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Prevalence and predictive factors of urinary tract infection among patients with stroke: A meta-analysis

  • Tianyuan Yan
    Affiliations
    Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China

    School of Nursing, Shandong University, Jinan, Shandong Province, China
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  • Chenxia Liu
    Affiliations
    Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China

    School of Nursing, Shandong University, Jinan, Shandong Province, China
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  • Yingxia Li
    Affiliations
    Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
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  • Wei Xiao
    Affiliations
    Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
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  • Yating Li
    Affiliations
    Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China

    School of Nursing, Shandong University, Jinan, Shandong Province, China
    Search for articles by this author
  • Shuhui Wang
    Correspondence
    Address correspondence to Shuhui Wang, MD, Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, Shandong Province P.C.250012, China. (S. Wang).
    Affiliations
    Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
    Search for articles by this author
Published:November 16, 2017DOI:https://doi.org/10.1016/j.ajic.2017.10.001

      Highlights

      • Researches within cerebrovascular diseases literature have shown mixed results regarding prevalence and predictive factors related to poststroke urinary tract infections (UTIs).
      • Our study indicated that prevalence of UTIs was quite high among patients with stroke; female sex, older age, higher modified Rankin Scale score, and postvoid residual volume >100 mL are associated with higher risk of UTIs.
      • This study is an extension of our previous work in health care–associated infections among different study population, such as patients undergoing renal transplantation, open gastrointestinal surgery, and so forth.

      Background

      Urinary tract infection (UTI) is thought to be a common complication of stroke and is regarded as a potential risk factor for poor stroke outcomes. However, there is a controversy among predictive factors of stroke-associated UTIs. We aim to estimate the prevalence and predisposing factors of UTIs among patients with stroke.

      Methods

      PubMed, EMBASE, and Elsevier Science Direct were searched by 2 independent researchers. Sixteen studies with a total of 13,513 patients were included to evaluate the prevalence and predictive factors of stroke-associated UTIs published from the earliest records to March 10, 2017. Pooled effect sizes were calculated using the fixed effect model or random effect model according to I2 and P values.

      Results

      The pooled prevalence of UTI was 19.0% (95% confidence interval [CI], 15%-22%; P < .01). The predisposing factors for UTIs include female sex (odds ratio [OR], 1.93; 95% CI, 1.55-2.41), older age (OR, 1.28; 95% CI, 1.09-1.50), higher modified Rankin Scale score (OR, 1.90; 95% CI, 1.43-2.53), and postvoid residual volume >100 mL (OR, 3.69; 95% CI, 2.09-6.52).

      Conclusions

      Approximately one-fifth of patients with stroke contracted at least 1 UTI after cerebral apoplexy. Female sex, older age, higher modified Rankin Scale score, and postvoid residual volume >100 mL were associated with higher risk of UTI.

      Key Words

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      References

        • Hamidon B.B.
        • Raymond A.A.
        • Norlinah M.I.
        • Jefferelli S.B.
        The predictors of early infection after an acute ischaemic stroke.
        Singapore Med J. 2003; 44: 344-346
        • Stott D.J.
        • Falconer A.
        • Miller H.
        • Tilston J.C.
        • Langhorne P.
        Urinary tract infection after stroke.
        QJM. 2009; 102: 243-249
        • Bogason E.
        • Morrison K.
        • Zalatimo O.
        • Ermak D.M.
        • Lehman E.
        • Markley E.
        • et al.
        Urinary tract infections in hospitalized ischemic stroke patients: source and impact on outcome.
        Cureus. 2017; 9: e1014
        • Adams H.
        • Adams R.J.
        • Brott T.
        • del Zoppo G.J.
        • Furlan A.
        • Goldstein L.B.
        • et al.
        Guidelines for the early management of patients with ischemic stroke: a scientific statement from the stroke council of the American Stroke Association.
        Stroke. 2003; 34: 1056-1083
        • McLean D.
        Medical complications experienced by a cohort of stroke survivors during inpatient, tertiary-level stroke rehabilitation.
        Arch Phys Med Rehabil. 2004; 85: 466-469
        • Langhorne P.
        • Stott D.J.
        • Robertson L.
        • MacDonald J.
        • Jones L.
        • McAlpine C.
        • et al.
        Medical complications after stroke: a multicenter study.
        Stroke. 2000; 31: 1223-1229
        • Aslanyan S.
        • Weir C.J.
        • Diener H.C.
        • Kaste M.
        • Lees K.R.
        • GAIN International Steering Committee and Investigators
        Pneumonia and urinary tract infection after acute ischaemic stroke: a tertiary analysis of the GAIN International trial.
        Eur J Neurol. 2004; 11: 49-53
        • Ersoz M.
        • Ulusoy H.
        • Oktar M.A.
        • Akyuz M.
        Urinary tract infection and bacteriuria in stroke patients: frequencies, pathogen microorganisms, and risk factors.
        Am J Phys Med Rehabil. 2007; 86: 734-741
        • Matz K.
        • Keresztes K.
        • Tatschl C.
        • Nowotny M.
        • Dachenhausenm A.
        • Brainin M.
        • et al.
        Disorders of glucose metabolism in acute stroke patients: an underrecognized problem.
        Diabetes Care. 2006; 29: 792-797
        • Indredavik B.
        • Rohweder G.
        • Naalsund E.
        • Lydersen S.
        Medical complications in a comprehensive stroke unit and an early supported discharge service.
        Stroke. 2008; 39: 414-420
        • Dromerick A.W.
        • Edwards D.F.
        Relation of postvoid residual to urinary tract infection during stroke rehabilitation.
        Arch Phys Med Rehabil. 2003; 84: 1369-1372
        • Jin Z.C.
        • Zhou X.H.
        • He J.
        Statistical methods for dealing with publication bias in meta-analysis.
        Stat Med. 2015; 34: 343-360
        • Gjerdevik M.
        • Heuch I.
        Improving the error rates of the Begg and Mazumdar test for publication bias in fixed effects meta-analysis.
        BMC Med Res Methodol. 2014; 14: 109
        • van Enst W.A.
        • Ochodo E.
        • Scholten R.J.
        • Hooft L.
        • Leeflang M.M.
        Investigation of publication bias in meta-analyses of diagnostic test accuracy: a meta-epidemiological study.
        BMC Med Res Methodol. 2014; 14: 70
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • PRISMA Group
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        BMJ. 2009; 339: b2535
        • Wells G.A.
        • Shea B.
        • O'Connell D.
        • Peterson J.
        • Welch V.
        • Losos M.
        • et al.
        The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.
        (Ottawa Hospital Research Institute; Available from:)
        http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
        Date: 2011
        Date accessed: February 5, 2013
        • Higgins J.P.T.
        • Green S.
        Section 13.5.2.3. Tools for assessing methodological quality or risk of bias in non-randomized studies.
        (editors)in: Cochrane handbook for systematic reviews of interventions, version 5.1.0. The Cochrane Collaboration, London,UK2011 (Available from)
        http://handbook-5-1.cochrane.org/
        Date accessed: March 1, 2011
        • Hootman J.M.
        • Driban J.B.
        • Sitler M.R.
        • Harris K.P.
        • Cattano N.M.
        Reliability and validity of three quality rating instruments for systematic reviews of observational studies.
        Res Synth Methods. 2011; 2: 110-118
        • Oremus M.
        • Oremus C.
        • Hall G.B.
        • McKinnon M.C.
        • ECT & Cognition Systematic Review Team
        Inter-rater and test-retest reliability of quality assessments by novice student raters using the Jadad and Newcastle-Ottawa Scales.
        BMJ Open. 2012; 2: e001368
        • Li W.
        • Ma D.
        • Liu M.
        • Liu H.
        • Feng S.
        • Hao Z.
        • et al.
        Association between metabolic syndrome and risk of stroke: a meta-analysis of cohort studies.
        Cerebrovasc Dis. 2008; 25: 539-547
        • Wu X.
        • Dong Y.
        • Liu Y.
        • Li Y.
        • Sun Y.
        • Wang J.
        • et al.
        The prevalence and predictive factors of urinary tract infection in patients undergoing renal transplantation: a meta-analysis.
        Am J Infect Control. 2016; 44: 1261-1268
        • Liu Y.
        • Dong Y.
        • Wu X.
        • Chen H.
        • Wang S.
        Influence of high body mass index on mortality and infectious outcomes in patients who underwent open gastrointestinal surgery: a meta-analysis.
        Am J Infect Control. 2016; 44: 572-578
        • Kim B.
        • Lim J.H.
        • Lee S.A.
        • Kim J.
        • Koh S.
        • Lee I.
        • et al.
        The relation between postvoid residual and occurrence of urinary tract infection after stroke in rehabilitation unit.
        Ann Rehabil Med. 2012; 36: 248-253
        • Hagerty T.
        • Kertesz L.
        • Schmidt J.M.
        • Agarwal S.
        • Claassen J.
        Risk factors for catheter-associated urinary tract infections in critically ill patients with subarachnoid hemorrhage.
        J Neurosci Nurs. 2015; 47: 51-54
        • Dasenbrock H.H.
        • Rudy R.F.
        • Smith T.R.
        • Guttieres D.
        • Frerichs K.U.
        • Gormley W.B.
        • et al.
        Hospital-acquired infections after aneurysmal subarachnoid hemorrhage: a nationwide analysis.
        World Neurosurg. 2016; 88: 459-474
        • Lord A.S.
        • Langefeld C.D.
        • Sekar P.
        • Moomaw C.J.
        • Badjatia N.
        • Vashkevich A.
        • et al.
        Infection after intracerebral hemorrhage.
        Stroke. 2014; 45: 3535-3542
        • Laban K.G.
        • Rinkel G.J.E.
        • Vergouwen M.D.I.
        Nosocomial infections after aneurysmal subarachnoid hemorrhage: time course and causative pathogens.
        Int J Stroke. 2015; 10: 763-766
        • Ovbiagele B.
        • Hills N.K.
        • Saver J.L.
        • Johnston S.C.
        Frequency and determinants of pneumonia and urinary tract infection during stroke hospitalization.
        J Stroke Cerebrovasc Dis. 2006; 15: 209-213
        • Chen C.M.
        • Hsu H.C.
        • Tsai W.S.
        • Chang C.H.
        • Chen K.H.
        • Hong C.Z.
        Infections in acute older stroke inpatients undergoing rehabilitation.
        Am J Phys Med Rehabil. 2012; 91: 211-219
        • Hinduja A.
        • Dibu J.
        • Achi E.
        • Patel A.
        • Samant R.
        • Yaghi S.
        Nosocomial infections in patients with spontaneous intracerebral hemorrhage.
        Am J Crit Care. 2015; 24: 227-231
        • Das S.
        • Ghosh K.C.
        • Pulai S.
        • Pulai D.
        • Bhar D.
        • Gangopadhyay P.K.
        Systemic infection and inflammation as trigger factors of ischemic stroke.
        Ann Neurosci. 2011; 18: 17-20
        • Popović N.
        • Stefanović-Budimkić M.
        • Mitrović N.
        • Urošević A.
        • Milošević B.
        • Pelemiš M.
        • et al.
        The frequency of poststroke infections and their impact on early stroke outcome.
        J Stroke Cerebrovasc Dis. 2013; 22: 424-429
        • Brogan E.
        • Langdon C.
        • Brookes K.
        • Budgeon C.
        • Blacker D.
        Can't swallow, can't transfer, can't toilet: factors predicting infections in the first week post stroke.
        J Clin Neurosci. 2015; 22: 92-97
        • Yilmaz G.R.
        • Cevik M.A.
        • Erdinc F.S.
        • Ucler S.
        • Tulek N.
        The risk factors for infections acquired by cerebral hemorrhage and cerebral infarct patients in a neurology intensive care unit in Turkey.
        Jpn J Infect Dis. 2007; 60: 87-91
        • Vermeij F.H.
        • Scholte Op Reimer W.J.M.
        • de Man P.
        • van Oostenbrugge R.J.
        • Franke C.L.
        • de Jong G.
        • et al.
        Stroke-associated infection is an independent risk factor for poor outcome after acute ischemic stroke: data from the Netherlands stroke survey.
        Cerebrovasc Dis. 2009; 27: 465-471
        • Westendorp W.F.
        • Nederkoorn P.J.
        • Vermeij J.D.
        • Dijkgraaf M.G.
        • van de Beek D.
        Post-stroke infection: a systematic review and meta-analysis.
        BMC Neurol. 2011; 11: 110
        • Lyden P.D.
        • Lu M.
        • Levine S.R.
        • Brott T.G.
        • Broderick J.
        • NINDS rtPA Stroke Study Group
        A modified National Institutes of Health Stroke Scale for use in stroke clinical trials: preliminary reliability and validity.
        Stroke. 2001; 32: 1310-1317
        • Bruno A.
        • Close B.
        • Switzer J.A.
        • Hess D.C.
        • Gross H.
        • Nichols 3rd, F.T.
        • et al.
        Simplified modified Rankin Scale questionnaire correlates with stroke severity.
        Clin Rehabil. 2013; 27: 724-727
        • Baggio J.A.
        • Santos-Pontelli T.E.
        • Cougo-Pinto P.T.
        • Camilo M.
        • Silva N.F.
        • Antunes P.
        • et al.
        Validation of a structured interview for telephone assessment of the modified Rankin scale in Brazilian stroke patients.
        Cerebrovasc Dis. 2014; 38: 297-301
        • Cheng B.
        • Forkert N.D.
        • Zavaglia M.
        • Hilgetag C.C.
        • Golsari A.
        • Siemonsen S.
        • et al.
        Influence of stroke infarct location on functional outcome measured by the modifed rankin scale.
        Stroke. 2014; 45: 1695-1702
        • Quinn T.J.
        • Dawson J.
        • Walters M.R.
        • Lees K.R.
        Reliability of the modified Rankin scale: a systematic review.
        Stroke. 2009; 40: 3393-3395
        • Fearon P.
        • McArthur K.S.
        • Garrity K.
        • Graham L.J.
        • McGroarty G.
        • Vincent S.
        • et al.
        Prestroke modified Rankin stroke scale has moderate interobserver reliability and validity in an acute stroke setting.
        Stroke. 2012; 43: 3184-3188
        • Brown J.S.
        Diabetic cystopathy–what does it mean?.
        J Urol. 2009; 181: 13-14
        • Kunin C.M.
        Urinary-catheter-associated infections in the elderly.
        Int J Antimicrob Agents. 2006; 28: S78-S81
        • Johnson J.R.
        • Kuskowski M.A.
        • Wilt T.J.
        Systematic review: antimicrobial urinary catheters to prevent catheter-associated urinary tract infection in hospitalized patients.
        Ann Intern Med. 2006; 144: 116-126
        • Maki D.G.
        • Tambyah P.A.
        Engineering out the risk for infection with urinary catheters.
        Emerg Infect Dis. 2001; 7: 342-347
        • Moriel D.G.
        • Schembri M.A.
        Vaccination approaches for the prevention of urinary tract infection.
        Curr Pharm Biotechnol. 2013; 14: 967-974
        • Brumbaugh A.R.
        • Mobley H.L.
        Preventing urinary tract infection: progress toward an effective Escherichia coli vaccine.
        Expert Rev Vaccines. 2012; 11: 663-676
        • O'Brien V.P.
        • Hannan T.J.
        • Nielsen H.V.
        • Hultgren S.J.
        Drug and vaccine development for the treatment and prevention of urinary tract infections.
        Microbiol Spectr. 2016; 4https://doi.org/10.1128/microbiolspec.UTI-0013-2012
        • Beveridge S.
        • Wintergerst E.S.
        • Maggini S.
        • Hornig D.
        Immune-enhancing role of vitamin C and zinc and effect on clinical conditions.
        Proc Nutr Soc. 2008; 67: E83