Clinical Scorecard: Mortality and Morbidity Rates in Urosepsis: Analyzing Risk Factors from the SERPENS Prospective Multi-Center Study
At a Glance
Category
Detail
Condition
Urosepsis, a form of sepsis originating from urinary tract infections
Key Mechanisms
Sepsis triggered by urinary tract infection leading to organ failure and mortality; influenced by severity, patient fitness, frailty, age, and pathogen resistance
Emergency units, urology wards, other hospital wards, outpatient clinics, and community care referrals across 34 European hospitals
Key Highlights
Urosepsis accounts for 20-40% of all sepsis cases with relatively low but significant mortality and morbidity within 30 days.
Risk factors include indwelling catheters, obstructive uropathy, tissue necrosis, abscesses, urinary tract interventions, and urological impairments, though their precise impact on outcomes remains unclear.
The study used SIRS criteria for diagnosis but acknowledges limitations and favors a risk-based approach for prognosis; antimicrobial resistance complicates treatment.
Guideline-Based Recommendations
Diagnosis
Diagnosis requires at least two SIRS criteria with urinary tract identified as the sepsis source.
Confirm urinary tract infection via positive urine and blood cultures before antibiotic treatment.
Use Sepsis-2 definitions to categorize severity (non-severe, severe sepsis, septic shock).
Management
Initial treatment details should be recorded within 24 hours of urosepsis onset.
Monitor and manage organ failure using SOFA score domains and invasive supportive treatments as needed.
Consider antimicrobial resistance patterns when selecting antibiotic therapy.
Monitoring & Follow-up
Assess organ failure at baseline and follow-ups on days 3, 7, 9, and 30 using SOFA scores.
Track use of mechanical ventilation, vasopressors, and renal replacement therapy to evaluate organ function.
Follow patients for 30 days to monitor mortality and morbidity outcomes.
Risks
Recognize that severity of sepsis, patient frailty, age, and presence of multi-drug resistant pathogens increase risk of organ failure and death.
Be aware of low specificity of SIRS criteria which may lead to overdiagnosis.
Antimicrobial resistance and multi-drug resistant pathogens complicate treatment effectiveness.
Patient & Prescribing Data
354 adult patients with confirmed urosepsis and identified pathogens, median age 65.1 years, 45% female
Early identification and management within 24 hours critical; antimicrobial susceptibility testing guides therapy; monitoring organ failure essential to adjust supportive treatments.
Clinical Best Practices
Employ a risk-based approach rather than relying solely on SIRS criteria for diagnosis and prognosis.
Use microbiological confirmation to guide targeted antibiotic therapy considering local resistance patterns.
Regularly assess organ function using SOFA scores and provide invasive supportive care when indicated.
Follow patients longitudinally for at least 30 days to capture mortality and morbidity outcomes.
Collaborate across multidisciplinary teams in various care settings to optimize patient management.
by Zafer Tandogdu, Bela Koves, Slobodan Ristovski, Mustafa Bahadir Can Balci, Kristin Rennesund, Stavros Gravas, DjordJe Nale, José Medina-Polo, Mária Kopilec Garabášová, Elisabetta Costantini, Jorge Cano-Valasco, Maja Sofronievska Glavinova, Franck Bruyere, Tamara Perepanova, Ekaterina Kulchavenya, Mete Cek, Florian Wagenlehner, Truls Erik Bjerklund Johansen
