Clinical Case Database / Category: Case Based Discussion

Diagnosis and management of urosepsis

Publication details

Dr Glynis Onwordi MBBS, BSc (Hons), Mr Dimitrios Volanis MD, PhD, FEBU, Mr Nimish Shah BSc(Hons), MBBS, MS, FRSC(Urol)
Foundation Years Journal, volume 8, issue 10, p.22 (123Doc Education, London, November 2014)

Abstract

Urosepsis is defined as sepsis syndrome caused by a urogenital tract infection. Overall, it accounts for approximately 25% of all sepsis cases. It is seen in both community-acquired and healthcare associated infections and it is associated with significant mortality rate. Generally, it is seen more frequently in patients with structural or functional abnormalities of the urinary tract. Understanding the complex pathophysiology of urosepsis is of paramount importance. Accumulating evidence suggests that cytokines play a central role in the pathogenesis of urosepsis by initiating a cascade of immune responses eventually leading to tissue-damaging inflammation. Early diagnosis and prompt management with adequate life-support measures, appropriate antibiotic treatment and reversal of any complicating factors are critical steps in the successful management of urosepsis. It is essential that urologists work in close collaboration with intensive care, radiology and microbiology specialists to provide the best conditions for improving patients' survival.

Access the Clinical Cases Database

A subscription is required to read the full article. Please subscribe using one of the options below.

Authors

Dr Glynis Onwordi MBBS, BSc (Hons) (Corresponding author)

Addenbrooke's Hospital Department of Urology
Cambridge University Hospitals, Cambridge Biomedical Campus
Hills Road, Cambridge, UK, CB2 0QQ
glynis.onwordi@doctors.org.uk

Mr Dimitrios Volanis MD, PhD, FEBU

Addenbrooke's Hospital Department of Urology
Cambridge University Hospitals, Cambridge Biomedical Campus
Hills Road, Cambridge, UK, CB2 0QQ
dimitrios.volanis@addenbrookes.nhs.uk

Mr Nimish Shah BSc(Hons), MBBS, MS, FRSC(Urol)

Addenbrooke's Hospital Department of Urology
Cambridge University Hospitals, Cambridge Biomedical Campus
Hills Road, Cambridge, UK, CB2 0QQ
nimish.shah@addenbrookes.nhs.uk

References

1. Martin GS, Mannino DM, Eaton S, Moss M.The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003 Apr 17;348(16):1546-54.
2. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med. 2002 Jul 8;113 Suppl 1A:5S-13S.
3. Wagenlehner FM, Pilatz A, Weidner W. Urosepsis--from the view of the urologist. Int J Antimicrob Agents. 2011 Dec;38 Suppl:51-7.
4. Brunkhorst FM. Epidemiology, economy and practice -- results of the German study on prevalence by the competence network sepsis. Anasthesiol Intensivmed Notfallmed Schmerzther. 2006 Jan;41(1):43-4.
5. Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med. 2003 Jan 9;348(2):138-50.
6. Rosser CJ, Bare RL, Meredith JW. Urinary tract infections in the critically ill patient with a urinary catheter. Am J Surg. 1999 Apr;177(4):287-90.
7. Brun-Buisson C, Meshaka P, Pinton P, et al; EPISEPSIS Study Group. EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Med 2004 Apr;30(4):580-8.
8. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013 Feb;41(2):580-637.
9. King EG, Bauzá GJ, Mella JRet al. Pathophysiologic mechanisms in septic shock. Lab Invest. 2014 Jan;94(1):4-12.
10. Schulte W, Bernhagen J, Bucala R. Cytokines in sepsis: potent immunoregulators and potential therapeutic targets--an updated view. Mediators Inflamm. 2013;2013:165974.
11. Levy MM, Fink MP, Marshall JC et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003 Apr;31(4):1250-6.
12. McNarry AF, Goldhill DR. Simple bedside assessment of level of consciousness: comparison of two simple assessment scales with the Glasgow Coma Scale. Anaesthesia 2004 Jan; 59 (1): 34-7
13. O'Leary C. Evidence-based management of sepsis. Clin J Oncol Nurs. 2014 Jun;18(3):280-2.
14. Goldman SM, Fishman EK. Upper urinary tract infection: the current role of CT, ultrasound, and MRI. Semin Ultrasound CT MR. 1991 Aug;12(4):335-60.
15. Stojadinović M, Mićić S, Milovanović D. Ultrasonographic and computed tomography findings in renal suppurations: performance indicators and risks for diagnostic failure. Urol Int. 2008;80(4):389-97.
16. Glück T, Opal SM. Advances in sepsis therapy. Drugs. 2004;64(8):837-59.
17. Annane D, Sébille V, Charpentier C et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002 Aug 21;288(7):862-71.
18. van den Berghe G, Wouters P, Weekers F, Intensive insulin therapy in critically ill patients. N Engl J Med. 2001 Nov 8;345(19):1359-67.
19. Wagenlehner FM, Lichtenstern C, Rolfes C et al. Diagnosis and management for urosepsis. Int J Urol. 2013 Oct;20(10):963-70.
20. Gorelov S, Zedan F, Startsev V. The choice of urinary drainage in patients with ureteral calculi of solitary kidneys. Arch Ital Urol Androl. 2004 Jun;76(2):56-8.
21. Regalado SP. Emergency percutaneous nephrostomy. Semin Intervent Radiol. Sep 2006; 23 (3): 287-294.
22. Paterson DL. Restrictive antibiotic policies are appropriate in intensive care units. Crit Care Med. 2003 Jan;31(1 Suppl):S25-8.
23. Stamm WE, Hooton TM. Management of urinary tract infections in adults. N Engl J Med. 1993 Oct 28;329(18):1328-34.
24. Johansen TE, Cek M, Naber KG, Stratchounski L, Svendsen MV, Tenke P. Hospital acquired urinary tract infections in urology departments: pathogens, susceptibility and use of antibiotics. Dara from the PEP and PEAP –studies. Int J Antimicrob Agents 2006; 28 (Suppl. 1): S91-107
25. Menninger M. Urosepsis, Klinik, Diagnostik und Therapie. In: Hofstetter A, editor. Urogenitale Infektionen. Berlin Heidelberg New York: Springer; 1998 p 521-8

Disclaimers

Conflict Of Interest

The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (http://www.icmje.org/urm_full.pdf).

Financial Statement

The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.

Patient Consent statement

All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts (http://www.icmje.org/urm_full.pdf). The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.

Animal & Human Rights

When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.

About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.