Thibault Ronan, Makhlouf Anne-Marie, Kossovsky Michel P, Iavindrasana Jimison, Chikhi Marinette, Meyer Rodolphe, Pittet Didier, Zingg Walter, Pichard Claude
Nutrition Unit, Geneva University Hospital, Geneva, Switzerland.
Rehabilitation and Geriatrics, Geneva University Hospital, Geneva, Switzerland.
PLoS One. 2015 Apr 29;10(4):e0123695. doi: 10.1371/journal.pone.0123695. eCollection 2015.
Indicators to predict healthcare-associated infections (HCAI) are scarce. Malnutrition is known to be associated with adverse outcomes in healthcare but its identification is time-consuming and rarely done in daily practice. This cross-sectional study assessed the association between dietary intake, nutritional risk, and the prevalence of HCAI, in a general hospital population.
Dietary intake was assessed by dedicated dieticians on one day for all hospitalized patients receiving three meals per day. Nutritional risk was assessed using Nutritional Risk Screening (NRS)-2002, and defined as a NRS score ≥ 3. Energy needs were calculated using 110% of Harris-Benedict formula. HCAIs were diagnosed based on the Center for Disease Control criteria and their association with nutritional risk and measured energy intake was done using a multivariate logistic regression analysis. From 1689 hospitalised patients, 1024 and 1091 were eligible for the measurement of energy intake and nutritional risk, respectively. The prevalence of HCAI was 6.8%, and 30.1% of patients were at nutritional risk. Patients with HCAI were more likely identified with decreased energy intake (i.e. ≤ 70% of predicted energy needs) (30.3% vs. 14.5%, P = 0.002). The proportion of patients at nutritional risk was not significantly different between patients with and without HCAI (35.6% vs.29.7%, P = 0.28), respectively. Measured energy intake ≤ 70% of predicted energy needs (odds ratio: 2.26; 95% CI: 1.24 to 4.11, P = 0.008) and moderate severity of the disease (odds ratio: 3.38; 95% CI: 1.49 to 7.68, P = 0.004) were associated with HCAI in the multivariate analysis.
Measured energy intake ≤ 70% of predicted energy needs is associated with HCAI in hospitalised patients. This suggests that insufficient dietary intake could be a risk factor of HCAI, without excluding reverse causality. Randomized trials are needed to assess whether improving energy intake in patients identified with decreased dietary intake could be a novel strategy for HCAI prevention.
预测医疗保健相关感染（HCAI）的指标稀缺。已知营养不良与医疗保健中的不良后果相关，但其识别耗时且在日常实践中很少进行。这项横断面研究评估了综合医院人群中饮食摄入、营养风险与HCAI患病率之间的关联。
由专业营养师对所有每日三餐的住院患者进行一天的饮食摄入评估。使用营养风险筛查（NRS）-2002评估营养风险，定义为NRS评分≥3。使用哈里斯-本尼迪克特公式的110%计算能量需求。根据疾病控制中心标准诊断HCAI，并通过多变量逻辑回归分析其与营养风险的关联以及测量的能量摄入情况。在1689名住院患者中，分别有1024名和1091名符合能量摄入和营养风险测量条件。HCAI的患病率为6.8%，30.1%的患者存在营养风险。发生HCAI的患者更有可能被发现能量摄入减少（即≤预测能量需求的70%）（30.3%对14.5%，P = 0.002）。发生HCAI和未发生HCAI的患者中存在营养风险的患者比例无显著差异（分别为35.6%对29.7%，P = 0.28）。在多变量分析中，测量的能量摄入≤预测能量需求的70%（比值比：2.26；95%置信区间：1.24至4.11，P = 0.008）和疾病的中度严重程度（比值比：3.38；95%置信区间：1.49至7.68，P = 0.004）与HCAI相关。
测量的能量摄入≤预测能量需求的70%与住院患者的HCAI相关。这表明饮食摄入不足可能是HCAI的一个风险因素，但不排除反向因果关系。需要进行随机试验来评估改善饮食摄入减少患者的能量摄入是否可能是预防HCAI的新策略。
