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Community-onset uro...
Community-onset urosepsis: incidence and risk factors for 30-day mortality - a retrospective cohort study
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- Holmbom, Martin (författare)
- Linköping University,Linköpings universitet,Avdelningen för kirurgi, ortopedi och onkologi,Medicinska fakulteten,Region Östergötland, Urologiska kliniken i Östergötland
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- Andersson, Maria (författare)
- Linköping University,Linköpings universitet,Avdelningen för inflammation och infektion,Medicinska fakulteten,Region Östergötland, Infektionskliniken i Östergötland
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- Grabe, Magnus (författare)
- Lund University,Lunds universitet,Urologisk cancerforskning, Malmö,Forskargrupper vid Lunds universitet,Urological cancer, Malmö,Lund University Research Groups
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- Peeker, Ralph, 1958 (författare)
- University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för urologi,Institute of Clinical Sciences, Department of Urology,Department of Urology, University of Gothenburg, Gothenburg, Sweden,Univ Gothenburg, Sweden
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- Saudi, Aus (författare)
- Linköping University,Linköpings universitet,Institutionen för biomedicinska och kliniska vetenskaper,Medicinska fakulteten,Region Östergötland, Urologiska kliniken i Östergötland
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- Styrke, Johan (författare)
- Umeå University,Umeå universitet,Urologi och andrologi,Umea Univ, Sweden
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- Aljabery, Firas (författare)
- Linköping University,Linköpings universitet,Avdelningen för kirurgi, ortopedi och onkologi,Medicinska fakulteten,Region Östergötland, Urologiska kliniken i Östergötland
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(creator_code:org_t)
- 2022-09-20
- 2022
- Engelska.
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Ingår i: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813. ; 56:5-6, s. 414-420
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Abstract
Ämnesord
Stäng
- Background Urosepsis is a life-threatening condition that needs to be addressed without delay. Two critical issues in its management are: (1) Appropriate empirical antibiotic therapy, considering the patients general condition, comorbidity, and the pathogen expected; and (2) Timing of imaging to identify obstruction requiring decompression. Objectives To identify risk factors associated with 30-day mortality in patients with urosepsis. Methods From a cohort of 1,605 community-onset bloodstream infections (CO-BSI), 282 patients with urosepsis were identified in a Swedish county 2019-2020. Risk factors for mortality with crude and adjusted odds ratios were analysed using logistic regression. Results Urosepsis was found in 18% (n = 282) of all CO-BSIs. The 30-day all-cause mortality was 14% (n = 38). After multivariable analysis, radiologically detected urinary tract disorder was the predominant risk factor for mortality (OR = 4.63, 95% CI = 1.47-14.56), followed by microbiologically inappropriate empirical antibiotic therapy (OR = 4.19, 95% CI = 1.41-12.48). Time to radiological diagnosis and decompression of obstruction for source control were also important prognostic factors for survival. Interestingly, 15% of blood cultures showed gram-positive species associated with a high 30-day mortality rate of 33%. Conclusion The 30-day all-cause mortality from urosepsis was 14%. The two main risk factors for mortality were hydronephrosis caused by obstructive stone in the ureter and inappropriate empirical antibiotic therapy. Therefore, early detection of any urinary tract disorder by imaging followed by source control as required, and antibiotic coverage of both gram-negative pathogens and gram-positive species such as E. faecalis to optimise management, is likely to improve survival in patients with urosepsis.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Urologi och njurmedicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Urology and Nephrology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Nyckelord
- Urosepsis
- risk factors
- bloodstream infection
- community-onset
- empirical antibiotic therapy
- 30-day mortality
- urinary tract disorder
- urinary tract infection
- surviving sepsis
- septic shock
- management
- campaign
- therapy
- Urology & Nephrology
- 30-day mortality
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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