| Abstract | Cilj istraživanja: Ispitati utjecaj hospitalnih infekcija na oporavak nakon ishemijskog moždanog udara te istražiti čimbenike rizika za njihov razvoj.
Ispitanici i postupci: Retrospektivno istraživanje provedeno je na Klinici za neurologiju KBC-a Split. Uvidom u medicinsku dokumentaciju prikupljeni su podaci o 358 pacijenata hospitaliziranih od 1. siječnja do 30. lipnja 2020. godine koji su zadovoljavali kriterije istraživanja. Prikupljeni su demografski podaci, podaci o komorbiditetima, terapiji, duljini hospitalizacije i funkcionalnom statusu na prijemu i otpustu korištenjem NIHSS-a i mRS-a. Za dio pacijenata prikupljeni su i podaci o uzročniku i sijelu infekcije, febrilitetu i korištenju urinarnog katetera, nazogastrične sonde i mehaničke ventilacije. Podaci su obrađeni metodama deskriptivne statistike, hi kvadrat (χ2) testom, Mann Whitney testom, Wilcoxon signed ranks testom te multivarijatnom logističkom regresijom.
Rezultati: Od 358 ispitanika, njih 115 (32%) razvilo je HI. Najčešće je bilo riječ o infekciji urinarnog sustava koju su razvila 92 pacijenta, odnosno 20% svih ispitanika. Pritom je 20 (17%) pacijenata razvilo više od jedne infekcije. Udio žena u skupini s infekcijom za 1,4 puta je veći nego u skupini bez infekcije (χ2=8,0; P=0,005) i izgled za nastajanje infekcije u žena je dva puta veći nego u muškaraca (P=0,003). Medijan životne dobi ispitanika s infekcijama za 8 godina je veći nego u skupini bez infekcija (Z=7,0; P<0,001). Medijan trajanja hospitalizacije u skupini ispitanika s infekcijom za 2 dana je veći nego u skupini ispitanika bez infekcije (Z=6,4; P<0,001). Medijan NIHSS-a na prijemu za 7 je veći u ispitanika s infekcijom u odnosu na ispitanike bez infekcije (Z=9,3; P<0,001). Od 358 ispitanika, njih 35 (9,8%) je umrlo. Smrtnost je veća u skupini ispitanika s infekcijom (χ2=36; P<0,001). U skupini ispitanika s infekcijom češće je došlo do pogoršanja funkcionalnog statusa nego u skupini ispitanika bez infekcije, mjereno NIHSS-om (χ2=4,26; P=0,039) i mRS-om (χ2=34,3; P<0,001). Multivarijatnom logističkom regresijom potvrđena je poezanost HI sa dobi (P=0,004), fibrilacijom atrija (P=0,038), trombektomijom (P=0,026) te NIHSS-om (P=0,001) i mRS-om (P=0,024) pri prijemu. Nije potvrđena povezanost HI sa spolom (P=0,877).
Zaključak: HI povećavaju smrtnost, pogoršavaju funkcionalni status i trajanje hospitalizacije nakon IMU. Najčešće je sijelo infekcije je urinarni sustav.Čimbenici rizika za razvoj HI nakon IMU su veći NIHSS i mRS pri prijemu, starija životna dob, fibrilacija atrija i trombektomija. |
| Abstract (english) | Objectives: To examine the impact of hospital - acquired infections (HAI) on recovery after ischemic stroke and to investigate risk factors for their development.
Patients and methods: A retrospective study was conducted at the Department of Neurology, University Hospital Center Split. Data were collected from the medical records of 358 patients hospitalized from January 1st to June 30th 2020 who met the research criteria. Demographic data, data on comorbidities, therapy, length of hospitalization, and functional status on admission and discharge using NIHSS and mRS were collected. For some patients, additional data were collected regarding the cause and severity of the infection, fever and the use of a urinary catheter, nasogastric tube and mechanical ventilation. Data were processed by descriptive statistics methods, chi square (χ2) test, Mann Whitney test, Wilcoxon signed ranks test and multivariate logistic regression.
Results: Of the 358 subjects, 115 (32%) developed HAI. The most common infection was urinary tract infection affecting 92 patients, or 20% of all subjects. Twenty (17%) patients developed more than one infection. The percentage of women in the group with infection was 1.4 times higher than in the group without infection (χ2 = 8.0; P = 0.005) and the probability of infection in women was twice as high as in men (P= 0.003). The median age of patients in the group with infections was 8 years higher than in the group without infections (Z = 7.0; P<0.001). The median hospitalization lenght was 2 days longer in patients with infection (Z=6,4; P<0,001). The median NIHSS on admission was higher by 7 in patients with infection compared to patients without infection (Z = 9.3; P<0.001). Thirty-five (9.8%) of the 358 patients, died. Mortality was higher in the group of patients with infection (χ2 = 36; P<0.001). Deterioration of functional status occurred more frequently in patients with infection than in those without infection, measured by NIHSS (χ2 = 4.26; P=0.039) and mRS (χ2 = 34.3; P<0.001). Multivariate logistic regression confirmed the association of HAI with age (P=0.004), atrial fibrillation (P=0.038), thrombectomy (P=0.026) and NIHSS (P=0.001) and mRS (P=0.024) on admission. Assocation of HAI with gender was not confirmed (P 0.877).
Conclusion: HAIs increase mortality, the risk of functional status deterioration, and the duration of hospitalization after stroke. The most common infection was urinary tract infection. Risk factors for the development of HAI after stroke are higher NIHSS and mRS on admission, older age, atrial fibrillation, and thrombectomy. |
