Is the term urosepsis still used in clinical practice?

The Term "Urosepsis" in Clinical Practice

Yes, the term "urosepsis" is still actively used in clinical practice to describe sepsis originating from urinary tract infections. 1

Definition and Clinical Significance

• Urosepsis is defined as sepsis caused by a urogenital tract infection, representing approximately 25% of all sepsis cases 2, 3
• It is characterized as life-threatening organ dysfunction resulting from a dysregulated host response to infection originating in the urinary tract 1
• Clinical assessment includes evaluation using Sequential Organ Failure Assessment (SOFA) or quick SOFA (qSOFA) scores to determine severity and risk of mortality 4
• While the overall incidence of sepsis is decreasing, there has been a notable rise in severe UTIs leading to urosepsis 1

Diagnostic Approach

• Diagnosis requires complete microbiological sampling, including two sets of blood cultures before starting antimicrobials 4
• Early imaging studies are essential to identify urinary tract obstruction, stones, or abscesses that may be causing urosepsis 4
• Ultrasound is often the first imaging modality of choice in suspected urosepsis due to its portability and rapid acquisition 1
• CT imaging plays an important role in evaluation of patients with suspected urosepsis due to its high positive predictive value 1

Management Framework

• Treatment of urosepsis comprises four major aspects 4, 2, 3:

  1. Early diagnosis
  2. Early goal-directed therapy including optimal antimicrobial treatment
  3. Identification and control of complicating factors in the urinary tract
  4. Specific sepsis therapy

• Empiric antimicrobial treatment options include 1, 4:

  • Amoxicillin plus an aminoglycoside
  • A second-generation cephalosporin plus an aminoglycoside
  • An intravenous third-generation cephalosporin

• Fluoroquinolones should be avoided if local resistance rates are ≥10% or if the patient has used them in the last 6 months 1, 4

Source Control

• Identifying and addressing any urinary tract obstruction or anatomical abnormality within 12 hours of diagnosis is critical 4, 3
• Any indwelling urinary catheter should be removed or replaced before starting antimicrobial therapy 4
• The least invasive approach for source control should be utilized 4, 5

Common Pitfalls to Avoid

• Delaying antimicrobial therapy beyond one hour in patients with septic shock significantly increases mortality 4, 6
• Failing to obtain appropriate cultures before starting antimicrobials 4
• Neglecting source control, particularly in obstructive uropathy 4, 3
• Using fluoroquinolones empirically in areas with high resistance rates 1, 4

Interdisciplinary Approach

• Optimal management of urosepsis requires collaboration between urologists, intensive care specialists, radiologists, microbiologists, and clinical pharmacologists 4, 6, 5
• This interdisciplinary approach is essential for rapid identification and control of the septic focus in the urinary tract 7, 3