Obesity and Hospital Acquired Infections

I am back to blogging about infectious diseases.

It is commonly accepted that obesity is associated with an increased risk of hospital acquired and surgical site infections.

Here is a state of the art review article on obesity and hospital acquired infections published in the Journal of Hospital Infection. 

The exact mechanism by which obesity increases the risk of hospital acquired infection is not known but may be due to several potential and inter-related factors. These include co-morbid conditions like vascular disease and diabetes mellitus, immunological changes, altered pharmacokinetics of antimicrobials, challenges in skin disinfection prior to invasive procedures, changes in gut microbiota and adverse effects on pulmonary function.

The obesity-infection association is most clear in cardiac, vascular, orthopaedic and gastrointestinal surgery. Unfortunately, a  clear BMI cut-off for increased infection risk cannot be determined. Also, obesity is frequently associated with underdosing of antimicrobials in both prophylaxis and treatment of hospital acquired infections. 

I am not entirely clear on the best preventive measures apart from systematically addressing the obesity crisis in the USA. On a more immediate level, we need to better optimize antimicrobial dosing and antisepsis for obese patients. This last point is pressing.

Given the habitus of the average North American, obesity will continue to vex infection prevention efforts.