CR and hospital-acquired infection

[Guest guest]

Hi All,

Are we CRers at increased risk of getting those infections derived from

hospitalization? It seems that the answer may be yes, in a new paper not yet in

Medline.

Was lower protein energy, vitamin or mineral intake responsible in the " CRers "

being

at increased risk?

Definitions:

nosocomial: Pertaining to or originating in the hospital, said of an infection

not

present or incubating prior to admittance to the hospital, but generally

occurring

72 hours after admittance, the term is usually used to refer to patient disease,

but

hospital personnel may also acquire nosocomial infection.

nosocomial infection: Hospital acquired infection: commonest are due to

Staphylococcus aureus, Pseudomonas aeruginosa, E. Coli, Klebsiella pneumoniae,

Serratia marcescens and Proteus mirabilis.

Key points:

The incidence rate of noscomial infections was 59% and the global infection rate

was

7.6/1000 bed days.

Age, energy intake, length of hospital stay and the presence of a urinary

catheter

were independent risk factors of nosocomial infection.

The clinical outcome was significantly different between patients with more than

one

nosocomial infection as compared with those with no or with one nosocomial

infection.

Age and Ageing 2005 34(6):619-625

Relations between undernutrition and nosocomial infections in elderly patients

Elena Paillaud, Stephane Herbaud, Philippe Caillet, Jean-Louis Lejonc, Bernard

Campillo, and Phuong-Nhi Bories

Abstract

Background: hospital-acquired infections and malnutrition are of major concern

in

public health in elderly patients. However, the interactions between these two

entities are not well established.

Objectives: to determine the incidence of nosocomial infections (NI) and its

association with malnutrition.

Subjects: 185 hospitalised older adults aged 81.6±0.6 years old were

nutritionally

assessed on admission by measurement of anthropometric variables, serum

nutritional

proteins and evaluation of dietary intake. During hospitalisation, patients’

progress was closely monitored, particularly for the detection of nosocomial

infections.

Results: the incidence rate of NI was 59% and the global infection rate was

7.6/1000

bed days. The most common infection site was the urinary tract (n = 63). The

nutritional status of the population was studied by comparing three groups

defined

according to the absence (group I, n = 116), presence of one infection (group

II, n

= 38) or presence of more than one infection (group III, n = 31). All but one

anthropometric parameters varied among the three groups. Total energy intake

also

varied among the three groups. The group I had higher daily nutrient intake than

the

other two groups (respectively P = 0.004 and P < 0.0001). Albumin,

transthyretin,

and C-reactive protein levels differed significantly among the three groups

(respectively P < 0.0001, P < 0.0001 and P = 0.0003). Age, energy intake, length

of

hospital stay and the presence of a urinary catheter were independent risk

factors

of nosocomial infection.

Conclusion: our findings show that patients with multiple NI were older, showed

an

altered nutritional status, a prolonged recovery, more frequently had urinary

catheters and more discharge placement.

.... Table 3. Anthropometric variables and energy intake in the three groups of

patients

===================

n No infection 116 One infection 38 >One infection 31 P

===================

Weight (kg) 61.2±1.5 58.9±3.1 51.3±1.7 0.0079

BMI (kg/m²) 23.8±0.5 24.0±1.2 21.2±0.7 0.046

MAC (cm) 27.1±0.4 26.7±1.0 24.1±0.7 0.011

TST (mm) 11.6±0.5 12.9±1.3 9.5±0.8 0.064

BST (mm) 4.9±0.3 5.9±0.9 3.1±0.3 0.011

Energy intake (kcal/day) 1717±40 1474±91 1284±74 <0.0001

Energy intake (kcal/kg/day) 29.3±0.8 27.2±2.1 25.1±1.4 0.089

===================

BMI, body mass index; MAC, mid-arm circumference; TST, tricipital skinfold

thickness; BST, bicipital skinfold thickness.

The three groups were compared by ANOVA.

As far as biological data were concerned (Table 4), albumin, transthyretin, and

CRP

levels differed significantly among the three groups (respectively P<0.0001,

P<0.0001 and P=0.0003). The group with several infections had a mean albumin

level

below the normal range (35–48 g/l) and lower than the other two groups (P<0.0001

and

P=0.006, respectively). The non-infected group had higher transthyretin levels

(P=0.013 and P<0.0001, respectively) and lower CRP levels (P=0.005 and P=0.001,

respectively) than the two groups with infections.

Table 4. Biological variables in the three groups of patients

==================

n No infection 116 One infection 38 >One infection 31 P

==================

Albumin (g/l) 36.3±0.4 34.6±0.6 31.7±0.9 <0.0001

Transthyretin (g/l) 0.26±0.01 0.23±0.01 0.19±0.01 <0.0001

Orosomucoid (g/l) 2.1±0.7 1.5±0.1 1.6±0.1 0.861

CRP (mg/l) 16±2 37±10 44±8 0.0003

Lymphocytes (g/l) 1.7±0.1 1.8±0.3 1.5±0.1 0.438

PMN leukocytes (g/l) 4.4±0.2 6.1±1.0 6.7±0.7 0.0027

===================

PMN, polymorphonuclear.

The three groups were compared by ANOVA.

.... Table 6. Multivariate analysis of factors associated with the development of

an

infection

===================

P OR [95% CI]

===================

Intrinsic factors (personal)

Age 0.035 1.06 [1.003–1.12]

Weight 0.811 1.003 [0.98–1.03]

Albumin 0.027 1.11 [1.01–1.21]

PMN leukocytes 0.031 1.17 [1.01–1.36]

Sex 0.075 2.51 [0.91–6.94]

Extrinsic factors

Length of stay 0.009 1.01 [1.002–1.01]

Urinary catheter 0.005 44.1 [3.2–611.7]

Daily intake <0.0001 1.002 [1.001–1.002]

==================

PMN polymorphonuclear ...

Al Pater, PhD; email: old542000@...

__________________________________

FareChase: Search multiple travel sites in one click.

http://farechase.

[Guest guest]

Hi Al:

" Are we CRers at increased risk of getting those infections derived

from hospitalization? It seems that the answer may be yes ..... "

Well maybe. But as usual those in hospital who have lowered nutrient

intakes may be consuming less than the RDAs of several nutrients, and

consequently for that reason have lowered immune function.

Hopefully, those on CRON will not have, despite their lower caloric

intake. And notice also that those who did not have infections had

lower CRP, just like CRONers. Or could that be explained by

inflammation caused by the infection?

Also, am I reading the data right, or not? It looks to me that

overwhelmingly the key factor in incidence of infection was female

sex and use of a urinary catheter. Am I right about that? Odds

ratios, it seems, of 2.51 and 44.1 - each way higher than any other

risk ....... if I am reading it right. (Correction requested, as

usual).

Rodney.

--- In , Al Pater <old542000@y...>

wrote:

>

> Hi All,

>

> Are we CRers at increased risk of getting those infections derived

from

> hospitalization? It seems that the answer may be yes, in a new

paper not yet in

> Medline.

>

> Was lower protein energy, vitamin or mineral intake responsible in

the " CRers " being

> at increased risk?

>

> Definitions:

>

> nosocomial: Pertaining to or originating in the hospital, said of

an infection not

> present or incubating prior to admittance to the hospital, but

generally occurring

> 72 hours after admittance, the term is usually used to refer to

patient disease, but

> hospital personnel may also acquire nosocomial infection.

>

> nosocomial infection: Hospital acquired infection: commonest are

due to

> Staphylococcus aureus, Pseudomonas aeruginosa, E. Coli, Klebsiella

pneumoniae,

> Serratia marcescens and Proteus mirabilis.

>

> Key points:

>

> The incidence rate of noscomial infections was 59% and the global

infection rate was

> 7.6/1000 bed days.

>

> Age, energy intake, length of hospital stay and the presence of a

urinary catheter

> were independent risk factors of nosocomial infection.

>

> The clinical outcome was significantly different between patients

with more than one

> nosocomial infection as compared with those with no or with one

nosocomial

> infection.

>

> Age and Ageing 2005 34(6):619-625

> Relations between undernutrition and nosocomial infections in

elderly patients

> Elena Paillaud, Stephane Herbaud, Philippe Caillet, Jean-Louis

Lejonc, Bernard

> Campillo, and Phuong-Nhi Bories

>

> Abstract

>

> Background: hospital-acquired infections and malnutrition are of

major concern in

> public health in elderly patients. However, the interactions

between these two

> entities are not well established.

>

> Objectives: to determine the incidence of nosocomial infections

(NI) and its

> association with malnutrition.

>

> Subjects: 185 hospitalised older adults aged 81.6±0.6 years old

were nutritionally

> assessed on admission by measurement of anthropometric variables,

serum nutritional

> proteins and evaluation of dietary intake. During hospitalisation,

patients'

> progress was closely monitored, particularly for the detection of

nosocomial

> infections.

>

> Results: the incidence rate of NI was 59% and the global infection

rate was 7.6/1000

> bed days. The most common infection site was the urinary tract (n =

63). The

> nutritional status of the population was studied by comparing three

groups defined

> according to the absence (group I, n = 116), presence of one

infection (group II, n

> = 38) or presence of more than one infection (group III, n = 31).

All but one

> anthropometric parameters varied among the three groups. Total

energy intake also

> varied among the three groups. The group I had higher daily

nutrient intake than the

> other two groups (respectively P = 0.004 and P < 0.0001). Albumin,

transthyretin,

> and C-reactive protein levels differed significantly among the

three groups

> (respectively P < 0.0001, P < 0.0001 and P = 0.0003). Age, energy

intake, length of

> hospital stay and the presence of a urinary catheter were

independent risk factors

> of nosocomial infection.

>

> Conclusion: our findings show that patients with multiple NI were

older, showed an

> altered nutritional status, a prolonged recovery, more frequently

had urinary

> catheters and more discharge placement.

>

> ... Table 3. Anthropometric variables and energy intake in the

three groups of

> patients

> ===================

> n No infection 116 One infection 38 >One infection 31 P

> ===================

> Weight (kg) 61.2±1.5 58.9±3.1 51.3±1.7 0.0079

> BMI (kg/m²) 23.8±0.5 24.0±1.2 21.2±0.7 0.046

> MAC (cm) 27.1±0.4 26.7±1.0 24.1±0.7 0.011

> TST (mm) 11.6±0.5 12.9±1.3 9.5±0.8 0.064

> BST (mm) 4.9±0.3 5.9±0.9 3.1±0.3 0.011

> Energy intake (kcal/day) 1717±40 1474±91 1284±74 <0.0001

> Energy intake (kcal/kg/day) 29.3±0.8 27.2±2.1 25.1±1.4 0.089

> ===================

> BMI, body mass index; MAC, mid-arm circumference; TST,

tricipital skinfold

> thickness; BST, bicipital skinfold thickness.

> The three groups were compared by ANOVA.

>

> As far as biological data were concerned (Table 4), albumin,

transthyretin, and CRP

> levels differed significantly among the three groups (respectively

P<0.0001,

> P<0.0001 and P=0.0003). The group with several infections had a

mean albumin level

> below the normal range (35–48 g/l) and lower than the other two

groups (P<0.0001 and

> P=0.006, respectively). The non-infected group had higher

transthyretin levels

> (P=0.013 and P<0.0001, respectively) and lower CRP levels (P=0.005

and P=0.001,

> respectively) than the two groups with infections.

>

> Table 4. Biological variables in the three groups of patients

> ==================

> n No infection 116 One infection 38 >One infection 31 P

> ==================

> Albumin (g/l) 36.3±0.4 34.6±0.6 31.7±0.9 <0.0001

> Transthyretin (g/l) 0.26±0.01 0.23±0.01 0.19±0.01 <0.0001

> Orosomucoid (g/l) 2.1±0.7 1.5±0.1 1.6±0.1 0.861

> CRP (mg/l) 16±2 37±10 44±8 0.0003

> Lymphocytes (g/l) 1.7±0.1 1.8±0.3 1.5±0.1 0.438

> PMN leukocytes (g/l) 4.4±0.2 6.1±1.0 6.7±0.7 0.0027

> ===================

> PMN, polymorphonuclear.

> The three groups were compared by ANOVA.

>

> ... Table 6. Multivariate analysis of factors associated with the

development of an

> infection

> ===================

> P OR [95% CI]

> ===================

> Intrinsic factors (personal)

> Age 0.035 1.06 [1.003–1.12]

> Weight 0.811 1.003 [0.98–1.03]

> Albumin 0.027 1.11 [1.01–1.21]

> PMN leukocytes 0.031 1.17 [1.01–1.36]

> Sex 0.075 2.51 [0.91–6.94]

> Extrinsic factors

> Length of stay 0.009 1.01 [1.002–1.01]

> Urinary catheter 0.005 44.1 [3.2–611.7]

> Daily intake <0.0001 1.002 [1.001–1.002]

> ==================

> PMN polymorphonuclear ...

>

> Al Pater, PhD; email: old542000@y...

>

>

>

> __________________________________

> FareChase: Search multiple travel sites in one click.

> http://farechase.

>

[Guest guest]

Hi Al:

" Are we CRers at increased risk of getting those infections derived

from hospitalization? It seems that the answer may be yes ..... "

Well maybe. But as usual those in hospital who have lowered nutrient

intakes may be consuming less than the RDAs of several nutrients, and

consequently for that reason have lowered immune function.

Hopefully, those on CRON will not have, despite their lower caloric

intake. And notice also that those who did not have infections had

lower CRP, just like CRONers. Or could that be explained by

inflammation caused by the infection?

Also, am I reading the data right, or not? It looks to me that

overwhelmingly the key factor in incidence of infection was female

sex and use of a urinary catheter. Am I right about that? Odds

ratios, it seems, of 2.51 and 44.1 - each way higher than any other

risk ....... if I am reading it right. (Correction requested, as

usual).

Rodney.

--- In , Al Pater <old542000@y...>

wrote:

>

> Hi All,

>

> Are we CRers at increased risk of getting those infections derived

from

> hospitalization? It seems that the answer may be yes, in a new

paper not yet in

> Medline.

>

> Was lower protein energy, vitamin or mineral intake responsible in

the " CRers " being

> at increased risk?

>

> Definitions:

>

> nosocomial: Pertaining to or originating in the hospital, said of

an infection not

> present or incubating prior to admittance to the hospital, but

generally occurring

> 72 hours after admittance, the term is usually used to refer to

patient disease, but

> hospital personnel may also acquire nosocomial infection.

>

> nosocomial infection: Hospital acquired infection: commonest are

due to

> Staphylococcus aureus, Pseudomonas aeruginosa, E. Coli, Klebsiella

pneumoniae,

> Serratia marcescens and Proteus mirabilis.

>

> Key points:

>

> The incidence rate of noscomial infections was 59% and the global

infection rate was

> 7.6/1000 bed days.

>

> Age, energy intake, length of hospital stay and the presence of a

urinary catheter

> were independent risk factors of nosocomial infection.

>

> The clinical outcome was significantly different between patients

with more than one

> nosocomial infection as compared with those with no or with one

nosocomial

> infection.

>

> Age and Ageing 2005 34(6):619-625

> Relations between undernutrition and nosocomial infections in

elderly patients

> Elena Paillaud, Stephane Herbaud, Philippe Caillet, Jean-Louis

Lejonc, Bernard

> Campillo, and Phuong-Nhi Bories

>

> Abstract

>

> Background: hospital-acquired infections and malnutrition are of

major concern in

> public health in elderly patients. However, the interactions

between these two

> entities are not well established.

>

> Objectives: to determine the incidence of nosocomial infections

(NI) and its

> association with malnutrition.

>

> Subjects: 185 hospitalised older adults aged 81.6±0.6 years old

were nutritionally

> assessed on admission by measurement of anthropometric variables,

serum nutritional

> proteins and evaluation of dietary intake. During hospitalisation,

patients'

> progress was closely monitored, particularly for the detection of

nosocomial

> infections.

>

> Results: the incidence rate of NI was 59% and the global infection

rate was 7.6/1000

> bed days. The most common infection site was the urinary tract (n =

63). The

> nutritional status of the population was studied by comparing three

groups defined

> according to the absence (group I, n = 116), presence of one

infection (group II, n

> = 38) or presence of more than one infection (group III, n = 31).

All but one

> anthropometric parameters varied among the three groups. Total

energy intake also

> varied among the three groups. The group I had higher daily

nutrient intake than the

> other two groups (respectively P = 0.004 and P < 0.0001). Albumin,

transthyretin,

> and C-reactive protein levels differed significantly among the

three groups

> (respectively P < 0.0001, P < 0.0001 and P = 0.0003). Age, energy

intake, length of

> hospital stay and the presence of a urinary catheter were

independent risk factors

> of nosocomial infection.

>

> Conclusion: our findings show that patients with multiple NI were

older, showed an

> altered nutritional status, a prolonged recovery, more frequently

had urinary

> catheters and more discharge placement.

>

> ... Table 3. Anthropometric variables and energy intake in the

three groups of

> patients

> ===================

> n No infection 116 One infection 38 >One infection 31 P

> ===================

> Weight (kg) 61.2±1.5 58.9±3.1 51.3±1.7 0.0079

> BMI (kg/m²) 23.8±0.5 24.0±1.2 21.2±0.7 0.046

> MAC (cm) 27.1±0.4 26.7±1.0 24.1±0.7 0.011

> TST (mm) 11.6±0.5 12.9±1.3 9.5±0.8 0.064

> BST (mm) 4.9±0.3 5.9±0.9 3.1±0.3 0.011

> Energy intake (kcal/day) 1717±40 1474±91 1284±74 <0.0001

> Energy intake (kcal/kg/day) 29.3±0.8 27.2±2.1 25.1±1.4 0.089

> ===================

> BMI, body mass index; MAC, mid-arm circumference; TST,

tricipital skinfold

> thickness; BST, bicipital skinfold thickness.

> The three groups were compared by ANOVA.

>

> As far as biological data were concerned (Table 4), albumin,

transthyretin, and CRP

> levels differed significantly among the three groups (respectively

P<0.0001,

> P<0.0001 and P=0.0003). The group with several infections had a

mean albumin level

> below the normal range (35–48 g/l) and lower than the other two

groups (P<0.0001 and

> P=0.006, respectively). The non-infected group had higher

transthyretin levels

> (P=0.013 and P<0.0001, respectively) and lower CRP levels (P=0.005

and P=0.001,

> respectively) than the two groups with infections.

>

> Table 4. Biological variables in the three groups of patients

> ==================

> n No infection 116 One infection 38 >One infection 31 P

> ==================

> Albumin (g/l) 36.3±0.4 34.6±0.6 31.7±0.9 <0.0001

> Transthyretin (g/l) 0.26±0.01 0.23±0.01 0.19±0.01 <0.0001

> Orosomucoid (g/l) 2.1±0.7 1.5±0.1 1.6±0.1 0.861

> CRP (mg/l) 16±2 37±10 44±8 0.0003

> Lymphocytes (g/l) 1.7±0.1 1.8±0.3 1.5±0.1 0.438

> PMN leukocytes (g/l) 4.4±0.2 6.1±1.0 6.7±0.7 0.0027

> ===================

> PMN, polymorphonuclear.

> The three groups were compared by ANOVA.

>

> ... Table 6. Multivariate analysis of factors associated with the

development of an

> infection

> ===================

> P OR [95% CI]

> ===================

> Intrinsic factors (personal)

> Age 0.035 1.06 [1.003–1.12]

> Weight 0.811 1.003 [0.98–1.03]

> Albumin 0.027 1.11 [1.01–1.21]

> PMN leukocytes 0.031 1.17 [1.01–1.36]

> Sex 0.075 2.51 [0.91–6.94]

> Extrinsic factors

> Length of stay 0.009 1.01 [1.002–1.01]

> Urinary catheter 0.005 44.1 [3.2–611.7]

> Daily intake <0.0001 1.002 [1.001–1.002]

> ==================

> PMN polymorphonuclear ...

>

> Al Pater, PhD; email: old542000@y...

>

>

>

> __________________________________

> FareChase: Search multiple travel sites in one click.

> http://farechase.

>