Community-onset urosepsis: incidence and risk factors for 30-day mortality – a retrospective cohort study

Abstract

Background: Urosepsis is a life-threatening condition that needs to be addressed without delay. Two critical issues in its management are: (1) Appropriate empirical antibiotic therapy, considering the patients general condition, comorbidity, and the pathogen expected; and (2) Timing of imaging to identify obstruction requiring decompression. Objectives: To identify risk factors associated with 30-day mortality in patients with urosepsis. Methods: From a cohort of 1,605 community-onset bloodstream infections (CO-BSI), 282 patients with urosepsis were identified in a Swedish county 2019-2020. Risk factors for mortality with crude and adjusted odds ratios were analysed using logistic regression. Results: Urosepsis was found in 18% (n ¼ 282) of all CO-BSIs. The 30-day all-cause mortality was 14% (n ¼ 38). After multivariable analysis, radiologically detected urinary tract disorder was the predominant risk factor for mortality (OR ¼ 4.63, 95% CI ¼ 1.47-14.56), followed by microbiologically inappropriate empirical antibiotic therapy (OR ¼ 4.19, 95% CI ¼ 1.41-12.48). Time to radiological diagnosis and decompression of obstruction for source control were also important prognostic factors for survival. Interestingly, 15% of blood cultures showed gram-positive species associated with a high 30-day mortality rate of 33%. Conclusion:The 30-day all-cause mortality from urosepsis was 14%. The two main risk factors for mortality were hydronephrosis caused by obstructive stone in the ureter and inappropriate empirical antibiotic therapy. Therefore, early detection of any urinary tract disorder by imaging followed by source control as required, and antibiotic coverage of both gram-negative pathogens and gram-positive species such as E. faecalis to optimise management, is likely to improve survival in patients with urosepsis.

Risk Factors and the Impact of Multidrug-Resistant Bacteria on Community-Acquired Urinary Sepsis

“…Known risk factors for 30-day mortality, such as age, comorbidity, dependency, HCA-urinary sepsis, septic shock and IEAT [ 31 , 32 , 33 , 34 , 35 ], were analyzed by univariate analysis ( Table 5 ). Barthel ≤ 40, HCA-urinary sepsis, and septic shock had statistically significant differences between the 30-day mortality group and the survivors in the univariate analysis.…”

“…IEAT was not related to mortality, as shown in another study with bloodstream infection [ 33 ] with 31.4% of patients with a UTI. However, it has been related to mortality in patients with UTI [ 31 , 34 ]. According to the results of this study, with patients admitted to a hospital ward with urinary sepsis, the clinical severity at admission (septic shock) is what determines the patient’s prognosis in the urinary sepsis [ 31 ], not the etiology due to MDRB or non-MDRB.…”

Urosepsis 30-day mortality, morbidity, and their risk factors: SERPENS study, a prospective, observational multi-center study

“…The sepsis mortality rate varies, commonly reported around 10%, depending on factors like sepsis source, population studied, local AMR prevalence, and management protocols [ 1 – 4 ]. However, our study found a lower mortality rate due to lower proportion of severe sepsis cases, a favourable Charlson score (0–1) in 60% of the cohort and timely management [ 16 , 17 ]. Still, severe sepsis cases had a notable 4.6% mortality rate.…”

“…Our findings also indicate MDR pathogens as significant predictors of urosepsis mortality and organ failure. In a Swedish retrospective study community onset urosepsis with blood stream infection (2019 and 2020), low AMR rates were observed and inappropriate empirical treatment was associated with mortality [ 16 ]. In our study in 89% of cases, the pathogens were susceptible to the antibiotics given.…”

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“…On the one hand, stones block the ureter and cause hydronephrosis, which provides favorable conditions for the growth and reproduction of bacteria. (Holmbom, et al 2022) On the other hand, infection damages the urinary tract mucosa, upregulates osteopontin in renal tubular cells and changes the pH value of urine to promote the formation of urinary calculi. (Espinosa-Ortiz, et al 2019) To address this problem, removing stones as completely as possible has become the foundation of treatment.…”