From the Guidelines
Urosepsis is a life-threatening condition that requires immediate medical attention, and its symptoms include fever, chills, flank pain, nausea, vomiting, and tenderness at the costovertebral angle, with or without symptoms of cystitis, as noted in the 2024 European Association of Urology guidelines 1. The symptoms of urosepsis can vary, but they typically present with systemic inflammatory response symptoms, including high fever, chills, rapid breathing, and increased heart rate.
- Fever is often above 38 °C, as indicated in the guidelines 1
- Chills and flank pain are common symptoms, along with nausea and vomiting
- Tenderness at the costovertebral angle is also a significant symptom, which may or may not be accompanied by symptoms of cystitis, as stated in the guidelines 1 Treatment of urosepsis requires prompt differentiation between uncomplicated and potentially obstructive pyelonephritis, and the use of fluoroquinolones and cephalosporins as the only recommended antimicrobial agents for oral empiric treatment of uncomplicated pyelonephritis, as recommended in the guidelines 1.
- For patients with uncomplicated pyelonephritis requiring hospitalization, an intravenous antimicrobial regimen such as a fluoroquinolone, an aminoglycoside, or an extended-spectrum cephalosporin or penicillin should be used, as outlined in the guidelines 1
- The choice of antimicrobial agent should be based on local resistance patterns and optimized, with carbapenems and novel broad-spectrum antimicrobial agents reserved for patients with multidrug-resistant organisms, as noted in the guidelines 1
- Urinalysis, urine culture, and antimicrobial susceptibility testing should be performed in all cases of pyelonephritis, along with evaluation of the upper urinary tract via ultrasound to rule out urinary tract obstruction or renal stone disease, as recommended in the guidelines 1
From the Research
Urosepsis Symptoms
- Urosepsis is a serious, life-threatening complication of infections originating from the urinary tract 2
- It is defined as sepsis caused by a urogenital tract infection, which can be due to complicated urinary tract infections, obstructed uropathy of the upper urinary tract, or ureterolithiasis 3, 4
- Symptoms of urosepsis can include severe sepsis or septic shock, with a reported mortality rate ranging from 30% to 40% 3
Treatment of Urosepsis
- Treatment of urosepsis comprises four major aspects:
- Early adequate tissue oxygenation, adequate initial antibiotic therapy, and rapid identification and control of the septic focus in the urinary tract are critical steps in the successful management of a patient with urosepsis 3
- Supportive therapy, antimicrobial therapy, control or elimination of the complicating factor, and specific sepsis therapy are also essential components of treatment 4, 5
- Accurate catheter care is the best measure to adopt for the prevention of urosepsis 6