Abstract
Introduction: Urinary tract infection (UTI) is reported in 4-20% ischemic stroke patients. Age, sex, indwelling urinary catheter, and atrial fibrillation have been reported as independent predictors of UTI in stroke patients. There is limited data about the relationship of ambulatory status and the rate of urinary tract infection (UTI) following a stroke admission. Hypothesis: The goal of our retrospective cohort study was to understand the relationship between UTI and a patient’s ambulatory status, adjusting for age, gender, stroke type (ischemic, intracerebral hemorrhage, or subarachnoid hemorrhage), atrial fibrillation, and use of indwelling urinary catheter use. We assessed the hypothesis that the stroke patients who are able to ambulate during hospitalization would have lower rates of UTI. Methods: We retrospectively analyzed 1670 acute stroke patients who were admitted to an academic comprehensive stroke center between Feb 2006 and May 2014. “Get with the guideline” dataset was used to identify acute stroke patients and their ambulatory status (yes/no). UTI was identified using discharge diagnosis. Chi square test and logistic regression methods were used for statistical analysis. Results: Mean age was 64.9 ± 14.6 years with 51% men. 1138 (68%) patients were classified as having ischemic stroke; 291 (17.5%) patients had intracerebral hemorrhage; and 241 (14.5%) patients had subarachnoid hemorrhage. During hospitalization, 444 (27%) were ambulatory. Patients able to ambulate during hospitalization had less rate of UTI (1.4% vs 9.8%; p<0.0001) when compared to non-ambulating patients. After adjusting for age, gender, stroke type, atrial fibrillation, and indwelling urinary catheter use; patients who were able to ambulate still had lower rates of UTI (OR: 0.41, 95% CI 0.25-0.63). Conclusion: In conclusion, our findings suggest that the stroke patients who are able to ambulate during their index hospitalization have lower rate of UTI. Early ambulation may result in earlier removal of indwelling urinary catheter which may explain the protective effect of ambulation against UTI.
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