Determinants of urinary tract infection in hospitalized patients with acute ischemic stroke
Abstract Background Stroke is a major cause of morbidity and mortality worldwide. Urinary tract infection (UTI) is a common post-acute ischemic stroke (AIS) complication. We assessed the incidence, determinant factors, infection characteristics, post-stroke complications, and outcomes of hospitalize...
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | BMC Neurology |
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| Online Access: | https://doi.org/10.1186/s12883-023-03296-2 |
| _version_ | 1797789737528852480 |
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| author | Pornpong Jitpratoom Adhiratha Boonyasiri |
| author_facet | Pornpong Jitpratoom Adhiratha Boonyasiri |
| author_sort | Pornpong Jitpratoom |
| collection | DOAJ |
| description | Abstract Background Stroke is a major cause of morbidity and mortality worldwide. Urinary tract infection (UTI) is a common post-acute ischemic stroke (AIS) complication. We assessed the incidence, determinant factors, infection characteristics, post-stroke complications, and outcomes of hospitalized AIS patients with UTI. Methods This retrospective cohort study included AIS patients admitted within 7 days of stroke onset. The patients were divided into the UTI group and the non-UTI (control) group. Clinical data were collected and compared between the groups. Results There were 342 AIS patients (31 with UTIs and 311 controls). The multivariate analysis showed that an initial National Institutes of Health Stroke Scale (NIHSS) score of ≥ 15 (odds ratio [OR] 5.00, 95% confidence interval [CI] 1.33–18.72) and Foley catheter retention (OR 14.10, 95% CI 3.25–61.28) were risk factors for UTI, whereas smoking (OR 0.08, 95% CI 0.01–0.50), an initial systolic blood pressure (SBP) of > 120 mmHg (OR 0.06, 95% CI 0.01–0.31), and statin use (OR 0.02, 95% CI 0.0006–0.42) were protective factors. Twenty cases (64.5%) were community-acquired and 11 cases (35.3%) were hospital-acquired. Ten patients (32.3%) had catheter-associated UTIs. The most common pathogen was Escherichia coli (13 patients, 41.9%). Post-stroke complications were significantly more common in the UTI group, including pneumonia, respiratory failure, sepsis, brain edema, seizure, symptomatic hemorrhagic transformation, congestive heart failure, atrial fibrillation with a rapid ventricular response, acute kidney injury, and hyponatremia. The median length of stay (LOS) in the UTI group was 12 days versus 3 days in the control group (p < 0.001). The median 3-month modified Rankin Scale score was higher (5 in UTI and 2 in control; p < 0.001) and the median 3-month Barthel Index was lower (0 in UTI and 100 in control; p < 0.001) in the UTI group than in the control group. Conclusions The risk factors for post-AIS UTI included severe stroke (NIHSS score ≥ 15) and urethral catheter indwelling. An initial SBP of > 120 mmHg and statin use were protective factors. The UTI group had significantly worse post-stroke complications, a longer LOS, and worse 3-month outcomes. Smoking was protective, which requires further investigation. |
| first_indexed | 2024-03-13T01:54:55Z |
| format | Article |
| id | doaj.art-e6cdc3440b0f42e1aafb48d4b5444f1c |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-03-13T01:54:55Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj.art-e6cdc3440b0f42e1aafb48d4b5444f1c2023-07-02T11:19:08ZengBMCBMC Neurology1471-23772023-06-0123111110.1186/s12883-023-03296-2Determinants of urinary tract infection in hospitalized patients with acute ischemic strokePornpong Jitpratoom0Adhiratha Boonyasiri1Division of Medicine, Chumphon Khet Udomsakdi HospitalDepartment of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol UniversityAbstract Background Stroke is a major cause of morbidity and mortality worldwide. Urinary tract infection (UTI) is a common post-acute ischemic stroke (AIS) complication. We assessed the incidence, determinant factors, infection characteristics, post-stroke complications, and outcomes of hospitalized AIS patients with UTI. Methods This retrospective cohort study included AIS patients admitted within 7 days of stroke onset. The patients were divided into the UTI group and the non-UTI (control) group. Clinical data were collected and compared between the groups. Results There were 342 AIS patients (31 with UTIs and 311 controls). The multivariate analysis showed that an initial National Institutes of Health Stroke Scale (NIHSS) score of ≥ 15 (odds ratio [OR] 5.00, 95% confidence interval [CI] 1.33–18.72) and Foley catheter retention (OR 14.10, 95% CI 3.25–61.28) were risk factors for UTI, whereas smoking (OR 0.08, 95% CI 0.01–0.50), an initial systolic blood pressure (SBP) of > 120 mmHg (OR 0.06, 95% CI 0.01–0.31), and statin use (OR 0.02, 95% CI 0.0006–0.42) were protective factors. Twenty cases (64.5%) were community-acquired and 11 cases (35.3%) were hospital-acquired. Ten patients (32.3%) had catheter-associated UTIs. The most common pathogen was Escherichia coli (13 patients, 41.9%). Post-stroke complications were significantly more common in the UTI group, including pneumonia, respiratory failure, sepsis, brain edema, seizure, symptomatic hemorrhagic transformation, congestive heart failure, atrial fibrillation with a rapid ventricular response, acute kidney injury, and hyponatremia. The median length of stay (LOS) in the UTI group was 12 days versus 3 days in the control group (p < 0.001). The median 3-month modified Rankin Scale score was higher (5 in UTI and 2 in control; p < 0.001) and the median 3-month Barthel Index was lower (0 in UTI and 100 in control; p < 0.001) in the UTI group than in the control group. Conclusions The risk factors for post-AIS UTI included severe stroke (NIHSS score ≥ 15) and urethral catheter indwelling. An initial SBP of > 120 mmHg and statin use were protective factors. The UTI group had significantly worse post-stroke complications, a longer LOS, and worse 3-month outcomes. Smoking was protective, which requires further investigation.https://doi.org/10.1186/s12883-023-03296-2Urinary tract infectionAcute ischemic strokeHospitalizationPredictorRisk factorProtective factor |
| spellingShingle | Pornpong Jitpratoom Adhiratha Boonyasiri Determinants of urinary tract infection in hospitalized patients with acute ischemic stroke BMC Neurology Urinary tract infection Acute ischemic stroke Hospitalization Predictor Risk factor Protective factor |
| title | Determinants of urinary tract infection in hospitalized patients with acute ischemic stroke |
| title_full | Determinants of urinary tract infection in hospitalized patients with acute ischemic stroke |
| title_fullStr | Determinants of urinary tract infection in hospitalized patients with acute ischemic stroke |
| title_full_unstemmed | Determinants of urinary tract infection in hospitalized patients with acute ischemic stroke |
| title_short | Determinants of urinary tract infection in hospitalized patients with acute ischemic stroke |
| title_sort | determinants of urinary tract infection in hospitalized patients with acute ischemic stroke |
| topic | Urinary tract infection Acute ischemic stroke Hospitalization Predictor Risk factor Protective factor |
| url | https://doi.org/10.1186/s12883-023-03296-2 |
| work_keys_str_mv | AT pornpongjitpratoom determinantsofurinarytractinfectioninhospitalizedpatientswithacuteischemicstroke AT adhirathaboonyasiri determinantsofurinarytractinfectioninhospitalizedpatientswithacuteischemicstroke |