Abstract TP95: Characterization And Comparison Of Hospitalization Outcomes Between Symptomatic And Asymptomatic Urinary Tract Infection In Acute Ischemic Stroke Patients

Abstract

Background: Urinary Tract Infection (UTI) has been associated with increased cost of care and poor outcomes in stroke patients. Guidelines from the Infectious Disease Society of America do not support treating asymptomatic UTI in the absence of objective markers of infection. Aims: Characterize demographics and hospitalization outcomes of symptomatic (sUTI) and asymptomatic (aUTI) in stroke patients compared to a control group without infectious complication. Method: This is a single center retrospective cohort study using the 2019 ischemic stroke database at the University of Kentucky. Cases were defined as patients with confirmed UTI on urine culture or urinalysis, and without other infections. Cases were subdivided into sUTI (subjectively endorsing UTI symptoms or objective vitals suggestive of infection) and aUTI group (reason for urine studies being encephalopathy or leukocytosis without fever). Controls were defined as patients without evidence of infection, and matched to the case group by age and sex. Demographics (age, sex, and stroke mechanism) were compared using Chi-squared analysis. Outcomes included length of stay (LOS), change in pre-hospital to discharge modified Rankin Scale (delta mRS), delta NIHSS (difference between admission and discharge NIHSS), and % change in NIHSS ((highest NIHSS -lowest NIHSS)/admission NIHSS)). Mean and standard deviation between the 3 groups were compared using ANOVA. Results: A total of 120 cases were identified as having UTI (sUTI = 35; aUTI = 85), with nearly all receiving antimicrobials. No difference in demographics was observed between sUTI and aUTI, except for stroke mechanism (p=0.007 for chi-squared comparison of TOAST classification). Both sUTI and aUTI had greater morbidity as defined by delta mRS compared to control (p=0.0066; p=0.0001 respectively), but not to each other (p=0.0625). Only sUTI resulted in longer LOS compared to control (p=0). No difference in delta or % change NIHSS was observed between the 3 groups. Conclusion: Both sUTI and aUTI were associated with poor outcome in mRS, which may suggest impaired stroke recovery. Withholding antibiotic treatment in aUTI, as suggested by IDSA guidelines, may lead to worse outcomes. Further study is needed to determine the impact of non-treatment.