How to modify the risk of complications such as urinary tract infections (UTIs) and bronchoaspiration after a cerebrovascular accident (CVA) or stroke?

From the Guidelines

To modify the risk of complications such as urinary tract infections and bronchoaspiration after stroke, implement a comprehensive care plan focusing on prevention strategies, including avoiding unnecessary catheterization, using aseptic technique, and removing catheters as soon as medically appropriate, as well as conducting formal swallowing assessments and implementing texture-modified diets. For urinary tract infections (UTIs), the evidence from 1 suggests that indwelling catheters should be assessed daily and removed as soon as possible, and excellent pericare and infection prevention strategies should be implemented to minimize the risk of infections. Additionally, ensuring adequate hydration of 1.5-2 liters daily unless contraindicated, and considering cranberry supplements (400-500 mg daily) as a preventive measure can help reduce the risk of UTIs. For patients requiring long-term catheterization, changing catheters every 2-4 weeks and performing meticulous perineal hygiene can also help prevent UTIs. To prevent bronchoaspiration, conducting formal swallowing assessments before oral intake, positioning patients at 30-45 degrees during and after meals, implementing texture-modified diets as recommended by speech therapists, and considering nasogastric or percutaneous endoscopic gastrostomy (PEG) feeding for patients with severe dysphagia can be effective, as suggested by 1. Early mobilization within 24-48 hours post-stroke (if hemodynamically stable) can also help prevent both complications by improving circulation and respiratory function, as noted in 1. Regular oral care with chlorhexidine 0.12% mouthwash twice daily can reduce oral bacteria that could cause aspiration pneumonia. These interventions are effective because they address the underlying risk factors: immobility, impaired swallowing, and compromised immune function that commonly occur after stroke. Some key points to consider include:

• Avoiding unnecessary catheterization and removing catheters as soon as medically appropriate
• Implementing excellent pericare and infection prevention strategies
• Ensuring adequate hydration and considering cranberry supplements
• Conducting formal swallowing assessments and implementing texture-modified diets
• Positioning patients at 30-45 degrees during and after meals
• Considering nasogastric or PEG feeding for patients with severe dysphagia
• Early mobilization within 24-48 hours post-stroke
• Regular oral care with chlorhexidine 0.12% mouthwash twice daily.

From the Research

Modifying the Risk of Complications after Stroke

To modify the risk of complications such as urinary tract infections (UTIs) and bronchoaspiration after stroke, several strategies can be employed:

• Prevention of UTIs: Identifying and managing risk factors for UTIs, such as diabetes mellitus, chronic renal disease, and use of immunosuppressive drugs, can help reduce the incidence of UTIs 2. Additionally, prophylactic antibiotics, such as Nitrofurantoin, Bactrim, or amoxicillin clavulanic acid, can be effective in reducing recurrent UTI episodes 2.
• Risk Factors for UTIs: Several risk factors have been identified, including sexual intercourse, spermicide use, having a new sex partner, having a mother with a history of UTI, and asymptomatic bacteriuria treatment 3. Other risk factors, such as reduced fluid intake, habitual and post-coital delayed urination, wiping from back to front after defecation, douching, and wearing occlusive underwear, should also be taken into account 3.
• Diagnosis and Treatment of UTIs: Early diagnosis and appropriate therapy with antibiotics are crucial for preventing complicated UTI conditions, such as urosepsis 4. Conventional and recent diagnostic methods, as well as treatment therapies with or without antibiotics, should be considered 4.
• Emerging Management Strategies: Novel compounds that block bacterial interactions with the urothelium and vaccines focused on preventing both acute and recurrent infections are being explored as alternative therapies for UTIs 5.
• Prevention of Bronchoaspiration: While the provided studies do not directly address bronchoaspiration, it is essential to note that preventing aspiration is critical in reducing the risk of complications after stroke. However, there are no research papers provided to assist in answering this specific question.

Management of UTIs

The management of UTIs involves:

• Antibiotic Therapy: Antibiotics are the primary treatment for UTIs, and the choice of antibiotic should be based on the severity of the infection and the patient's medical history 2, 4.
• Prophylactic Antibiotics: Prophylactic antibiotics can be effective in reducing recurrent UTI episodes, especially in patients with a history of recurrent UTIs 2.
• Non-Pharmacological Methods: Non-pharmacological methods, such as increasing fluid intake, urinating when the bladder is full, and practicing good hygiene, can also help prevent UTIs 3.