Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 14
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Sollid, J.U.E. Furberg, A.S. Hanssen, A.M. and Johannessen, M. 2014. Staphylococcus aureus: Determinants of human carriage. Infection, Genetics and Evolution, Vol. 21, p. 531.

    Sahay, Tanya and Ananthakrishnan, Ashwin N 2014. Vitamin D deficiency is associated with community-acquired clostridium difficile infection: a case–control study. BMC Infectious Diseases, Vol. 14, Issue. 1,

    Curtis, Luke 2013. More Nutritional Research Needed to Prevent and Treat Clostridium difficile Infections. The American Journal of Gastroenterology, Vol. 108, Issue. 11, p. 1813.

    Youssef, Dima A. Ranasinghe, Tamra Grant, William B. and Peiris, Alan N. 2012. Vitamin D's potential to reduce the risk of hospital-acquired infections. Dermato-Endocrinology, Vol. 4, Issue. 2, p. 167.

    Kempker, Jordan A. Han, Jenny E. Tangpricha, Vin Ziegler, Thomas R. and Martin, Greg S. 2012. Vitamin D and sepsis. Dermato-Endocrinology, Vol. 4, Issue. 2, p. 101.

    Thomason, Jenna Rentsch, Christopher Stenehjem, Edward A. Hidron, Alicia I. and Rimland, David 2015. Association between vitamin D deficiency and methicillin-resistant Staphylococcus aureus infection. Infection, Vol. 43, Issue. 6, p. 715.

    McKinney, T. J. Patel, Jayshil J. Benns, Matthew V. Nash, Nicholas A. and Miller, Keith R. 2016. Vitamin D Status and Supplementation in the Critically Ill. Current Gastroenterology Reports, Vol. 18, Issue. 4,

    Islam, Tariq Peiris, Prith Copeland, Rebecca J. El Zoghby, Maria and Peiris, Alan N. 2011. Vitamin D: Lessons from the Veterans Population. Journal of the American Medical Directors Association, Vol. 12, Issue. 4, p. 257.

    Abdelfatah, Mohamed Nayfe, Rabih Moftakhar, Bahar Nijim, Ala El Zoghbi, Maysaa Donskey, Curtis J. Kandil, Hossam and Watkins, Richard R. 2015. Low Vitamin D Level and Impact on Severity and Recurrence of Clostridium difficile Infections. Journal of Investigative Medicine, Vol. 63, Issue. 1, p. 17.

    Ananthakrishnan, A. N. Cagan, A. Gainer, V. S. Cheng, S.-C. Cai, T. Szolovits, P. Shaw, S. Y. Churchill, S. Karlson, E. W. Murphy, S. N. Kohane, I. and Liao, K. P. 2014. Higher plasma vitamin D is associated with reduced risk ofClostridium difficileinfection in patients with inflammatory bowel diseases. Alimentary Pharmacology & Therapeutics, Vol. 39, Issue. 10, p. 1136.

    Youssef, Dima A El Abbassi, Adel M Cutchins, Della C Chhabra, Shalini and Peiris, Alan N 2011. Vitamin D deficiency: Implications for acute care in the elderly and in patients with chronic illness. Geriatrics & Gerontology International, Vol. 11, Issue. 4, p. 395.

    Youssef, Dima A. Miller, Christopher W.T. El-Abbassi, Adel M. Cutchins, Della C. Cutchins, Coleman Grant, William B. and Peiris, Alan N. 2011. Antimicrobial implications of vitamin D. Dermato-Endocrinology, Vol. 3, Issue. 4, p. 220.

    Olsen, K. Falch, B. M. Danielsen, K. Johannessen, M. Ericson Sollid, J. U. Thune, I. Grimnes, G. Jorde, R. Simonsen, G. S. and Furberg, A.-S. 2012. Staphylococcus aureus nasal carriage is associated with serum 25-hydroxyvitamin D levels, gender and smoking status. The Tromsø Staph and Skin Study. European Journal of Clinical Microbiology & Infectious Diseases, Vol. 31, Issue. 4, p. 465.

    Youssef, D. Bailey, B. El-Abbassi, A. Vannoy, M. Manning, T. Moorman, J. P. and Peiris, A. N. 2012. Healthcare costs of methicillin resistant Staphylococcus aureus and Pseudomonas aeruginosa infections in veterans: role of vitamin D deficiency. European Journal of Clinical Microbiology & Infectious Diseases, Vol. 31, Issue. 3, p. 281.


Healthcare costs of Staphylococcus aureus and Clostridium difficile infections in Veterans: role of vitamin D deficiency

  • D. YOUSSEF (a1) (a2), B. BAILEY (a3), A. EL ABBASSI (a1) (a2), R. COPELAND (a2), L. ADEBONOJO (a4), T. MANNING (a1) and A. N. PEIRIS (a1) (a2)
  • DOI:
  • Published online: 08 January 2010

Clostridium difficile and staphylococcal infections are associated with increased morbidity, mortality and healthcare costs. Vitamin D deficiency may also contribute to increased healthcare costs. There is increasing evidence that vitamin D may have an antimicrobial role. We examined the relationship of serum 25(OH)D levels to staphylococcal and C. difficile infections to determine if vitamin D deficiency was associated with adverse outcomes. In the outpatient setting, vitamin D deficiency in patients with C. difficile and staphylococcal infections were associated with significantly increased total outpatients costs and fee-based consultation. Laboratory expenses had a trend towards higher costs in the vitamin D-deficient group but did not reach statistical significance. The differences were most clearly seen in the in-patient group with enhanced laboratory, pharmacy and radiology costs. These differences resulted in vitamin D-deficient patients with C. difficile or staphylococcal infections having costs more than five times higher than the non-deficient patients. The total length of hospital stay was four times greater in the vitamin D-deficient group. In addition, the total number of hospitalizations was also significantly greater in the vitamin D-deficient group. Surgery costs demonstrated a tendency to be higher in the vitamin D-deficient group but failed to reach statistical significance. Vitamin D deficiency is intimately linked to adverse health outcomes and costs in Veterans with staphylococcal and C. difficile infections in North East Tennessee. We recommend that vitamin D status be checked in patients with these infections and appropriate therapy be instituted to restore vitamin D level to normal in an expeditious manner.

Corresponding author
*Author for correspondence: Dr A. N. Peiris, Medicine Service, 111 Mountain Home, VAMC, Mountain Home, TN37684, USA. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1.MF Holick . The vitamin D deficiency pandemic and consequences for nonskeletal health: mechanisms of action. Molecular Aspects of Medicine 2008; 29: 361368.

2.DD Bikle . Vitamin D and the immune system: role in protection against bacterial infection. Current Opinion in Nephrology and Hypertension 2008; 17: 348352.

3.E Feindt , J Ströder . Studies on the antimicrobial effect of vitamin D. Wiener Klinische Wochenschrift 1977; 55: 507508.

4.DE Roth , Vitamin D receptor polymorphisms and the risk of acute lower respiratory tract infection in early childhood. Journal of Infectious Diseases 2008; 197: 676680.

5.G Karatekin , Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers. European Journal of Clinical Nutrition 2009; 63: 473477.

6.MS De la Torre , Vitamin D receptor gene haplotypes and susceptibility to HIV-1 infection in injection drug users. Journal of Infectious Diseases 2008; 197: 405410.

8.PT Liu , Cutting edge: vitamin D-mediated human antimicrobial activity against Mycobacterium tuberculosis is dependent on the induction of cathelicidin. Journal of Immunology 2007; 179: 20602063.

9.KA O'Connor , Antibiotic prescribing policy and Clostridium difficile diarrhoea. Quarterly Journal of Medicine 2004; 97: 423429.

10.D Gravel , Health care-associated Clostridium difficile infection in adults admitted to acute care hospitals in Canada: a Canadian Nosocomial Infection Surveillance Program Study. Clinical Infectious Diseases 2009; 48: 568576.

15.RJ Rubin , The economic impact of Staphylococcus aureus infection in New York City hospitals. Emerging Infectious Diseases 1999; 5: 9–17.

16.AN Peiris , BA Bailey , T Manning . The relationship of vitamin D deficiency to health care costs in veterans. Military Medicine 2008; 173: 12141218.

17.RH Napier , Insurance billing and coding. Dental Clinics of North America 2008; 52: 507–27, viii.

18.LM Bodnar , MA Krohn , HN Simhan . Maternal vitamin D deficiency is associated with bacterial vaginosis in the first trimester of pregnancy. Journal of Nutrition 2009; 139: 11571161.

20.C Haug , Subnormal serum concentration of 1,25-vitamin D in human immunodeficiency virus infection: correlation with degree of immune deficiency and survival. Journal of Infectious Diseases 1994; 169: 889893.

21.AA Ginde , JM Mansbach , CA Camargo Jr.. Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Archives of Internal Medicine 2009; 169: 384390.

22.V Wayse , Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y. European Journal of Clinical Nutrition 2004; 58: 563567.

24.AC Leandro , Genetic polymorphisms in vitamin D receptor, vitamin D-binding protein, Toll-like receptor 2, nitric oxide synthase 2, and interferon-gamma genes and its association with susceptibility to tuberculosis. Brazilian Journal of Medical and Biological Research 2009; 42: 312322.

25.AK Wilbur , Vitamin D receptor gene polymorphisms and susceptibility M. tuberculosis in native Paraguayans. Tuberculosis (Edinburgh) 2007; 87: 329337.

26.GR Huff , Effect of dietary supplementation with vitamin D metabolites in an experimental model of turkey osteomyelitis complex. Poultry Science 2002; 81: 958965.

27.ME Silva , Vitamin D overload and experimental Trypanosoma cruzi infection: parasitological and histopathological aspects. Comparative Biochemistry and Physiology 1993; 104: 175181.

28.AF Gombart , N Borregaard , HP Koeffler . Human cathelicidin antimicrobial peptide (CAMP) gene is a direct target of the vitamin D receptor and is strongly up-regulated in myeloid cells by 1,25-dihydroxyvitamin D3. FASEB Journal 2005; 19: 10671077.

29.P Leventis , PD Kiely . The tolerability and biochemical effects of high-dose bolus vitamin D2 and D3 supplementation in patients with vitamin D insufficiency. Scandinavian Journal of Rheumatology 2009; 38: 149153.

31.R Scragg , KT Khaw , S Murphy . Life-style factors associated with winter serum 25-hydroxyvitamin D levels in elderly adults. Age and Ageing 1995; 24: 271275.

32.SH Sedrani . Low 25-hydroxyvitamin D and normal serum calcium concentrations in Saudi Arabia: Riyadh region. Annals of Nutrition and Metabolism 1984; 28: 181185.

33.L Jeng , Alterations in vitamin D status and anti-microbial peptide levels in patients in the intensive care unit with sepsis. Journal of Translational Medicine 2009; 7: 28.

34.AA Ginde , MC Liu , CA Camargo Jr.. Demographic differences and trends of vitamin D insufficiency in the US population, 1988–2004. Archives of Internal Medicine 2009; 169: 626632.

35.P Autier , S Gandini . Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Archives of Internal Medicine 2007; 167: 17301737.

36.WB Grant , Estimated benefit of increased vitamin D status in reducing the economic burden of disease in Western Europe. Progress in Biophysics and Molecular Biology 2009; 99: 104113.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *