How does malnutrition affect outcomes of patients with musculoskeletal infection?”     Good nutrition is essential for normal wound healing and host defense against infection.  A lack of proteins, fats, vitamins and minerals creates a welcome environment for invading bacteria:  1) decreased production of new blood vessels to heal wounds, potentiate antimicrobial effectiveness and thereby prevent infection; 2) lack of proteins to seal and heal wounds, stop bleeding and kill bacteria (antibodies against bacteria and viruses);  3) impotent white blood cells (natural  killer cells ) to destroy invaders.   In our protocols and staging system, patients with obesity and/or mal-nutrition are considered B-hosts with co-morbidities affecting wound healing and treatment outcomes.

 How can I be obese and still be malnourished?  Concomitant  obesity and malnutrition can offend occur if the obesity is linked to: 1)  the consumption of empty calories in a diet of processed, fast  foods lacking minerals and containing additives to prolong shelf life; 2) bariatric patients following bariatric surgery where absorption is altered; 3) dietary deficiencies in folate, selenium, zinc and vitamins A, B-12, B-1, C, D and E.  Obesity, for these purposes, is defined as a Mean Body Index (BMI) > 40.   Our treatment center has introduced many innovations in treatment that have improved outcomes for all B-hosts.

How do you diagnose mal-nutrition?  Common measurements of nutritional status include: laboratory tests (serum albumin, transferring, pre-albumin and total lymphocyte count); body measurements such as BMI, tricps skin fold thickness (fat reserves) and a  mid-humeral circumference (protein reserves).  

Can I still be operated if I am malnourished?  In order to prevent post-operative wound complications (healing) and infection (SSI), surgery is often delayed until a mal-nourished patient can first be restored to good health and nutrition.  However, in the case of a serious infection or tumor, when a delay of surgery cannot be advised, alternative and sometimes more circuitous methods must be employed to reach a similar goal (TREATMENT OUTCOMES: slide #4).