10.6084/M9.FIGSHARE.21173429.V1
Martin Holmbom
Martin
Holmbom
Linköping University
Maria Andersson
Maria
Andersson
Magnus Grabe
Magnus
Grabe
Ralph Peeker
Ralph
Peeker
Aus Saudi
Aus
Saudi
Johan Styrke
Johan
Styrke
Umeå University
Firas Aljabery
Firas
Aljabery
Linköping University
Community-onset urosepsis: incidence and risk factors for 30-day mortality – a retrospective cohort study
<p>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.</p> <p>To identify risk factors associated with 30-day mortality in patients with urosepsis.</p> <p>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.</p> <p>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%.</p> <p>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 <i>E. faecalis</i> to optimise management, is likely to improve survival in patients with urosepsis.</p>
Medicine
69999 Biological Sciences not elsewhere classified
Developmental Biology
Science Policy
Taylor & Francis
2022
2022-09-21
2022-12-28
Journal contribution
38232 Bytes
10.1080/21681805.2022.2123039
10.6084/m9.figshare.21173429
CC BY 4.0