Hospital-Acquired Infection Underlies Poor Functional Outcome in Patients with Prolonged Length of Stay

George, Alexander; Boehme, Amelia K; Siegler, James E.; Monlezun, Dominique; Fowler, Bethena D.; Shaban, Amir; Albright, Karen C.; Beasley, T. Mark; Martin‐Schild, Sheryl

doi:10.1155/2013/312348

Cited by 23 publications

(21 citation statements)

References 23 publications

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“…Infection is considered a confounding variable because previous studies in Taiwan, the United States, Denmark, and the United Kingdom mentioned infection affecting the length of stay in acute ischemic stroke patients. 11,19 The results of this study are in accordance with previous studies in the United States. Research in the United States found that ischemic stroke patients with gastrointestinal bleeding had a longer average length of stay (11 days) than without gastointestinal bleeding (5 days) with a 2.3 times longer risk of treatment.…”

Section: Relationship To Gastrointestinal Bleeding With Length Of Staysupporting

confidence: 92%

Association Between Gastrointestinal Bleeding With Clinical Outcome On Acute Ischemic Stroke Patient

Amalia¹,

Defryantho²,

Parwati³

et al. 2019

Preprint

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Background Gastrointestinal bleedingis one of the complication of acute ischemic stroke and cause of increased mortality and length of stay. This is caused by a delay in the administration of antiplatelet or anticoagulant.Objective.To find the association between gastrointestinal bleeding with clinical outcome in acute ischemic stroke patient.Methods.This study was a prospective observational, conducted at Hasan Sadikin Hospital Bandung for 4 months (November 2017-February 2018). Acute ischemic stroke patients that fulfill the inclusion and exclusion were observed while being inpatients to observe their mortality and length of stay.This study used univariat, bivariat, multivariat, and stratification analysis.Results. A total of 100 acute ischemic stroke patients were found, and 24 patients had gastrointestinal bleeding. A history of previous peptic ulcer/gastrointestinal bleeding was found most often in patient with gastrointestinal bleeding (20.8%/p=0.003).Median NIHSS score is higher (16 vs 7/p<0.001) and GCS score was lower (12 vs 15/p<0.001) in patients with gastrointestinal bleeding. Multivariate analysis showed that gastrointestinal bleeding were significantly associated with survival (p = 0.021) and length of stay (p = 0.008). The analysis of stratification showed subjects with infections who later experienced gastrointestinal bleeding had a lower risk of death and length of stay than subjects without infection who experienced gastrointestinal bleeding (1.7 vs 22.5 times and 1.5 vs 2 times).Conclusion.Gastrointestinal bleeding had more increased mortality and length of stay than without gastrointestinal bleeding in acute ischemic stroke patient.

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Section: Relationship To Gastrointestinal Bleeding With Length Of Staysupporting

confidence: 92%

Association Between Gastrointestinal Bleeding With Clinical Outcome On Acute Ischemic Stroke Patient

Amalia¹,

Defryantho²,

Parwati³

et al. 2019

Preprint

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“…Sepsis and pneumonia are common, and highly morbid, infectious complications in stroke patients (1). The development of post-stroke infection leads to multiple poor outcomes including neurologic deterioration (2), prolonged hospital length of stay (3), poor functional outcome, and death (4). The high clinical impact and limited effective strategies for prevention or treatment of post-stroke infection indicate the need for further investigation into underlying mechanisms and potential therapeutic options.…”

Section: Introductionmentioning

confidence: 99%

Sex-Related Differences in the Risk of Hospital-Acquired Sepsis and Pneumonia Post Acute Ischemic Stroke

Colbert

Traystman

Poisson

et al. 2016

Journal of Stroke and Cerebrovascular Diseases

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Background and Goal Infectious complications after ischemic stroke are frequent and lead to neurologic deterioration, poor functional outcomes, and higher mortality. Local and systemic inflammatory responses to brain ischemia differ between males and females, but little is known about differences in post-stroke susceptibility to infection by sex. The purpose of this study was to compare sex-related differences in the risk of hospital-acquired sepsis and pneumonia after acute ischemic stroke (AIS). Materials and Methods This was a retrospective, secondary analysis of the 2010–2011 California State Inpatient Database. Previously validated ICD-9 codes were used to identify adult hospitalizations for AIS. The primary outcome was hospital-acquired sepsis or pneumonia, also identified using ICD-9 codes. Associations between sex and hospital-acquired sepsis or pneumonia were adjusted for baseline characteristics and comorbidities using multivariable logistic regression. Findings There were 91,643 visits for AIS included in this analysis, of which 1,027 had hospital-acquired sepsis and 1,225 had hospital-acquired pneumonia. The in-hospital mortality without infection was 4.6%; the presence of hospital-acquired infections was associated with higher mortality for sepsis (32.7%) and pneumonia (21.9%). Female (vs. male) sex was associated with a lower adjusted odds of hospital-acquired sepsis (OR 0.74, 95%CI 0.65–0.84) and pneumonia (OR 0.69, 95%CI 0.62–0.78). This difference was similar across age strata. Among visits with either hospital-acquired sepsis or pneumonia, sex did not influence mortality. Conclusions Female sex was associated with a lower risk of hospital-acquired sepsis and pneumonia after AIS. Further investigation is needed to determine the mechanisms underlying this clinical observation.

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“…This new information contrasts with AC studies, where the presence of SUTI was predictive of rehabilitation care in a SNF, a level of care suggestive of lower functional status and worse outcomes [12,15]. The obviated impact of UTI on community discharge is due to the standard protocol of collecting a urine sample within 24 hours of rehabilitation admission.…”

Section: Discussionmentioning

confidence: 77%

“…HAIs in the acute stroke patient have been associated with poor outcomes due to both prolonged hospitalization for antibiotic treatment and suboptimal participation in acute rehabilitation [8][9][10]. The most prevalent, SUTI (symptomatic urinary tract infection), accounts for over 21% of HAI incidence; studies have found that UTI [urinary tract infection] is one of the most frequent complications of stroke, with rates of 1 to 24% within the first month [11][12][13]. Sien Ng et al [14] noted that higher discharge FIM score was associated the absence of HAI's.…”

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confidence: 99%

Acute Intravenous Tissue Plasminogen Activator Therapy does not Impact Community Discharge after Inpatient Rehabilitation

Vahidy

Aramburo-Maldonado

Cai

et al. 2015

Int J Neurorehabilitation Eng

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IntroductionCerebrovascular disease is the leading cause of disability in the United States, costing an estimated $36.5 billion annually [1]. To curb cost and decrease disability rates, iterations of outcomes research are of critical importance, particularly related to post-acute rehabilitation care. In 1995, the NINDS [National Institute of Neurologic Disorders and Stroke] and Stroke t-PA (tissue plasminogen activator) trial showed improved functional outcomes at three months in patients treated with t-PA compared to placebo [2]. However, the impact of t-PA on the rehabilitation process and acute care re-hospitalization during those three months has not been elucidated.Early efforts to quantify the impact of intravenous thrombolysis on the need for inpatient rehabilitation in the acute stroke setting have been promising. In a 2011 study, acute stroke patients who received t-PA were found to have significant improvement in their NIHSS [National Institutes of Health Stroke Scale] values and increased likelihood of community discharge without an inpatient rehabilitation stay [3]. Unfortunately for the acute stroke patient who requires inpatient rehabilitation, the impact of intravenous thrombolysis on NIHSS score and eventual community discharge is unknown. AbstractBackground and purpose: Discharge status and acute re-hospitalization are used as indicators of stroke severity and recovery. Intravenous t-PA (tissue plasminogen activator) is one of two treatments shown to have a positive impact. Stroke rehabilitation patients are an important population who will end up integrated back into the community, institutionalized or hospitalized due to late stroke complications. We sought to determine factors contributing to post rehabilitation discharge and acute re-hospitalization, in particular, the impact of t-PA therapy.Methods: Retrospective analysis of census data from ischemic stroke patients on the UTHealth Stroke/ Neurorehabilitation Services at Memorial Hermann Hospital -Texas Medical Center between Jan 2011 and Nov 2013, discharged to the Community, SNF (Skilled Nursing Facility) or AC (Acute Care). Demographics and NIHSS (National Institutes of Health Stroke Scale) were collected. Discharge FIM (Functional Independence Measure) was the reference standard. Genitourinary infections were a negative mediator in the multivariate regression.Results: Of 346 patients, 274 returned to the community, 47 to SNF, and 25 to AC.NIHSS and t-PA therapy: Median NIHSS values were 8 in the community group, 11 in SNF and 9.5 in AC.31.8% of patients received IV t-PA in the community group, 23.4% in SNF and 24% in AC. There were no statistically differences in community discharge rates.Community vs. AC: One day increase in rehabilitation hospitalization correlated with 19% decreased odds of AC readmission (OR 0.81; P=0.001).One unit discharge FIM increase correlated with 13% decreased odds of AC readmission (OR 0.87; P=0.003).Community vs. SNF: One year age increase correlated with 4% increased odds of SNF admission (OR 1.04; P=0.02)...

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Hospital-Acquired Infection Underlies Poor Functional Outcome in Patients with Prolonged Length of Stay

Cited by 23 publications

References 23 publications

Association Between Gastrointestinal Bleeding With Clinical Outcome On Acute Ischemic Stroke Patient

Association Between Gastrointestinal Bleeding With Clinical Outcome On Acute Ischemic Stroke Patient

Sex-Related Differences in the Risk of Hospital-Acquired Sepsis and Pneumonia Post Acute Ischemic Stroke

Acute Intravenous Tissue Plasminogen Activator Therapy does not Impact Community Discharge after Inpatient Rehabilitation

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