Factores predisponentes a la infección nosocomial en el ictus agudo y su influencia en la morbimortalidad

Abstract

Stroke is a very important cause of mortality and disability. This study has the objective of identifying predictor factors and the clinical consequences of nosocomial infection in acute stroke. We prospectively identified a consecutive cohort of patients who were admitted after an acute stroke. We used predefined diagnostic criteria by the World Health Organization and Sociedad Española de Neurología for stroke, and by Centers for Disease Control and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica for infection. 258 patients with acute stroke were included. 102 (39.5%) had at least one nosocomial infection -45.5% women; age (standard deviation) 78.2 (9.7) years-. The mean hospital stay was 14.9 days (8.4) in infection patients and 8.4 days (5.6) in no infection patients (p < 0.001). 31 patients died and 22 (71%) had at least one cause of infection. Using logistic regression analysis, the dysphagia (odds ratio [OR] = 12.7; 95% confidence interval [CI], 5.3-30.1; p < 0.001) is the strongest and independent predictor of nosocomial infection. Others factors are crural motor affectation (OR = 4.5; 95% CI, 1.7-12.3; p = 0.003), urinary incontinence (OR = 2.9; 95% CI, 1.3-6.4; p = 0.009) and diabetes mellitus (OR = 2.3; 95% CI, 1.1-4.7; p = 0.03). Baseline imbalance National Institutes of Health Stroke Scale (NIHSS) > 20 during the admission (OR = 17.3; 95% CI, 5.1-59.5; p < 0.001), mass effect diagnosticated on computerized axial tomography (OR = 4.4; 95% CI, 1.4-14; p = 0.012), poor neurological outcome during the first day (OR = 11.6; 95% CI, 3.6-37.2; p < 0.001), chest infection (OR = 5.7; 95% CI, 1.8-18.3; p = 0.003) and the hyperglucemia in admission (OR = 6; 95% CI, 1.5-25.6; p = 0.015) are the independient predictor factors that increased the likelihood for mortality in acute stroke. Baseline imbalance NIHSS > 20 (OR = 8.9; 95% CI, 2.7-29; p < 0.001), poor outcome neurological during the first day (OR = 8.1; 95% CI, 2.2-29.6%; p = 0.002) and the urinary incontinence (OR = 10.1; 95% CI, 5-20.6; p < 0.001) are the independient predictor factors that increased the likelihood of poor functional state in discharge. Dysphagia, crural motor affectation, urinary incontinence and diabetes mellitus are the independient predictor factors that increase the likelihood for nosocomial infection in acute stroke. The chest infection increases significantly the likelihood of mortality during the hospital stay.