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Copyright (c) 2025 Fahad Muzil O Al Harbi, Abdulaziz Abdulmajeed Almalki, Hani Eid Alharbi, Abeer Ali Almatrafi, Anfal Abdulrazaq Alabdulwahed, Safer Atif Alqahtani, AbdulRahman Bakeet Ayed Alharbi, Khalid Ali Alrashidi, Aisha Awad Alanazi, Basheer Ayadh ALRashidi , Abeer Eid Alrashidi , Abdullah Ghadhyan Abdullah Alrashdi, Abdulmajid Ali Al-Rashidi, Khalil Mohammed Khalil ALdhuwaymir
This work is licensed under a Creative Commons Attribution 4.0 International License.
Clinical Management of Urosepsis in Emergency Settings: Nursing Care, Nutritional Support, and EMS Interventions
Corresponding Author(s) : Fahad Muzil O Al Harbi
Saudi Journal of Medicine and Public Health, Vol. 2 No. 2 (2025)
Abstract
Background: Urosepsis is a life-threatening systemic response to urinary tract infections resulting from a dysregulated host reaction leading to inflammation, tissue hypoperfusion, and organ dysfunction. It commonly arises from ascending infections such as pyelonephritis, complicated UTIs, and infections associated with urinary obstruction or indwelling catheters. Gram-negative bacteria, particularly Escherichia coli, are the predominant causative organisms.
Aim: This review aims to summarize current evidence on the clinical presentation, diagnostic workup, management strategies, and multidisciplinary roles in improving outcomes in urosepsis.
Methods: The article synthesizes evidence from clinical trials, epidemiologic trends, and contemporary guidelines focusing on etiology, pathophysiology, diagnostic evaluation, emergency management, and interprofessional practices.
Results: Urosepsis continues to exhibit high morbidity and mortality, with death rates reaching up to 40% despite advances in care. Early recognition, rapid initiation of antibiotics within one hour, and aggressive fluid resuscitation significantly improve survival. CT imaging is valuable in identifying obstructive or structural causes requiring source-control procedures such as stenting or nephrostomy. Complications include acute kidney injury, septic shock, and multiorgan dysfunction. Multidisciplinary collaboration, including infectious-disease pharmacists and urology specialists, enhances antimicrobial stewardship and improves outcomes.
Conclusion: Early diagnosis, prompt antimicrobial therapy, aggressive resuscitation, and timely correction of urologic abnormalities are essential for reducing mortality and long-term complications. Interprofessional coordination remains critical to optimal outcomes.
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- Björck V, Påhlman LI, Bodelsson M, Petersson AC, Kander T. Morbidity and mortality in critically ill patients with invasive group A streptococcus infection: an observational study. Critical care (London, England). 2020 Jun 6:24(1):302. doi: 10.1186/s13054-020-03008-z. Epub 2020 Jun 6
- Shimoni Z, Salah M, Kasem A, Hermush V, Froom P. Bacterial Resistance to Cephalosporin Treatment in Elderly Stable Patients Hospitalized With a Urinary Tract Infection. The American journal of the medical sciences. 2020 Sep:360(3):243-247. doi: 10.1016/j.amjms.2020.05.008.
- Vikrant S, Gupta D, Singh M. Epidemiology and outcome of acute kidney injury from a tertiary care hospital in India. Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia. 2018 Jul-Aug:29(4):956-966. doi: 10.4103/1319-2442.239633.
- Scotland KB, Lange D. Prevention and management of urosepsis triggered by ureteroscopy. Research and reports in urology. 2018:10():43-49. doi: 10.2147/RRU.S128071.
- Liu YQ, Lu J, Hao YC, Xiao CL, Ma LL. [Predicting model based on risk factors for urosepsis after percutaneous nephrolithotomy]. Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences. 2018 Jun 18:50(3):507-513
- Kozyrakis D, Perikleous S, Chatzistamou SE, Kateris D, Soukias G, Karatzas A, Dimitriadis I. Is There a Role for Double J Stent Culture in Contemporary Urology? Urologia internationalis. 2018:100(2):203-208. doi: 10.1159/000486798.
- Sarhan M, von Mässenhausen A, Hugo C, Oberbauer R, Linkermann A. Immunological consequences of kidney cell death. Cell death & disease. 2018 Jan 25:9(2):114. doi: 10.1038/s41419-017-0057-9.
- Kodner CM, Thomas Gupton EK. Recurrent urinary tract infections in women: diagnosis and management. American family physician. 2010 Sep 15:82(6):638-43
- Saade A, Styczynski J, Cesaro S, Infectious Disease Working party of EBMT. BK virus infection in allogeneic hematopoietic cell transplantation: An update on pathogenesis, immune responses, diagnosis and treatments. The Journal of infection. 2020 Sep:81(3):372-382. doi: 10.1016/j.jinf.2020.06.009.
- Parlak E. A case of glomerulonephritis caused by brucellosis. Tropical doctor. 2020 Oct:50(4):360-361. doi: 10.1177/0049475520929505.
- Reddivari AKR, Mehta P. Prostatic Abscess. StatPearls. 2025 Jan
- Vigil HR, Hickling DR. Urinary tract infection in the neurogenic bladder. Translational andrology and urology. 2016 Feb:5(1):72-87. doi: 10.3978/j.issn.2223-4683.2016.01.06.
- Dreger NM, Degener S, Ahmad-Nejad P, Wöbker G, Roth S. Urosepsis--Etiology, Diagnosis, and Treatment. Deutsches Arzteblatt international. 2015 Dec 4:112(49):837-47; quiz 848. doi: 10.3238/arztebl.2015.0837.
- Morin A, Bergevin M, Rivest N, Lapointe SP. Antibiotic prophylaxis for transrectal ultrasound-guided prostate needle biopsy: Compared efficacy of ciprofloxacin vs. the ciprofloxacin/fosfomycin tromethamine combination. Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2020 Aug:14(8):267-272. doi: 10.5489/cuaj.6248.
- Caron F, Galperine T, Flateau C, Azria R, Bonacorsi S, Bruyère F, Cariou G, Clouqueur E, Cohen R, Doco-Lecompte T, Elefant E, Faure K, Gauzit R, Gavazzi G, Lemaitre L, Raymond J, Senneville E, Sotto A, Subtil D, Trivalle C, Merens A, Etienne M. Practice guidelines for the management of adult community-acquired urinary tract infections. Medecine et maladies infectieuses. 2018 Aug:48(5):327-358. doi: 10.1016/j.medmal.2018.03.005.
- Wagenlehner FM, Tandogdu Z, Bjerklund Johansen TE. An update on classification and management of urosepsis. Current opinion in urology. 2017 Mar:27(2):133-137. doi: 10.1097/MOU.0000000000000364.
- Reynolds LF, Kroczak T, Pace KT, D'Arcy Honey RJ, Ordon M, Lee JY. Are Routine Laboratory Investigations Necessary Following Percutaneous Nephrolithotomy? Urology. 2020 Sep:143():80-84. doi: 10.1016/j.urology.2020.05.025.
- Grüne B, Viehweger V, Waldbillig F, Nientiedt M, Kriegmair MC, Rassweiler-Seyfried MC, Ritter M. Preoperative urine culture - Is it necessary to prevent infectious complications following ureterorenoscopy? Journal of microbiological methods. 2020 Jun:173():105933. doi: 10.1016/j.mimet.2020.105933.
- Heppner HJ, Yapan F, Wiedemann A. [Urosepsis in Geriatric Patients]. Aktuelle Urologie. 2016 Feb:47(1):54-9. doi: 10.1055/s-0041-106184.
- Goveas B. Urosepsis: A simple infection turns toxic. The Nurse practitioner. 2017 Jul 15:42(7):53-54. doi: 10.1097/01.NPR.0000520425.91534.b8.
- Pietropaolo A, Hendry J, Kyriakides R, Geraghty R, Jones P, Aboumarzouk O, Somani BK. Outcomes of Elective Ureteroscopy for Ureteric Stones in Patients with Prior Urosepsis and Emergency Drainage: Prospective Study over 5 yr from a Tertiary Endourology Centre. European urology focus. 2020 Jan 15:6(1):151-156. doi: 10.1016/j.euf.2018.09.001.
- Zhu Z, Cui Y, Zeng F, Li Y, Chen Z, Hequn C. Comparison of suctioning and traditional ureteral access sheath during flexible ureteroscopy in the treatment of renal stones. World journal of urology. 2019 May:37(5):921-929. doi: 10.1007/s00345-018-2455-8.
References
Björck V, Påhlman LI, Bodelsson M, Petersson AC, Kander T. Morbidity and mortality in critically ill patients with invasive group A streptococcus infection: an observational study. Critical care (London, England). 2020 Jun 6:24(1):302. doi: 10.1186/s13054-020-03008-z. Epub 2020 Jun 6
Shimoni Z, Salah M, Kasem A, Hermush V, Froom P. Bacterial Resistance to Cephalosporin Treatment in Elderly Stable Patients Hospitalized With a Urinary Tract Infection. The American journal of the medical sciences. 2020 Sep:360(3):243-247. doi: 10.1016/j.amjms.2020.05.008.
Vikrant S, Gupta D, Singh M. Epidemiology and outcome of acute kidney injury from a tertiary care hospital in India. Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia. 2018 Jul-Aug:29(4):956-966. doi: 10.4103/1319-2442.239633.
Scotland KB, Lange D. Prevention and management of urosepsis triggered by ureteroscopy. Research and reports in urology. 2018:10():43-49. doi: 10.2147/RRU.S128071.
Liu YQ, Lu J, Hao YC, Xiao CL, Ma LL. [Predicting model based on risk factors for urosepsis after percutaneous nephrolithotomy]. Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences. 2018 Jun 18:50(3):507-513
Kozyrakis D, Perikleous S, Chatzistamou SE, Kateris D, Soukias G, Karatzas A, Dimitriadis I. Is There a Role for Double J Stent Culture in Contemporary Urology? Urologia internationalis. 2018:100(2):203-208. doi: 10.1159/000486798.
Sarhan M, von Mässenhausen A, Hugo C, Oberbauer R, Linkermann A. Immunological consequences of kidney cell death. Cell death & disease. 2018 Jan 25:9(2):114. doi: 10.1038/s41419-017-0057-9.
Kodner CM, Thomas Gupton EK. Recurrent urinary tract infections in women: diagnosis and management. American family physician. 2010 Sep 15:82(6):638-43
Saade A, Styczynski J, Cesaro S, Infectious Disease Working party of EBMT. BK virus infection in allogeneic hematopoietic cell transplantation: An update on pathogenesis, immune responses, diagnosis and treatments. The Journal of infection. 2020 Sep:81(3):372-382. doi: 10.1016/j.jinf.2020.06.009.
Parlak E. A case of glomerulonephritis caused by brucellosis. Tropical doctor. 2020 Oct:50(4):360-361. doi: 10.1177/0049475520929505.
Reddivari AKR, Mehta P. Prostatic Abscess. StatPearls. 2025 Jan
Vigil HR, Hickling DR. Urinary tract infection in the neurogenic bladder. Translational andrology and urology. 2016 Feb:5(1):72-87. doi: 10.3978/j.issn.2223-4683.2016.01.06.
Dreger NM, Degener S, Ahmad-Nejad P, Wöbker G, Roth S. Urosepsis--Etiology, Diagnosis, and Treatment. Deutsches Arzteblatt international. 2015 Dec 4:112(49):837-47; quiz 848. doi: 10.3238/arztebl.2015.0837.
Morin A, Bergevin M, Rivest N, Lapointe SP. Antibiotic prophylaxis for transrectal ultrasound-guided prostate needle biopsy: Compared efficacy of ciprofloxacin vs. the ciprofloxacin/fosfomycin tromethamine combination. Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2020 Aug:14(8):267-272. doi: 10.5489/cuaj.6248.
Caron F, Galperine T, Flateau C, Azria R, Bonacorsi S, Bruyère F, Cariou G, Clouqueur E, Cohen R, Doco-Lecompte T, Elefant E, Faure K, Gauzit R, Gavazzi G, Lemaitre L, Raymond J, Senneville E, Sotto A, Subtil D, Trivalle C, Merens A, Etienne M. Practice guidelines for the management of adult community-acquired urinary tract infections. Medecine et maladies infectieuses. 2018 Aug:48(5):327-358. doi: 10.1016/j.medmal.2018.03.005.
Wagenlehner FM, Tandogdu Z, Bjerklund Johansen TE. An update on classification and management of urosepsis. Current opinion in urology. 2017 Mar:27(2):133-137. doi: 10.1097/MOU.0000000000000364.
Reynolds LF, Kroczak T, Pace KT, D'Arcy Honey RJ, Ordon M, Lee JY. Are Routine Laboratory Investigations Necessary Following Percutaneous Nephrolithotomy? Urology. 2020 Sep:143():80-84. doi: 10.1016/j.urology.2020.05.025.
Grüne B, Viehweger V, Waldbillig F, Nientiedt M, Kriegmair MC, Rassweiler-Seyfried MC, Ritter M. Preoperative urine culture - Is it necessary to prevent infectious complications following ureterorenoscopy? Journal of microbiological methods. 2020 Jun:173():105933. doi: 10.1016/j.mimet.2020.105933.
Heppner HJ, Yapan F, Wiedemann A. [Urosepsis in Geriatric Patients]. Aktuelle Urologie. 2016 Feb:47(1):54-9. doi: 10.1055/s-0041-106184.
Goveas B. Urosepsis: A simple infection turns toxic. The Nurse practitioner. 2017 Jul 15:42(7):53-54. doi: 10.1097/01.NPR.0000520425.91534.b8.
Pietropaolo A, Hendry J, Kyriakides R, Geraghty R, Jones P, Aboumarzouk O, Somani BK. Outcomes of Elective Ureteroscopy for Ureteric Stones in Patients with Prior Urosepsis and Emergency Drainage: Prospective Study over 5 yr from a Tertiary Endourology Centre. European urology focus. 2020 Jan 15:6(1):151-156. doi: 10.1016/j.euf.2018.09.001.
Zhu Z, Cui Y, Zeng F, Li Y, Chen Z, Hequn C. Comparison of suctioning and traditional ureteral access sheath during flexible ureteroscopy in the treatment of renal stones. World journal of urology. 2019 May:37(5):921-929. doi: 10.1007/s00345-018-2455-8.