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Urosepsis

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Evidence-Based Critical Care

Abstract

Urosepsis, often termed sepsis of a urinary source, is a commonly encountered diagnosis in the ICU accounting for approximately 30% of cases of sepsis worldwide. It can present with or without urinary tract obstruction. The diagnosis is typically made by demonstrating signs and symptoms of urinary tract infection in a patient with sepsis or septic shock. Management specific to urosepsis includes therapies common to treatment of sepsis in general: early recognition, resuscitation, and early appropriate antibiotic administration. In urosepsis, recognition and amelioration of urinary obstruction plays an important role in management. Urinary obstruction can be identified by CT or ultrasound. Relieving urinary obstruction can be accomplished percutaneously, surgically, or via cystoscopy. Conflicting data exists for the appropriate up-front antibiotic regimen, indications for imaging, and the most appropriate method for intervention when obstruction is present. In this chapter, the diagnosis and management of urosepsis will be discussed. The conflicting data on antibiotics, imaging, and intervention will be addressed.

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References

  1. Brunkhorst FM. Epidemiology, economy and practice—results of the German study on prevalence by the competence network sepsis (SepNet) [in German]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2006;41:43–4.

    Article  CAS  Google Scholar 

  2. Tandogdu Z, Bjerklund Johansen TE, Bartoletti R, Wagenlehner FME. Management of the urologic sepsis syndrome. Eur Urol Suppl. 2016;15:102–11.

    Article  Google Scholar 

  3. Nicolle L. Urinary tract infection. Crit Care Clin. 2013;29:699–715.

    Article  Google Scholar 

  4. Calandra T, et al. International sepsis forum definition of infection in the ICU Consensus Conference. The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Crit Care Med. 2005;33:1538–48.

    Article  Google Scholar 

  5. Demertzis J, et al. State of the art: imaging of renal infections. Emerg Radiol. 2007;14:13–22.

    Article  Google Scholar 

  6. Grabe M, Bjerklund-Johansen TE, Botto H, et al. Guidelines on urological infections. Eur Assoc Urol. Website. http://www.uroweb.org/gls/pdf/15_U.

  7. Pappas PG, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48:503–35.

    Article  CAS  Google Scholar 

  8. Naber KG, et al. Intravenous Doripenem at 500 milligrams versus levofloxacin at 250 milligrams with an option to switch to Oral therapy, for treatment of complicated lower tract infection and pyelonephritis. Antimicrob Agents Chemother. 2009;53(9):3782–92.

    Article  CAS  Google Scholar 

  9. Wells WG, et al. Treatment of complicated urinary tract infection in adults: combined analysis of two randomized, double-blind, multicentre trials comparing ertapenem and ceftriaxone followed by appropriate oral therapy. J Antimicrob Chemother. 2004;53(Suppl. S2):ii67–74.

    CAS  PubMed  Google Scholar 

  10. Demertzis J, et al. State of the art: imaging of renal infections. Emerg Radiol. 2007;14:13–22.

    Article  Google Scholar 

  11. Pearle M, et al. Optimal method of urgent decompression of the collecting system for obstruction and infection due to ureteral calculi. J Urol. 1998;160:1260–4.

    Article  CAS  Google Scholar 

  12. Ramsey S. Evidence-based drainage of infected hydronephrosis secondary to ureteric calculi. J Endourol. 2010;24(2):185–9.

    Article  Google Scholar 

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Correspondence to Garth W. Garrison .

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Euceda, G., Keveson, B., Garrison, G.W. (2020). Urosepsis. In: Hyzy, R.C., McSparron, J. (eds) Evidence-Based Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-26710-0_59

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  • DOI: https://doi.org/10.1007/978-3-030-26710-0_59

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-26709-4

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