Epidemiology and Infection

Original Papers

Hospital-acquired infections

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

D. YOUSSEFa1a3, B. BAILEYa2, A. EL ABBASSIa1a3, R. COPELANDa3, L. ADEBONOJOa4, T. MANNINGa1 and A. N. PEIRISa1a3 c1

a1 Mountain Home VAMC Medicine Service, East Tennessee State University, Johnson City, TN, USA

a2 Department of Family Medicine, East Tennessee State University, Johnson City, TN, USA

a3 Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA

a4 Library Administration, Charles C. Sherrod Library, East Tennessee State University, Johnson City, TN, USA

SUMMARY

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.

(Accepted December 01 2009)

(Online publication January 08 2010)

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