Shock due to urosepsis: A multicentre study

Abstract

Introduction: Urosepsis is a severe infection that can cause shock afterwards. The purpose of this study is to investigate the clinical and bacterial risk factors for shock in those cases with urosepsis caused by urinary tract infection in a multicentre study. Methods: Our study included 77 consecutive urosepsis cases from four hospitals. We examined factors such as patient characteristics, underlying disease, serum white blood cell (WBC) count, platelet count, C-reactive protein (CRP) level at the time of diagnosis of urosepsis, urinary tract occlusion, causative bacteria, and bacterial antibiotic susceptibilities. Statistical analyses were performed to assess the potential risk factors for shock during the clinical course of urosepsis by a multivariate analysis. Results: We had 38 male and 39 female patients aged 25-104 (median 73). Underlying diseases included cancers (n=22, 28.6 %) and diabetes mellitus (n=17, 22.1 %). Positive blood culture was seen in 74 cases; these involved 88 bacterial strains, of which Escherichia coli was the most common (34 strains, 38.6 %). There were 31 cases with shock (40.3 %) and multivariate analyses demonstrated that serum CRP was the only clinical risk factor for shock due to urosepsis. Conclusions: Our study demonstrated that serum CRP was a risk factor for shock during urosepsis in a multicentre analysis. Further prospective studies with a greater number of patients are needed to draw more definitive conclusions.

Bacteremia complicating urinary tract infection by Pseudomonas aeruginosa: Mortality risk factors

“…found that frequently isolated causative bacteria for urosepsis or bacteremic UTI other than E. coli with or without ESBL‐producing bacteria included Proteus species, Enterococcus species, Klebsiella species, other Gram‐positive cocci and P. aeruginosa . In the present study, we showed that clinical risk factors for death associated with P. aeruginosa ‐causing bacteremia included the isolations of Klebsiella pneumoniae , Staphylococcus aureus or Staphylococcus epidermidis . However, as aforementioned, our comparatively high mortality rate (14.5%) from P. aeruginosa urosepsis required particular attention.…”

“…6 In the present study, we showed that clinical risk factors for death associated with P. aeruginosa-causing bacteremia included the isolations of Klebsiella pneumoniae, Staphylococcus aureus or Staphylococcus epidermidis. 8 However, as aforementioned, our comparatively high mortality rate (14.5%) from P. aeruginosa urosepsis required particular attention. Other risky bacteria, for instance ESBL-producing E. coli or K. pneumoniae cases, accounted for 41.5% of adults with hospital-acquired urosepsis, but the clinical risk factors for infection-related death from P. aeruginosa should be also monitored in order to reduce mortality.…”

“…6 Several reports have emphasized the importance of detecting risk factors for urosepsis, septic shock from urosepsis and clinical factors associated with shock in bacteremic UTI. 7,8 Risk factors of death from bacteremic UTI include age, female sex, immunosuppression (due to diabetes, organ transplantation, chemotherapy or steroid dosing), chronic renal failure, acquired immunodeficiency syndrome, anemia, stone with a diameter of >2.5 cm and extremely long operation time. [9][10][11] Instead, Escherichia coli is representative bacteria for UTI or urogenital infection, and there are several studies of E. coli bacteremia.…”

Risk Factors for Progression to Severe Sepsis or Septic Shock in Patients with Urolith Induced Obstructive Urosepsis

“…CRP and PCT are widely used in clinical practice as important indicators to reflect the degree of inflammation in the body. Fukashi Yamamichi et al 14 analysed on the data of77 patients with urosepsis, suggesting that CRP was the only risk factor for sepsis involving tumor obstructionto progress to septic shock. In contrast to Yamamichi, most scholars believe that PCT is significantly superior to CRP in the diagnostic sensitivity and specificity of severe sepsis and septic shock, and is also superior to CRP in the assessment of the severity and prognosis of the disease.…”

Urolithiasis Is a Risk Factor for Uroseptic Shock and Acute Kidney Injury in Patients With Urinary Tract Infection

“…Multiple factors attributing to septic shock have previously been reported in patients with UTI. Indwelling urinary catheter and increased C-reactive protein levels were risk factors of septic shock in UTI patients with or without bacteremia (18, 21). Our study showed that urolithiasis could be a good predictor of the development of uroseptic shock in UTI patients.…”