Healthcare-Associated Infections Are Associated with Insufficient Dietary Intake: An Observational Cross-Sectional Study
Healthcare-Associated Infections Are Associated with Insufficient Dietary Intake: An Observational Cross-Sectional Study
复制标题
医疗保健相关感染与膳食摄入不足有关：一项观察性横断面研究
作者：
R. Thibault;A. Makhlouf;M. Kossovsky;J. Iavindrasana;M. Chikhi;R. Meyer;D. Pittet;W. Zingg;C. Pichard
预测医疗相关感染（HCAI）的指标很少。众所周知，营养不良与医疗保健的不良后果有关，但其识别是耗时的，很少在日常实践中进行。这项横断面研究评估了综合医院人群中饮食摄入、营养风险和HCAI患病率之间的关系。方法和结果膳食摄入量进行了评估，由专门的营养师对所有住院患者接受一日三餐。使用营养风险筛查（NRS）-2002评估营养风险，定义为NRS评分≥ 3。能量需求使用110%的Harris-Benedict公式计算。根据疾病控制中心的标准诊断HCAIs，并使用多变量logistic回归分析进行其与营养风险和测量能量摄入的相关性。在1689名住院患者中，分别有1024名和1091名有资格测量能量摄入和营养风险。HCAI的患病率为6.8%，30.1%的患者存在营养风险。HCAI患者更可能被确定为能量摄入减少（即≤ 70%的预测能量需求）（30.3% vs. 14.5%，P = 0.002）。营养风险的患者比例在有和没有HCAI的患者之间没有显著差异（35.6% vs.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% CI：1.24至4.11，P = 0.008）和疾病的中度严重程度（比值比：3.38; 95% CI：1.49至7.68，P = 0.004）与HCAI相关。结论：测量能量摄入≤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，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的患者的能量摄入是否可能是预防HCAI的新策略。
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.
影响因子：
158.5
作者：
Pronovost, Peter;Needham, Dale;Goeschel, Christine
通讯作者：
Goeschel, Christine