From the Guidelines
Clinical complications after 90 days post-stroke include urinary tract infections (UTIs), which affect approximately 15% to 60% of stroke survivors, and should be treated with appropriate antibiotics and prevention strategies to improve outcomes and quality of life. The management of UTIs in post-stroke patients is crucial to prevent further complications such as bacteremia or sepsis. According to the guidelines for the early management of patients with acute ischemic stroke 1, UTIs are common and can lead to worse outcomes, and therefore, urinalysis for evidence of infection should be performed whenever a patient develops a fever after stroke.
Some key points to consider in the management of UTIs in post-stroke patients include:
- Early removal of urinary catheters to avoid increased risk of urinary tract infection 1
- Use of silver alloy–coated urinary catheters if a catheter is required 1
- Assessment of bladder function in acute stroke patients, including measurement of urinary frequency, volume, and control 1
- Treatment of UTIs with appropriate antibiotics, such as nitrofurantoin 100mg twice daily for 5-7 days for uncomplicated cases, or broader spectrum antibiotics for complicated infections
- Prevention strategies, including adequate hydration, proper hygiene, and regular follow-up appointments
It is also important to note that post-stroke patients often experience mobility limitations, swallowing difficulties, and neurological deficits that increase their susceptibility to complications such as UTIs, pneumonia, deep vein thrombosis, pulmonary embolism, pressure ulcers, falls, depression, and cognitive impairment. Regular follow-up appointments, rehabilitation therapy, and preventive measures like anticoagulation for those at risk of clots, proper positioning to prevent pressure ulcers, and screening for depression are essential components of long-term stroke management, as recommended by the guidelines for adult stroke rehabilitation and recovery 1. Early recognition and treatment of these complications significantly improve outcomes and quality of life for stroke survivors.
From the Research
Clinical Complications Related to Stroke After 90 Days
Urinary Tract Infections
- Urinary tract infections (UTIs) are a common complication in patients after a stroke, particularly after 90 days 2, 3, 4, 5, 6.
- The most common bacteria causing UTIs in these patients are Escherichia coli, which can be resistant to various antibiotics, including trimethoprim-sulfamethoxazole (TMP-SMX) 4, 5.
- Studies have shown that the use of TMP-SMX as a prophylactic measure against UTIs in patients with chronic spinal cord injury may not be effective in reducing the incidence of symptomatic bacteriuria and can increase the percentage of cultures resistant to TMP-SMX 6.
- Other antibiotics, such as fosfomycin, may be a viable option for treating UTIs in patients after a stroke, particularly in those with resistance to TMP-SMX 4.
- Patient-specific risk factors, such as prior urinary infection/colonization with TMP-SMX-resistant Enterobacteriaceae and recent use of TMP-SMX, can predict the likelihood of TMP-SMX resistance in patients with community-onset UTIs 5.
Treatment and Management
- The treatment of UTIs in patients after a stroke should be guided by antibiotic susceptibility testing and patient-specific risk factors 4, 5.
- Fosfomycin may be a suitable alternative to TMP-SMX for treating UTIs in patients with resistance to TMP-SMX 4.
- Suppressing therapy with antibiotics, such as TMP-SMX, may not be effective in reducing the incidence of symptomatic bacteriuria and can increase the percentage of cultures resistant to the antibiotic 6.