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Volume 2020, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Urosepsis contributes significantly to the epidemiology of sepsis. Urosepsis can be classified as community acquired or hospital acquired, depending upon the origin of infection acquisition: either from the community or from a healthcare facility. A great deal of literature is available about nosocomial urosepsis, but the literature regarding community-acquired urosepsis (CAUs) is limited, and studies are underpowered. The aim of our study was to determine the epidemiology, bacteriology, severity, and outcome of CAUs. All patients admitted from the emergency department to the surgical intensive care unit (SICU) with urosepsis over a period of 10 years were identified and included retrospectively from the SICU registry. The study was retrospective. Data were entered into the SPSS program version 23, and groups were compared by using chi-square and t-tests. Results were considered statistically significant at  ≤ 0.05. During the study period, 302 patients with CAUs were admitted to the SICU. The common etiology was obstructive uropathy (60%). The Local Arab population outnumbered the non-Arab population (164/54.3%), and there were equal numbers of patients of both genders. Diabetes mellitus and hypertension together were the common comorbidities. Seventy-five percent of patients had acute kidney injury (AKI). Thirty-eight percent of patients had percutaneous nephrostomy, and 24.8% of patients underwent endoscopic stent insertion to relieve the obstruction. Ninety-three percent of patients were admitted with septic shock, and 71.5% had bacteremia. The common bacteria (36.1%) was extended-spectrum beta-lactamase-(ESBL)-producing bacteria, with a predominance of (31.5%). Fifty-four percent of patients required a change of antibiotics to carbapenem. Eighty-two percent of patients had acute respiratory distress syndrome (ARDS). Patients with bacteremia had a statistically significant AKI, ARDS, and septic shock ( < 0.001). Male patients had a significantly higher incidence of oliguria, intubation, and ARDS ( < 0.05). Eight patients died of urosepsis during the study period, giving a mortality rate of 2.6%. In our patients, obstruction of urine flow was the most common cause of CAUs. Our urosepsis patients had a higher bacteremia rate, which led to higher incidences of organ dysfunction and septic shock. ESBL bacteria were a frequent cause of urosepsis, requiring a change of the initial antibiotic to carbapenem. Male patients had a significantly higher rate of organ dysfunction. Mortality in our urosepsis patients was lower than mentioned in the literature.

© 2020 Shaikh, Momin, Atef Shible, Al-Musalmani, Ansari, licensee HBKU Press.
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2020-04-02
2024-11-14
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References

  1. Dreger NM, Degener S, Ahmad-Nejad P, Wöbker G, Roth S. Urosepsis–etiology, diagnosis, and treatment. Dtsch Arztebl Int. 2015; 112::837–847.
     [Google Scholar]
  2. Taha H, Raji SJ, Khallaf A, Abu HS, Mathew R, Rashed H, et al.  Improving catheter associated urinary tract infection rates in the medical units. BMJ Qual Improv Rep. 2017; 6::1–4.
     [Google Scholar]
  3. Shaikh N, Umm-E-Amara, Hassan J, Qazi Z, Chanda A, Mahemood Z, et al. Urosepsis: flow is life, IntechOpen, DOI: 10.5772/intechopen.82262.
  4. Liang X, Huang J, Xing M, He L, Zhu X, Weng Y, et al.  Risk factors and outcomes of urosepsis in patients with calculous pyonephrosis receiving surgical intervention: a single center retrospective study. BMC Anesthesiology. 2019; 61::2–8.
     [Google Scholar]
  5. Qiang XH, Duyu T, Li YN, Zhou LX. Prognosis risk of urosepsis in critical care medicine: A prospective observational study. Biomed Res Int. 2016; 2016::1–5.
     [Google Scholar]
  6. Cardoso T, Ribeiro O, Costa-Pereira A, Carneiro A. A SACiUCI Study Group. Community-acquired and healthcare-related urosepsis: a multicenter prospective study. Crit Care. 2008; 12:Suppl 2:P8.
     [Google Scholar]
  7. Bonkat G, Cai T, Veeratterapillay R, Bruyère F, Bartoletti R, Pilatz A, et al.  Management of Urosepsis in 2018. European Urology Focus. 2019; 4::5–9.
     [Google Scholar]
  8. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al.  Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017; 43::304–377.
     [Google Scholar]
  9. Gitz Holler J, Jensen HK, Henriksen DP, Rasmussen LM, Mikkelsen S, Pedersen C, et al.  Etiology of shock in the emergency department. Shock. 2019; 51::60–67.
     [Google Scholar]
  10. Fontenelle LF, Sarti TD. Kidney stones. Am Fam Physician. 2019; 99::490–496.
     [Google Scholar]
  11. Robertson WG. Stone formation in Middle Eastern Gulf States: A review. AJU. 2012; 10::265–272.
     [Google Scholar]
  12. Yamamichi F, Shigemura K, Kitagawa K, Toki Matsu I, Arakawa S, Fujisawa M. Shock due to urosepsis: A multicentre study. Can Urol Assoc. 2017; 11::e105–e109.
     [Google Scholar]
  13. Van Nieuwkoop C, Bonten TN, Van't Wout JW, Kuijper EJ, Groenevld GH, Becker MJ, et al.  Procalcitonin reflects bacteraemia and bacterial overload in urosepsis syndrome: A prospective observational study. Critical Care. 2010; 14::R206.
     [Google Scholar]
  14. Hsiao CY, Yang HY, Chang CH, Lin HL, Wu CY, Hsiao MC, et al.  Risk factors for development of septic shock in patients with urinary tract infection. Biomed Res Int. 2015; 2015::1–7.
     [Google Scholar]
  15. Jones GR, Lowes JA. The systemic inflammatory response as predictor of bacteraemia and outcome from sepsis. QJM. 1996; 89::5–15.
     [Google Scholar]
  16. Hamdi A, Hajage D, Glabeke EV, Belenfant X, Vincent F, Gonzalez F, et al.  Severe post-renal acute kidney injury, post-obstructive diuresis and renal recovery. BJUI. 2012; 110::1027–1034.
     [Google Scholar]
  17. Li AC, Regalado SP. Emergent PERCUTANEOUS nephrostomy for diagnosis and management of pyonephrosis. Semin Intervent Radiol. 2012; 29::218–225.
     [Google Scholar]
  18. Hsu CS, Wang CJ, Chang CH, Tsai PC, Chen HW, Su YC. Emergency percutaneous nephrostomy versus emergency percutaneous nephrolithotomy in patients with sepsis associated with large uretero-pelvic junction stone impaction: a randomized controlled trial. Int Braz J Urol. 2017; 43::481–488.
     [Google Scholar]
  19. www.uptodate.com/content/placement-and-management of indwelling-urethral-stents/down loaded on 10th Sep 2019.
  20. Chin BS, Kim JM. Risk factors for all causes in hospital mortality among Korean bacteraemia in urinary tract infection patients. Archives Gerontology and Geriatric. 2010; 52::50–55.
     [Google Scholar]
  21. Kim WY, Hong SB. Sepsis and acute respiratory distress syndrome. Recent Update. Tuberc Respir Dis (Seoul). 2016; 79::53–57.
     [Google Scholar]
  22. Bilgili B, Haliloglu M, Cinel I. Sepsis and acute injury kidney injury. Turk J Anesthesiol Reanim. 2014; 42::294–301.
     [Google Scholar]
  23. Angele MK, Pratschke S, Hubbard WJ, Chaudhary IH. Gender differences in sepsis. Cardiological and immunological aspects. Virulence. 2014; 5::12–19.
     [Google Scholar]
  24. Fukunaga A, KawakitaIn M. Risk factors for mortality in patients with urosepsis. European Urology Supplements. 2017; 16::e129.
     [Google Scholar]
/content/journals/10.5339/qmj.2020.8
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Community Acquired Urosepsis: A surgical intensive care Experience
Qatar Medical Journal 2020, 8 (2020); https://doi.org/10.5339/qmj.2020.8
/content/journals/10.5339/qmj.2020.8
/content/journals/10.5339/qmj.2020.8
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  • Article Type: Research Article
Keyword(s): acute kidney injury, Acute respiratory distress syndrome, Arabs, bacteremia, diabetes mellitus, Escherichia coli, extended-spectrum beta-lactamase, fever, leukocytosis, oliguria, septic shock and urosepsis

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