Highlights
- •Stroke severity plays a large role in developing urinary tract infections.
- •Urinary tract infections after stroke may prolong length of stay and increase costs.
- •Post-stroke urinary tract infection does not significantly impact long term outcome.
Abstract
Background
Urinary tract infection (UTI) is one of the most common infections seen in patients
hospitalized for acute stroke, resulting in greater utilization of hospital resources
in addition to patient discomfort. Although post-stroke infections (PSIs) are commonly
referenced for interference with stroke recovery as well as associations with worse
clinical outcome, factors associated specifically with UTI after stroke remain unclear.
Aim
To provide a comprehensive narrative synthesis covering literature published with
results specific to the topic of UTI in stroke patients.
Methods
Literature review was performed searching the keywords “stroke” and “urinary tract
infection” in Pubmed. All manuscripts published in English were appraised for information
relevant to UTI in stroke patients. Applicable content was obtained, synthesized,
and summarized.
Results
Post-stroke UTI is found to be associated with prolongation of hospital length of
stay (LOS), discharge to a Care Home, and increased medical care costs. This process
possibly reflects the consequences of greater stroke severity and clinical courses
requiring urinary catheterization in hospitalized patients. However, UTI does not
share an independent association with long-term clinical outcomes including morbidities
and mortality.
Conclusions
A narrative review was performed, including the following topics: classifications
and epidemiology, pathogenesis, clinical features, and future directions. The heterogeneous
nature of reports on UTI in stroke patients remains as a major limitation in literature.
Keywords
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References
- Effect of medical complications on the after-stroke rehabilitation outcome.NeuroRehabilitation. 2017; 40: 223-232https://doi.org/10.3233/NRE-161407
- Stroke-induced immunodepression and post-stroke infections: lessons from the preventive antibacterial therapy in stroke trial.Neuroscience. 2009; 158: 1184-1193https://doi.org/10.1016/j.neuroscience.2008.07.044
- Urinary tract infections complicating stroke: mechanisms, consequences, and possible solutions.Stroke. 2010; 41: e180-e184https://doi.org/10.1161/STROKEAHA.109.576413
- Post-stroke infection: a systematic review and meta-analysis.BMC Neurol. 2011; 11110https://doi.org/10.1186/1471-2377-11-110
- The evolution of catheter-associated urinary tract infection (CAUTI): is it time for more inclusive metrics?.Infect. Control Hosp. Epidemiol. 2019; : 1-5https://doi.org/10.1017/ice.2019.43
- Update on the Preventive Antibiotics in Stroke Study (PASS): a randomised controlled phase 3 clinical trial.Trials. 2014; 15: 133https://doi.org/10.1186/1745-6215-15-133
- Prevalence and predictive factors of urinary tract infection among patients with stroke: a meta-analysis.Am. J. Infect. Control. 2018; 46: 402-409https://doi.org/10.1016/j.ajic.2017.10.001
- Can't swallow, can't transfer, can't toilet: factors predicting infections in the first week post stroke.J. Clin. Neurosci. 2015; 22: 92-97https://doi.org/10.1016/j.jocn.2014.05.035
- Ischemia, immunosuppression and infection—tackling the predicaments of post-stroke complications.Int. J. Mol. Sci. 2016; 17https://doi.org/10.3390/ijms17010064
- Retrospective analysis of catheter-acquired urinary tract infection: relationship to stroke diagnosis.Clin. Nurse Spec. 2017; 31: E11-E16https://doi.org/10.1097/NUR.0000000000000307
- Urinary tract infections: epidemiology, mechanisms of infection and treatment options.Nat. Rev. Microbiol. 2015; 13: 269-284https://doi.org/10.1038/nrmicro3432
- Ten-year temporal trends in medical complications after acute intracerebral hemorrhage in the United States.Stroke. 2017; 48: 596-603https://doi.org/10.1161/STROKEAHA.116.015746
- Urinary tract infection after stroke.QJM. 2009; 102: 243-249https://doi.org/10.1093/qjmed/hcp012
- Catheter-associated urinary tract infections and other infections in patients hospitalized for acute stroke: a prospective cohort study of two different silicone catheters.Scand. J. Urol. 2016; 50: 483-488https://doi.org/10.1080/21681805.2016.1194459
- Neuroanatomical correlates of stroke-associated infection and stroke-induced immunodepression.Brain Behav. Immun. 2017; 60: 142-150https://doi.org/10.1016/j.bbi.2016.10.004
- Indwelling urinary catheterization after acute stroke.Neurourol. Urodyn. 2013; 32: 480-485https://doi.org/10.1002/nau.22317
- The relation between postvoid residual and occurrence of urinary tract infection after stroke in rehabilitation unit.Ann. Rehabil. Med. 2012; 36: 248-253https://doi.org/10.5535/arm.2012.36.2.248
- Urinary tract infection and bacteriurua in stroke patients: frequencies, pathogen microorganisms, and risk factors.Am. J. Phys. Med. Rehabil. 2007; 86: 734-741https://doi.org/10.1097/PHM.0b013e31813e5f96
- Urinary tract infections in hospitalized ischemic stroke patients: source and impact on outcome.Cureus. 2017; 9e1014https://doi.org/10.7759/cureus.1014
- Predictors of post-stroke fever and infections: a systematic review and meta-analysis.BMC Neurol. 2018; 18: 49https://doi.org/10.1186/s12883-018-1046-z
- Copeptin, procalcitonin and routine inflammatory markers-predictors of infection after stroke.PLoS ONE. 2012; 7e48309https://doi.org/10.1371/journal.pone.0048309
- Increased infections with β-blocker use in ischemic stroke, a β.Neurol. Sci. 2017; 38: 967-974https://doi.org/10.1007/s10072-017-2877-x
- Infection after acute ischemic stroke: a manifestation of brain-induced immunodepression.Stroke. 2007; 38: 1097-1103https://doi.org/10.1161/01.STR.0000258346.68966.9d
- Pathogen colonization in patients with acute cerebral stroke.Disabil. Rehabil. 2013; 35: 662-667https://doi.org/10.3109/09638288.2012.708817
- Frequency and determinants of pneumonia and urinary tract infection during stroke hospitalization.J. Stroke Cerebrovasc. Dis. 2006; 15: 209-213https://doi.org/10.1016/j.jstrokecerebrovasdis.2006.05.004
- Using population-based routinely collected data from the Sentinel Stroke National Audit Programme to investigate factors associated with discharge to care home after rehabilitation.Clin. Rehabil. 2018; 32: 1108-1118https://doi.org/10.1177/0269215517748715
- Predictors for total medical costs for acute hemorrhagic stroke patients transferred to the rehabilitation ward at a regional hospital in Taiwan.Top. Stroke Rehabil. 2016; 23: 59-66https://doi.org/10.1179/1945511915Y.0000000006
- Portable bladder ultrasound reduces incidence of urinary tract infection and shortens hospital length of stay in patients with acute ischemic stroke.J. Cardiovasc. Nurs. 2018; 33: 551-558https://doi.org/10.1097/JCN.0000000000000507
- Diagnosis, management, and prevention of catheter-associated urinary tract infections.Infect. Dis. Clin. N. Am. 2014; 28: 105-119https://doi.org/10.1016/j.idc.2013.09.002
- Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review.BMJ Qual. Saf. 2014; 23: 277-289https://doi.org/10.1136/bmjqs-2012-001774
- Hospitalization for infection and risk of acute ischemic stroke: the Cardiovascular Health Study.Stroke. 2011; 42: 1851-1856https://doi.org/10.1161/STROKEAHA.110.608588
- Risk of myocardial infarction and stroke after acute infection or vaccination.N. Engl. J. Med. 2004; 351: 2611-2618https://doi.org/10.1056/NEJMoa041747
- Beneficial effects of implementing stroke protocols require establishment of a geographically distinct unit.Stroke. 2015; 46: 3494-3501https://doi.org/10.1161/STROKEAHA.115.010552
Article Info
Publication History
Published online: June 05, 2019
Accepted:
June 4,
2019
Received in revised form:
May 9,
2019
Received:
April 14,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
