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Kurt G. Naber - One of the best experts on this subject based on the ideXlab platform.
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antimicrobial resistance in Urosepsis outcomes from the multinational multicenter global prevalence of infections in urology gpiu study 2003 2013
World Journal of Urology, 2016Co-Authors: Zafer Tandogdu, Kurt G. Naber, B. La ,köves, T. Cai, R. Bartoletti, Mete Cek, Magnus Grabe, Ekaterina Kulchavenya, Vandana Menon, Tamara PerepanovaAbstract:Objective Primary objective was to identify the (1) relationship of clinical severity of Urosepsis with the pathogen spectrum and resistance and (2) appropriateness of using the pathogen spectrum and resistance rates of health-care-associated urinary tract infections (HAUTI) as representative of Urosepsis. The secondary objective was to provide an overview of the pathogens and their resistance profile in patients with Urosepsis.
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Antimicrobial resistance in Urosepsis: outcomes from the multinational, multicenter global prevalence of infections in urology (GPIU) study 2003–2013
World journal of urology, 2015Co-Authors: Zafer Tandogdu, Kurt G. Naber, B. La ,köves, T. Cai, R. Bartoletti, Mete Cek, Magnus Grabe, Ekaterina Kulchavenya, Vandana Menon, Tamara PerepanovaAbstract:Objective Primary objective was to identify the (1) relationship of clinical severity of Urosepsis with the pathogen spectrum and resistance and (2) appropriateness of using the pathogen spectrum and resistance rates of health-care-associated urinary tract infections (HAUTI) as representative of Urosepsis. The secondary objective was to provide an overview of the pathogens and their resistance profile in patients with Urosepsis.
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Urinary Tract Infections - Urosepsis: Overview of the Diagnostic and Treatment Challenges.
Microbiology spectrum, 2015Co-Authors: F. Wagenlehner, Wolfgang Weidner, Adrian Pilatz, Kurt G. NaberAbstract:Urosepsis is defined as sepsis caused by an infection in the urogenital tract. In approximately 30% of all septic patients the infectious focus is localized in the urogenital tract, mainly due to obstructions at various levels, such as ureteral stones. Urosepsis may also occur after operations in the urogenital tract. In Urosepsis, complete bacteria and components of the bacterial cell wall from the urogenital tract trigger the host inflammatory event and act as exogenous pyrogens on eukaryotic target cells of patients. A burst of second messenger molecules leads to several different stages of the septic process, from hyperactivity to immunosuppression. As pyelonephritis is the most frequent cause for Urosepsis, the kidney function is therefore most important in terms of cause and as a target organ for dysfunction in the course of the sepsis.Since effective antimicrobial therapy must be initiated early during sepsis, the empiric intravenous therapy should be initiated immediately after microbiological sampling. For the selection of appropriate antimicrobials, it is important to know risk factors for resistant organisms and whether the sepsis is primary or secondary and community or nosocomially acquired. In addition, the preceding antimicrobial therapies should be recorded as precisely as possible. Resistance surveillance should, in any case, be performed locally to adjust for the best suitable empiric treatment. Treatment challenges arise from the rapid increase of antibiotic resistance in Gram-negative bacteria, especially extended-spectrum β-lactamase (ESBL)-producing bacteria. Treatment of Urosepsis comprises four basic strategies I) supportive therapy (stabilizing and maintaining blood pressure), II) antimicrobial therapy, III) control or elimination of the complicating factor, and IV) specific sepsis therapy.
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Urosepsis overview of the diagnostic and treatment challenges
Microbiology spectrum, 2015Co-Authors: F. Wagenlehner, Adrian Pilatz, W Weidner, Kurt G. NaberAbstract:Urosepsis is defined as sepsis caused by an infection in the urogenital tract. In approximately 30% of all septic patients the infectious focus is localized in the urogenital tract, mainly due to obstructions at various levels, such as ureteral stones. Urosepsis may also occur after operations in the urogenital tract. In Urosepsis, complete bacteria and components of the bacterial cell wall from the urogenital tract trigger the host inflammatory event and act as exogenous pyrogens on eukaryotic target cells of patients. A burst of second messenger molecules leads to several different stages of the septic process, from hyperactivity to immunosuppression. As pyelonephritis is the most frequent cause for Urosepsis, the kidney function is therefore most important in terms of cause and as a target organ for dysfunction in the course of the sepsis.Since effective antimicrobial therapy must be initiated early during sepsis, the empiric intravenous therapy should be initiated immediately after microbiological sampling. For the selection of appropriate antimicrobials, it is important to know risk factors for resistant organisms and whether the sepsis is primary or secondary and community or nosocomially acquired. In addition, the preceding antimicrobial therapies should be recorded as precisely as possible. Resistance surveillance should, in any case, be performed locally to adjust for the best suitable empiric treatment. Treatment challenges arise from the rapid increase of antibiotic resistance in Gram-negative bacteria, especially extended-spectrum β-lactamase (ESBL)-producing bacteria. Treatment of Urosepsis comprises four basic strategies I) supportive therapy (stabilizing and maintaining blood pressure), II) antimicrobial therapy, III) control or elimination of the complicating factor, and IV) specific sepsis therapy.
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Therapeutic challenges of Urosepsis.
European journal of clinical investigation, 2008Co-Authors: F. Wagenlehner, Kurt G. Naber, A Pilatz, W WeidnerAbstract:Urosepsis accounts for approximately 25% of all sepsis cases and may develop from a community or nosocomial acquired urinary tract infection (UTI). The underlying UTI is almost exclusively a complicated one with involvement of parenchymatous urogenital organs (e.g. kidneys, prostate). In Urosepsis, as in other types of sepsis, the severity of sepsis depends mostly upon the host response. The treatment of Urosepsis comprises four major aspects: Early goal directed therapy, early optimal pharmacodynamic exposure to antimicrobials, early control of the complicating factor in the urinary tract and specific sepsis therapy. Following these prerequisites there appear two major challenges that need to be addressed: Firstly, time from admission to therapy is critical; the shorter the time to effective treatment, the higher the success rate. This aspect has to become incorporated into the organisational process. Secondly, adequate initial antibiotic therapy has to be insured. This goal implies however, a wide array of measures to ensure rational antibiotic policy. Both challenges are best targeted if an interdisciplinary approach at any level of the process is established, encompassing urologists, intensive care specialists, radiologists, microbiologists and clinical pharmacologists working tightly together at any time.
F. Wagenlehner - One of the best experts on this subject based on the ideXlab platform.
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Urosepsis
Medizinische Klinik - Intensivmedizin und Notfallmedizin, 2018Co-Authors: Mathias W Pletz, Christina Forstner, Sebastian Weis, F. WagenlehnerAbstract:ZusammenfassungDie Urosepsis ist als schweres Krankheitsbild durch Organversagen aufgrund einer Harnwegsinfektion definiert. Eine empirische Antibiotikatherapie sollte innerhalb der ersten Stunde nach Diagnose erfolgen. Des Weiteren sollten Urin- und Blutkulturen vor Antibiotikatherapie angelegt werden. Eine weiterführende Diagnostik sollte frühzeitig erfolgen, um ggf. eine (innerhalb von 6 h) interventionelle Fokuskontrolle bei Harnwegsobstruktion und Abszessen zu ermöglichen. Gramnegative Erreger werden am häufigsten isoliert. ESBL(„extended-spectrum beta-lactamase“)-Bildner als Erreger der Urosepsis nehmen zu. Carbapenemase-bildende Enterobacteriaceae sind dagegen derzeit noch selten. Die empirische Therapie besteht aus einem Breitspektrumbetalaktamantibiotikum. Während Piperacillin/Tazobactam, Carbapeneme und die neuen Cephalosporin/BLI(Betalaktamaseinhibitoren)-Kombinationen bei ausreichender Empfindlichkeit als Monotherapie gegeben werden können, sollten Cephalosporine mit Aminoglykosiden (bevorzugt) oder Fluorochinolonen kombiniert werden. Wird eine Kombinationstherapie gegeben, sollte nach 48–72 h auf eine Monotherapie deeskaliert werden.AbstractUrosepsis 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.
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Urinary Tract Infections - Urosepsis: Overview of the Diagnostic and Treatment Challenges.
Microbiology spectrum, 2015Co-Authors: F. Wagenlehner, Wolfgang Weidner, Adrian Pilatz, Kurt G. NaberAbstract:Urosepsis is defined as sepsis caused by an infection in the urogenital tract. In approximately 30% of all septic patients the infectious focus is localized in the urogenital tract, mainly due to obstructions at various levels, such as ureteral stones. Urosepsis may also occur after operations in the urogenital tract. In Urosepsis, complete bacteria and components of the bacterial cell wall from the urogenital tract trigger the host inflammatory event and act as exogenous pyrogens on eukaryotic target cells of patients. A burst of second messenger molecules leads to several different stages of the septic process, from hyperactivity to immunosuppression. As pyelonephritis is the most frequent cause for Urosepsis, the kidney function is therefore most important in terms of cause and as a target organ for dysfunction in the course of the sepsis.Since effective antimicrobial therapy must be initiated early during sepsis, the empiric intravenous therapy should be initiated immediately after microbiological sampling. For the selection of appropriate antimicrobials, it is important to know risk factors for resistant organisms and whether the sepsis is primary or secondary and community or nosocomially acquired. In addition, the preceding antimicrobial therapies should be recorded as precisely as possible. Resistance surveillance should, in any case, be performed locally to adjust for the best suitable empiric treatment. Treatment challenges arise from the rapid increase of antibiotic resistance in Gram-negative bacteria, especially extended-spectrum β-lactamase (ESBL)-producing bacteria. Treatment of Urosepsis comprises four basic strategies I) supportive therapy (stabilizing and maintaining blood pressure), II) antimicrobial therapy, III) control or elimination of the complicating factor, and IV) specific sepsis therapy.
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Urosepsis overview of the diagnostic and treatment challenges
Microbiology spectrum, 2015Co-Authors: F. Wagenlehner, Adrian Pilatz, W Weidner, Kurt G. NaberAbstract:Urosepsis is defined as sepsis caused by an infection in the urogenital tract. In approximately 30% of all septic patients the infectious focus is localized in the urogenital tract, mainly due to obstructions at various levels, such as ureteral stones. Urosepsis may also occur after operations in the urogenital tract. In Urosepsis, complete bacteria and components of the bacterial cell wall from the urogenital tract trigger the host inflammatory event and act as exogenous pyrogens on eukaryotic target cells of patients. A burst of second messenger molecules leads to several different stages of the septic process, from hyperactivity to immunosuppression. As pyelonephritis is the most frequent cause for Urosepsis, the kidney function is therefore most important in terms of cause and as a target organ for dysfunction in the course of the sepsis.Since effective antimicrobial therapy must be initiated early during sepsis, the empiric intravenous therapy should be initiated immediately after microbiological sampling. For the selection of appropriate antimicrobials, it is important to know risk factors for resistant organisms and whether the sepsis is primary or secondary and community or nosocomially acquired. In addition, the preceding antimicrobial therapies should be recorded as precisely as possible. Resistance surveillance should, in any case, be performed locally to adjust for the best suitable empiric treatment. Treatment challenges arise from the rapid increase of antibiotic resistance in Gram-negative bacteria, especially extended-spectrum β-lactamase (ESBL)-producing bacteria. Treatment of Urosepsis comprises four basic strategies I) supportive therapy (stabilizing and maintaining blood pressure), II) antimicrobial therapy, III) control or elimination of the complicating factor, and IV) specific sepsis therapy.
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Diagnosis and management for Urosepsis
International journal of urology : official journal of the Japanese Urological Association, 2013Co-Authors: F. Wagenlehner, Wolfgang Weidner, Christoph Lichtenstern, Caroline Rolfes, Konstantin Mayer, Florian Uhle, Markus A. WeigandAbstract:Urosepsis is defined as sepsis caused by a urogenital tract infection. Urosepsis in adults comprises approximately 25% of all sepsis cases, and is in most cases due to complicated urinary tract infections. The urinary tract is the infection site of severe sepsis or septic shock in approximately 10–30% of cases. Severe sepsis and septic shock is a critical situation, with a reported mortality rate nowadays still ranging from 30% to 40%. Urosepsis is mainly a result of obstructed uropathy of the upper urinary tract, with ureterolithiasis being the most common cause. The complex pathogenesis of sepsis is initiated when pathogen or damage-associated molecular patterns recognized by pattern recognition receptors of the host innate immune system generate pro-inflammatory cytokines. A transition from the innate to the adaptive immune system follows until a TH2 anti-inflammatory response takes over, leading to immunosuppression. Treatment of Urosepsis comprises four major aspects: (i) early diagnosis; (ii) early goal-directed therapy including optimal pharmacodynamic exposure to antimicrobials both in the plasma and in the urinary tract; (iii) identification and control of the complicating factor in the urinary tract; and (iv) specific sepsis therapy. Early adequate tissue oxygenation, adequate initial antibiotic therapy, and rapid identification and control of the septic focus in the urinary tract are critical steps in the successful management of a patient with Urosepsis, which includes early imaging, and an optimal interdisciplinary approach encompassing emergency unit, urological and intensive-care medicine specialists.
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Urosepsis--from the view of the urologist.
International journal of antimicrobial agents, 2011Co-Authors: F. Wagenlehner, Adrian Pilatz, Wolfgang WeidnerAbstract:Urosepsis accounts for approximately 25% of all sepsis cases and may develop from a community-or nosocomial-acquired urinary tract infection (UTI). The underlying UTI is almost exclusively a complicated one with involvement of parenchymatous urogenital organs (e.g. kidneys, prostate). In Urosepsis, as in other types of sepsis, the severity of sepsis depends mostly upon the host response. The urological management of Urosepsis comprises early diagnosis, early fluid and oxygen treatment, early antibiotic therapy and early control of the complicating factor in the urinary tract. Time from admission to therapy is critical. The shorter the time to effective treatment, the higher is the success rate. This aspect has to become incorporated into the organisational process, including urologists, radiologists and intensive care specialists amongst others. Adequate initial antibiotic therapy has to be insured. This goal implies, however, a wide array of measures over time to ensure a rational antibiotic policy, including microbiologists and clinical pharmacologists. Dosage of an antibiotic in the septic patient generally has to be high to ensure adequate pharmacological exposure in the individual patient.
Wolfgang Weidner - One of the best experts on this subject based on the ideXlab platform.
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Urinary Tract Infections - Urosepsis: Overview of the Diagnostic and Treatment Challenges.
Microbiology spectrum, 2015Co-Authors: F. Wagenlehner, Wolfgang Weidner, Adrian Pilatz, Kurt G. NaberAbstract:Urosepsis is defined as sepsis caused by an infection in the urogenital tract. In approximately 30% of all septic patients the infectious focus is localized in the urogenital tract, mainly due to obstructions at various levels, such as ureteral stones. Urosepsis may also occur after operations in the urogenital tract. In Urosepsis, complete bacteria and components of the bacterial cell wall from the urogenital tract trigger the host inflammatory event and act as exogenous pyrogens on eukaryotic target cells of patients. A burst of second messenger molecules leads to several different stages of the septic process, from hyperactivity to immunosuppression. As pyelonephritis is the most frequent cause for Urosepsis, the kidney function is therefore most important in terms of cause and as a target organ for dysfunction in the course of the sepsis.Since effective antimicrobial therapy must be initiated early during sepsis, the empiric intravenous therapy should be initiated immediately after microbiological sampling. For the selection of appropriate antimicrobials, it is important to know risk factors for resistant organisms and whether the sepsis is primary or secondary and community or nosocomially acquired. In addition, the preceding antimicrobial therapies should be recorded as precisely as possible. Resistance surveillance should, in any case, be performed locally to adjust for the best suitable empiric treatment. Treatment challenges arise from the rapid increase of antibiotic resistance in Gram-negative bacteria, especially extended-spectrum β-lactamase (ESBL)-producing bacteria. Treatment of Urosepsis comprises four basic strategies I) supportive therapy (stabilizing and maintaining blood pressure), II) antimicrobial therapy, III) control or elimination of the complicating factor, and IV) specific sepsis therapy.
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Diagnosis and management for Urosepsis
International journal of urology : official journal of the Japanese Urological Association, 2013Co-Authors: F. Wagenlehner, Wolfgang Weidner, Christoph Lichtenstern, Caroline Rolfes, Konstantin Mayer, Florian Uhle, Markus A. WeigandAbstract:Urosepsis is defined as sepsis caused by a urogenital tract infection. Urosepsis in adults comprises approximately 25% of all sepsis cases, and is in most cases due to complicated urinary tract infections. The urinary tract is the infection site of severe sepsis or septic shock in approximately 10–30% of cases. Severe sepsis and septic shock is a critical situation, with a reported mortality rate nowadays still ranging from 30% to 40%. Urosepsis is mainly a result of obstructed uropathy of the upper urinary tract, with ureterolithiasis being the most common cause. The complex pathogenesis of sepsis is initiated when pathogen or damage-associated molecular patterns recognized by pattern recognition receptors of the host innate immune system generate pro-inflammatory cytokines. A transition from the innate to the adaptive immune system follows until a TH2 anti-inflammatory response takes over, leading to immunosuppression. Treatment of Urosepsis comprises four major aspects: (i) early diagnosis; (ii) early goal-directed therapy including optimal pharmacodynamic exposure to antimicrobials both in the plasma and in the urinary tract; (iii) identification and control of the complicating factor in the urinary tract; and (iv) specific sepsis therapy. Early adequate tissue oxygenation, adequate initial antibiotic therapy, and rapid identification and control of the septic focus in the urinary tract are critical steps in the successful management of a patient with Urosepsis, which includes early imaging, and an optimal interdisciplinary approach encompassing emergency unit, urological and intensive-care medicine specialists.
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Urosepsis--from the view of the urologist.
International journal of antimicrobial agents, 2011Co-Authors: F. Wagenlehner, Adrian Pilatz, Wolfgang WeidnerAbstract:Urosepsis accounts for approximately 25% of all sepsis cases and may develop from a community-or nosocomial-acquired urinary tract infection (UTI). The underlying UTI is almost exclusively a complicated one with involvement of parenchymatous urogenital organs (e.g. kidneys, prostate). In Urosepsis, as in other types of sepsis, the severity of sepsis depends mostly upon the host response. The urological management of Urosepsis comprises early diagnosis, early fluid and oxygen treatment, early antibiotic therapy and early control of the complicating factor in the urinary tract. Time from admission to therapy is critical. The shorter the time to effective treatment, the higher is the success rate. This aspect has to become incorporated into the organisational process, including urologists, radiologists and intensive care specialists amongst others. Adequate initial antibiotic therapy has to be insured. This goal implies, however, a wide array of measures over time to ensure a rational antibiotic policy, including microbiologists and clinical pharmacologists. Dosage of an antibiotic in the septic patient generally has to be high to ensure adequate pharmacological exposure in the individual patient.
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Urosepsis—from the view of the urologist
International Journal of Antimicrobial Agents, 2011Co-Authors: F. Wagenlehner, Adrian Pilatz, Wolfgang WeidnerAbstract:Urosepsis accounts for approximately 25% of all sepsis cases and may develop from a community-or nosocomial-acquired urinary tract infection (UTI). The underlying UTI is almost exclusively a complicated one with involvement of parenchymatous urogenital organs (e.g. kidneys, prostate). In Urosepsis, as in other types of sepsis, the severity of sepsis depends mostly upon the host response. The urological management of Urosepsis comprises early diagnosis, early fluid and oxygen treatment, early antibiotic therapy and early control of the complicating factor in the urinary tract. Time from admission to therapy is critical. The shorter the time to effective treatment, the higher is the success rate. This aspect has to become incorporated into the organisational process, including urologists, radiologists and intensive care specialists amongst others. Adequate initial antibiotic therapy has to be insured. This goal implies, however, a wide array of measures over time to ensure a rational antibiotic policy, including microbiologists and clinical pharmacologists. Dosage of an antibiotic in the septic patient generally has to be high to ensure adequate pharmacological exposure in the individual patient.
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Urosepsis und Therapie
Der Urologe. Ausg. A, 2010Co-Authors: F. Wagenlehner, Christoph Lichtenstern, Markus A. Weigand, Wolfgang WeidnerAbstract:Die Urosepsis gehort zu den haufigsten Sepsisentitaten. Die Letalitat der Urosepsis liegt heutzutage weitgehend unter der anderer Sepsisentitaten. Pathophysiologisch ist das Sepsissyndrom durch eine generalisierte Infektion und Immundysregulation charakterisiert. Exogene mikrobiologische und aktiv oder passiv freigesetzte endogene Faktoren aus korpereigenen Zellen initiieren und begleiten die Immundysregulation. Die Diagnostik und Therapie der Urosepsis muss so fruh wie moglich (innerhalb der ersten Stunde) erfolgen, um die Zell- und Gewebeschadigung im Fruhstadium verhindern zu konnen. Hierzu wird ein Masnahmenpaket initiiert, welches eine fruhe Fokuskontrolle und Antibiotikatherapie, sowie die Stabilisierung der Atem- und Kreislauffunktion zur Optimierung der Gewebeoxygenierung beinhaltet. Ein wichtiges klinisches Problem stellt die zunehmende Antibiotikaresistenz v. a. der Enterobakterien dar. Die Antibiotikaauswahl richtet sich deswegen nach der lokalen Erregerresistenzstatistik. Die Applikation der Antibiotika sollte sich sowohl an den individuellen Merkmalen des Patienten als auch den aktuellen pharmakokinetischen/-dynamischen Erkenntnissen orientieren. Der septische Patienten muss bei Krankenhausaufnahme oder im Falle stationarer Patienten auf Normalstation zugig identifiziert werden um die intensive Behandlung unmittelbar zu beginnen bevor sie gegebenenfalls auf der Intensivstation weitergefuhrt werden muss.
Yasuharu Tokuda - One of the best experts on this subject based on the ideXlab platform.
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Effectiveness of early ureteric stenting for Urosepsis associated with urinary tract calculi
Critical Care, 2013Co-Authors: Sho Nishiguchi, Yasuharu TokudaAbstract:Urosepsis associated with urinary tract calculi is a critical disease. Patients with this condition occasionally require drainage, mostly ureteric stent placement and these patients need longer hospitalization. However, indications for timely ureteric stenting for Urosepsis associated with urinary tract calculi have not been clearly determined. The objective of the study was to evaluate whether earlier stent placement might lead to shorter length of stay (LOS) in hospitals.
Adrian Pilatz - One of the best experts on this subject based on the ideXlab platform.
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Management of Urosepsis in 2018.
European urology focus, 2018Co-Authors: Gernot Bonkat, B. La ,köves, T. Cai, Rajan Veeratterapillay, Franck Bruyère, Riccardo Bartoletti, Adrian Pilatz, Suzanne E. Geerlings, Benjamin Pradere, Robert PickardAbstract:Despite optimal treatment, Urosepsis has still high morbidity and mortality rates. An updated definition and classification system for sepsis have recently been introduced. Management of Urosepsis comprises four major aspects: (1) early diagnosis, (2) early empiric intravenous antimicrobial treatment, (3) identification and control of complicating factors, and (4) specific sepsis therapy. The quick sequential organ failure assessment is replacing the systemic inflammatory response syndrome scoring for rapid identification of patients with Urosepsis. PATIENT SUMMARY: Urosepsis is a serious, life-threatening complication of infections originating from the urinary tract. As Urosepsis has a very high mortality rate, it is important that is quickly spotted and that appropriate treatment is swiftly begun. Imaging of urinary tract disorders has been shown to be useful in decreasing mortality from Urosepsis, and in the future microbiology techniques may also prove useful. Given the severity of Urosepsis and the associated risks, large efforts need to be made to prevent high-risk infections in hospitals with appropriate prevention measures, such as the early removal of catheters used whenever possible.
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Urinary Tract Infections - Urosepsis: Overview of the Diagnostic and Treatment Challenges.
Microbiology spectrum, 2015Co-Authors: F. Wagenlehner, Wolfgang Weidner, Adrian Pilatz, Kurt G. NaberAbstract:Urosepsis is defined as sepsis caused by an infection in the urogenital tract. In approximately 30% of all septic patients the infectious focus is localized in the urogenital tract, mainly due to obstructions at various levels, such as ureteral stones. Urosepsis may also occur after operations in the urogenital tract. In Urosepsis, complete bacteria and components of the bacterial cell wall from the urogenital tract trigger the host inflammatory event and act as exogenous pyrogens on eukaryotic target cells of patients. A burst of second messenger molecules leads to several different stages of the septic process, from hyperactivity to immunosuppression. As pyelonephritis is the most frequent cause for Urosepsis, the kidney function is therefore most important in terms of cause and as a target organ for dysfunction in the course of the sepsis.Since effective antimicrobial therapy must be initiated early during sepsis, the empiric intravenous therapy should be initiated immediately after microbiological sampling. For the selection of appropriate antimicrobials, it is important to know risk factors for resistant organisms and whether the sepsis is primary or secondary and community or nosocomially acquired. In addition, the preceding antimicrobial therapies should be recorded as precisely as possible. Resistance surveillance should, in any case, be performed locally to adjust for the best suitable empiric treatment. Treatment challenges arise from the rapid increase of antibiotic resistance in Gram-negative bacteria, especially extended-spectrum β-lactamase (ESBL)-producing bacteria. Treatment of Urosepsis comprises four basic strategies I) supportive therapy (stabilizing and maintaining blood pressure), II) antimicrobial therapy, III) control or elimination of the complicating factor, and IV) specific sepsis therapy.
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Urosepsis overview of the diagnostic and treatment challenges
Microbiology spectrum, 2015Co-Authors: F. Wagenlehner, Adrian Pilatz, W Weidner, Kurt G. NaberAbstract:Urosepsis is defined as sepsis caused by an infection in the urogenital tract. In approximately 30% of all septic patients the infectious focus is localized in the urogenital tract, mainly due to obstructions at various levels, such as ureteral stones. Urosepsis may also occur after operations in the urogenital tract. In Urosepsis, complete bacteria and components of the bacterial cell wall from the urogenital tract trigger the host inflammatory event and act as exogenous pyrogens on eukaryotic target cells of patients. A burst of second messenger molecules leads to several different stages of the septic process, from hyperactivity to immunosuppression. As pyelonephritis is the most frequent cause for Urosepsis, the kidney function is therefore most important in terms of cause and as a target organ for dysfunction in the course of the sepsis.Since effective antimicrobial therapy must be initiated early during sepsis, the empiric intravenous therapy should be initiated immediately after microbiological sampling. For the selection of appropriate antimicrobials, it is important to know risk factors for resistant organisms and whether the sepsis is primary or secondary and community or nosocomially acquired. In addition, the preceding antimicrobial therapies should be recorded as precisely as possible. Resistance surveillance should, in any case, be performed locally to adjust for the best suitable empiric treatment. Treatment challenges arise from the rapid increase of antibiotic resistance in Gram-negative bacteria, especially extended-spectrum β-lactamase (ESBL)-producing bacteria. Treatment of Urosepsis comprises four basic strategies I) supportive therapy (stabilizing and maintaining blood pressure), II) antimicrobial therapy, III) control or elimination of the complicating factor, and IV) specific sepsis therapy.
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Urosepsis--from the view of the urologist.
International journal of antimicrobial agents, 2011Co-Authors: F. Wagenlehner, Adrian Pilatz, Wolfgang WeidnerAbstract:Urosepsis accounts for approximately 25% of all sepsis cases and may develop from a community-or nosocomial-acquired urinary tract infection (UTI). The underlying UTI is almost exclusively a complicated one with involvement of parenchymatous urogenital organs (e.g. kidneys, prostate). In Urosepsis, as in other types of sepsis, the severity of sepsis depends mostly upon the host response. The urological management of Urosepsis comprises early diagnosis, early fluid and oxygen treatment, early antibiotic therapy and early control of the complicating factor in the urinary tract. Time from admission to therapy is critical. The shorter the time to effective treatment, the higher is the success rate. This aspect has to become incorporated into the organisational process, including urologists, radiologists and intensive care specialists amongst others. Adequate initial antibiotic therapy has to be insured. This goal implies, however, a wide array of measures over time to ensure a rational antibiotic policy, including microbiologists and clinical pharmacologists. Dosage of an antibiotic in the septic patient generally has to be high to ensure adequate pharmacological exposure in the individual patient.
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Urosepsis—from the view of the urologist
International Journal of Antimicrobial Agents, 2011Co-Authors: F. Wagenlehner, Adrian Pilatz, Wolfgang WeidnerAbstract:Urosepsis accounts for approximately 25% of all sepsis cases and may develop from a community-or nosocomial-acquired urinary tract infection (UTI). The underlying UTI is almost exclusively a complicated one with involvement of parenchymatous urogenital organs (e.g. kidneys, prostate). In Urosepsis, as in other types of sepsis, the severity of sepsis depends mostly upon the host response. The urological management of Urosepsis comprises early diagnosis, early fluid and oxygen treatment, early antibiotic therapy and early control of the complicating factor in the urinary tract. Time from admission to therapy is critical. The shorter the time to effective treatment, the higher is the success rate. This aspect has to become incorporated into the organisational process, including urologists, radiologists and intensive care specialists amongst others. Adequate initial antibiotic therapy has to be insured. This goal implies, however, a wide array of measures over time to ensure a rational antibiotic policy, including microbiologists and clinical pharmacologists. Dosage of an antibiotic in the septic patient generally has to be high to ensure adequate pharmacological exposure in the individual patient.
