Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 22 , ISSUE 1 ( 2018 ) > List of Articles

BRIEF COMMUNICATION

Outcome of patients admitted to a tertiary referral intensive care unit with urosepsis needing source control

Karthik Rao, Chaitra C. Rao, Pradeep Rangappa, Ipe Jacob

Keywords : nonobstructive uropathy, obstructive uropathy, ureteral stent,Early source control in urosepsis

Citation Information : Rao K, Rao CC, Rangappa P, Jacob I. Outcome of patients admitted to a tertiary referral intensive care unit with urosepsis needing source control. Indian J Crit Care Med 2018; 22 (1):27-29.

DOI: 10.4103/ijccm.IJCCM_322_17

License: CC BY-ND 3.0

Published Online: 00-01-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Urosepsis is one of the common causes of admission to the Intensive Care Unit (ICU). It has traditionally been treated with antibiotics, but surgical management with Double J [DJ] ureteral stents is gaining popularity. This study compares patients with complicated urosepsis who underwent surgical source control by ureteral stenting with those managed medically. Materials and Methods: The study enrolled patients admitted to a tertiary adult ICU with a diagnosis of urosepsis over a period of 2 years. The primary outcomes were renal replacement therapy (RRT) requirement and ICU mortality. The secondary outcomes were ICU and hospital length of stay, ventilator-free days, and inotrope free days. Patients were divided those with obstructive and nonobstructive urinary tract infection (UTI). Results: A total of 58 patients met the criteria, of who 32 had obstructive UTI and were included in Group A, with the remaining 26 with nonobstructive UTI comprised Group B. In Group A, 27 patients underwent source control with ureteral DJ stenting, three patients recovered with medical management, and two who were advised source control did not consent to the procedure. Seventeen patients in Group A and seven patients in Group B required RRT (P = 0.044). There was no significant difference in ICU mortality, hospital mortality, and 28 days survival between the two groups. Conclusion: With early source control, obstructive UTI outcomes were comparable to nonobstructive UTI. However, despite undergoing ureteric stenting, more patients with obstructive UTI required RRT than those with nonobstructive UTI.


PDF Share
  1. Wagenlehner FM, Pilatz A, Naber KG, Weidner W. Therapeutic challenges of urosepsis. Eur J Clin Invest 2008;38 Suppl 2:45-9.
  2. Nicolle LE; AMMI Canada Guidelines Committee*. Complicated urinary tract infection in adults. Can J Infect Dis Med Microbiol 2005;16:349-60.
  3. Docimo SG, Dewolf WC. High failure rate of indwelling ureteral stents in patients with extrinsic obstruction: Experience at 2 institutions. J Urol 1989;142:277-9.
  4. Finney RP. Experience with new Double J ureteral catheter stent. J Urol 1978;120:678-81.
  5. Çeçen K, Ülker K. The comparison of Double J stent insertion and conservative treatment alone in severe pure gestational hydronephrosis: A case controlled clinical study. ScientificWorldJournal 2014;2014:989173.
  6. Kalra OP, Raizada A. Approach to a patient with urosepsis. J Glob Infect Dis 2009;1:57-63.
  7. Wenzler DL, Kim SP, Rosevear HM, Faerber GJ, Roberts WW, Wolf JS Jr., et al. Success of ureteral stents for intrinsic ureteral obstruction. J Endourol 2008;22:295-9.
  8. Das D, Pal DK. Double J stenting: A rewarding option in the management of emphysematous pyelonephritis. Urol Ann 2016;8:261-4.
  9. Sharma PK, Sharma R, Vijay MK, Tiwari P, Goel A, Kundu AK, et al. Emphysematous pyelonephritis: Our experience with conservative management in 14 cases. Urol Ann 2013;5:157-62.
  10. Arsene C, Saste A, Arul S, Mestrovich J, Kammo R, Elbashir M, et al. A case series of emphysematous pyelonephritis. Case Rep Med 2014;2014:587926.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.