Urosepsis and Septic Shock: A Simple Infection Progressing to Complex One

The systemic inflammatory response (SIRS) in the urinary tract, which includes the male genital organ (prostate), is known as urosepsis. One-fourth of all cases of sepsis are due to urosepsis. Sepsis is primarily caused by a microbial infection, although the host ultimately plays a major role in the development of the illness. The morbidity and mortality are high if it is not identified and treated promptly. All acute care physicians, anesthesiologists, intensivists, and urologists should be aware of this potentially fatal condition. The risk factors for urosepsis are impaired voiding, congenital obstruction of urinary flow, acquired obstruction, urinary tract interventions, metabolic disorder, and immunocompromised state. In community-acquired urosepsis, there are more UTIs with ESBL E. coli; 15% of urinary tract infections are caused by gram-positive bacteria, followed by Proteus species 15%, enterobacteria and Klebsiella 15%, and Pseudomonas aeruginosa in 5% and 15% of cases. The “CHAOS” theory is an excellent explanation of the interaction between the host’s pro- and anti-inflammatory responses as well as the many stages or states of sepsis patients. Patients with urosepsis typically have a fever, widespread weakness, and flank pain. The patient will be tachycardic and tachypneic and could have borderline or low blood pressure. Leukocytosis and elevated sepsis indicators (CRP, procalcitonin) will be seen in a blood count. Emergency genitourinary tract ultrasonography allows for the quick identification of urosepsis. The common cause of urosepsis, blockages to the urinary system and urine flow, will be found with USG. As soon as urosepsis is suspected, start measuring urine output; take a blood and urine culture, CBC, and serum lactate; and start broad-spectrum antibiotics within an hour. Start giving oxygen and intravenous fluids, following the local hospital antibiogram. For a better outcome, the source of urosepsis or septic shock must be controlled quickly. Percutaneous nephrostomy (PCN) and drainage of pus or infected urine are the two options. It typically has a high success rate and is performed with local anesthetic and USG guidance.