In-hospital infections drive readmissions for ischemic stroke patients

Ischemic stroke patients—regardless of their individual characteristics or the severity of their stroke—are 20 percent more likely to be readmitted to the hospital within 30 days of discharge if they acquire any kind of infection during their initial stay, according to a study published Nov.1 in Stroke.

First author Amelia K. Boehme, PhD, MSPH, of Columbia University in New York, and colleagues studied the impact of common infections like sepsis, pneumonia and urinary tract infections (UTIs) on 319,317 ischemic stroke patients enrolled in the 2013 National Readmission Database. They said in-hospital infections are relatively common during stroke recovery—something that’s likely the result of stroke-related deficits like dysphagia, catheter use or stroke-induced immunosuppression.

“Preventing medical and neurological complications after stroke is an integral goal of hospital admission and leads to improved stroke outcomes,” Boehme et al. wrote. “Infections after stroke, whether hospital-acquired infections or postdischarge infections, are associated with morbidity, mortality and decreased functional outcome within 30 days poststroke.”

Boehme and her team identified common infections and comorbidities in their study population using the International Classification of Diseases Ninth Revision (ICD-9) diagnosis codes, and identified intravenous tissue-type plasminogen activator or intra-arterial therapy using ICD-9 procedure codes. After analysis, they found 12.1 percent of the pool was readmitted to the hospital within 30 days of their stroke.

Of that 12.1 percent, 29 percent had an infection during their index hospitalization, Boehme and co-authors said. Those who acquired infections during their stay saw a 21 percent increased risk of 30-day readmission, though an infection-specific analysis found only UTIs were associated with a hiked risk (10 percent). The connection persisted even after adjusting for disease severity and “other factors that could influence the infection-readmission relationship.”

“This finding highlights the importance of nursing and admission protocols targeted at preventing UTIs, notably avoiding the use of indwelling catheters and the use of bladder ultrasounds to treat retention,” the authors said. “These strategies may be an additional mechanism to prevent 30-day readmissions, particularly if they are carried forward in acute and subacute rehabilitation centers or at home.”

The team said future work will be needed to extend their findings to other populations, as well as to develop effective strategies to mitigate the risk of infection in stroke survivors.

“In a nationally representative cohort, patients who had a common infection during their stroke hospitalization were at increased odds of being readmitted,” Boehme et al. wrote. “Patients with infection may benefit from earlier poststroke follow-up or closer monitoring.”