Urinary tract infection is the source of 10–30% of all sepsis cases, with high morbidity and mortality.
The global incidence of sepsis is estimated worldwide 31.5 million Number of cases per year, which cause 5.3 million Of deaths. Detecting and managing sepsis has become a top priority for many hospitals and the World Health Organization considers sepsis a serious problem. It is important to distinguish between sepsis and shock Septic due to high mortality rate in the latter.
Urinary tract infection (UTI) is the source of approximately 10–30% of all sepsis cases, with high morbidity and mortality. Complicated UTI (cUTI) is the most common cause urosepsis In adults over 65 years of age. It is essential to promptly diagnose urosepsis and provide time-sensitive antibiotic treatment, supportive therapy, and source control.
Conditions that cause febrile UTIs include any structural, anatomic, and/or functional abnormality that obstructs the flow of urine and is the main cause of Euroseptic shock This is a blockage in the urinary tract. Therefore, with patients urosepsis They generally require initial radiological evaluation to rule out any obstructive urinary tract disorders.
As a physician facing a patient with suspected or proven urosepsis, there are two important issues.
- the first choice is empiric antibiotic treatment and appropriate dosage, taking into account the patient’s general condition, comorbidities and expected pathogen, especially taking into account increased Patience For antibiotics among Enterobacteriaceae.
- Second is the timing of imaging for diagnosis and potential source control to eliminate obstruction requiring decompression.
In this study on patients with community-onset bloodstream infection (CO-BSI) during 2019 and 2020, a well-defined retrospective cohort was selected to determine. death risk factors Within 30 days from the date of performance of the first positive blood culture related to urosepsis.
Urosepsis is a life-threatening condition that must be addressed without delay. There are two important aspects in its management:
(1) Appropriate empirical antibiotic therapy, taking into account the patient’s general condition, comorbidities, and expected pathogen.
(2) Timing of imaging to identify the obstruction requiring decompression.
identify the risk Associated with 30-day mortality in patients with urosepsis.
from a group of 1605 infection community-onset hemorrhage (CO-BSI) identified 282 patients With urosepsis in a Swedish county 2019–2020. mortality risk factors odds ratio Crude and adjusted analyzes were performed using logistic regression.
I got this urosepsis in 18% (n = 282) of all community-onset bloodstream infections (CO-BSIs).
death rate All-cause mortality at 30 days was 14% (n = 38).
After multivariate analysis, urinary tract disorders Radiologically detected was the major risk factor for mortality (OR = 4.63, 95% CI = 1.47-14.56), followed by microbiologically followed by empirical antibiotic therapy Inappropriate (OR = 4.19, 95% CI = 1.41-12.48).
Time to radiological diagnosis and decompression of the obstruction for source control were also significant prognostic factors for survival.
Interestingly, 15% of blood cultures showed Gram-positive species associated with a high 30-day mortality rate of 33%.
The 30-day all-cause mortality rate for urosepsis was 14%. The two main risk factors for mortality were hydronephrosis Due to obstructive stones in the ureter and inadequate empirical antibiotic therapy,
Therefore, early detection of any urinary tract disorder by imaging and subsequent source control as needed, and antibiotic coverage of gram-negative pathogens and gram-positive species such as E. faecalis to optimize management may improve survival. There is a possibility. In patients with urosepsis.
Several independent risk factors were associated with 30-day mortality in patients with community-onset bloodstream infection (CO-BSI) with urosepsis during the 2-year study period. In a multivariable logistic regression model, urinary tract disorders, inadequate empiric antibiotic treatment, and disease severity (IN-SOFA score and 24-hour SOFA) were associated with a significantly increased risk of all-cause mortality at 30 days.