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Malnutrition is an independent factor associated with nosocomial infections

Published online by Cambridge University Press:  09 March 2007

Stéphane M. Schneider ,
Patricia Veyres ,
Xavier Pivot ,
Anne-Marie Soummer ,
Patrick Jambou ,
Jérôme Filippi ,
Emmanuel van Obberghen  and
Xavier Hébuterne
Stéphane M. Schneider*
Affiliation:
Comité de Liaison Alimentation-Nutrition, CHU de Nice, France
Patricia Veyres
Affiliation:
Comité de Lutte contre l'Infection Nosocomiale, CHU de Nice, France
Xavier Pivot
Affiliation:
Service d'Oncologie, CHU de Besançon, France
Anne-Marie Soummer
Affiliation:
Laboratoire de Biochimie, CHU de Nice, France
Patrick Jambou
Affiliation:
Comité de Lutte contre l'Infection Nosocomiale, CHU de Nice, France
Jérôme Filippi
Affiliation:
Comité de Liaison Alimentation-Nutrition, CHU de Nice, France
Emmanuel van Obberghen
Affiliation:
Laboratoire de Biochimie, CHU de Nice, France
Xavier Hébuterne
Affiliation:
Comité de Liaison Alimentation-Nutrition, CHU de Nice, France
*
*Corresponding author: fax +33 4 92 03 65 75, Email [email protected]
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Abstract

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The aim of the present prospective study was to determine if malnutrition, measured using a simple validated score, is an independent risk factor for nosocomial infections (NI) in non-selected hospital in-patients. Between 29 and 31 May 2001, a survey on the prevalence of NI was conducted on all 1637 in-patients (61 (sd 25) years old) in a French university hospital as part of a national survey. Actual and usual body weights were recorded in all in-patients, and serum albumin levels were measured on all blood samples taken during the week before the study. Nutritional status was evaluated by using the nutritional risk index (NRI). Albumin values were obtained in 1084 patients, and complete weight information was obtained in 911. Therefore, NRI was calculated in 630 patients (61 (sd 20) years old): 427 (67·8%) were malnourished. NI prevalence was 8·7%: 4·4% in non-malnourished patients, 7·6% in moderately malnourished patients and 14·6% in severely malnourished patients. In univariate analysis, the odds ratios for NI were 1·46 (95% CI 1·2, 2·1) in moderately malnourished patients and 4·8 (95% CI 4·6, 6·4) in severely malnourished patients. In multivariate analysis, age, immunodeficiency and NRI class influenced NI risk. Vascular and urinary catheters, and surgical intervention, were the extrinsic factors associated with NI, with odds ratios ranging from 2·0 (95% CI 1·8, 2·6) for vascular catheters to 10·8 (95% CI 8·8, 12·6) for association of the three factors. In conclusion, in non-selected hospitalized patients, malnutrition assessed with a simple and objective marker is an independent risk factor for NI. An early screening for malnutrition may therefore be helpful to reduce the high prevalence of NI.

Keywords

Nosocomial infectionsProtein–energy malnutritionSurgical wound infectionHospitalsSurgical wound infectionUrinary catheterizationImmunocompromised host
Type
Research Article
Information
British Journal of Nutrition , Volume 92 , Issue 1 , July 2004 , pp. 105 - 111
Copyright
Copyright © The Nutrition Society 2004

References

1 Anonymous Perioperative total parenteral nutrition in surgical patients. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group N Engl J Med 1991 325 525 – 532CrossRefGoogle Scholar
2 Anonymous Anonymous Public health focus: surveillance, prevention, and control of nosocomial infections MMWR Morb Mortal Wkly Rep 1992 41 783 – 787Google Scholar
3 Anonymous Prevalence of nosocomial infections in France: results of the nationwide survey in 1996. The French Prevalence Survey Study Group J Hosp Infect 2000 46 186 – 193Google Scholar
4Anker, SDPonikowski, PVarney, SChua, TPClark, ALWebb-Peploe, KMHarrington, DKox, WJPoole-Wilson, PACoats, AJWasting as independent risk factor for mortality in chronic heart failure Lancet 1997 349 1050 – 1053CrossRefGoogle ScholarPubMed
5Brugler, LDiPrinzio, MJBernstein, LThe five-year evolution of a malnutrition treatment program in a community hospital Jt Comm J Qual Improv 1999 25 191 – 206Google Scholar
6Buzby, GPKnox, LSCrosby, LOEisenberg, JMHaakenson, CMMcNeal, GEPage, CPPeterson, OLReinhardt, GFWilliford, WOStudy protocol: a randomized clinical trial of total parenteral nutrition in malnourished surgical patients Am J Clin Nutr 1988 47 366 – 381Google Scholar
7Edington, JBoorman, JDurrant, ERPerkins, AGiffin, CVJames, RThomson, JMOldroyd, JCSmith, JCTorrance, ADPrevalence of malnutrition on admission to four hospitals in England. The Malnutrition Prevalence Group Clin Nutr 2000 19 191 – 195CrossRefGoogle ScholarPubMed
8Galanos, ANPieper, CFKussin, PSWinchell, MTFulkerson, WJHarrell, FEJr Teno, JMLayde, PConnors, AFJr Phillips, RSRelationship of body mass index to subsequent mortality among seriously ill hospitalized patients. SUPPORT Investigators. The Study to Understand Prognoses and Preferences for Outcome and Risks of Treatments Crit Care Med 1997 25 1962 – 1968Google Scholar
9Garcia-Martin, MLardelli-Claret, PJimenez-Moleon, JJBueno-Cavanillas, ALuna-del-Castillo, JDGalvez-Vargas, RProportion of hospital deaths potentially attributable to nosocomial infection Infect Control Hosp Epidemiol 2001 22 708 – 714CrossRefGoogle ScholarPubMed
10Gariballa, SEAnonymous Public health focus: surveillance, prevention, and control of nosocomial infections Clin Nutr 2001 20 487 – 491Google Scholar
11Garner, JSJarvis, WREmori, TGHoran, TCHughes, JMCDC definitions for nosocomial infections, 1988 Am J Infect Control 1988 16 128 – 140Google Scholar
12Gastmeier, PKampf, GWischnewski, NSchumacher, MDaschner, FRuden, HImportance of the surveillance method: national prevalence studies on nosocomial infections and the limits of comparison Infect Control Hosp Epidemiol 1998 19 661 – 667CrossRefGoogle Scholar
13Haley, RWThe scientific basis for using surveillance and risk factor data to reduce nosocomial infection rates J Hosp Infect 1995 30 3 – 14CrossRefGoogle ScholarPubMed
14Hassell, JTGames, ADShaffer, BHarkins, LENutrition support team management of enterally fed patients in a community hospital is cost-beneficial J Am Diet Assoc 1994 94 993 – 998CrossRefGoogle Scholar
15Herrmann, FRSafran, CLevkoff, SEMinaker, KLSerum albumin level on admission as a predictor of death, length of stay, and readmission Arch Intern Med 1992 152 125 – 130CrossRefGoogle ScholarPubMed
16Horan, TCGaynes, RPMartone, WJJarvis, WREmori, TGRuden, HCDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections Am J Infect Control 1992 20 271 – 274Google Scholar
17Jarvis, WRSelected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention Infect Control Hosp Epidemiol 1996 17 552 – 557CrossRefGoogle ScholarPubMed
18Kirkland, KBBriggs, JPTrivette, SLWilkinson, WESexton, DJThe impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs Infect Control Hosp Epidemiol 1999 20 725 – 730CrossRefGoogle ScholarPubMed
19Klein, SThe myth of serum albumin as a measure of nutritional status Gastroenterology 1990 99 1845 – 1846CrossRefGoogle ScholarPubMed
20Kyle, UGUnger, PMensi, NGenton, LPichard, CNutrition status in patients younger and older than 60?y at hospital admission: a controlled population study in 995 subjects Nutrition 2002 18 463 – 469Google Scholar
21Llop, JMMunoz, CBadia, MBVirgili, NTubau, MRamon, JMPita, AJodar, JRSerum albumin as indicator of clinical evolution in patients on parenteral nutrition Multivariate study. Clin Nutr 2001 20 77 – 81CrossRefGoogle ScholarPubMed
22McClave, SAMitoraj, TEThielmeier, KAGreenburg, RADifferentiating subtypes (hypoalbuminemic vs marasmic) of protein-calorie malnutrition: incidence and clinical significance in a university hospital setting J Parenter Enter Nutr 1992 16 337 – 342CrossRefGoogle Scholar
23McMillan, DCWatson, WSO'Gorman, PPreston, TScott, HRMcArdle, CSAlbumin concentrations are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss Nutr Cancer 2001 39 210 – 213CrossRefGoogle ScholarPubMed
24McWhirter, JPPennington, CRIncidence and recognition of malnutrition in hospital Br Med J 1994 308 945 – 948Google Scholar
25Mayon-White, RTDucel, GKereselidze, TTikomirov, EAn international survey of the prevalence of hospital-acquired infection J Hosp Infect 1988 11 43 – 48CrossRefGoogle ScholarPubMed
26Mullen, JLGertner, MHBuzby, GPGoodhart, GLRosato, EFImplications of malnutrition in the surgical patient Arch Surg 1979 114 121 – 125Google Scholar
27Naber, THde Bree, ASchermer, TRBakkeren, JBar, Bde Wild, GKatan, MBSpecificity of indexes of malnutrition when applied to apparently healthy people: the effect of age Am J Clin Nutr 1997 a 65 1721 – 1725CrossRefGoogle ScholarPubMed
28Naber, THSchermer, Tde Bree, ANusteling, KEggink, LKruimel, JWBakkeren, Jvan Heereveld, HKatan, MBPrevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications Am J Clin Nutr 1997 b 66 1232 – 1239CrossRefGoogle ScholarPubMed
29Rady, MYRyan, TStarr, NJClinical characteristics of preoperative hypoalbuminemia predict outcome of cardiovascular surgery J Parenter Enter Nutr 1997 21 81 – 90Google Scholar
30Robinson, GGoldstein, MLevine, GMImpact of nutritional status on DRG length of stay J Parenter Enter Nutr 1987 11 49 – 51Google Scholar
31Roubenoff, RRoubenoff, RAPreto, JBalke, CWMalnutrition among hospitalized patients. A problem of physician awareness Arch Intern Med 1987 147 1462 – 1465CrossRefGoogle ScholarPubMed
32Schneider, SMHébuterne, XLevine, GMUse of nutritional scores to predict clinical outcomes in chronic diseases Nutr Rev 2000 58 31 – 38Google Scholar
33Scrimshaw, NSSanGiovanni, JPSynergism of nutrition, infection, and immunity: an overview Am J Clin Nutr 1997 66 464S – 477SCrossRefGoogle ScholarPubMed
34Setia, UServenti, ILorenz, PNosocomial infections among patients in a long-term care facility: spectrum, prevalence, and risk factors Am J Infect Control 1985 13 57 – 62Google Scholar
35Sullivan, DHWalls, RCThe risk of life-threatening complications in a select population of geriatric patients: the impact of nutritional status J Am Coll Nutr 1995 14 29 – 36CrossRefGoogle Scholar
36Thomas, DRZdrowski, CDWilson, MMConright, KCLewis, CTariq, SMorley, JEAm J Clin Nutr Am J Clin Nutr 2002 75 308 – 313Google Scholar
37Trilla, AGatell, JMMensa, JLatorre, XAlmela, MSoriano, EJimenez de Anta, MTGarcia San Miguel, JRisk factors for nosocomial bacteremia in a large Spanish teaching hospital: a case-control study Infect Control Hosp Epidemiol 1991 12 150 – 156Google Scholar
38Tucker, HNMiguel, SGCost containment through nutrition intervention Nutr Rev 1996 54 111 – 121CrossRefGoogle ScholarPubMed
39Waitzberg, DLCaiaffa, WTCorreia, MIHospital malnutrition: the Brazilian national survey (IBRANUTRI): a study of 4000 patients Nutrition 2001 17 573 – 580CrossRefGoogle ScholarPubMed
40Weinsier, RLHunker, EMKrumdieck, CLButterworth, CE JrHospital malnutrition. A prospective evaluation of general medical patients during the course of hospitalization Am J Clin Nutr 1979 32 418 – 426CrossRefGoogle ScholarPubMed
41Weinstein, JWMazon, DPantelick, EReagan-Cirincione, PDembry, LMHierholzer, WJ JrA decade of prevalence surveys in a tertiary-care center: trends in nosocomial infection rates, device utilization, and patient acuity Infect Control Hosp Epidemiol 1999 20 543 – 548CrossRefGoogle Scholar
42Wenzel, RPNosocomial infections, diagnosis-related groups, and study on the efficacy of nosocomial infection control. Economic implications for hospitals under the prospective payment system Am J Med 1985 78 3 – 7CrossRefGoogle Scholar
43Worming, AMStratégies de réduction des infections nosocomiales. Un modèle pour le développement de la qualité (Strategies for reducing nosocomial infections. A model for developing quality) Etudes de Politique de SantéReviews of Healthcare Systems Paris, FranceOCDE OECD 1994 9 – 25Google Scholar