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6. SEPSIS SYNDROME IN UROLOGY (UROSEPSIS)

SUMMARY

Patients with urosepsis should be diagnosed at an early stage, especially in the case of a complicated UTI. Systemic inflammatory response (fever or hypothermia, tachycardia, tachypnoea, hypotension, oliguria, leucocyturia or leucopenia) is recognized as the first event in a cascade to multi-organ failure.

Urosepsis treatment calls for the combination of adequate life-supporting care, appropriate antibiotic therapy, adjunctive measures (e.g. sympathomimetic amines, corticosteroids, anticoagulation, granulocyte-colony stimulating factor [G-CSF] or granulocyte-macrophage-colony stimulating factor [GM-CSF], naloxone), and the optimal management of urinary tract disorders.

Urologists are recommended to treat patients in collaboration with intensivie care specialists.

Much urosepsis can be avoided by measures used to prevent nosocomial infection, e.g. reduction of hospital stay, early removal of indwelling urethral catheters, avoidance of unnecessary urethral catheterizations, correct use of closed catheter systems and attention to simple daily techniques in order to avoid cross-infection.

6.2 Background

A UTI can manifest itself as bacteriuria, bacteraemia, septicaemia or sepsis syndrome, depending on its localized or systemic extension. Sepsis syndrome is diagnosed when clinical evidence of infection is accompanied by signs of systemic inflammation (fever or hypothermia, tachycardia, tachypnoea, hypotension, oliguria, leucocyturia or leucopenia).

Sepsis syndrome is a severe situation with a reported mortality rate ranging from 20% to 60% (1-7). In urology, sepsis syndrome depends upon the host response. Those more likely to develop the condition include: elderly patients; diabetics; immunosuppressed patients, such as transplant recipients; patients receiving cancer chemotherapy or corticosteroids and patients with acquired immunodeficiency syndrome. Urosepsis also depends on local conditions, such as urinary tract calculi, obstruction at any level in the urinary tract, congenital uropathies, neurogenic bladder disorders or endoscopic manoeuvres. However, all patients can be affected by bacterial species capable of inducing inflammation within the urinary tract. Moreover, it is now recognized that a 'systemic inflammatory response syndrome' (SIRS) may be present without septicaemia (7).

For therapeutic purposes, the diagnostic criteria of sepsis should identify patients at an early stage of the syndrome, prompting urologists and intensive care specialists to search for and treat infection, apply appropriate therapy, and monitor for organ failure and other complications.

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