Original article
Frequency and Determinants of Pneumonia and Urinary Tract Infection During Stroke Hospitalization

https://doi.org/10.1016/j.jstrokecerebrovasdis.2006.05.004Get rights and content

Background: Patients with acute stroke are at risk for pneumonia and urinary tract infection (UTI). Identifying patients with stroke at high risk for common infections could enhance timely treatment and improve clinical outcomes. We aimed to identify risk factors associated with the occurrence of pneumonia and UTI during stroke hospitalization. Methods: We analyzed the frequency of pneumonia and UTI and their influence on outcomes during hospitalization in patients diagnosed with ischemic stroke in the California Acute Stroke Prototype Registry. Generalized estimating equations were used to identify factors and outcomes independently associated with pneumonia and UTI. Results: Overall, 663 patients were admitted with acute ischemic stroke at 11 hospitals. Pneumonia occurred in 66 (10%) and UTI in 84 (13%). Older age, atrial fibrillation, and congestive heart failure were independently associated with greater risk for developing pneumonia, whereas a history of dementia was associated with lesser risk. Women and patients with a history of cerebrovascular events were significantly more likely to experience a UTI. Both pneumonia and UTI were associated with significantly greater length of stay, but only pneumonia was independently associated with higher inpatient mortality and poorer discharge ambulatory status. Conclusions: Several factors are associated with an increased risk of developing pneumonia and UTI during ischemic stroke hospitalization. Early identification and treatment of these patients may improve clinical outcomes.

Section snippets

Methods

Data from the California Acute Stroke Prototype Registry (CASPR) were analyzed. CASPR’s study methods have been previously described.15 CASPR collected prospective data on acute stroke care in individuals with a diagnosis of suggested stroke or transient ischemic attack, in 11 hospitals in 5 major population regions of California from November 1, 2002, through January 31, 2003, and from November 1, 2003, though January 31, 2004. CASPR hospitals comprised 4 university hospitals, 4 community

Results

Overall, 663 patients were diagnosed with ischemic stroke at the 11 CASPR hospitals. Complete data regarding presence or absence of UTI were available for all 663 CASPR patients, and complete pneumonia data for 660 patients. Men constituted 45.0% of the cohorts and 56.1% were white. During stroke hospitalization, pneumonia occurred in 66 patients (10%), whereas UTI occurred in 84 patients (13%). Seventeen patients (2.6%) had both pneumonia and UTI. Rates of infection varied significantly among

Discussion

This study shows that at representative hospitals in California, almost 1 of every 8 individuals discharged from the hospital after an ischemic stroke or transient ischemic attack develops either a UTI or pneumonia, and it confirms that the incidence of UTI tends to be more common than pneumonia.3, 16 A major advantage of our study over previously conducted analyses of hospital infection during stroke is the evaluation of routine stroke practice at multiple hospitals operating within different

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Supported by the Centers for Disease Control and Prevention (Dr. Johnston, U50 CCU920271), and in part by National Institutes of Health-National Institute of Neurological Disorders and Stroke (Dr. Saver, P50 NS044378).

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