Management of the Urosepsis Syndrome

Urosepsis is defined as a serious disease due to organ failure caused by a urinary tract infection. The course of the disease is driven by the host response. An adequate empirical antibiotic therapy should be instigated within the first hour after diagnosis. Urine cultures and blood cultures should be performed before antibiotic treatment. Early diagnostics should be carried out, to diagnose the focus and enable an early interventional focus control. Gram-negative pathogens are the main organisms that are cultured. Depending on the geographic region, ESBL-forming bacteria and multidrug-resistant organisms are increasing. The empirical therapy consists of a broad-spectrum beta-lactam antibiotic. While piperacillin/tazobactam, carbapenems, and the new cephalosporin/beta-lactamase inhibitor combinations are given as monotherapy in patients with renal impairment, cephalosporines should be combined with aminoglycosides (preferred) or fluoroquinolones. If a combination therapy is given, it should be de-escalated to a monotherapy after 48–72 h.