[Urosepsis]

Urologe A. 2018 Jan;57(1):79-92. doi: 10.1007/s00120-017-0559-1.
[Article in German]

Abstract

Urosepsis is defined as a severe disease due to organ failure caused by a urinary tract infection. An empirical antibiotic therapy should be instigated within the first hour after diagnosis. Urine cultures and blood cultures should be performed before antibiotic treatment. Further diagnostics should be carried out at an early stage to enable an interventional focus control in the case of urinary tract obstruction or abscess formation, if necessary. Gram-negative pathogens are most frequently isolated. Extended spectrum beta-lactamase (ESBL) forming bacteria as a cause of urosepsis are increasing. Carbapenemase-forming Enterobacteriaceae, on the other hand, are still rare. The empirical treatment consists of a broad spectrum beta-lactam antibiotic. While piperacillin/tazobactam, carbapenems and the new cephalosporin/beta-lactamase inhibitor (BLI) combinations are given as monotherapy, cephalosporins should be combined with aminoglycosides (preferred) or fluoroquinolones. If a combination therapy is given, it should be de-escalated to a monotherapy after 48-72 h.

Keywords: Antibiotic therapy; Sepsis; Staphylococcus aureus; Urinary tract infections; Urogenital system.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Cephalosporins / therapeutic use
  • Fluoroquinolones / therapeutic use
  • Gram-Negative Bacterial Infections / drug therapy*
  • Humans
  • Sepsis / drug therapy*
  • Sepsis / microbiology
  • Urinary Tract Infections / complications*
  • beta-Lactamases / therapeutic use
  • beta-Lactams / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Cephalosporins
  • Fluoroquinolones
  • beta-Lactams
  • beta-Lactamases