Healthcare costs of Staphylococcus aureus and Clostridium difficile infections in Veterans: role of vitamin D deficiency

Abstract

Clostridium difficile and staphylococcal infections are associated with increased morbidity, mortality and healthcare costs. Vitamin D deficiency may also contribute to increased healthcare costs. There is increasing evidence that vitamin D may have an antimicrobial role. We examined the relationship of serum 25(OH)D levels to staphylococcal and C. difficile infections to determine if vitamin D deficiency was associated with adverse outcomes. In the outpatient setting, vitamin D deficiency in patients with C. difficile and staphylococcal infections were associated with significantly increased total outpatients costs and fee-based consultation. Laboratory expenses had a trend towards higher costs in the vitamin D-deficient group but did not reach statistical significance. The differences were most clearly seen in the in-patient group with enhanced laboratory, pharmacy and radiology costs. These differences resulted in vitamin D-deficient patients with C. difficile or staphylococcal infections having costs more than five times higher than the non-deficient patients. The total length of hospital stay was four times greater in the vitamin D-deficient group. In addition, the total number of hospitalizations was also significantly greater in the vitamin D-deficient group. Surgery costs demonstrated a tendency to be higher in the vitamin D-deficient group but failed to reach statistical significance. Vitamin D deficiency is intimately linked to adverse health outcomes and costs in Veterans with staphylococcal and C. difficile infections in North East Tennessee. We recommend that vitamin D status be checked in patients with these infections and appropriate therapy be instituted to restore vitamin D level to normal in an expeditious manner.

Antimicrobial implications of vitamin D

“…105 Moreover, vitamin D deficiency has been linked to adverse and more costly outcomes in veterans with Clostridium difficile and methicillin-sensitive S. aureus infections. 106 Animal studies also confirm a potential beneficial role for vitamin D treatment. In the turkey osteomyelitis complex, vitamin D treatment to liver cirrhosis.…”

Increasing ultraviolet light exposure is associated with reduced mortality from Clostridium difficile infection

“…1 Risk factors for CDI include age, prior hospitalizations, prior antibiotic use, proton pump inhibitor use, 2 inflammatory bowel diseases (IBD) 3 ; and more recently, there is also data to suggest that patients with lower vitamin D levels have a more aggressive CDI course. 4 The importance of vitamin D in diseases beyond calcium homeostasis and bone health is becoming more apparent. Vitamin D has been found to have an antimicrobial effect, aiding the macrophage suppression of mycobacterial growth, in in vitro experiments.…”

Higher plasma vitamin D is associated with reduced risk of Clostridium difficile infection in patients with inflammatory bowel diseases

“…In a study from the Veterans affairs population, Youssef et al . identified a five-fold increase in risk of health care costs associated with CDI in individuals who were deficient in vitamin D compared to those with sufficient levels 33 . Wang et al .…”

“…A few recent studies have examined this association between vitamin D levels and CDI in non-IBD cohorts 33–36 . In a study from the Veterans affairs population, Youssef et al .…”