Portable Bladder Ultrasound Reduces Incidence of Urinary Tract Infection and Shortens Hospital Length of Stay in Patients With Acute Ischemic Stroke

Chen, Shu‐Chuan; Chen, Pei-Ya; Chen, Guei-Chiuan; Chuang, Su-Yun; Tzeng, I‐Shiang; Lin, Shinn-Kuang

doi:10.1097/jcn.0000000000000507

Cited by 21 publications

(23 citation statements)

References 21 publications

(29 reference statements)

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“…Univariate and multivariate analysis showed that increased age was associated with UTI in this study, which is consistent with previous findings suggesting that age (>75 years) is a factor associated with UTI in stroke patients [2,16,17]. With the increase of age, the anatomical barrier and physiological function of the urinary system gradually decline.…”

Section: Discussionsupporting

confidence: 92%

A Retrospective Study on Risk Factors for Urinary Tract Infection in Patients with Intracranial Cerebral Hemorrhage

et al. 2020

BioMed Research International

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Objective. This study aimed to explore the risk factors of urinary tract infection (UTI) in patients with intracranial cerebral hemorrhage (ICH). Design. This is a retrospective study, and a total of 77 patients with ICH consecutively admitted to the First Affiliated Hospital of USTC (Anhui Provincial Hospital, Hefei, China) during the period of August 2015 to August 2017 were included. The patients were divided into an UTI group (24 cases) and a non-UTI group (53 cases); patients with UTI were diagnosed according to clinical manifestations, recent urinary routines, and urine culture results. The following information in these two groups was recorded: age, sex, course of disease, side of paralysis, location and type of cerebral hemorrhage, disturbance of consciousness or not, the Brunnstrom stage of paralysed lower limbs, number of basic diseases, whether there were complications (tracheotomy, retention catheterization, pulmonary infection, pressure sore, deep venous thrombosis, etc.), whether rehabilitation interventions were conducted, blood routine, biochemistry index, DIC complete set, urine routine, and urine culture data. Univariate analysis and multivariate logistic regression analysis were used to examine the risk factors of UTI in patients with ICH. Results. Univariate analysis showed that age, side of paralysis, disturbance of consciousness, the Brunnstrom stage of lower limbs, tracheotomies, retention catheterization, pulmonary infection, leukocyte count, neutrophil proportion, sodium, uric acid, D-dimer, and fibrinogen may be related to UTI in patients with ICH (P<0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), P=0.026), right-sided paralysis (OR (95% CI) = 0.20 (0.001–0.650), P=0.028), and D-dimer (OR (95% CI) = 1.403 (1.003–1.961), P=0.048) were associated with UTI in ICH patients. Conclusions. Increased age and high D-dimer are independent risk factors for UTI in patients with ICH, while right-sided paralysis is a protective factor for UTI in patients with ICH.

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Section: Discussionsupporting

confidence: 92%

A Retrospective Study on Risk Factors for Urinary Tract Infection in Patients with Intracranial Cerebral Hemorrhage

et al. 2020

BioMed Research International

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“…Despite lowering UTI frequency, prophylactic antibiotics did not benefit functional outcome or reduce mortality in clinical trials similar to SAP [ 46 ]. Risk factors include catheter use, incontinence, and post-void residual urine volume [ 47 ], though high rates of UTI have been reported in patient cohorts both with (50%) and without (24%) indwelling catheters [ 48 ]. Programs that prompted routine assessment, stop orders, or early removal reduced catheter duration and incidence of UTI [ 49 ], as did measuring post-void urine volume with portable bladder ultrasound [ 47 ].…”

Section: Stroke-induced Immunodepressionmentioning

confidence: 99%

“…Risk factors include catheter use, incontinence, and post-void residual urine volume [ 47 ], though high rates of UTI have been reported in patient cohorts both with (50%) and without (24%) indwelling catheters [ 48 ]. Programs that prompted routine assessment, stop orders, or early removal reduced catheter duration and incidence of UTI [ 49 ], as did measuring post-void urine volume with portable bladder ultrasound [ 47 ]. Antimicrobial or antibiotic-impregnated catheters have been shown to delay or prevent bacteriuria, but evidence of UTI reduction is scarce [ 50 ] and highlights immune system complexity after stroke.…”

Section: Stroke-induced Immunodepressionmentioning

confidence: 99%

Beyond the Brain: The Systemic Pathophysiological Response to Acute Ischemic Stroke

et al. 2020

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Stroke research has traditionally focused on the cerebral processes following ischemic brain injury, where oxygen and glucose deprivation incite prolonged activation of excitatory neurotransmitter receptors, intracellular calcium accumulation, inflammation, reactive oxygen species proliferation, and ultimately neuronal death. A recent growing body of evidence, however, points to far-reaching pathophysiological consequences of acute ischemic stroke. Shortly after stroke onset, peripheral immunodepression in conjunction with hyperstimulation of autonomic and neuroendocrine pathways and motor pathway impairment result in dysfunction of the respiratory, urinary, cardiovascular, gastrointestinal, musculoskeletal, and endocrine systems. These end organ abnormalities play a major role in the morbidity and mortality of acute ischemic stroke. Using a pathophysiology-based approach, this current review discusses the pathophysiological mechanisms following ischemic brain insult that result in end organ dysfunction. By characterizing stroke as a systemic disease, future research must consider bidirectional interactions between the brain and peripheral organs to inform treatment paradigms and develop effective, comprehensive therapeutics for acute ischemic stroke.

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“…Por otro lado, tampoco se han encontrado diferencias en cuanto a la incidencia de ITU posterior al sondaje vesical en ambos grupos, dado que solo disponemos de los sondajes, y no del total de pacientes ingresados. Los resultados obtenidos en cuanto a la duración del ingreso, siguen la línea de estudios previos en pacientes quirúrgicos (31,32) .…”

Section: Discussionunclassified

Impacto de la ecografía volumétrica portátil en el sondaje vesical por retención urinaria en una unidad de medicina interna

Ortega

Díaz²,

Hernández³

et al. 2019

Enf Global

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Objetivo: Estimar el impacto que el uso de ecógrafo vesical tiene en los sondajes vesicales por sospecha de retención urinaria de una unidad de Medicina interna.Metodología: Estudio de cohortes retrospectivas, comparando la cohorte expuesta a la disponibilidad del ecógrafo vesical, con la no expuesta el año previo. Se analizan todos los registros en la Historia Clínica Electrónica (HCE) de sondajes vesicales permanentes de corta duración en pacientes adultos que ingresaron en la unidad de hospitalización de Medicina Interna del Hospital Universitario Fundación Alcorcón (HUFA) durante los años 2015 y 2016. Se estima la frecuencia de retención urinaria como causa del sondaje después de la incorporación del dispositivo en la unidad y se compara con la frecuencia en sondajes durante el mismo periodo del año anterior en la misma unidad. Se estima el impacto que disponer de este dispositivo tiene en la frecuencia de retención urinaria como motivo del sondaje.Resultados: Se incluyen 134 sondajes en 113 pacientes, 62 en el grupo sin ecógrafo y 72 en el grupo con ecógrafo. La frecuencia de sondajes por retención se reduce del 47.5% al 21.4% después de introducir el ecógrafo en la unidad. Esto supone una reducción del 50% (RR ajustado= 0.48; IC95%:0.27-0.84, p=0.01) en la frecuencia de sondaje vesical por sospecha de retención urinaria. Aim: To estimate the impact of the use of portable bladder volumetric ultrasound on bladder catheterization due to suspicion of urinary retention in an internal medicine unit. Methodology: Study of retrospective cohorts, comparing the cohort exposed to the availability of bladder ultrasound, with the not exposed the previous year. All records in the Electronic Medical Record (EHR) of short-term permanent bladder catheters in adult patients admitted to the Internal Medicine hospitalization unit of the University Hospital Fundación Alcorcón (HUFA) during the years 2015 and 2016 were analyzed. The urinary retention frequency is estimated as the cause of the catheterization after the device has been incorporated into the unit and compared with the frequency of catheterization during the same period of the previous year in the same unit. It is estimated that the impact of having this device on the urinary retention frequency is the reason for the catheterization. Results: 134 catheters are included in 113 patients, 62 in the group without ultrasound and 72 in the group with ultrasound. The frequency of catheterizations due to retention is reduced from 47.5% to 21.4% after introducing the ultrasound unit into the unit. This represents a 50% reduction (adjusted RR=0.48; CI95%:0.27-0.84, p=0.01) in the frequency of urinary catheterization for suspected urinary retention.

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Portable Bladder Ultrasound Reduces Incidence of Urinary Tract Infection and Shortens Hospital Length of Stay in Patients With Acute Ischemic Stroke

Cited by 21 publications

References 21 publications

A Retrospective Study on Risk Factors for Urinary Tract Infection in Patients with Intracranial Cerebral Hemorrhage

A Retrospective Study on Risk Factors for Urinary Tract Infection in Patients with Intracranial Cerebral Hemorrhage

Beyond the Brain: The Systemic Pathophysiological Response to Acute Ischemic Stroke

Impacto de la ecografía volumétrica portátil en el sondaje vesical por retención urinaria en una unidad de medicina interna

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