Post-Stroke Bacteriuria: A Longitudinal Study among Stroke Outpatients and Inpatients at the Korle-Bu Teaching Hospital in Ghana

Abstract

Infections of the urinary tract constitute an important post-stroke complication but in Africa, little is known about such infections in relation to stroke patients. The aim of the study was to investigate the epidemiology of bacteriuria among stroke patients at the Korle-Bu Teaching Hospital (KBTH) in Ghana including the prevalence, incidence, risk factors and aetiological agents. This was a longitudinal study involving 55 outpatients and 16 inpatients of stroke from the physiotherapy clinic and stroke admission ward of KBTH respectively. Urine cultures for inpatient subjects were done each day until the patient was discharged. With outpatients, urine specimens were analysed every week or two for 6 months. Information on demographics and clinical history of the study participants were extracted from their clinical records. The results showed that the prevalence of bacteriuria among stroke outpatients and inpatients were 10.9% (6/55) and 18.8% (3/16) respectively (p = 0.411). Among both the outpatients and inpatients, there was one new case of bacteriuria each during the period of follow-up. Overall, 1/9 (11%) of the bacteriuria cases among the stroke patients was symptomatic. Severe stroke (OR = 17.7, p = 0.008) and pyuria (OR = 38.7, p = 0.002) were identified as predictors of bacteriuria. Escherichia coli was the most common organism implicated in bacteriuria and was susceptible to amikacin, but resistant to augmentin, ampicillin, cefuroxime, cotrimoxazole, meropenem, norfloxacin and tetracycline. Overall, bacteriuria is a common complication among both stroke inpatients and outpatients at KBTH, though it appears to be more common among the former. Stroke severity appears to be the main stroke-related determinant of bacteriuria among stroke patients. Bacteriuria among stroke patients is mainly asymptomatic and E. coli is the most important aetiological agent.

Uropathogenic distribution and antibiotic resistance patterns according to multidrug-resistant bacteria colonization status in patients with stroke

“…In this study, the uropathogenic distribution was consistent with study by Donkor et al [23] but differed from that of study The statistical analysis was performed using multinomial logistic regression analysis. CRE = carbapenem-resistant Enterobacteriaceae, VRE = vancomycin-resistant enterococcus.…”

Stroke in the21stCentury: A Snapshot of the Burden, Epidemiology, and Quality of Life

“…It is important to note that the data included in this systematic review was largely from the developed world and there was hardly any data from Sub-Saharan Africa. In Ghana, a recent study reported a significantly higher prevalence of UTI among stroke outpatients (24.3%) than among a healthy control group (7.2%) [91], while another study reported a significantly higher prevalence among stroke inpatients (18.8%) than among outpatients (10.9%) [92]. Risk factors of UTI among stroke patients include stroke severity, depressed conscious level, increased post-void residual urine volume, catheterization, and diabetes mellitus [90].…”

“…A number of bacterial pathogens have been implicated in UTI among stroke patients and the major ones include Staphylococcus aureus and gram-negative bacteria such as Pseudomonas aeruginosa , Escherichia coli , and Enterobacter spp. [90–92]. Compared to UTI, pneumonia is a more serious complication following stroke and is commonly caused by Klebsiella pneumoniae , Pseudomonas aeruginosa , and Escherichia coli [90, 93].…”

Carbapenem Resistance: A Review

“…In Ghana, a recent study by Codjoe [ 192 ] showed that KPC was absent in all 111 carbapenem resistant Gram-negative bacteria that were screened; the carbapenemase genes identified were bla NDM-1 in Acinetobacter baumannii , bla VIM-1 in Pseudomonas species and bla OXA-48 in Klebsiella pneumoniae . In Ghana, multi-drug resistance of Gram-negative bacteria has reached alarming rates [ 193 , 194 , 195 , 196 ]. Strict infection control measures and regular surveillance programmes instituted by countries such as Australia and New Zealand have recorded prevalence as low as 1% of KPC harbouring genes in hospital acquired Enterobacteriaceae infections.…”