Urologic sepsis/shock.

At Columbia-Presbyterian Medical Center during the six-year period 1968-1973, there were 1236 cases of sepsis from Gram-negative pathogens; 124 of these originated in the urinary tract. Of these 124 patients, 19 died-a mortality rate of 15.3 percent. There were 205 deaths among the 1236 patients with sepsis from Gramnegative organisms-a mortality rate of 16.6 percent. Previously, in the 1959-1964 and 1965-19067 periods, the mortality rates had been 56.3 percent and 19.6 percent respectively. The lowered mortality rate during 1968-1973 for urologic sepsis/shock was associated with improved management procedures: a) preventive measures such as postponement of urologic instrumentation and surgical intervention in patients infected with drug-resistant urea splitters, until the infection is under control, with emergency surgical patients being treated by susceptibility-tested drugs to control possible postoperative complications; b) early diagnosis and treatment of sepsis and immediate administration of bactericidal antibiotics parenterally; c) immediate restoration of fluid/electrolyte balance, with monitoring of renal and pulmonary functions and metabolic acidosis; and d) early administration of large pharmacologic doses of glucocorticoids, with monitoring of the microcirculation and use of beta-adrenergic isoproterenol.