Community-onset urosepsis – Article

introduce

The global incidence of sepsis is estimated to be 31.5 million cases every year, which results in 5.3 million death toll. The detection and management of sepsis has become a priority for many hospitals, and the World Health Organization considers sepsis a serious problem.It is important to distinguish between the two sepsis and shock Sepsis due to high mortality in the latter.

Urinary tract infection (UTI) is the source of approximately 10-30% of sepsis cases and is associated with high morbidity and mortality.Complicated urinary tract infection (cUTI) is the most common cause urosepsis Adults over 65 years of age. Prompt diagnosis of urosepsis and provision of prompt antibiotic therapy, supportive care, and source control are critical.

Conditions predisposing to febrile urinary tract infections include any structural, anatomical and/or functional abnormality that impedes the flow of urine, as well as the primary causes of febrile urinary tract infections. uremic shock This is a urinary tract obstruction.Therefore, patients urosepsis They usually require early radiologic evaluation to rule out any obstructive urinary tract disease.

As a clinician facing a patient with suspected or confirmed urosepsis, there are two key questions.

1. The first is choice empiric antibiotic therapy and appropriate dosage, taking into account the patient’s general condition, comorbidities and anticipated pathogens, especially given the increased endurance Enterobacteriaceae antibiotics.
   
2. The second is the timing of imaging for diagnosis and possible source control to exclude obstruction requiring decompression.

In this study of patients with community-onset bloodstream infections (CO-BSI) in 2019 and 2020, a defined retrospective cohort was selected to determine risk factors for death associated with urosepsis within 30 days of the date of the first positive blood culture.

background

Urosepsis is a life-threatening condition that must be addressed immediately. Two key aspects of its management are:

(1) Appropriate empiric antibiotic therapy, taking into account the patient’s general condition, comorbidities, and expected pathogens.

(2) Timing of imaging to identify obstruction requiring decompression.

Target

identify risk factors Associated with 30-day mortality in patients with urosepsis.

method

from a group 1,605 infections community-onset bleeding (CO-BSI), identified 282 patients Urosepsis in a Swedish county in 2019-2020.Mortality risk factors odds ratio Crude and adjusted values ​​were analyzed using logistic regression.

result

it was found urosepsis Accounted for 18% (n = 282) of all community-onset bloodstream infections (CO-BSI).

this die All-cause mortality at 30 days was 14% (n = 38).

After multi-factor analysis, urinary tract disease Radiologically detected major risk factor for death (OR = 4.63, 95% CI = 1.47–14.56), followed by microbiological empiric antibiotic therapy improper (OR = 4.19, 95% CI = 1.41–12.48).

Time to radiographic diagnosis and decompression of the obstruction to control the source are also important prognostic factors for survival.

Interestingly, 15% of blood cultures showing Gram-positive bacteria were associated with a 33% higher 30-day mortality rate.

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in conclusion

The 30-day all-cause mortality rate for urosepsis is 14%.The two main risk factors for death are hydronephrosis Caused by ureteral stone obstruction Insufficient empiric antibiotic therapy.

Therefore, early detection of any urinary tract disease with imaging, followed by source control as needed and optimal management with antibiotic coverage of Gram-negative pathogens and Gram-positive bacteria (e.g., Enterococcus faecalis) may improve the outcome of pyuria Survival rate of toxic patients. .

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discuss

Several independent risk factors were associated with 30-day mortality in patients with community-onset bloodstream infection (CO-BSI) and urosepsis during the 2-year study period. In multivariable logistic regression models, urinary tract disease, inadequate empiric antibiotic therapy, and disease severity (In-SOFA score and 24-hour SOFA) were associated with a significantly increased risk of 30-day all-cause mortality.