What are the criteria for diagnosing urosepsis (urinary tract infection (UTI) with sepsis)?

From the Guidelines

Urosepsis is diagnosed when a patient has sepsis originating from a urinary tract infection (UTI), characterized by organ dysfunction attributed to an infection, and is defined as a life-threatening condition that requires prompt recognition and treatment. The criteria for sepsis include signs of systemic inflammatory response syndrome (SIRS) plus evidence of a urinary source of infection, such as urinary symptoms (dysuria, frequency, urgency), pyuria (>10 white blood cells per high-power field), bacteriuria, or positive urine culture 1. Patients with at least two of three clinical abnormalities, including Glasgow coma score of 14 or less, systolic blood pressure of 100 mmHg or less, and respiratory rate 22/min or greater, may have a poor outcome typical of sepsis 1.

Key Diagnostic Criteria

• Temperature >38°C or <36°C
• Heart rate >90 beats/minute
• Respiratory rate >20 breaths/minute or PaCO2 <32 mmHg
• White blood cell count >12,000/mm³ or <4,000/mm³ or >10% immature bands
• Evidence of a UTI, such as urinary symptoms, pyuria, bacteriuria, or positive urine culture

Treatment Approach

• Start empiric broad-spectrum antibiotics immediately after obtaining blood and urine cultures
• Common regimens include piperacillin-tazobactam 4.5g IV every 6 hours, ceftriaxone 2g IV daily plus metronidazole 500mg IV every 8 hours, or meropenem 1g IV every 8 hours for more severe cases
• Adjust antibiotics based on culture results, typically continuing for 7-14 days depending on clinical response
• Source control is essential, so any urinary obstruction should be relieved promptly
• Fluid resuscitation and hemodynamic support are crucial components of management, with the goal of restoring a mean arterial pressure of 65 to 70 mmHg 1

Importance of Early Recognition and Treatment

Early recognition and treatment of urosepsis are vital, as it can rapidly progress to septic shock and multi-organ failure, particularly in elderly patients and those with comorbidities 1. Prompt administration of intravenous fluids and vasopressors is always mandatory, and norepinephrine is now the first-line vasopressor agent used to correct hypotension in the event of septic shock 1.

From the Research

Urosepsis Criteria

Urosepsis is defined as sepsis caused by a urogenital tract infection 2, 3, 4, 5, 6. The criteria for urosepsis include:

• Sepsis caused by a urogenital tract infection
• Presence of obstructive uropathy, such as urolithiasis, tumors, or strictures 2, 3, 4, 6
• Clinical features, altered vital signs, and laboratory abnormalities 4
• Diagnosis made early on the basis of physical examination, blood cultures, urinalysis, procalcitonin measurement, and ultrasonography 4

Causes of Urosepsis

The causes of urosepsis include:

• Complicated urinary tract infections 2
• Obstructed uropathy of the upper urinary tract, with ureterolithiasis being the most common cause 2
• Nosocomial infections 6
• Enterobacteria and Gram-positive organisms as the most common pathogens 4

Treatment of Urosepsis

The treatment of urosepsis comprises:

• Early diagnosis and treatment with antibiotics 2, 3, 4, 5
• Identification and control of the complicating factor in the urinary tract 2, 3
• Supportive therapy, including stabilizing and maintaining blood pressure 3
• Specific sepsis therapy, including antimicrobial therapy and life support 2, 3, 5
• Multidisciplinary management, including urology, intensive care, imaging, and laboratory medicine departments 5