Infections Increase Risk of Readmission among Stroke Survivors

Patients with ischemic stroke who acquire an infection during hospitalization have an increased risk of being readmitted within 30 days, according to a new study.

Researchers at Columbia University (New York, NY, USA) and Columbia University College of Physicians and Surgeons (New York, NY, USA) conducted a study of the U.S. 2013 National Readmission Database, which included 319,317 adults hospitalized for ischemic stroke. The study assessed the relationship between common infections (defined as sepsis, pneumonia, and urinary tract infection) during hospitalization and 30-day readmission rates. The researchers also reviewed tissue-type plasminogen activator (tPA) administration.

The results revealed that 29% of the stroke patients had an infection during their index hospitalization, and 12.1% were readmitted within 30 days. Patients with infection during their stroke admission had 21% higher odds of being readmitted than patients without infections. When analyzed for specific types of infections, the researchers found more common infections, such as urinary tract infections, increased the risk of 30-day readmission by 10%, possibly because urinary tract infections are more common than pneumonia. The study was published on November 1, 2018, in Stroke.

“It appears that ischemic stroke patients who develop a urinary tract infection in the hospital may be candidates for earlier follow-up and closer monitoring by their healthcare team,” said lead author epidemiologist Amelia Boehme, PhD, MPH, of Columbia University. “We suspect the reason the association was so much stronger for urinary tract infections was that urinary tract infections are very common compared to other infections, so the association was significant.”

A UTI is an infection involving any part of the urinary system, including urethra, bladder, ureters, and kidney. Among UTIs acquired in the hospital, approximately 75% are associated with a urinary catheter inserted into the bladder through the urethra to drain urine, which are indicated in between 15-25% of hospitalized patients. The most important risk factor for developing a catheter-associated UTI (CAUTI) is prolonged use of the urinary catheter.

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