Clinico-microbiological profile of urosepsis patients in a tertiary care hospital in India: A 1-year study

Abstract

Objectives: Urosepsis is a life-threatening bacterial infection resulting from a complicated urinary tract infection. Early diagnosis of urosepsis, its causative agent, and the susceptibility pattern are most important for accurate treatment to prevent mortality. Diagnosis includes recognition of the presence of sepsis and the investigations that help in the management of patients. The most common organism causing urosepsis is Escherichia coli, followed by other members of the Enterobacteriaceae family. With this background, this study was conducted to determine the clinical-microbiological profile of urosepsis patients in our tertiary care hospital. Materials and Methods: This was a prospective observational study; patients with clinical urosepsis and growing identical bacteria from both urine and blood cultures taken simultaneously are included in the study. The details of the clinical presentation and laboratory investigation results were recorded on an Excel sheet. Statistical analysis: Statistical analysis was done using IBM Statistical Package for the Social Sciences Statistics V.23. The categorical variables such as demographic, microbiological, and other laboratory characteristics and clinical outcomes were analyzed and expressed in terms of frequencies and percentages. Continuous variables were expressed in terms of median. Independent t-test, Mann–Whitney U-test, Chi-square test, or Fisher’s exact test were used wherever applicable. Results: We found 87 urosepsis patients in one year with a mortality rate of 22.98%. The mean age of the patients was 61.5 years, with majority (42.42%) above 65 years. Gram-negative bacilli were frequently isolated, with the highest number of E. coli (68.96%), followed by Klebsiella pneumoniae (20.68%). Sixteen (18.4%) of Gram-negative bacilli were Carbapenem-resistant Enterobacteriaceae. Multiple risk factors were seen in 58/87 (66.66%) patients, with diabetes mellitus as the most common risk factor. Conclusions: Urosepsis is a critical condition with a high mortality rate. Meropenem can be used as an empirical therapy with careful observation of patients in view of the occurrence of carbapenem resistance. A multidisciplinary team approach comprising intensive care specialists, urologists, radiologists, and microbiologists is very important for the effective and rapid management of urosepsis.