacteriemia. J Microbiol Immunol Infect 2005;38:127–36. [6] Wintergerst ES, Maggini R, Hornig DH. Contribution of selected vitamins and trace elements to immune function. Ann Nutr Metab 2007;51:301–23.
Contents lists available at ScienceDirect
Journal of Critical Care journal homepage: www.jccjournal.org
More nutritional research needed to prevent and treat Acinetobacter infections
To the Editor: I read with interest your recent article by Turkoglu et al [1], which reports that among 201 critically ill hospitalized patients, Acinetobacter infections were significantly more common in vitamin D–deficient patients as compared with those with normal vitamin D levels (25% vs 10%; P = .012). This article also cited a number of important articles, which report that vitamin D deficiency is common in both the general and hospitalized populations and that vitamin D levels are associated with significantly higher rates of infection and mortality. Many hospitalized patients are deficient in many nutrients including vitamin D. A 2007 review of 110 published articles reported that 13% to 78% of all hospitalized patients had protein-calorie malnutrition [2]. Protein-calorie malnutrition ranged from 42% to 91% in elderly hospitalized patients [2]. Malnutrition is associated with higher rates of hospital-acquired infections in general. A French study of 630 hospitalized patients reported that hospital-acquired infections were 4.98 times as common in severely malnourished patients as compared with well-nourished patients (95% confidence interval, 4.6-6.4) [3]. Several articles have reported that low albumin and other indicators of malnutrition are associated with significantly higher mortality rates from Acinetobacter infection. A Taiwan study reported that low albumin levels (below 2.5 g/dL) were associated with significantly higher rates of mortality among hospitalized patients with antibiotic-resistant Acinetobacter baumannii (80% vs 28%; P = .0102) [4]. A second Taiwan study of 149 hospitalized patients with Acinetobacter baumannii infections reported that serum albumin
0883-9441/$ – see front matter © 2013 Elsevier Inc. All rights reserved.
levels were significantly lower among mortality patients vs survivors (2.9 ± 0.5 vs 3.2 ± 0.5 g/dL; P = .005) [5]. Vitamin D and many other nutrients (such as water, protein, calories, omega-3 fats, vitamins A, B complex and C, zinc, iron, and copper) play a critical role in preventing and fighting off infections [6]. Much more research and clinical attention are needed to prevent and treat hospital-acquired infections of Acinetobacter and other pathogens. I hope the Journal of Critical Care will continue to publish articles that examine the relationships between nutrition and infection. Luke Curtis MD, MS Forest Hills, NY 11375 E-mail address: [email protected] http://dx.doi.org/10.1016/j.jcrc.2013.09.010 References [1] Turkoglu M, Aygencel G, Dizbay M, et al. Is Vitamin D deficiency associated with development of Acinetobacter baumannii infections in critically ill patients? J Crit Care 2013;28:735–40. [2] Kubrak C, Jensen L. Malnutrition in acute care patients: a narrative review. Int J Nurs Stud 2007;44:1036–54. [3] Schneider SM, Veyres P, Pivot X, et al. Malnutrition is an independent risk factor associated with nosocomial infections. Br J Nutr 2004;92:105–11. [4] Tseng YC, Wang JT, Wu FLL, et al. Prognosis of adult patients with bacteremia caused by extensively resistant Acinetobacter baumannii. Diagn Microbiol Infect Dis 2007;59:181–90. [5] Chen HP, Chen TL, Lai CH, et al. Predictors of mortality in Acinetobacter baumanni bacteriemia. J Microbiol Immunol Infect 2005;38:127–36. [6] Wintergerst ES, Maggini R, Hornig DH. Contribution of selected vitamins and trace elements to immune function. Ann Nutr Metab 2007;51:301–23.
