ASSOCIATION BETWEEN METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS INFECTION AND VITAMIN D DEFICIENCY Open Access

Thomason, Jenna Lynne (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/8g84mn183?locale=en
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Abstract

Purpose. Given that vitamin D (25(OH)D) contributes to immunity, we sought to determine if 25(OH)D deficiency was significantly associated with Methicillin-resistant Staphylococcus aureus (MRSA) infection. Methods. All patients with 25(OH)D determinations at the Atlanta VAMC from 2007-10 were included in the analyses. The first recorded 25(OH)D level was used for each patient. These patients were matched with an on-going study of patients with well-characterized MRSA infection (2005-10). Patients with 25(OH)D determinations without an MRSA infection served as controls. Multivariate logistic regression was used to determine the independent association between 25(OH)D level, dichotomized into deficient (<20 ng/mL) vs. non-deficient (≥20 ng/mL), and case/control status. Results. A total of 6405 patients with 25(OH)D determinations were included in the analyses, of which 401 (6.3%) experienced an MRSA infection during the study period. The majority of the MRSA infections were skin and soft tissue infections (SSTIs) (n=232; 57.9%) and almost all were diagnosed in the outpatient setting (n=366; 91.3%). Mean (SD) vitamin D levels were 21.1 (12.4) and 24.0 (12.6) for cases and controls, respectively (p<0.0001). MRSA infection was also significantly associated with younger age (p=0.0008), male gender (p=0.0023), lower BMI (p<0.0001), and HIV positive status (p<0.0001) in the univariate analyses. The multivariate logistic regression model confirmed an independent association for gender, race, BMI, HIV status, and 25(OH)D (OR for 25(OH)D: 1.63; 95% CI: 1.31-2.03). Sensitivity analyses using only SSTIs or outpatient cases still revealed 25(OH)D as an independent risk factor, although in the former model the association was not significant. Conclusions. MRSA cases had significantly lower serum 25(OH)D levels than controls, even when controlling for age, gender, BMI, HIV status, and race. Further study is necessary to investigate this association in other populations and to determine if optimization of 25(OH)D levels could potentially be useful for prevention or treatment of MRSA infection.

Table of Contents


TABLE OF CONTENTS

Background...1
Methods...8
Results...13
Discussion...17
Strengths and Weaknesses...20
Future Directions...21
References...22
Tables
Table I. Subject Characteristics (all cases and controls)...32
Table II. Vitamin D levels by patient characteristics and season of measurement (all cases and controls)...33
Table III. Subject Characteristics (cases with skin and soft tissue infection and controls)...34
Table IV. Vitamin D levels by patient characteristics and season of measurement (cases with skin and soft tissue infection and controls)...35
Table V. Subject Characteristics (outpatient cases and controls)...36
Table VI. Vitamin D levels by patient characteristics and season of measurement (outpatient cases and controls)...37
Table VII. Logistic Regression Results (all cases and controls)...38
Table VIII. Season of MRSA Infection...40
Table IX. Serum Vitamin D Levels by Year (all vitamin Ds)...41

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