Abstract
Background Urosepsis and septic shock are a critical situation leading to a mortality rate up to 30% in patients with obstructive diseases of the urinary tract. Aim To analyze the bacterial distribution and drug resistance of pathogenic bacteria in patients with urosepsis and to provide a basis for the rational application of antibacterial drugs in clinical practice. Methods A retrospective analysis of 94 hospitalized patients with urosepsis for 6 years was performed. The strain composition, resistance characteristics, and the antibiogram of common bacteria from positive blood and midstream urine culture were analyzed. Results A total of 87 strains were isolated, including 65 strains (74.71%) of Gram-negative bacilli, 14 strains (16.09%) of Gram-positive cocci, and 8 strains (9.20%) of fungi. The Gram-negative bacilli included 42 strains of Escherichia coli (E. coli) (64.62%), among which 34 strains (80.95%) were producing ESBLs, and 14 strains (21.84%) of Klebsiella pneumoniae (K. pneumoniae), among which nine strains (64.29%) were producing ESBLs. The most common pathogenic bacteria, ESBL+ E. coli and K. pneumoniae strains, showed sensitivity towards imipenem, ertapenem, piperacillin/tazobactam, amikacin, and cefotetan, but were highly resistant to quinolones. The cure rate of urosepsis was 88.30%, and the susceptibility rate of septic shock was 45.47%. Significance Gram-negative bacterial infections are the main cause of urosepsis. The mild patient group showed more E. coli (ESBL-) infections, and the number of ESBL producing E. coli isolated from the mild group showed higher drug resistance rates for aztreonam and levofloxacin compared with isolates from the severe group.
Highlights
Sepsis is a global public health problem, and it is one of the most common critical infectious diseases, with a mortality rate as high as 20-42%
Urosepsis was diagnosed according to the 2017 European Guidelines for Urinary Tract Infection: life-threatening organ dysfunction caused by imbalanced response to the infection in the host induced by urinary tract infections
This study suggested that the detection rates of extendedspectrum β-lactamases (ESBLs) in E. coli and K. pneumoniae strains were 80.95% and 64.29%, respectively, which were higher than in previous reports
Summary
Sepsis is a global public health problem, and it is one of the most common critical infectious diseases, with a mortality rate as high as 20-42%. Most of the current surgical methods are based on intraluminal invasive procedures and, for example, percutaneous nephrolithotomy (PCNL) involving high pressure irrigation and exosmose of the irrigating fluid can lead to the destruction of the tissue structure [5]. Other invasive procedures such as transrectal prostate biopsy can lead to damage of the intestinal mucosal barrier, and the intestinal flora entering the blood can increase the risk of BioMed Research International sepsis and subsequent septic shock. Urosepsis and septic shock are a critical situation leading to a mortality rate up to 30% in patients with obstructive diseases of the urinary tract. The mild patient group showed more E. coli (ESBL-) infections, and the number of ESBL producing E. coli isolated from the mild group showed higher drug resistance rates for aztreonam and levofloxacin compared with isolates from the severe group
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