Community-onset urosepsis : incidence and risk factors for 30-day mortality–a retrospective cohort study
(2022) In Scandinavian Journal of Urology 56(5-6). p.414-420- Abstract
Background: Urosepsis is a life-threatening condition that needs to be addressed without delay. Two critical issues in its management are: (1) Appropriate empirical antibiotic therapy, considering the patients general condition, comorbidity, and the pathogen expected; and (2) Timing of imaging to identify obstruction requiring decompression. Objectives: To identify risk factors associated with 30-day mortality in patients with urosepsis. Methods: From a cohort of 1,605 community-onset bloodstream infections (CO-BSI), 282 patients with urosepsis were identified in a Swedish county 2019–2020. Risk factors for mortality with crude and adjusted odds ratios were analysed using logistic regression. Results: Urosepsis was found in 18% (n =... (More)
Background: Urosepsis is a life-threatening condition that needs to be addressed without delay. Two critical issues in its management are: (1) Appropriate empirical antibiotic therapy, considering the patients general condition, comorbidity, and the pathogen expected; and (2) Timing of imaging to identify obstruction requiring decompression. Objectives: To identify risk factors associated with 30-day mortality in patients with urosepsis. Methods: From a cohort of 1,605 community-onset bloodstream infections (CO-BSI), 282 patients with urosepsis were identified in a Swedish county 2019–2020. Risk factors for mortality with crude and adjusted odds ratios were analysed using logistic regression. Results: Urosepsis was found in 18% (n = 282) of all CO-BSIs. The 30-day all-cause mortality was 14% (n = 38). After multivariable analysis, radiologically detected urinary tract disorder was the predominant risk factor for mortality (OR = 4.63, 95% CI = 1.47–14.56), followed by microbiologically inappropriate empirical antibiotic therapy (OR = 4.19, 95% CI = 1.41–12.48). Time to radiological diagnosis and decompression of obstruction for source control were also important prognostic factors for survival. Interestingly, 15% of blood cultures showed gram-positive species associated with a high 30-day mortality rate of 33%. Conclusion: The 30-day all-cause mortality from urosepsis was 14%. The two main risk factors for mortality were hydronephrosis caused by obstructive stone in the ureter and inappropriate empirical antibiotic therapy. Therefore, early detection of any urinary tract disorder by imaging followed by source control as required, and antibiotic coverage of both gram-negative pathogens and gram-positive species such as E. faecalis to optimise management, is likely to improve survival in patients with urosepsis.
(Less)
- author
- Holmbom, Martin ; Andersson, Maria ; Grabe, Magnus LU ; Peeker, Ralph ; Saudi, Aus ; Styrke, Johan and Aljabery, Firas
- organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- 30-day mortality, bloodstream infection, community-onset, empirical antibiotic therapy, risk factors, urinary tract disorder, urinary tract infection, Urosepsis
- in
- Scandinavian Journal of Urology
- volume
- 56
- issue
- 5-6
- pages
- 7 pages
- publisher
- Taylor & Francis
- external identifiers
-
- scopus:85139160066
- pmid:36127849
- ISSN
- 2168-1805
- DOI
- 10.1080/21681805.2022.2123039
- language
- English
- LU publication?
- yes
- id
- 2b216738-94eb-404d-ae3f-7ce335a0b54a
- date added to LUP
- 2022-12-14 13:26:22
- date last changed
- 2024-04-14 10:14:50
@article{2b216738-94eb-404d-ae3f-7ce335a0b54a,
abstract = {{<p>Background: Urosepsis is a life-threatening condition that needs to be addressed without delay. Two critical issues in its management are: (1) Appropriate empirical antibiotic therapy, considering the patients general condition, comorbidity, and the pathogen expected; and (2) Timing of imaging to identify obstruction requiring decompression. Objectives: To identify risk factors associated with 30-day mortality in patients with urosepsis. Methods: From a cohort of 1,605 community-onset bloodstream infections (CO-BSI), 282 patients with urosepsis were identified in a Swedish county 2019–2020. Risk factors for mortality with crude and adjusted odds ratios were analysed using logistic regression. Results: Urosepsis was found in 18% (n = 282) of all CO-BSIs. The 30-day all-cause mortality was 14% (n = 38). After multivariable analysis, radiologically detected urinary tract disorder was the predominant risk factor for mortality (OR = 4.63, 95% CI = 1.47–14.56), followed by microbiologically inappropriate empirical antibiotic therapy (OR = 4.19, 95% CI = 1.41–12.48). Time to radiological diagnosis and decompression of obstruction for source control were also important prognostic factors for survival. Interestingly, 15% of blood cultures showed gram-positive species associated with a high 30-day mortality rate of 33%. Conclusion: The 30-day all-cause mortality from urosepsis was 14%. The two main risk factors for mortality were hydronephrosis caused by obstructive stone in the ureter and inappropriate empirical antibiotic therapy. Therefore, early detection of any urinary tract disorder by imaging followed by source control as required, and antibiotic coverage of both gram-negative pathogens and gram-positive species such as E. faecalis to optimise management, is likely to improve survival in patients with urosepsis.</p>}},
author = {{Holmbom, Martin and Andersson, Maria and Grabe, Magnus and Peeker, Ralph and Saudi, Aus and Styrke, Johan and Aljabery, Firas}},
issn = {{2168-1805}},
keywords = {{30-day mortality; bloodstream infection; community-onset; empirical antibiotic therapy; risk factors; urinary tract disorder; urinary tract infection; Urosepsis}},
language = {{eng}},
number = {{5-6}},
pages = {{414--420}},
publisher = {{Taylor & Francis}},
series = {{Scandinavian Journal of Urology}},
title = {{Community-onset urosepsis : incidence and risk factors for 30-day mortality–a retrospective cohort study}},
url = {{http://dx.doi.org/10.1080/21681805.2022.2123039}},
doi = {{10.1080/21681805.2022.2123039}},
volume = {{56}},
year = {{2022}},
}