Abstract W MP97: Post-discharge Pneumonia And Urinary Tract Infection After Hospitalization For Ischemic And Hemorrhagic Strokes

Abstract

Background and purpose: Stroke related disability is a risk factor for infectious complications and the risk persists even after discharge from the hospital. Therefore, we studied the incidence and predictors of pneumonia and urinary tract infection (UTI) up to 1 year after hospitalization for ischemic stroke, spontaneous intracerebral hemorrhage (ICH) and non-traumatic subarachnoid hemorrhage (SAH). Methods: We analyzed all adult cases treated in acute care hospitals and emergency departments in California state between 2005 and 2011 using state inpatient and emergency databases of Healthcare Cost and Utilization Project. Patients with principle diagnosis of ischemic stroke (ICD-9 codes 433.x1, 434.x1, 436), ICH (431) and SAH (430) surviving up to discharge were followed up for development of first episode of pneumonia and UTI at 30-days, 90-days and 1-year intervals. Index cases were limited to 2005-2010 to ensure at least 1 year of follow up. Negative binomial regression was used to obtain predictors of post-discharge pneumonia or UTI. Results: Among 168,194 ischemic strokes, 26,502 ICH and 10,659 SAH cases, 5.7%, 7.3% and 4.9% developed pneumonia, and 8.6%, 11.5% and 8.8% developed UTI within 90-days after discharge respectively. The incidence rate of pneumonia during first 30 days was 38.8 per 100 person years which decreased to 14.8 per 100 person years between 31-90 days. The rate decreased further during 91-365 days to 7.3 per 100 person years. The rates of pneumonia among ICH and SAH and of UTI among different stroke types showed similar trend with higher risk during immediate post-discharge period. Factors independently associated with post-discharge infections were older age, female sex, non-white race, hypertension, diabetes, congestive heart failure, dementia, liver disease, anemia, atrial fibrillation, mechanical ventilation, gastrostomy and longer length of index admission. Conclusions: Risk of infectious complications is highest after ICH among different stroke types. The risk is highest during immediate post-discharge period but remains higher than general hospital population at least up to 1 year.