Hospital-level Variations in Rates of Inpatient Urinary Tract Infections in Stroke

Michelle Tornes* (Corresponding Author), David J. McLernon, Max O. Bachmann, Stanley D. Musgrave, Elizabeth A. Warburton, John F. Potter, Phyo Kyaw Myint, On behalf of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group

*Corresponding author for this work

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Background and purpose: Urinary tract infection (UTI) is one of the most common complications following stroke and has prognostic significance. UTI rates have been shown to vary between hospitals, but it is unclear whether this is due to case-mix differences or heterogeneities in care among hospitals.

Methods: A prospective multi-center cohort study of acute stroke patients admitted to eight National Health Service acute hospital trusts within the Anglia Stroke & Heart Clinical Network between 2009 and 2011 was conducted. We modelled the association between hospital (as a fixed-effect) and inpatient UTI using a multivariable logistic regression model, adjusting for established patient-level risk factors. We graphically and descriptively analyzed heterogeneities in hospital-level characteristics.

Results: We included 2241 stroke admissions in our analysis; 171 (7.6%) acquired UTI as an inpatient. UTI rates varied significantly between the eight hospitals, ranging from 3% to 11%. The hospital that had the lowest odds of UTI (odds ratio (OR)=0.50 (95% confidence interval (CI) 0.22 to 1.11)) in adjusted analysis, had the highest number of junior doctors and occupational therapists per five beds of all hospitals. The hospital with the highest adjusted UTI rate (OR=2.69 (1.56 to 4.64)) was tertiary, the largest and had the highest volume of stroke patients, lowest number of stroke unit beds per 100 admissions, and the highest number of hospital beds per CT scanner.

Conclusions: There is hospital-level variation in post-stroke UTI. Our results suggest the potential influence of service characteristics independently of patient-level factors which may be amenable to address to improve the ultimate stroke outcome.
Original languageEnglish
Article number827
JournalFrontiers in Neurology
Publication statusPublished - 6 Aug 2019

Bibliographical note

Sources of Funding: MT holds a PhD studentship funded by the School of Medicine, Medical Sciences and Nutrition, University Aberdeen. The Anglia Stroke Clinical Network Evaluation Study (ASCNES) is funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme (PB-PG-1208-18240). This paper presents independent research funded by the NIHR under its Research for Patient Benefit (RfPB) programme (Grant Reference Number PB-PG-1208-18240). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. EW receives funding support from the NIHR Biomedical Research Centre award to Cambridge.

Data Availability: The raw data supporting the conclusions of this manuscript will be made available by the authors, without undue reservation, to any qualified researcher.


  • stroke
  • health services resaerch
  • acute hospital
  • outcome
  • urinary tract infection (UTI)
  • health services research
  • acute hospitals
  • urinary tract infections
  • STAY
  • Acute hospitals
  • Stroke
  • Health services research
  • Outcome
  • Urinary tract infections


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