Urinary tract infections complicating stroke: mechanisms, consequences, and possible solutions.

BACKGROUND AND PURPOSE: Hospital-acquired urinary tract infection (UTI) is a common complication in hospitalized patients. Recently, catheter-associated UTI has been identified by the Centers for Medicare and Medicaid Services as a preventable condition, and additional payments to hospitals for its treatment are now declined, increasing the need for prevention of this important complication.

SUMMARY OF REVIEW: This article explores in-depth the pathophysiology, risk factors for, and consequences of UTI after stroke and possible methods to reduce its incidence in the stroke population. Patients with stroke are particularly vulnerable to UTI due to increased risk from immunosuppression, bladder dysfunction, and increased Foley catheter use; and the fever and systemic inflammatory response associated with UTI may impair stroke recovery. UTI is associated with poorer neurological outcomes, longer hospital stays, and increased cost of care after stroke. Intervention strategies previously attempted in this and other populations include prophylactic antibiotics, antiseptic-impregnated catheters, and quality improvement interventions to reduce inappropriate catheterization.

CONCLUSION: Patients with stroke have different risks for, consequences of, and barriers to reducing UTI than other hospitalized patients. Further research is needed to develop an effective approach to decreasing this important complication in the stroke population.