DOI: 10.1097/CCM.0b013e3181f96f92
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PMID: 21088521
Issn Print: 0090-3493
Publication Date: 2010/12/01
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Excerpt
One very common and usually overlooked factor that greatly increases risk of fungal and bacterial infections is malnutrition. Five studies have reported that between 42% and 91% of hospitalized elderly have protein–calorie malnutrition (3). A large percentage of hospitalized patients are deficient in a wide range of nutrients known to be important for immunity, including protein; omega-3 fatty acids; vitamins A, B6, B12, C, D, and E; selenium; zinc; copper; and iron (4). A French study of 630 hospitalized patients reported that the risk of hospital-acquired infections was 4.98 times as great (95% confidence interval, 4.6–6.4) in malnourished patients as compared with well-nourished hospital patients (5).
Published reports linking malnutrition to increasing incidence and mortality from infections from Candida, Aspergillus, and other fungi have been rather sparse. Protein–calorie malnutrition and/or low blood albumin has been linked to significantly higher hospital mortality rates from Candida (6) and Aspergillus (7) infections. A study of 79 elderly hospitalized patients reported that the incidence of oral candidiasis was significantly more common in patients with low blood levels of albumin, zinc, or vitamin C (8).
Providing prompt and nutritious enteral feeding of intensive care unit patients can significantly reduce rates of infection and mortality. A meta-analysis of six published studies reported that prompt (within 24 hrs of intensive care unit admission) beginning of enteral feeding was associated with a 66% drop in intensive care unit mortality (95% confidence interval, 0.14–0.85) and a 69% drop in intensive care unit pneumonia rates (95% CI, 0.12–0.78) (9). In recent years, “immunonutrition” enteral formulas have been developed that contain larger quantities of antioxidant vitamins, zinc and other trace metals, omega-3 fatty acids, and amino acids like glutamine. Meta-analysis has calculated that use of such immonutrition enteral formulas in hospitalized patients is associated with a 46% lower risk of nosocomial pneumonia (11 studies, p = .007), a 55% lower risk of bacteremia (nine studies, p = .0002), a 78% lower risk of abdominal abscesses (six studies, p = .005), and a 34% lower risk of urinary tract infections (ten studies, p = .05) compared with patients receiving standard enteral formula (10).
Much more clinical and research attention needs to be focused on nutrition for hospitalized patients. Better hospital nutrition can prevent thousands of infections and deaths and save billions of dollars in healthcare costs. I hope journals like Critical Care Medicine can publish more good research papers on hospital nutrition.
The author has not disclosed any potential conflicts of interest.
