title: Hospital-Acquired Infection Underlies Poor Functional Outcome in Patients with Prolonged Length of Stay.
abstract: BACKGROUND
  Prolonged length of stay (pLOS) following ischemic stroke inflates cost, increases risk for hospital-acquired complications, and has been associated with worse prognosis.
  
  
  METHODS
  Acute ischemic stroke patients admitted between July 2008 and December 2010 were retrospectively analyzed for pLOS, defined as a patient stable for discharge hospitalized for an additional ≥24 hours.
  
  
  RESULTS
  Of 274 patients included, 106 (38.7%) had pLOS (median age 65 years, 60.6% female, 69.0% black). Patients with pLOS had higher admission NIHSS than patients without pLOS (9 versus 5,P= 0.0010). A larger proportion of patients with pLOS developed an infection (P< 0.0001), and after adjusting for covariates, these patients had greater odds of poor short-term functional outcome (OR = 2.25, 95% CI 1.17-4.32,P= 0.0148). Adjusting for infection, the odds of patients with pLOS having poor short-term functional outcome were no longer significant (OR = 1.68, 95% CI 0.83-3.35,P= 0.1443).
  
  
  CONCLUSIONS
  The contraction of a hospital-acquired infection was a significant predictor of pLOS and a contributor of poor short-term outcome following an ischemic stroke. Whether the cause or the consequence of pLOS, hospital-acquired infections are largely preventable and a target for reducing length of stay.
authors.affiliation: Stroke Program at Tulane University Hospital, Department of Neurology, 1440 Canal Street, TB-52, Suite 1000, New Orleans, LA 70112-2715, USA.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: George
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL 35294-0022, USA ; Department of Neurology, School of Medicine, University of Alabama at Birmingham, 1670 University Blvd., Birmingham, AL 35233-0022, USA.
authors.forename: Amelia K
authors.initials: AK
authors.lastname: Boehme
authors.affiliation: Stroke Program at Tulane University Hospital, Department of Neurology, 1440 Canal Street, TB-52, Suite 1000, New Orleans, LA 70112-2715, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Siegler
authors.affiliation: Stroke Program at Tulane University Hospital, Department of Neurology, 1440 Canal Street, TB-52, Suite 1000, New Orleans, LA 70112-2715, USA.
authors.forename: Dominique
authors.initials: D
authors.lastname: Monlezun
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL 35294-0022, USA ; Department of Neurology, School of Medicine, University of Alabama at Birmingham, 1670 University Blvd., Birmingham, AL 35233-0022, USA.
authors.forename: Bethena D
authors.initials: BD
authors.lastname: Fowler
authors.affiliation: Stroke Program at Tulane University Hospital, Department of Neurology, 1440 Canal Street, TB-52, Suite 1000, New Orleans, LA 70112-2715, USA.
authors.forename: Amir
authors.initials: A
authors.lastname: Shaban
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL 35294-0022, USA ; Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE), 1530 3rd Avenue South, Medical Towers, Birmingham, AL 35294-4410, USA ; Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health & Health Disparities Research Center (MHRC), Medical Towers Building, 1717 11th Avenue South, Suite 516A, Birmingham, AL 35294-4410, USA.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Albright
authors.affiliation: Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL 35294-0022, USA.
authors.forename: T Mark
authors.initials: TM
authors.lastname: Beasley
authors.affiliation: Stroke Program at Tulane University Hospital, Department of Neurology, 1440 Canal Street, TB-52, Suite 1000, New Orleans, LA 70112-2715, USA.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Martin-Schild