Characterize demographics and hospitalization outcomes of symptomatic and asymptomatic urinary tract infection (sUTI and aUTI) in acute ischemic stroke patients.

Urinary Tract Infection (UTI) is associated with increased hospital costs and poor outcomes in stroke patients. Guidelines from the Infectious Disease Society of America (IDSA) do not support treating asymptomatic UTI in the absence of objective markers. 

A single center retrospective cohort study was conducted using the University of Kentucky 2019 ischemic stroke database. Cases were patients with confirmed UTI on urine culture or urinalysis, and without other infections. Cases were subdivided into sUTI (subjective UTI symptoms or objective signs of infection) and aUTI (reason for urinalysis being encephalopathy or leukocytosis without fever). Controls were patients without evidence of infection, and were age and sex matched. 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), difference between admission and discharge NIHSS (delta NIHSS), and % change in NIHSS ((highest NIHSS -lowest NIHSS)/admission NIHSS)). Mean and standard deviation between the 3 groups were compared using ANOVA. 

91 cases were identified as having UTI (sUTI = 34; aUTI = 57), with nearly all receiving antimicrobials. aUTI cohort were older (p=0.035 vs. sUTI) and cause of stroke was more likely cardioembolic (p=0.017 vs. sUTI; p=0.047 vs. control based on TOAST classification). Comparing delta mRS, both sUTI and aUTI had similar morbidity (p=0.61) but each were higher compared to control (p=0; p=0.0011 respectively). sUTI resulted in longer LOS compared to aUTI and controls (p=0.049; p=0 respectively). No difference in delta or % change NIHSS was observed.