Clinical Profile and Outcome Analysis among Patients with Urosepsis at a Tertiary Care Centre: A Retrospective Cohort Study

Abstract

Introduction: Urosepsis is a systemic reaction of the body to a bacterial infection of the urogenital organs with the risk of lifethreatening complications including septic shock. Aim: To assess the profile of patients with urosepsis and to analyse outcomes in patient management at a tertiary care centre. Materials and Methods: A retrospective, single-centre study was conducted between January 2015 and December 2019 including patients of either sex, aged ≥20 to <80 years, with a confirmed diagnosis of urosepsis. Clinical report forms were reviewed to obtain patient characteristics (including age, sex, co-morbid conditions and clinical data). Blood, pus, urine culture data were evaluated to identify the source of infection. Details of upper and lower urinary tract symptoms and their imaging and urological intervention done were also recorded. Results: A total of 582 patients with urosepsis were included in this study. The majority of patients belonged to the age group of 41 to 60 years (n=315). The most frequent radiological diagnosis was infected hydronephrosis with calculus disease (n=237). The associated co-morbid conditions contributing to the perpetuation of urosepsis were Type II Diabetes Mellitus (T2DM), systemic hypertension, chronic kidney disease, decompensated liver disease, neurological disease, and coronary artery disease. Escherichia coli was the most commonly observed uropathogen (57.90%) in this study. Bilateral Double-J (DJ) stenting was usually preferred in patients with infected hydronephrosis and acute pyelonephritis (n=85, 76.58%). The insertion of a suprapubic catheter was more frequent among patients with obstructive lower urinary tract symptoms. Multivariate analysis showed that urosepsis with emphysematous pyelonephritis, uncontrolled diabetes, and persistent hypotension inspite of inotropic agents had a prolonged intensive care unit and higher mortality rate. Conclusion: Renal salvage is achievable in majority of cases with early surgical intervention, either DJ stenting or percutaneous nephrostomy. Suprapubic catheterisation is indicated in urosepsis patients with predominant lower urinary tract symptoms. An early diagnosis and an appropriate treatment can reduce the costs of hospitalisation, morbidity, mortality and better outcome.