Healthcare-associated infections are associated with insufficient dietary intake: an observational cross-sectional study

Ronan Thibault, Anne-Marie Makhlouf, Michel P Kossovsky, Jimison Iavindrasana, Marinette Chikhi, Rodolphe Meyer, Didier Pittet, Walter Zingg, Claude Pichard, Ronan Thibault, Anne-Marie Makhlouf, Michel P Kossovsky, Jimison Iavindrasana, Marinette Chikhi, Rodolphe Meyer, Didier Pittet, Walter Zingg, Claude Pichard

Abstract

Background: 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.

Methods and findings: 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.

Conclusion: 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.

Conflict of interest statement

Competing Interests: These authors Dr. Thibault and Pr. Pichard received grants from the following commercial funders BBraun, Fresenius-Kabi, Nutricia, Nestlé, Baxter, Swiss National Science Foundation, Public Foundation Nutrition 2000plus, Nestle Nutrition, Abbott, Danone and Cosmed. Dr. Thibault has a patent EPA, Evaluation of Patient's Alimentation with royalties paid. This does not alter the authors' adherence to all PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Study flow chart.
Fig 1. Study flow chart.
Fig 2. Distribution of the Nutritional Risk…
Fig 2. Distribution of the Nutritional Risk Screening-2002 score in the study population (n = 1091).
Patients with score ≥3 are at nutritional risk (grey bars).
Fig 3. Probability of healthcare-associated infections according…
Fig 3. Probability of healthcare-associated infections according to the measured energy intake (expressed as % of predicted energy needs.
Predicted energy needs are calculated as 110% of the Harris-Benedict formula. The Fig 3 shows that the probability of healthcare-associated infection is high when measured energy intake is ≤ 70% of predicted energy needs according to the locally weighted scatterplot smoothing graphical procedure.

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