Presentation, Risk Factors, Microbiological Pattern and Management of Urosepsis in a Tertiary Hospital in Nigeria

Abstract

Introduction: Urosepsis is a common urologic emergency due severe urogenital tract infection. It is associated with a high mortality rate of 25-60% worldwide. Urinary tract obstruction and presence of indwelling catheter/ stent are the commonest risk factors. Aggressive management is associated with good outcome. No previous study done in our environment. We studied presentation, risk factors, microbiological pattern and management of urosepsis in our hospital.
Methods: This is a retrospective study of patients managed for urosepsis by the Urology Unit, of our hospital from January to December 2017. All urological patients with genito-urinary infection that fulfil systemic inflammatory response criteria were included. Patients who did not fulfil the criteria or have incomplete data were excluded. Data was collected via a proforma and analyzed using SPSS version 25.0 for windows. Data collected include biodata, clinical, laboratory, imaging findings, treatment and outcome. Results were reported in percentages and mean ± standard deviation.
Results: There were 77 patients with urosepsis within the study period, with mean age of 50.9 ± 21.1 years and a range of 1 to 80 years. The male to female ratio was 4:1. The patients' presentations were fever (68.8%), lower urinary tract symptoms (51.9%), weight loss (35.1%), anorexia (29.9%), hematuria (29.9%) pyonephrosis (13%) and vomiting (7.8%). The most common risk factors for the urosepsis were urinary tract obstruction + indwelling catheter/ stent (93.2%), complicated genito-urinary infection (4.2%) and immunosuppressive medical conditions (2.6%). The microbiological pattern included Escherichia coli in 45 patients (58.4%), Staphyloccus aureus and Klebsiella spp in 2 patients (2.6%) each. Candida albicans was found in 1 patient (1.3%). All patients had parenteral antibiotics, fluid therapy with normal saline ± blood transfusion and monitoring. The recovery and mortality rate were 93.5% and 3.9% respectively.
Conclusion: Urosepsis present with local and systemic symptoms in patients with urinary tract obstruction, indwelling urethral catheter, urogenital infections and immunosuppression. Escherichia coli, Staphylococcus aureus and Klebsiella spp were most common organisms involved. Aggressive management is associated with a good outcome.