In-hospital infections increase odds of readmission for stroke patients

November 01, 2018

DALLAS, Nov. 1, 2018 -- Hospitalized ischemic stroke patients with an infection are significantly more likely to be readmitted within 30 days, regardless of the severity of their stroke or other individual patient characteristics, according to new research published in the American Heart Association's journal Stroke.

Ischemic strokes are caused by a blockage in an artery leading to the brain and are the most common type of stroke.

Researchers reviewed 319,317 stroke patient records in the 2013 National Readmission Database to determine if there was a relationship between in-hospital infections, such as sepsis (an infection in the blood), pneumonia, respiratory and urinary tract infections, and being readmitted to the hospital within 30-days. They found that any infection developed while hospitalized was associated with a 20 percent higher risk of 30-day readmission after being adjusted for other factors linked to rehospitalization. When the researchers investigated specific types of infections, they found that more common infections, such as urinary tract infections, increased the risk of 30-day by 10 percent.

"Although our study had some limitations, 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 Amelia K. Boehme, Ph.D., lead researcher and assistant professor of epidemiology in neurology at Columbia University Mailman School of Public Health in New York, New York. "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."

This study highlights the importance of nursing and admission protocols targeted at preventing urinary tract infections, such as avoiding the use of indwelling catheters (which is a type of catheter inserted into the bladder when a person cannot urinate) as well as performing bladder ultrasounds to diagnose urinary retention. These strategies may help prevent 30-day re-admissions, particularly if they are carried forward in rehabilitation centers or at home, Boehme said.
Co-authors are Erin R. Kulick M.P.H.; Michelle Canning M.P.H.; Trevor Alvord M.P.H.; Bijan Khaksari M.P.H.; Setareh Omran, M.D.; Joshua Z. Willey, M.D.; and Mitchell S.V. Elkind, M.D. Author disclosures are on the manuscript.

This study did not receive outside funding.

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