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Author Topic: Should hospitals use sunbeds to prevent infections?  (Read 3037 times)

Offline Kevan Gelling

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Specifically, would narrow-band ultraviolet light (NB-UVB) treatment for patients before surgery reduce the risk of post-operative infections, such as MRSA and C.Difficile?

According to figures from the Health Protection Agency, MRSA and C.Difficile infection rates have a small but noticeable winter peak




We get most of our vitamin D by the action of UVB radiation from sunshine on our skin, however, in the UK between October and March the radiation is too weak for vitamin D to be made. Consequently, our vitamin D levels are at their lowest in March.  Is the winter peak in infections due to low vitamin D levels?

It is well established that vitamin D is important to the body's immune system - in the innate immune system it regulates the production of the antimicrobial peptides cathelicidin and beta-defensin 2; in the adaptive immune system it controls the activation of T-cells.

And there appears to be a correlation between vitamin D and infections:

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

SUMMARY
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.

...

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.

From Digestive Disease Week 2010 conference:
Quote
Higher Resolution Rate of Clostridia Difficile Enteritis in Hospitalized Patients with Normal Vitamin D Levels (Abstract #T1793)

...

Researchers tracked 83 patients who had been admitted to the hospital who were then diagnosed with C. diff. They measured vitamin D levels in all of the patients, then followed their hospital course. Researchers noted how many patients were still alive after 30 days, and compared the outcome of patients with normal vitamin D levels to those with low levels. They found that up to 40 percent of people, especially in an older age group with multiple illnesses, died from some cause if they developed C. diff during that hospitalization.

...

Researchers found that those with normal levels of vitamin D had a higher resolution rate, and a lower recurrence rate than those with low vitamin D levels. These findings are consistent with what is currently understood about vitamin D — it plays a role in immune function, may be an important factor in fighting infection, low levels seem to be a marker for not resolving diseases in general and it is associated with higher mortality rates.

So improving vitamin D levels should at least improve infection outcomes, if not reduce infection rates.

But does anything prevent MRSA or C.Difficile infections?  Beta-defensin 3 appears to be effective against MRSA.  Beta-defensin 3 is created by UVB light.

From PubMed
Quote
UV-B radiation induces the expression of antimicrobial peptides in human keratinocytes in vitro and in vivo

RESULTS:
Real-time PCR of normal human keratinocytes revealed a dose-dependent increase of human beta-defensin-2, -3, ribonuclease 7, and psoriasin (S100A7) after UV radiation. This was confirmed at the protein level by intracellular fluorescence-activated cell sorting and in vitro immunofluorescence analysis. Immunohistochemistry of biopsies taken from healthy volunteers exposed to different UV radiation doses revealed enhanced epidermal expression of antimicrobial peptides after UV exposure. This was also confirmed by exposing human skin explants to UV radiation.

So a NB-UVB sunbed would increase a patient's vitamin D levels and produce skin-level antimicrobial peptides including beta-defensin 3.
« Last Edit: 06/05/2010 13:43:07 by Kevan Gelling »


 

Offline Kevan Gelling

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Should hospitals use sunbeds to prevent infections?
« Reply #1 on: 27/05/2010 22:03:53 »
From the Digestive Disease Week 2010 conference

Quote

Introduction:
Clostridium difficile associated diarrhea (CDAD) has increased markedly over the past 10 years and is responsible for 3 million cases annually. Despite adequate treatment, the recurrence rate of CDAD remains high. A recent study demonstrated that an all cause 30 day mortality for hospitalized patients with CDAD was 43%. Although multiple risk factors have been associated with recurrent CDAD, the role of serum vitamin D levels has not been ascertained. Low vitamin D levels are known to be associated with osteoporosis, cardiovascular disease, fractures, poor wound healing and increased hospital mortality. The objective of the present study is to determine whether there is an association between serum Vitamin D levels and resolution of CDAD.

Methods:
83 patients, (36 male and 47 female) admitted to New York Hospital Queens, a large urban community teaching hospital, between May 2008 and June 2009 with documented CDAD (+ELISA for toxin A & B ) were enrolled in a prospective cohort study. 21 patients were lost to follow up. Baseline 25-hydroxy Vitamin D levels were measured in all patients. Low Vitamin D was defined as < 21 ng/dl. Patients were followed in hospital and after discharge for a total of 30 days by telephone questionnaire. Resolution of CDAD was defined as absence of diarrhea at 30 days. Statistical analysis utilized fisher’s exact test.

Results:
Of the 62 patients who completed the study, 28 (45%) had normal Vitamin D levels and 34 (54%) had low levels. In 15/28 CDAD patients with normal vitamin D levels, (53%) resolved and remained disease free at 30 days. In contrast, only 9/34 (26%) patients with low Vitamin D levels resolved (P<0.05). Although there was a trend towards increased 30 day mortality rates in patients with abnormal Vitamin D levels, 19/28 (67%), compared to those with normal Vitamin D levels 15/34 (44%), this did not reach statistical significance (p=0.08).

Conclusion:
In conclusion, hospitalized patients with CDAD and normal baseline Vitamin D levels have higher resolution rates compared to patients with low Vitamin D levels. Further studies in which patients with CDAD receive Vitamin D supplementation may be warranted.

 

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Should hospitals use sunbeds to prevent infections?
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