Abstract
Urosepsis contributes significantly to the epidemiology of sepsis. Urosepsis can be classified as community acquired or hospital acquired, depending upon the origin of infection acquisition: either from the community or from a healthcare facility. A great deal of literature is available about nosocomial urosepsis, but the literature regarding community-acquired urosepsis (CAUs) is limited, and studies are underpowered. The aim of our study was to determine the epidemiology, bacteriology, severity, and outcome of CAUs. Methods and Patients: All patients admitted from the emergency department to the surgical intensive care unit (SICU) with urosepsis over a period of 10 years were identified and included retrospectively from the SICU registry. The study was retrospective. Data were entered into the SPSS program version 23, and groups were compared by using chi-square and t-tests. Results were considered statistically significant at p ≤ 0.05. Results: During the study period, 302 patients with CAUs were admitted to the SICU. The common etiology was obstructive uropathy (60%). The Local Arab population outnumbered the non-Arab population (164/54.3%), and there were equal numbers of patients of both genders. Diabetes mellitus and hypertension together were the common comorbidities. Seventy-five percent of patients had acute kidney injury (AKI). Thirty-eight percent of patients had percutaneous nephrostomy, and 24.8% of patients underwent endoscopic stent insertion to relieve the obstruction. Ninety-three percent of patients were admitted with septic shock, and 71.5% had bacteremia. The common bacteria (36.1%) was extended-spectrum beta-lactamase-(ESBL)-producing bacteria, with a predominance of Escherichia coli (31.5%). Fifty-four percent of patients required a change of antibiotics to carbapenem. Eighty-two percent of patients had acute respiratory distress syndrome (ARDS). Patients with bacteremia had a statistically significant AKI, ARDS, and septic shock (p < 0.001). Male patients had a significantly higher incidence of oliguria, intubation, and ARDS (p < 0.05). Eight patients died of urosepsis during the study period, giving a mortality rate of 2.6%. Conclusion: In our patients, obstruction of urine flow was the most common cause of CAUs. Our urosepsis patients had a higher bacteremia rate, which led to higher incidences of organ dysfunction and septic shock. ESBL bacteria were a frequent cause of urosepsis, requiring a change of the initial antibiotic to carbapenem. Male patients had a significantly higher rate of organ dysfunction. Mortality in our urosepsis patients was lower than mentioned in the literature.
Highlights
Patients required a change of antibiotics to carbapenem
After permission was obtained from the research department of our institution (Permission Number: 13429/13), all patients admitted to the surgical intensive care unit of our hospital with urosepsis were identified from the admission registry for a duration of 10 years (2008 –18)
Urosepsis patients' demographic data, presenting complaints, laboratory data on admission, diagnosis, bacteriology, antibiotic therapy, sequential organ failure assessment (SOFA) score, ICU length of stay, image-guided interventions, endoscopic/surgical interventions performed, severity of sepsis or septic shock status, and outcome were recorded retrospectively
Summary
Patients required a change of antibiotics to carbapenem. Eighty-two percent of patients had acute respiratory distress syndrome (ARDS). The aim of our study was to determine the epidemiology, bacteriology, antibiotic therapy, and intensive care management of CAUs. After permission was obtained from the research department of our institution (Permission Number: 13429/13), all patients admitted to the surgical intensive care unit of our hospital (the only tertiary care hospital in the country) with urosepsis were identified from the admission registry for a duration of 10 years (2008 –18). Urosepsis is defined as systemic inflammatory response syndrome with a suspected or diagnosed source in the urogenital tract.[2] Urosepsis is severe if sepsis leads to organ dysfunction in these patients. If these patients with severe sepsis develop hypotension and do not respond to fluid resuscitation, they are in septic shock.[7]
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