Shaikh Nissar, Momin Umais, Atef Shible Ahmed, Al-Musalmani Muna, Ansari Abdulla
Surgical Intensive Care Unit, Hamad Medical Corporation, Doha, Qatar.
Department of Radiology, Hamad Medical Corporation, Doha, Qatar.
Qatar Med J. 2020 Apr 2;2020(1):8. doi: 10.5339/qmj.2020.8. eCollection 2020.
Urosepsis contributes significantly to the epidemiology of sepsis. Urosepsis can be classified as community acquired or hospital acquired, depending upon the origin of infection acquisition: either from the community or from a healthcare facility. A great deal of literature is available about nosocomial urosepsis, but the literature regarding community-acquired urosepsis (CAUs) is limited, and studies are underpowered. The aim of our study was to determine the epidemiology, bacteriology, severity, and outcome of CAUs. All patients admitted from the emergency department to the surgical intensive care unit (SICU) with urosepsis over a period of 10 years were identified and included retrospectively from the SICU registry. The study was retrospective. Data were entered into the SPSS program version 23, and groups were compared by using chi-square and t-tests. Results were considered statistically significant at ≤ 0.05. During the study period, 302 patients with CAUs were admitted to the SICU. The common etiology was obstructive uropathy (60%). The Local Arab population outnumbered the non-Arab population (164/54.3%), and there were equal numbers of patients of both genders. Diabetes mellitus and hypertension together were the common comorbidities. Seventy-five percent of patients had acute kidney injury (AKI). Thirty-eight percent of patients had percutaneous nephrostomy, and 24.8% of patients underwent endoscopic stent insertion to relieve the obstruction. Ninety-three percent of patients were admitted with septic shock, and 71.5% had bacteremia. The common bacteria (36.1%) was extended-spectrum beta-lactamase-(ESBL)-producing bacteria, with a predominance of (31.5%). Fifty-four percent of patients required a change of antibiotics to carbapenem. Eighty-two percent of patients had acute respiratory distress syndrome (ARDS). Patients with bacteremia had a statistically significant AKI, ARDS, and septic shock ( < 0.001). Male patients had a significantly higher incidence of oliguria, intubation, and ARDS ( < 0.05). Eight patients died of urosepsis during the study period, giving a mortality rate of 2.6%. In our patients, obstruction of urine flow was the most common cause of CAUs. Our urosepsis patients had a higher bacteremia rate, which led to higher incidences of organ dysfunction and septic shock. ESBL bacteria were a frequent cause of urosepsis, requiring a change of the initial antibiotic to carbapenem. Male patients had a significantly higher rate of organ dysfunction. Mortality in our urosepsis patients was lower than mentioned in the literature.
泌尿系统脓毒症在脓毒症流行病学中占重要比例。泌尿系统脓毒症可根据感染源分为社区获得性或医院获得性，即感染源是来自社区还是医疗机构。关于医院获得性泌尿系统脓毒症有大量文献，但关于社区获得性泌尿系统脓毒症（CAUs）的文献有限，且研究力度不足。我们研究的目的是确定CAUs的流行病学、细菌学、严重程度及转归。回顾性纳入了10年间从急诊科收治入外科重症监护病房（SICU）的所有泌尿系统脓毒症患者，数据来自SICU登记册。本研究为回顾性研究。数据录入SPSS 23版程序，采用卡方检验和t检验对组间进行比较。结果以P≤0.05为有统计学意义。研究期间，302例CAUs患者被收治入SICU。常见病因是梗阻性尿路病（60%）。当地阿拉伯人群数量超过非阿拉伯人群（164例/54.3%），男女患者数量相等。糖尿病和高血压是常见的合并症。75%的患者发生急性肾损伤（AKI）。38%的患者接受了经皮肾造瘘术，24.8%的患者接受了内镜下支架置入术以解除梗阻。93%的患者因感染性休克入院，71.5%的患者有菌血症。常见细菌（36.1%）是产超广谱β-内酰胺酶（ESBL）细菌，其中以[具体细菌名称未给出]为主（31.5%）。54%的患者需要更换抗生素为碳青霉烯类。82%的患者发生急性呼吸窘迫综合征（ARDS）。有菌血症的患者在AKI、ARDS和感染性休克方面有统计学显著差异（P<0.001）。男性患者少尿、插管和ARDS的发生率显著更高（P<0.05）。研究期间8例患者死于泌尿系统脓毒症，死亡率为2.6%。在我们的患者中，尿流梗阻是CAUs最常见的原因。我们的泌尿系统脓毒症患者菌血症发生率更高，导致器官功能障碍和感染性休克的发生率更高。ESBL细菌是泌尿系统脓毒症的常见病因，需要将初始抗生素更换为碳青霉烯类。男性患者器官功能障碍发生率显著更高。我们的泌尿系统脓毒症患者死亡率低于文献报道。
