Risk Factors for Urosepsis in Older Adults

Peach, Brian C.; Garvan, Gerard; Garvan, Cynthia; Cimiotti, Jeannie P.

doi:10.1177/2333721416638980

Cited by 49 publications

(43 citation statements)

References 26 publications

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“…Pseudomonas aeruginosa infection is somewhat problematic; for instance, many immunocompromised patients are subject to P. aeruginosa, which is considered as attenuated bacteria. 11,12 In such patients, P. aeruginosa infection can easily become severe, and P. aeruginosa causing UTI is often refractory and leads to bacteremia or urosepsis. Urosepsis is defined as urological sepsis caused by UTI or urogenital infection.…”

Section: Discussionmentioning

confidence: 99%

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Bacteremia complicating urinary tract infection by Pseudomonas aeruginosa: Mortality risk factors

Kitagawa

Shigemura

Yamamichi³

et al. 2018

Int J of Urology

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Objectives To examine the clinical risk factors for death within 30 days of diagnosis of Pseudomonas aeruginosa‐causing bacteremia after a urinary tract infection. Methods A total of 62 patients with Pseudomonas aeruginosa isolated from both urine and blood at the same episode from January 2009 to December 2016 were enrolled in the present study. We retrospectively investigated clinical risk factors for death by comparison between surviving patients and those who died within 30 days after diagnosis of P. aeruginosa bacteremia. The comparison for risk factors for bacteremia‐related death included 31 categories, such as age, laboratory data, underlying diseases, clinical history, history of surgery, care in the intensive care unit, P. aeruginosa susceptibility to the antibiotics used at the time of bacteremia diagnosis and consultation with urological department. Results The study included 48 men and 14 women aged 71.3 ± 10.4 years. Nine patients (14.5%) died of P. aeruginosa bacteremia. Statistical analysis showed that non‐survivors had significantly lower albumin levels than survivors (2.07 ± 0.62 vs 2.62 ± 0.65; P = 0.023). The non‐survivors had significantly higher rates of ventilator use, history of heart disease, septic shock and lower rates of consultation with urological departments after diagnosis (P < 0.05). Conclusions Patients with bacteremia complicating urinary infection by P. aeruginosa have a low death rate. Earlier intervention by urologists might improve patients’ outcome. Lower albumin levels, ventilator use, history of heart disease and septic shock are factors associated with higher mortality rate.

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Section: Discussionmentioning

confidence: 99%

“…Peach et al . stated that indwelling urinary catheter and recent exposure to antibiotics were risk factors for death or septic shock . However, there are not enough reports addressing Pseudomonas aeruginosa bacteremia.…”

Section: Introductionmentioning

confidence: 99%

Bacteremia complicating urinary tract infection by Pseudomonas aeruginosa: Mortality risk factors

Kitagawa

Shigemura

Yamamichi³

et al. 2018

Int J of Urology

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“…More frequent UTI in these cohorts is not merely bothersome; UTI is known to exacerbate MS 12 , lead to confusion and falls in the elderly 13 , and increase the risk of organ rejection in renal transplant patients 14 . Furthermore, catheter-associated UTI carries an increased risk of urosepsis 15 , and bacteriuria in pregnant women is associated with preterm birth and other maternal morbidities 16 .…”

Section: Introductionmentioning

confidence: 99%

A urine-dependent human urothelial organoid offers a potential alternative to rodent models of infection

Horsley

Dharmasena

Malone‐Lee

et al. 2018

Sci Rep

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Murine models describe a defined host/pathogen interaction for urinary tract infection, but human cell studies are scant. Although recent human urothelial organoid models are promising, none demonstrate long-term tolerance to urine, the natural substrate of the tissue and of the uropathogens that live there. We developed a novel human organoid from progenitor cells which demonstrates key structural hallmarks and biomarkers of the urothelium. After three weeks of transwell culture with 100% urine at the apical interface, the organoid stratified into multiple layers. The apical surface differentiated into enlarged and flattened umbrella-like cells bearing characteristic tight junctions, structures resembling asymmetric unit membrane plaques, and a glycosaminoglycan layer. The apical cells also expressed cytokeratin-20, a spatial feature of the mammalian urothelium. Urine itself was necessary for full development, and undifferentiated cells were urine-tolerant despite the lack of membrane plaques and a glycosaminoglycan layer. Infection with Enterococcus faecalis revealed the expected invasive outcome, including urothelial sloughing and the formation of intracellular colonies similar to those previously observed in patient cells. This new biomimetic model could help illuminate invasive behaviours of uropathogens, and serve as a reproducible test bed for disease formation, treatment and resolution in patients.

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“…Each year in the UK there are 150,000 cases of sepsis in the population, causing 44,000 deaths. 3 UTI is the commonest cause of sepsis in older adults, 4 with urinary sepsis causing an in-hospital mortality of 33% in this age group. 2 In the United States (US), sepsis is the tenth leading cause of death in patients over 65.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of symptoms and signs for identifying urinary tract infection in older adult outpatients: Systematic review and meta-analysis

Gbinigie

Ordóñez‐Mena

Fanshawe

et al. 2018

Journal of Infection

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HighlightsOlder adults may present atypically with UTI and making a diagnosis can be difficult.There is limited authoritative guidance on how older adult outpatients present with UTI.Symptoms and signs traditionally associated with UTI (e.g. nocturia, urgency and abnormal vital signs) may have limited utility in diagnosing these infections in older adult outpatients.Disability in performing a number of acts of daily living may be better predictors of UTI; high quality studies should be conducted in this area to confirm this.

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Risk Factors for Urosepsis in Older Adults

Cited by 49 publications

References 26 publications

Bacteremia complicating urinary tract infection by Pseudomonas aeruginosa: Mortality risk factors

Bacteremia complicating urinary tract infection by Pseudomonas aeruginosa: Mortality risk factors

A urine-dependent human urothelial organoid offers a potential alternative to rodent models of infection

Diagnostic value of symptoms and signs for identifying urinary tract infection in older adult outpatients: Systematic review and meta-analysis

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