Infectious Diseases in Critical Care Medicine

CLINICAL PRESENTATION OF UROSEPSIS

The clinical presentation of urosepsis is not different from sepsis from a non-genitourinary

(GU) procedure. The interaction between microorganisms and the host determines the

systemic response rather than the origin of the infection. The clinical diagnostic approach is to

identify systemic disorders or urinary tract abnormalities that predispose to urosepsis, i.e., a

history of preexisting renal disease, recurrent UTIs (relapse variety), recent GU procedures,

history of bladder/renal stones, stents/nephrostomy tubes, or history of systemic illnesses

predisposing to urosepsis (e.g., diabetes mellitus, SLE), CLL, myeloma (1–5,13).

DIFFERENTIAL DIAGNOSTIC CONSIDERATIONS

The physical exam in urosepsis is unhelpful unless the patient has pyelonephritis, with renal

colic stone disease or obstruction, or prostatitis. Gram stain and culture of the urine with

urinalysis plus blood cultures are the definitive diagnostic tests. While blood cultures will not

Table 1 Acute Urosepsis: Community and Nosocomially Acquired

Type of UTI and acquired associated urosepsis

Community-acquired

urosepsis

Nosocomially acquired

urosepsis

Acute pyelonephritis (normal/abnormal hosts) þ

Cystitis (normal hosts) 

Cystitis (non-leukopenic compromised hosts) þ

Acute prostatitis (normal/abnormal hosts) þ

Prostatic abscess þ

Urologic instrumentation (with infected urine) þ

Abbreviation: UTI, urinary tract infection.

Table 2 The Relationship Between Urinary Tract Instrumentation and Nosocomial Urosepsis

Organisms Bacteriuria Bacteremia

Bacteremia associated with

UT instrumentation

E. coli 1007 72 9
Proteussp. 301 11 6
K. pneumoniae 243 29 4
P. aeruginosa 296 31 1
Serratia marcescens 166 8 1
Enterococcussp. 181 20 4
Enterobactersp. 150 23 3
Citrobactersp. 15 2 2
Other 242 130 0
Total 2601 326 30

Conditions Number of cases

Preexisting UT disease alone 23
Preexisting UT disease and
diabetes

4

Preexisting UT disease and
cirrhosis

2

Preexisting UT disease, diabetes
mellitus, cirrhosis

1

No preexisting UT disease 0
Total 30

Abbreviation: UT, urinary tract.
Source: Ref. 12.

Urosepsis in Critical Care 289