title: Urosepsis--Etiology, Diagnosis, and Treatment.
abstract: BACKGROUND
  Sepsis is among the most common causes of death in Germany. Urosepsis accounts for 9-31% of all cases and has a mortality of 20-40%, which is low compared with that of sepsis in general. As the population ages, the incidence of urosepsis is likely to rise.
  
  
  METHODS
  Review of pertinent articles and guidelines retrieved by a selective search in PubMed.
  
  
  RESULTS
  Enterobacteria and Gram-positive organisms are the pathogens that most commonly cause urosepsis. The diagnosis can and must be made early on the basis of the typical clinical features, altered vital signs, and laboratory abnormalities, so that timely treatment can be initiated. 80% of cases are due to obstructive uropathy. The diagnostic evaluation includes physical examination, blood cultures, urinalysis, procalcitonin measurement, and ultrasonography. In one study, each additional hour of delay in the treatment of urosepsis with antibiotics was found to lower the survival rate by 7.6%. Antibiotics should be chosen in consideration of local resistance patterns and the expected pathogen spectrum.
  
  
  CONCLUSIONS
  Urologists, intensive care specialists, and microbiologists should all be involved in the interdisciplinary treatment of urosepsis. Patients' outcomes have improved recently, probably because of the frequent use of minimally invasive treatments to neutralize foci of infection. New biomarkers and new treatments still need to be validated in multicenter trials.
authors.affiliation: Department of Adult and Pediatric Urology, Witten/Herdecke University, HELIOS, Klinikum Wuppertal, Center for Research in Clinical Medicine (ZFKM), Institute for Microbiology and Laboratory Medicine, Witten/Herdecke University, Center for Research in Clinical Medicine (ZFKM), HELIOS Klinikum, Wuppertal, Department of Intensive Care Medicine, Witten/Herdecke University, HELIOS, Klinikum Wuppertal.
authors.forename: Nici Markus
authors.initials: NM
authors.lastname: Dreger
authors.forename: Stephan
authors.initials: S
authors.lastname: Degener
authors.forename: Parviz
authors.initials: P
authors.lastname: Ahmad-Nejad
authors.forename: Gabriele
authors.initials: G
authors.lastname: Wöbker
authors.forename: Stephan
authors.initials: S
authors.lastname: Roth
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001424:Bacterial Infections / Q000175:diagnosis* / Q000628:therapy* / Q000652:urine; D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic; D018805:Sepsis / Q000175:diagnosis* / Q000628:therapy* / Q000652:urine; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000628:therapy* / Q000652:urine
chemical_list: D000900:Anti-Bacterial Agents