Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-19T02:52:20.323Z Has data issue: false hasContentIssue false
  • English
  • Français

Total Cholesterol, HDL-Cholesterol, and Risk of Nosocomial Infection: A Prospective Study in Surgical Patients

Published online by Cambridge University Press:  02 January 2015

Miguel Delgado-Rodríguez ,
Marcelino Medina-Cuadros ,
Gabriel Martínez-Gallego  and
María Sillero-Arenas
Miguel Delgado-Rodríguez*
Affiliation:
Division of Preventive Medicine and Public Health, School of Medicine, University of Cantabria, Santander, Jaén, Spain
Marcelino Medina-Cuadros
Affiliation:
General Surgery Service, General Hospital Ciudad de Jaén, Jaén, Spain
Gabriel Martínez-Gallego
Affiliation:
General Surgery Service, General Hospital Ciudad de Jaén, Jaén, Spain
María Sillero-Arenas
Affiliation:
Division of Health Programs, Provincial Office for Health, Jaén, Spain
*
Division of Preventive Medicine and Public Health, School of Medicine, University of Cantabria, Avenida Cardenal Herrera Oria s/n, 39011-Santander, Spain
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To study the relationship between serum high-density lipoprotein cholesterol (HDL-C), total serum cholesterol, and nosocomial infection in patients undergoing general surgery.

Design:

Prospective cohort study, with an extended follow-up to 1 month after hospital discharge.

Setting:

The general surgery service of a tertiary hospital.

Main Outcome Measure:

Nosocomial infection, mainly surgical-site infection (SSI), urinary tract infection, respiratory tract infection (RTI), and bacteremia.

Patients:

1,267 surgery patients aged 10 to 92 years.

Results:

182 subjects acquired 194 nosocomial infections, a cumulative incidence of 14.5%; most (116, 62.3%) were postoperative wound infections. There was an increase in infection risk at low levels of HDL-C, and both low and high total cholesterol levels. After adjusting simultaneously for several confounders, including total cholesterol, low levels of HDL-C (≤20 mg/dL) yielded an odds ratio (OR) of 2.2 (95% confidence interval [CI95], 0.6-7.9) for SSI and an OR of 10.3 (CI95, 0.7-151.5) for RTI. Otherwise, no trend was observed between HDL-C levels and infection risk, and no increased risk of nosocomial infection was observed for HDL-C values in the range of 21 to 49 mg/dL. Serum cholesterol showed a U-shaped relationship with nosocomial infection risk. Both low levels (below 102 mg/dL) and high levels (above 290 mg/dL) of total cholesterol were associated with a higher risk of SSI (mainly those caused by gram-negative bacteria) and RTI in comparison with the reference group (139-261 mg/dL).

Conclusions:

Serum HDL-C and total cholesterol seem to be associated with the risk of nosocomial infection in surgical patients

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 1 , January 1997 , pp. 9 - 18
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Freudenberg, MA, Bog-Hansen, TC, Back, U, Galanos, C. Interaction of lipopolysaccharides with plasma high density lipoprotein. Infect Immun 1980;28:373–380.Google Scholar
2. Munford, RS, Hall, CL, Dietschy, DM. Binding of Salmonella typhimurium lipopolysaccharides to rat high density lipoprotein. Infect Immun 1981;34:835–843.Google Scholar
3. Ulevitch, RJ, Johnson, AR. The modification of biophysical and endotoxic properties of bacterial lipopolysaccharides by serum. J Clin Invest 1978;62:1313–1324.Google Scholar
4. Tobias, PS, McAdam, KPWJ, Soldau, K, Ulevitch, RJ. Control of lipopolysaccharide-high density lipoprotein interactions by an acute phase reactant in human serum. Infect Immun 1985;50:73–76.Google Scholar
5. Tobias, PS, Soldau, K, Ulevitch, RJ. Isolation of a lipopolysaccharidebinding acute phase reactant from rabbit serum. J Exp Med 1986;164:777–793.Google Scholar
6. Ulevitch, RJ, Johnson, AR, Weinstein, DB. New function for high density lipoprotein: their participation in intravascular reactions of bacterial lipopolysaccharides by serum. J Clin Invest 1979;64:1516–1524.CrossRefGoogle Scholar
7. Vosbeck, K, Tobias, P, Mueller, H, et al. Priming of polymorphonuclear granulocytes by lipopolysaccharides and its complexes with lipopolysaccharide binding protein and high density lipoprotein. J Leukoc Biol 1990;47:97–104.Google Scholar
8. Wiernik, A, Carlson, LA, Jarstrand, C. High density lipoprotein inhibit the bacterial mediated increase in oxidative metabolism and lysozyme released by neutrophilic granulocytes in vitro. J Clin Lab Immunol 1986;21:131–135.Google Scholar
9. Owens, BJ, Anantharamaiah, GM, Kahlon, JB, Srinivas, RV, Compans, RW, Segrest, JP. Apolipoprotein A-I and its amphipathic helix peptide analogues inhibit human immunodeficiency virus-induced syncytium formation. J Clin Invest 1990;86:1142–1150.CrossRefGoogle ScholarPubMed
10. Srinivas, RV, Birkedal, B, Owens, BJ, Anantharamaiah, GM, Segrest, JP, Compans, RW. Antiviral effects of apolipoprotein A-I and its synthetic amphipathic peptides analogs. Virology 1990;176:48–57.CrossRefGoogle Scholar
11. Owen, JS, Gillett, MP, Hughes, TE. Transgenic mice expressing human apolipoprotein A-I have sera with modest trypanolytic activity in vitro but remain susceptible to infection by Trypanosoma brucei brucei. J Lipid Res 1992;33:1639–1646.Google Scholar
12. Seed, JR, Sechelski, JB, Ortiz, JC, Chapman, JF. Relationship between human serum trypanocidal activity and host resistance to the African trypanosomes. J Parasitol 1993;79:226–232.Google Scholar
13. Verducci, G, Perito, S, Rossi, R, Mannarino, E, Bistoni, F, Marconi, P. Identification of a trypanocidal factor against Trypanosoma equiperdum in normal human serum. Parasitology 1989;98:401–407.Google Scholar
14. Kerttula, Y, Weber, T. Serum lipids in pneumonia of different etiology. Ann Clin Res 1988;20:184–188.Google Scholar
15. Mukerjee, S, Chander, R, Tekwani, BL, et al. Molecular basis of hyperlipidemia in golden hamsters during experimental infection with Ancylostoma ceylanicum (Nematoda: Strongylidae) . Int J Parasitol 1990;20:217–223.Google Scholar
16. Vignon, F, Clavert, A, Cranz, C, Koll-Back, MH, Reville, P. Alterations in the lipid composition of seminal plasma in patients with a chronic infection of the urogenital tract. Urol Int 1993;50:36–38.Google Scholar
17. Sammalkorpi, K, Valtonen, V, Kerttula, Y, Nikkila, E, Taskinen, MR. Changes in serum lipoprotein pattern induced by acute infections. Metabolism 1988;37:859–865.Google Scholar
18. Levy, E, Gurbindo, C, Lacaille, F, Paradis, K, Thibault, L, Seidman, E. Circulating tumor necrosis factor-alpha levels and lipid abnormalities in patients with cystic fibrosis. Pediatr Res 1993; 34:162–166.Google Scholar
19. Garbagnati, E. Changes in lipid profile observed in children over the course of infectious disease. Acta Paediatr 1993;82:948–952.CrossRefGoogle ScholarPubMed
20. Nilsson-Ehle, I, Nilsson-Ehle, P. Changes in plasma lipoproteins in acute malaria. J Intern Med 1990;227:151–155.CrossRefGoogle ScholarPubMed
21. Grunfeld, C, Pang, M, Doerrler, W, Shigenaga, JK, Jensen, P, Feingold, KR. Lipids, lipoproteins, triglyceride clearance, and cytokines in human immunodeficiency virus infection and the acquired immunodeficiency syndrome. J Clin Endocrinol Metab 1992;74:1045–1052.Google Scholar
22. Muga, R, Tor, J, Rey-Joly, C, Pardo, A, Llobet, P, Foz, M. Dislipemia e infección por el VIH-1 en adictos a drogas por vía intravenosa. Med Clin (Barc) 1993;100:161–163.Google Scholar
23. Feingold, KR, Hardardottir, I, Memon, R, et al. Effect of endotoxin on cholesterol biosynthesis and distribution in serum lipoproteins in Syrian hamsters. J Lipid Res 1993;34:2147–2158.Google Scholar
24. Chen, Z, Keech, A, Collins, R, et al. Prolonged infection with hepatitis B virus and association between low blood cholesterol concentration and liver cancer. BMJ 1993;306:890–894.CrossRefGoogle ScholarPubMed
25. McCabe, WR, Jackson, GG. Gram-negative bacteremia: II, clinical, laboratory and therapeutic observations. Arch Intern Med 1962;110:856–864.CrossRefGoogle Scholar
26. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128–140.Google Scholar
27. Haley, RW, Quade, D, Freeman, H, Bennet, J, the CDC SENIC Planning Committee. Appendix E: algorithms for diagnosing infections. Am J Epidemiol 1980;111:635–643.Google Scholar
28. Mills, JL. Data torturing. N Engl J Med 1993;329:1196–1199.Google Scholar
29. Savitz, DA. In defense of black box epidemiology. Epidemiology 1994;5:550–552.Google ScholarPubMed
30. Skrabanek, P. The emptiness of black box. Epidemiology 1994;5:553–555.Google Scholar
31. Gordis, L. Challenges to epidemiology in the next decade. Am J Epidemiol 1988;128:1–9.Google Scholar
32. Kleinbaum, DG, Kupper, LL, Morgenstern, H. Epidemiologic Research. Belmont, CA: Lifetime Learning Publications; 1982.Google Scholar
33. Garibaldi, RA, Cushiong, D, Lerer, T. Risk factors for postoperative infection. Am J Med 1991;91(suppl 3B):158S–163S.Google Scholar
34. Mayhall, CG. Surgical infections including burns. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. 2nd ed. Baltimore, MD: Williams & Wilkins; 1993:614–664.Google Scholar
35. Flanders, WD, Khoury, MJ. Indirect assessment of confounding: graphic description and limits on effect of adjusting for covariates. Epidemiology 1990;1:239–246.Google Scholar
36. Jarstrand, C, Rasool, O. Intralipid decreases the bacterial lipopolysaccharide induced release of oxygen radicals and lysozyme from human neutrophils. Scand J Infect Dis 1991;23:481–487.Google Scholar
37. Harris, HW, Grunfeld, C, Feingold, KR, Rapp, JH. Human very low density lipoproteins and chylomicrons can protect against endotoxin-induced death in mice. J Clin Invest 1990;86:696–702.CrossRefGoogle ScholarPubMed
38. Van Lenten, BJ, Fogelman, AM, Haberland, ME, Edwards, PA. The role of lipoproteins and receptor-mediated endocytosis in the transport of bacterial lipopolysaccharide. Proc Natl Acad Sci USA 1986;83:2704–2708.Google Scholar
39. Navab, M, Hough, GP, Van Lenten, BJ, Berliner, JA, Fogelman, AM. Low density lipoproteins transfer bacterial lipopolysaccharides across endothelial monolayers in a biologically active form. J Clin Invest 1988;81:601–605.Google Scholar
40. Haga, Y, Sakamoto, K, Egami, H, et al. Changes in production of interleukin-1 and interleukin-2 associated with obstructive jaundice and biliary drainage in patients with gastrointestinal cancer. Surgery 1989;106:842–848.Google Scholar
41. Galdiero, F, Carratelli, CR, Nuzzo, I, et al. Beneficial effects of myristic, stearic or oleic acid as part of liposomes on experimental infection and antitumor effect in a murine model. Life Sci 1994;55:499–509.Google Scholar
42. Braunwald, J, Nonnenmacher, H, Pereira, CA, Kirn, A. Increased susceptibility to mouse hepatitis virus type 3 (MHV3) infection induced by a hypercholesterolemic diet with increased adsorption of MHV3 to primary hepatocyte cultures. Res Virol 1991;142:5–15.Google Scholar
43. US Preventive Services Task Force. Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions. Baltimore, MD: Williams & Wilkins; 1989.Google Scholar
44. Kinosian, B, Glick, H, Garland, G. Cholesterol and coronary heart disease: predicting risks by levels and ratios. Ann Intern Med 1994;121:641–647.Google Scholar