Septic Shock in the Elderly
Thomas T. Yoshikawa, Shobita Rajagopalan in Antibiotic Therapy for Geriatric Patients, 2005
The most common cause of septic shock in elderly patients is urosepsis. Urosepsis is defined as sepsis of urinary tract origin when the urinary isolate and the organism in the bloodstream are the same. In adult elderly men, enlargement of the prostate is a normal phenomenon of aging, and predisposes to relative urinary tract obstruction due to prostate enlargement. Elderly women have altered genitourinary tracts because of a relaxed pelvic musculature, which is a function of age, and often have cystocele or rectocele, which predisposes to bacteriuria. Bacteriuria alone is insufficient to cause sepsis and additional factors are necessary to make the patient septic, e.g., compromised host defenses. For this reason, elderly women with diabetes mellitus or systemic lupus erythematosus may develop bacteremia, sepsis, or septic shock from cystitis (4,6,12,13).
Nosocomial Pneumonia in the Critical Care Unit
Cheston B. Cunha, Burke A. Cunha in Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
There are many causes of new or persistent fever/leukocytosis in the CCU. The most common causes for persistent fever/leukocytosis in the CCU are stress of being in the CCU, hemorrhage, steroids, or drug fever. Non-pulmonary infection /non-infectious disorders should also be considered, e.g., phlebitis, DVT, PE, MI, and pancreatitis (drug or TPN induced). Causes are virtually never urosepsis (without recent urologic instrumentation), even with or without pyuria/bacteriuria. C. difficile diarrhea may cause mild leukocytosis without fevers. In contrast, C. difficile colitis presents with new high fevers (>102°F) and prominent abdominal pain, often with sudden cessation if antecedent C. difficile water diarrhea. In all these scenarios, selecting appropriate therapy depends on accurate clinical syndromic diagnosis. The approach to persistent fever/leukocytosis should be directed at determining the cause, rather than adding or changing antibiotics [2,7,8].
Infectious Complications of Urologic Surgery
Kevin R. Loughlin in Complications of Urologic Surgery and Practice, 2007
Urosepsis is a syndrome resulting from a complicated UTI in a patient with one or more of the following signs: tachypnea, tachycardia, hyperthermia or hypothermia, or evidence of inadequate end-organ perfusion. Inadequate tissue perfusion is often accompanied by elevated plasma lactate, oliguria, or hypoxemia. Septic shock refers to sepsis syndrome that is accompanied by hypotension. Septic shock is a rare event after urologic procedures. Fortunately, septic shock following urologic procedures (often termed “urosepsis”) has a more favorable prognosis than septic shock from diseases of other organ systems because many urologic disorders are correctable. After correction of underlying urologic factors, the pathophysiology of urosepsis is often reversible.
Ureteral stent-associated infection and sepsis: pathogenesis and prevention: a review
Published in Biofouling, 2019
Kymora B. Scotland, Joey Lo, Thomas Grgic, Dirk Lange
Stent-associated urosepsis is thought to result from several mechanisms. The ability of indwelling stents to promote the vesicoureteral reflux of urine from the bladder into the renal collecting system assists in the process of retrograde ascension of bacteria, resulting in the spread of an initially localized infection (Dyer et al. 2002). The colonization of ureteral stents by bacteria also facilitates the retrograde ascent of bacteria from the bladder to the kidney via the ureter (Dyer et al. 2002). Additionally, indwelling stents have been demonstrated to decrease ureteral peristalsis (Venkatesh et al. 2005), thus further assisting bacterial ascent. Bacteria at the renal collecting system are able to subsequently enter the renal parenchymal tissue via the papillary collecting ducts in the renal calyces. This process is likely promoted by the increased intrapelvic pressure resulting from ureteral stent-mediated reflux (Shao et al. 2009). Once bacteria have entered the renal parenchyma, they are then capable of gaining access to the renal circulatory system, leading to bacteremia. This spread of infection from the urine to the blood is the initiation of urosepsis.
Emergency decompression for patients with ureteral stones and SIRS: a prospective randomized clinical study
Published in Annals of Medicine, 2023
Xiaofei Lu, Benzheng Zhou, Dechao Hu, Yanting Ding
MUC and blood culture are the most commonly used methods to identify pathogens. However, some experts believe the MUC cannot be a good predictor of urosepsis because of its low positive rate [24,25]. In a previous study, the positive MUC rate in patients with pyonephrosis was below 50% [24]. Liu et al. also found that the infection may persist in the upper system when the MUC is negative due to the obstruction caused by the ureteral stone [26]. In this study, the positive MUC rate is 24% in patients with ureteral stones and SIRS, and we found that MUC is not a risk factor for patients developing urosepsis after decompression (p = .731). However, blood culture results seem to be a good predictor of urosepsis. In the literature, a positive blood culture result is the gold standard for confirming urosepsis [27]. In this study, 32 patients had a positive blood culture result and did not develop urosepsis, but there was a significant difference between patients with or without urosepsis (p < .001). Our data suggest that a positive blood culture result is a risk factor for the development of urosepsis after decompression.
Renal trauma: a 6-year retrospective review from a level 1 trauma center in Denmark
Published in Scandinavian Journal of Urology, 2019
Sophia Liff Maibom, Mette Lind Holm, Niklas Kahr Rasmussen, Ulla Germer, Ulla Nordström Joensen
Of the 68 patients admitted to our urological ward, 13% (n = 9) were treated with one or more blood transfusions. From the other patients we could not obtain valid data on blood transfusions. Seven percent (n = 5) of the patients originally admitted to the urological ward were readmitted within 30 days, all because of infections. One patient had a grade III injury and four patients grade IV. Three patients were treated for urosepsis. One patient had re-bleeding and infection and was treated conservatively. The last patient (grade IV) was treated with antibiotics for infection and a follow-up CT revealed a pseudoaneurism and massive urinary extravasation; this patient was treated with an internal stent and the pseudo aneurism was embolized successfully. Only patients with symptoms of complications had repeat CT imaging performed in accordance with EAU guidelines [4] and patients with signs of infection who responded clinically to antibiotics did not have repeat CT imaging performed.
Related Knowledge Centers
- Acute Kidney Injury
- Costovertebral Angle Tenderness
- Dysuria
- Fever
- Pyonephrosis
- Nausea
- Polyuria
- Kidney
- Pathogenic Bacteria
- Sepsis