title: [Stone treatment after urosepsis in elderly or multimorbid patients--influence on sepsis recurrence rate and rehospitalisation].
abstract: BACKGROUND
  In elderly and multimorbid patients urosepsis is a particularly serious condition with a high mortality. Whether a secondary therapy for an underlying stone disease after -initial sepsis treatment improves the prognosis of these patients has not been systematically investigated. We retrospectively reviewed the clinical course of elderly and multimorbid patients with urosepsis regarding the frequency of rhospitalisation and sepsis recurrence after initial and subsequent therapy.
  
  
  METHODS
  Patients with and without urolithiasis and urosepsis were compared. Inclusion criteria were multimorbidity, defined by an ASA score (≥2) or a Charlson score (≥3) and age (≥60 years), and general sepsis features. Both groups (patients with urolithiasis [U+] and patients without urolithiasis [U-]) did not differ in terms of demographic data. We investigated the influence of the primary sepsis therapy and secondary stone treatment on the incidence of rehospitalisation and sepsis recurrence rate.
  
  
  RESULTS
  The incidence of rehospitalisation in stone patients (U+) with and without therapy did not differ (22.1% vs. 21%), while the occurrence of urosepsis was lower in treated patients (0% vs. 8.7%). Rehospitalisation in stone patients was generally less common than in patients without urolithiasis (U+ 21.6%, U- 44.4%). Recurrences of sepsis were higher in patients without stone disease (U+ 4.35%, U- 8.9%). If the subpopulation with successful stone therapy was extracted from the U+ group, the difference disappeared (U+ 8.7%, U- 8.9%).
  
  
  CONCLUSIONS
  Stone treatment after initial urosepsis therapy reduces the incidence of recurrent sepsis (0% vs. 8.7%). Patients without underlying urolithiasis (U-) have a similar risk of sepsis recurrence as urolithiasis patients without secondary stone treatment. A complete stone clearance should be pursued in multimorbid or elderly patients with urosepsis to reduce secondary morbidity.
authors.affiliation: Urologische Klinik Charité, Berlin.
authors.forename: K
authors.initials: K
authors.lastname: Stier
authors.forename: M
authors.initials: M
authors.lastname: Albrecht
authors.forename: H
authors.initials: H
authors.lastname: Cash
authors.forename: K
authors.initials: K
authors.lastname: Miller
authors.forename: T F
authors.initials: TF
authors.lastname: Fuller
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment; D005858:Germany; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D052878:Urolithiasis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*