Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary. The recommendations that follow are based on the previous version of the guideline.
The following is a summary of the recommendations for urosepsis. Refer to the original guideline for more detailed recommendations and discussion.
Levels of evidence (Ia-IV) and grades of recommendation (A-C) are defined at the end of the "Major Recommendations" field.
Patients with urosepsis should be diagnosed at an early stage, especially in the case of a complicated urinary tract infection (UTI). The systemic inflammatory response syndrome, known as SIRS (fever or hypothermia, hyperleucocytosis or leucopenia, tachycardia, tachypnoea), is recognized as the first event in a cascade to multi-organ failure. Mortality is considerably increased when severe sepsis or septic shock are present, though the prognosis of urosepsis is globally better than sepsis due to other infectious sites.
The treatment of urosepsis calls for the combination of adequate life-supporting care, appropriate and prompt antibiotic therapy, adjunctive measures (e.g., sympathomimetic amines, hydrocortisone, blood glucose control, recombinant activated protein C) and the optimal management of urinary tract disorders (IaA). The drainage of any obstruction in the urinary tract is essential as first-line treatment (IbA).
Urologists are recommended to treat patients in collaboration with intensive care and infectious diseases specialists (IIaB).
Urosepsis can be due to both community- or nosocomial-acquired infections. Most nosocomial urosepsis can be avoided by measures used to prevent nosocomial infection (e.g., reduction of hospital stay, early removal of indwelling urethral catheters, avoidance of unnecessary urethral catheterizations, correct use of closed catheter systems and attention to simple daily asepsis techniques in order to avoid cross-infection) (IIaB).
Definitions:
Levels of Evidence
Ia Evidence obtained from meta-analysis of randomized trials
Ib Evidence obtained from at least one randomized trial
IIa Evidence obtained from at least one well-designed controlled study without randomization
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study
III Evidence obtained from well-designed non-experimental studies, such as comparative studies, correlation studies and case reports
IV Evidence obtained from expert committee reports or opinions or clinical experience of respected authorities
Grades of Recommendation
- Based on clinical studies of good quality and consistency addressing the specific recommendations and including at least one randomized trial
- Based on well-conducted clinical studies, but without randomized clinical studies
- Made despite the absence of directly applicable clinical studies of good quality
