Urosepsis

Classification according to ICD-10
N39.0	Urinary tract infection, location unspecified
A41.9	Sepsis, unspecified
ICD-10 online (WHO version 2019)

Urosepsis is an acute infection with bacteria from the urogenital tract . These pass from the urinary tract into the bloodstream and then cause sepsis ("blood poisoning"). Bacterial products, the so-called toxins (in gram-positive bacteria) or dead bacteria (in gram-negative bacteria) cause damage to the vascular skin ( endothelium ), leak blood vessels and often cause endotoxin-related septic shock.

Causes and course of the disease

Urosepsis often has an underlying cause (e.g. an obstacle to drainage), such as prostatic hyperplasia , kidney stones, malignant tumors or congenital malformations (e.g. strictures ). The resulting backlog of urine in the kidneys enables pathogens from the urogenital tract to pass into the bloodstream. Cystic kidneys, pregnancy, diabetes, and indwelling urinary catheters are also predisposing factors.

Urosepsis is a serious clinical picture that, if left untreated, can lead to death within a few hours to days. According to Campbell's Urology 2002, studies have shown that this syndrome without shock has a lethality of 13%, sepsis with shock has a lethality of 28% and shock after sepsis even has a lethality of 43%.

therapy

Causal therapy

Depending on the cause of the disease, operations on the urinary tract are necessary to reduce the concentration of the pathogen: ureteral splints for urinary obstruction, abscess drainage for kidney abscesses or urinary catheters for urinary retention.

Antibiotics

The options include cephalosporins of group 3a / b, possibly in combination with an aminoglycoside or alternatively fluoroquinolones with high urinary excretion, carbapenems or acylaminopenicillins with a beta-lactamase inhibitor . It is important to detect the pathogen with a subsequent antibiogram so that the therapy can be targeted. E. coli in particular often has unusual resistances.

literature

Cord Schneuzer: Kidney. In: Jörg Braun, Roland Preuss (Ed.): Clinic Guide Intensive Care Medicine. 9th edition. Elsevier, Munich 2016, ISBN 978-3-437-23763-8 , pp. 401-414, here: pp. 407 f. ( Urosepsis ).

Web links

Journal for Chemotherapy Recommendations for the antimicrobial therapy of infections of the kidneys and the urogenital tract in adults

Individual evidence

↑ ^a ^b Alphabetical directory for the ICD-10-WHO version 2019, volume 3. German Institute for Medical Documentation and Information (DIMDI), Cologne, 2019, p. 917
↑ D. Manski (online textbook of urology) ; accessed January 30, 2012
^ Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , p. 138.

[Uro-1] Alphabetical directory for the ICD-10-WHO version 2019, volume 3. German Institute for Medical Documentation and Information (DIMDI), Cologne, 2019, p. 917

[2] D. Manski (online textbook of urology) ; accessed January 30, 2012

[3] Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , p. 138.