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Retrospective Analysis of Catheter-Acquired Urinary Tract Infection: Relationship to Stroke Diagnosis
Julia Retelski1, Tammy Richardson, Rohan Mahabaleshwarkar
1Author Affiliations: Clinical Nurse Specialist, Critical Care Network (Ms Retelski); Nurse Manager, Carolinas Medical Center-Mercy 3N (Ms Richardson); and Data Scientist (Dr Mahabaleshwarkar), Application Specialist and Manager (Mr Gohs), and Assistant Vice President (Dr Spencer), Center for Outcomes Research and Evaluation, Carolinas HealthCare System, Charlotte, North Carolina.
Insights
Stroke patients have a significantly higher risk of developing catheter-associated urinary tract infections (CAUTIs). This highlights the need for targeted CAUTI prevention strategies in stroke care, especially considering steroid use.
Area of Science:
- Infectious Disease Epidemiology
- Neurology
- Healthcare Quality Improvement
Background:
- Catheter-associated urinary tract infections (CAUTIs) are a common healthcare-associated infection.
- Stroke patients represent a vulnerable population often requiring indwelling urinary catheters.
Purpose of the Study:
- To investigate the association between stroke diagnosis and the incidence of CAUTIs.
- To explore the impact of specific healthcare variables on CAUTI rates in stroke patients.
Main Methods:
- Retrospective chart review at a large teaching hospital.
- Matched cohort study comparing 300 stroke patients with 300 non-stroke patients using indwelling urinary catheters.
- Statistical analysis included bivariate tests and generalized estimating equations.
Main Results:
- Stroke patients exhibited a significantly higher CAUTI incidence (6.0% vs 1.7%, P = .005).
- Stroke patients were 3.5 times more likely to develop CAUTI (OR = 3.53, P = .018).
- Steroid use was more prevalent in stroke patients who developed CAUTI (55.6% vs 24.5%, P = .004).
Conclusions:
- Stroke patients are at increased risk for CAUTI.
- Interventions to reduce CAUTI should prioritize stroke patients.
- Steroid use may be a contributing factor to CAUTI in stroke patients.
Aims:
The objective of this study was to determine if a diagnosis of stroke was associated with a higher incidence of catheter-associated urinary tract infections (CAUTIs). Secondary aims included examining the effect of healthcare-related variables including antibiotic and steroid use, length of stay before catheter insertion, and duration of catheter use on the incidence of CAUTI in stroke patients.
Design:
This was a retrospective chart review analysis set in a large teaching hospital in the Southeastern United States.
Methods:
A total of 300 patients with indwelling urinary catheter use who also had a stroke diagnosis were randomly selected and matched (on age, gender, race, and admission date) to 300 randomly selected patients with indwelling urinary catheter use and without stroke. Bivariate statistical tests included Wilcoxon signed-rank test and McNemar's test, whereas the multivariate test consisted of generalized estimating equations.
Results:
The incidence of CAUTIs in stroke patients was significantly higher than that in nonstroke patients (6.0% vs 1.7%, P = .005). In the multivariable generalized estimating equations analysis, stroke patients were found to be approximately 3.5 times more likely to experience CAUTI compared with nonstroke patients (odds ratio = 3.53; 95% confidence interval, 1.24-10.03; P = .018). The proportion of patients who used steroids was greater among stroke patients who experienced CAUTI compared with those who did not experience CAUTI (55.6% vs 24.5%, P = .004).
Conclusion:
Stroke patients were more likely to develop CAUTI compared with nonstroke patients. These patients should be considered as key targets when implementing interventions aimed at reducing CAUTIs. Use of steroids may be associated with a higher likelihood of CAUTI in stroke patients.
Implications:
Clinical nurse specialists are directly influential in preventing CAUTIs. This study provides evidence regarding the association between stroke and CAUTI to clinical nurse specialists to help them plan CAUTI prevention initiatives.
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