Urosepsis: from the intensive care viewpoint

Abstract

A recent survey conducted by the Competence Network Sepsis (SepNet) revealed that severe sepsis and/or septic shock occurs in 75 000 inhabitants (110 per 100 000) and sepsis occurs in 79 000 inhabitants (116 per 100 000) in Germany annually. The prevalence of urosepsis in this survey was 7%. Early diagnosis of sepsis prior to the onset of clinical deterioration is of particular interest because this would increase the possibility of early and specific treatment, which in turn is the major determining factor of mortality in septic patients. Treatment of urosepsis consists of source control, early antimicrobial therapy as well as supportive and adjunctive therapy. For supportive therapy, adequate volume loading is the most important step in the treatment of patients with urosepsis in order to restore and maintain oxygen transport and tissue oxygenation. Therefore, supportive treatment should focus on adequate volume resuscitation and appropriate use of inotropes/vasopressors. The PROWESS study is the first investigation demonstrating the decrease in mortality in patients with sepsis following administration of activated protein C (APC). Thus, administration of APC to patients with two-organ failure or an APACHE II score ≥25 within the first 24 h after the first sepsis-induced organ failure is a part of adjunctive therapy. Additionally, current data support low-dose hydrocortisone therapy in patients with vasopressor-dependent severe septic shock. Time to initiation of therapy is crucial for surviving sepsis. Implementing new medical evidence in this context into daily clinical intensive care remains a major hurdle.

Introduction

A recent survey conducted by the publicly funded Competence Network Sepsis (SepNet) revealed that severe sepsis and/or septic shock occurs in 75 000 inhabitants (110 per 100 000) and sepsis occurs in 79 000 inhabitants (116 per 100 000) in Germany annually [1]. In this prospective, observational, cross-sectional, 1-day prevalence study, 3877 patients were screened in Germany in a representative random sample of 310 hospitals with 454 Intensive Care Units (ICUs) out of a total of 1380 German hospitals. Among the 1348 patients with infections, 415 (30.8%) had severe sepsis or septic shock according to the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) Consensus Conference. The prevalence of urosepsis was 7%. Urosepsis is defined as sepsis caused by urinary tract infection (UTI). Because of the increasing prevalence of sepsis, this entity will be seen more frequently in medical practice and outpatient units. Immediate identification and treatment of the septic focus is crucial; 60 000 of 154 000 septic patients die each year owing to sepsis [1]. Thus, sepsis is the third most common cause of death in Germany; more people die only due to coronary heart disease and acute myocardial infarction. In the last 3–4 years, substantial progress in sepsis therapy has been made. The gap between implementing the new medical evidence into daily clinical practice on the ICU remains as a major hurdle in this context. Early diagnosis of sepsis prior to the onset of clinical deterioration is of particular interest, as this would increase the possibility for early and specific treatment. Similar to acute myocardial infarction or ischaemic stroke, the time to initiation of therapy appears to be crucial and the major determining factor for surviving sepsis.