Risk factors for urosepsis in chronic kidney disease patients with urinary tract infections

Abstract

Occurrence of urosepsis is not uncommon following urinary tract infections (UTI). However, there is a lack of evidence explaining the risk factors predisposing to urosepsis in patients with chronic kidney disease (CKD). This retrospective study was undertaken to evaluate the incidence and possible risk factors for urosepsis among patients hospitalized with UTI in a cohort of CKD patients. Patients were divided into the urosepsis group and the non-urosepsis group. Of 489 hospitalized patients with UTI, 70 (14.3%) acquired urosepsis. Stepwise multivariate logistic regression demonstrated that diabetes, urinary catheter and length of hospital stay (p < 0.001 for all) were significant independent predictive risk factors for urosepsis in CKD patients with UTI in addition to age, glomerular filtration rate, hydronephrosis, acute kidney injury and E. coli infection (p < 0.05 for all). Finally, Klebsiella spp. cases were associated with significantly higher odds for urosepsis than E. coli cases (OR: 3.5, 95% CI: 2.86–7.23, p < 0.001 vs. OR: 1.38, 95% CI: 1.19–3.69, p = 0.038). Diabetes, presence of an indwelling urinary catheter, length of hospitalization, and infection with Klebsiella spp were independent risk factors for urosepsis in CKD patients with UTI.

Urosepsis among Sudanese Patients: A Paradigm from Limited Resources Country

“…Proteus mirabilis which is a causative agent of cystitis and pyelonephritis primarily in individuals with indwelling catheters or structural abnormalities and K. penumoniae is frequently opportunistic pathogens implicated in UT and catheter associated UTIs of hospitalized patients it has been suggested to involve the formation of biofilms on this surface include adherence factors. Each of Proteus mirabilis and K. penumoniae are pathogens implicated in catheter associated UTI and had been isolated from urosepsis patients in the present study, in study of Jessica reported same frequencies of Proteus mirabilis [32] and Dimitrijevic et al reported 11.7% of K. penumoniae causes urosepsis while in this study finding showed 7.7% [33].…”

Chronic Kidney Disease—An Underestimated Risk Factor for Antimicrobial Resistance in Patients with Urinary Tract Infections

“…Regarding non-infectious complications in hospitalized patients with UTIs, namely AKI, in a European cohort of 489 CKD patients, the reported rate of AKI in patients hospitalized for UTIs was 73.6%, the mean length of hospital-stay (days) 13.2 ± 18.5 [ 26 ] compared to a 34.9% incidence of AKI and 8.33 ± 5.82 days mean length of stay in our group. Other studies reported AKI incidence in hospitalized patients ranging from 45.4% [ 10 ] to 75.2% in a kidney transplant cohort [ 39 ].…”

“…It is known that the CKD population has an increased susceptibility to infectious events, both community-acquired and hospital-acquired [ 3 , 4 , 23 , 24 ]. This could be explained in part by frequent contact with the healthcare system, higher comorbidity index, impaired host defense mechanisms secondary to immune system impairments in both humoral and cellular immune responses, cytokine generation and oxidative stress [ 3 , 25 , 26 , 27 , 28 ]. Specifically, for increased susceptibility to UTIs, some of the potential risk factors are urinary tract abnormalities, disruption of the urinary epithelial barrier or impaired regeneration capacity, impaired bladder voiding, impairment in inflammasome signaling [ 29 ], progressive loss of kidney functions associated to decreased levels of urinary secreted molecules, namely antimicrobial peptides such as β-defensin 1, urinary uromodulin–a multifunctional protein also implicated in susceptibility and immune response to UTI [ 30 , 31 ] and other urothelium-secreted antimicrobial substances, such as tissue-type plasminogen activator and urokinase-type plasminogen activator [ 32 ].…”

Ureteral Obstruction Due to Inadvertent Placement of the Suprapubic Catheter and Bladder Indwelling Catheter: Presentation of Two Clinical Cases and Review of the Literature

“…Long-term urinary catheter users often have multiple medical, surgical, and even radiotherapeutic background, following damage to the detrusor muscle's structure, and consequent bladder alteration emptying, recurrent UTI, and high prevalence of renal scarring, caliectasis, and CKD (33). These antecedents associated with the permanent presence of a catheter increase the risk of suffering urosepsis (34).…”