Sepsis associated with urinary tract infection. Antibiotic treatment with piperacillin.

Urosepsis is mostly induced by nosocomial gram-negative organisms. It is an infection that is difficult to treat and has high mortality, especially when associated with septic shock. For obstructive urosepsis, which occurs mostly after an acute stone occlusion of the upper urinary tract in pyelonephritis, intensive systemic medical therapy and drainage (and sometimes removal) of the septic kidney are necessary. For non-obstructive urosepsis, which is mostly an iatrogenic complication of diagnostic or therapeutic procedures on the genito-urinary tract, the same intensive medical care and urinary drainage are adequate. Systemic therapy in the treatment of urosepsis encompasses several disorders. Specific pathogenic mechanisms of shock, including failure of the microcirculation, hemostatic disorders, and microbiological problems, have to be considered in the systemic treatment of urosepsis. Appropriate antibiotic therapy may triple chances of survival. In this connection, piperacillin was successfully used in 30 patients with urosepsis treated at our institution.