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Hypothesis: A hospital diarrhea epidemic caused vitamin D deficiency – Oct 2012

Vitamin D deficiency: A potential risk factor for Clostridium difficile infection

This article was published in the following Dove Press journal: Risk Management and Healthcare Policy 5 October 2012
Dima Youssef 1 William B Grant 2 Alan N Peiris 3,4
1 Department of Internal Medicine, Division of Infectious Diseases,
2 Sunlight, Nutrition and Health Research Center, San Francisco, CA USA;
3 Department of Medicine, Mountain Home VAMC,
4 Department of Medicine, East Tennessee State University, Johnson City, Tennessee, USA

In the July 3, 2012 issue of the journal of Risk Management and Healthcare Policy, Martinez et al present a nice review on Clostridium difficile (C. difficile) infections.1 The different manifestations of this challenging disease along with the high cost and burden on the health care system were discussed. While the authors did an admirable job in discussing traditional risk factors, they do not mention vitamin D deficiency.

Vitamin D deficiency has reached a pandemic status.2 Vitamin D has an important role in boosting the innate immunity, and thus preventing infections.3 We have recently reviewed the potential role of vitamin D in the prevention of hospital acquired infections.4 In a veterans study, vitamin D deficiency in patients with C. difficile was associated with significantly increased total costs and fee-based consultation. The deficient patients had five times higher costs than the non-deficient patients.5 Most cells have vitamin D receptors and vitamin D has a plethora of actions leading to boosting innate immunity including increased oxidative burst of macrophages and enhancing neutrophil motility and phagocytic function, T cell activation and increased expression of antimicrobial peptides, such as cathelicidin, and beta-defensins. While awaiting additional confirmatory studies of the antimicrobial effects of vitamin D, there are sufficient benefits including better intensive care unit outcomes,6 for the authors to include a vitamin D replete state as a part of their therapeutic approach. Vitamin D is inexpensive and has the potential to tilt the balance in favor of patients with this devastating infection.


This material is the result of works supported with resources and the use of facilities at the Mountain Home VAMC. The contents of this report do not reflect the position of the US government and the Department of Veterans Affairs.
Correspondence: Dima Youssef Quillen College of Medicine, East Tennessee State University, Department of Internal Medicine, Division of Infectious Diseases, Box 70622, VAMC Bldg Dogwood Ave, Johnson City, TN 37614, USA Email estecina at hotmail.com


WBG receives funding from the UV Foundation (McLean, VA), Bio-Tech Pharmacal (Fayetteville, AR), the Vitamin D Council (San Luis Obispo, CA), the Vitamin D Society (Canada), and the Sunlight Research Forum (Veldhoven).


1. Martinez FJ, Leffler DA, Kelly CP. Clostridium difficile outbreaks: prevention and treatment strategies. RiskManagHealthc Policy. 2012;5:55-64. (PDF attached at bottom of this page)
2. Holick MF. Vitamin D deficiency. NEngl J Med. 2007;357(3):266-281.
3. Youssef DA, Miller CW, El-Abbassi AM, et al. Antimicrobial implications of vitamin D. Dermatoendocrinol. 2011;3(4):220-229.On-line full text
4. Youssef D, Ranasinghe T, Grant WB, Peiris AN. Vitamin D's potential to reduce the risk of hospital-acquired infections. Dermatoendocrinol. Apr/May/Jun 2012;4(2):1-9. In VitaminDWiki
5. Youssef D, Bailey B, El Abbassi A, et al. Healthcare costs of Staphylococcus aureus and Clostridium difficile infections in veterans: role of vitamin D deficiency. Epidemiol Infect. 2010;138(9):1322-1327.
6. Matthews LR, Ahmed Y, Wilson KL, Griggs DD, Danner OK. Worsening severity of vitamin D deficiency is associated with increased length of stay, surgical intensive care unit cost, and mortality rate in surgical intensive care unit patients. Am J Surg. 2012;1(204):37—43.
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AHRQ graph shows the extent of the epidemic

Almost 4X increase



People in good health usually do not get CDI. Increased risk is associated with:

  • Prolonged use of broad spectrum antibiotics such as cephalosporins and clindamycin
  • Advanced age (Usually over 65)
  • Gastrointestinal surgery
  • Immunologically compromised

See also VitaminDWiki

Attached files

ID Name Comment Uploaded Size Downloads
1646 CDI Martinez.pdf admin 08 Oct, 2012 22:59 592.05 Kb 793
1645 Youssef Grant Peiris C difficile RMHP.pdf PDF admin 08 Oct, 2012 22:37 112.45 Kb 601
1644 CDI AHRQ.jpg admin 08 Oct, 2012 22:33 79.34 Kb 9731
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