Article

Urinary catheterization and acute urinary retention increase the
risk of urinary tract infection (UTI). Our study aimed to investigate the
incidence of UTI following acute stroke at our stroke center (SC) and to assess
urinary catheter-care practices among French SCs.
METHODS: Stroke patients
hospitalized within 24h of stroke onset were prospectively enrolled between May
and September 2013. Neurological deficit level was assessed on admission using
the US National Institutes of Health Stroke Scale (NIHSS). Patients were
followed-up until discharge. Indwelling urinary catheterization (IUC) was the
only technique authorized during the study. An electronic survey was also
conducted among French SCs to assess their practices regarding urinary
catheterization in acute stroke patients. RESULTS: A total of 212 patients were
included, with 45 (21.2%) receiving indwelling urinary catheters. The overall
estimated incidence of UTI was 14.2%, and 18% among patients receiving IUC. On
univariate analysis, IUC was significantly associated with older age, longer
hospital stays and higher NIHSS scores. Of the 30 SCs that responded to our
survey, 19 (63.3%) declared using IUC when urinary catheterization was needed.
The main argument given to justify its use was that it was departmental policy to
adopt this technique. Also, 27 participants (90%) stated that conducting a study
to assess the impact of urinary catheterization techniques on UTI rates in acute
stroke patients would be relevant. DISCUSSION: Our results are in accord with
previously reported data and confirm the high burden of UTI among acute stroke
subjects. However, no association was found between IUC and UTI on univariate
analysis due to a lack of statistical power. Also, our survey showed high
heterogeneity in catheter-use practices among French SCs, but offered no data to
help determine the best urinary catheterization technique. CONCLUSION: Urinary
catheterization is common after acute stroke and a well-known risk factor of UTI.
However, as high heterogeneity in catheter-use practices is found among French
SCs, randomized studies comparing the efficacy of urinary catheterization
techniques in terms of UTI prevention in acute stroke patients are now warranted.
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