From the Guidelines
Urosepsis treatment involves comprehensive life-supportive measures, timely and suitable antimicrobial therapy, adjunctive interventions, and effective management of urinary tract abnormalities.
Key Components of Treatment
- Source control: Establishing source control by alleviating any obstruction and draining significant abscesses within the urinary tract is crucial 1.
- Antimicrobial therapy: Timely and suitable antimicrobial therapy is essential, with consideration of the typical gram-negative Enterobacteriaceae, gram-positive cocci, and obligate anaerobes involved in urinary tract infections 1.
- Urinary tract decompression: In patients with pyonephrosis (hydronephrosis with infection), urinary tract decompression can be lifesaving, and percutaneous drainage or retrograde ureteral catheterization may be necessary 1.
- Collaborative treatment: Collaborative treatment involving urologists, intensive care, and infectious disease specialists is recommended for optimal patient care 1.
Antimicrobial Therapy Considerations
- Empirical antibiotic treatment: Empirical antibiotic treatment should be administered preoperatively and adapted to the results of hemocultures and microbiological cultures 1.
- Antibiotic de-escalation: Antibiotic de-escalation, starting with broad-spectrum antibiotics and narrowing the drug spectrum based on culture sensitivities, should be implemented to avoid selecting resistant pathogens 1.
- Specific antibiotics: Fourth-generation cephalosporins or carbapenems, such as meropenem or imipenem, may be used for multidrug-resistant Enterobacter infections 1.
Additional Considerations
- Imaging investigations: Early imaging investigations, including sonography and computed tomography scans, should be conducted to guide treatment 1.
- Microbiological sampling: Microbiological sampling, including urine, blood cultures, and drainage fluids, is essential for guiding antibiotic treatment 1.
From the Research
Treatment of Urosepsis
The treatment of urosepsis comprises four major aspects:
- Early goal-directed therapy
- Early optimal pharmacodynamic exposure to antimicrobials
- Early control of the complicating factor in the urinary tract
- Specific sepsis therapy 2, 3, 4
Key Components of Treatment
The key components of treatment include:
- Early tissue oxygenation
- Appropriate initial antibiotic therapy
- Rapid identification and control of the septic focus in the urinary tract 3
- Early empiric intravenous antimicrobial treatment 4
- Identification and control of complicating factors 4
Importance of Interdisciplinary Approach
An optimal interdisciplinary approach encompassing urologists, intensive care specialists, radiologists, microbiologists, and clinical pharmacologists is necessary for the successful management of urosepsis 2, 3, 5
Pharmacokinetic Characteristics of Antimicrobials
The treatment of urosepsis should take into account the pharmacokinetic characteristics of antimicrobials, including renal pharmacokinetics, variations in pH, and biofilm infection 5
Prevention Measures
Prevention measures, such as the early removal of catheters and optimal catheter care, may help reduce the frequency of urosepsis 5