Urologic sepsis/shock.
At Columbia-Presbyterian Medical Center during the six-year period 1968-1973, there were 1236 cases of sepsis from Gram-negative pathogens; 124 of these originated in the urinary tract. Of these 124 patients, 19 died-a mortality rate of 15.3 percent. There were 205 deaths among the 1236 patients with sepsis from Gramnegative organisms-a mortality rate of 16.6 percent. Previously, in the 1959-1964 and 1965-19067 periods, the mortality rates had been 56.3 percent and 19.6 percent respectively. The lowered mortality rate during 1968-1973 for urologic sepsis/shock was associated with improved management procedures: a) preventive measures such as postponement of urologic instrumentation and surgical intervention in patients infected with drug-resistant urea splitters, until the infection is under control, with emergency surgical patients being treated by susceptibility-tested drugs to control possible postoperative complications; b) early diagnosis and treatment of sepsis and immediate administration of bactericidal antibiotics parenterally; c) immediate restoration of fluid/electrolyte balance, with monitoring of renal and pulmonary functions and metabolic acidosis; and d) early administration of large pharmacologic doses of glucocorticoids, with monitoring of the microcirculation and use of beta-adrenergic isoproterenol.
D058186:Acute Kidney Injury / Q000209:etiology; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D045930:Anabolic Agents / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007668:Kidney / Q000503:physiopathology; D018805:Sepsis / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D012772:Shock, Septic / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D014552:Urinary Tract Infections / Q000150:complications* / Q000503:physiopathology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014883:Water-Electrolyte Imbalance / Q000209:etiology
D000305:Adrenal Cortex Hormones; D045930:Anabolic Agents; D000900:Anti-Bacterial Agents; D014662:Vasoconstrictor Agents