Indwelling urinary catheterization after acute stroke.
OBJECTIVE
Prolonged indwelling urinary catheterization (IUC) increases risk of urinary tract infection. We aimed to investigate the incidence and risk factors associated with IUC following acute stroke, and its impact on stroke outcome.


METHODS
We prospectively enrolled stroke patients hospitalized within 10 days after onset from August 2006 to December 2008. Kaplan-Meier method was used to estimate the cumulative incidence of IUC, and Cox regression analysis to evaluate the independent predictors. The impact of IUC on poor outcome (modified Rankin Scale >2 or dead) at 3 months was studied by logistic regression.


RESULTS
Of 2,803 patients, 697 (25%) received indwelling urinary catheters. Catheterization was carried out mostly within 1-2 days of admission (86%), with estimated cumulative incidence of 13% (95% confidence interval, 11-14%) at 2 days in patients with ischemic stroke (IS), and 57% (53-61%) in patients with intracerebral hemorrhage (ICH). In IS patients, IUC was significantly associated with increasing age, baseline stroke severity, and neurological deterioration. In ICH patients, stroke severity on admission was the only significant predictor after adjustment. We assessed the 3-month outcome in 2,388 patients, after excluding 177 (6%) dead at discharge, 164 (6%) without providing informed consent, and 74 (3%) lost to follow-up. IUC during acute hospitalization was significantly associated with unfavorable 3-month outcome after adjustment.


CONCLUSIONS
IUC was common in acute stroke care and associated with unfavorable outcome at 3 months. Whether judicious use of urinary catheters in acute stroke patients would improve outcomes may warrant further studies.
Department of Urology, Yuan's General Hospital, Kaohsiung, Taiwan.
Chun-Hsien
CH
Wu
Mei-Chiun
MC
Tseng
Yu-Wei
YW
Chen
Sheng-Feng
SF
Sung
Poh-Shiow
PS
Yeh
Huey-Juan
HJ
Lin
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D002408:Catheters, Indwelling / Q000009:adverse effects; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D016009:Chi-Square Distribution; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000453:epidemiology; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D014546:Urinary Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D062885:Urinary Catheters / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000453:epidemiology