Clinicolaboratory Profile and Outcome of Patients with Urosepsis at a Tertiary Care Centre in Southern India

Abstract

Introduction: Urosepsis is a serious, life-threatening consequence of a complicated Urinary Tract Infection (UTI). It is caused by bacterial infection of the urinary tract or prostate that spreads into the bloodstream. Since urosepsis is associated with a very high mortality rate (20-40%), an early diagnosis and identification of the causative bacteria is important so as to facilitate a prompt treatment with appropriate antibiotics. Nearly 50% cases of urosepsis are caused by the Gram Negative Bacterial (GNB) pathogen, Escherichia coli(E. coli). Aim: To determine the bacteriological profile, antimicrobial susceptibility pattern, phenotypic resistance of the organisms associated with urosepsis and to correlate the levels of proinflammatory markers with the clinical outcome of the patient associated with urosepsis. Materials and Methods: This was a prospective observational study including all patients with simultaneously positive urine and blood cultures, with identical bacterial isolate(s). The details of clinical presentation, antibiotic therapy and other relevant information such as C-Reactive Protein (CRP) and Procalcitonin (PCT) values were recorded and analysed using Microsoft office excel 2013. Results:E. coli was the commonest isolate (43/53, 81.1%). Of the total 43 E. coli isolates, 4/43 (9.3%) were Extended Spectrum Beta Lactamase (ESBL) producers and 23/43 (53.49%) were Carbapenemase producers. Significant rise of the proinflammatory markers (PCT>10 ng/mL) and (CRP>100 mg/l) were associated with high mortality (49%). Out of the 53 patients, 43.4% (23/53) patients had more than one risk factor associated with severe sepsis and poor prognosis. conclusion: Early recognition of symptoms followed by accurate diagnosis and early goal directed therapy is essential to decrease morbidity and mortality from urosepsis.