卒中患者伴或不伴感染的再入院率：发生率和危险因素。
Readmission Rates in Stroke Patients with and without Infections: Incidence and Risk Factors.
机构信息
Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
出版信息
J Stroke Cerebrovasc Dis. 2022 Jan;31(1):106172. doi: 10.1016/j.jstrokecerebrovasdis.2021.106172. Epub 2021 Nov 16.
BACKGROUND
Stroke patients are at increased risk for acquiring infections in the hospital and risk of readmission. We aimed to examine whether an infection acquired during the initial stroke admission contributes to increased risk of readmission and infection during readmission.
METHODS
We performed a retrospective cohort study incorporating all adult ischemic stroke patients from three New York City hospitals from 2006 to 2016. A validated computer algorithm defined infections based on electronically-available laboratory culture data. Multivariable logistic regression was used to evaluate the crude and adjusted association of infections present on admission (IPOA) and healthcare-associated infections (HAI) with 60-day readmissions, and infection during readmission.
RESULTS
Among the 10,436 stroke patients, 17% had infections during initial admission of which 52% were IPOA and 48% were HAI. The risk of readmission was significantly higher for those with HAIs (OR = 1.40; 95% CI: 1.20-1.64) and IPOA (OR = 1.26; 95% CI: 1.09-1.47). The presence of infection during the 60-day readmission was also independently predicted by HAI (OR = 3.27; 95% CI: 2.60-4.12) and IPOA (OR = 2.54; 95% CI: 2.01-3.22). Patients with a Gram-negative infection were not at higher odds for readmission compared to patients with a Gram-positive infection (OR 1.07, 95%CI 0.81-1.42).
CONCLUSION
Among stroke patients, HAI and IPOA were predictors of readmission within 60 days and infection during readmission.
背景
中风患者在医院中感染和再次入院的风险增加。我们旨在研究初次中风入院期间获得的感染是否会增加再次入院和再次入院期间感染的风险。
方法
我们进行了一项回顾性队列研究，纳入了 2006 年至 2016 年期间来自纽约市三家医院的所有成年缺血性中风患者。经过验证的计算机算法根据电子可得的实验室培养数据定义了感染。多变量逻辑回归用于评估初次入院时存在的感染（IPOA）和与 60 天再入院相关的医疗相关感染（HAI）以及再入院期间感染与再入院之间的粗关联和调整关联。
结果
在 10436 例中风患者中，17％的患者在初次入院期间发生了感染，其中 52％为 IPOA，48％为 HAI。HAI（OR = 1.40；95％CI：1.20-1.64）和 IPOA（OR = 1.26；95％CI：1.09-1.47）的患者再入院风险明显更高。60 天再入院期间感染的存在也独立地由 HAI（OR = 3.27；95％CI：2.60-4.12）和 IPOA（OR = 2.54；95％CI：2.01-3.22）预测。与革兰氏阳性感染相比，革兰氏阴性感染的患者再入院的几率没有更高（OR 1.07，95％CI 0.81-1.42）。
结论
在中风患者中，HAI 和 IPOA 是 60 天内再入院和再入院期间感染的预测指标。
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