**4. Risk factors**

compliment system causes coagulopathy and fibrinolysis leading to microthrombi

stone for survival of these patients, hence giving the title of the chapter.

*Clinical Management of Shock - The Science and Art of Physiological Restoration*

We will discuss urosepsis in the following subheadings.

European countries and 15.5% higher in developing countries [8, 9]**.**

Urosepsis is classified into two categories.

Obstructive uropathy or genitourinary tract abnormalities

Gram-negative bacteria in 85% and Gram-positive in 15%

Source control by endoscopic stent or image-guided

**3.1 Community-acquired urosepsis**

The common aetiology of community-acquired urosepsis is the obstruction to the urine flow, and patient quickly tends to go into septic shock and multi-organ dysfunction due to urinary stagnation and bacterial growth. The obstruction also affects the pharmacokinetics of antibiotics. Relieving the obstruction is the corner-

The community acquired urosepsis is rare and commonly occurs due to structural or functional abnormality leading to urinary flow obstruction. It contributes to 5% of total sepsis case, whereas the hospital-acquired urosepsis contributes to 40% of sepsis cases [5]. Occurrence of urosepsis is more frequent in females than in males. For the community-acquired urosepsis, the frequent risk groups are the patients with obstructive uropathy. Hofmann reported that majority of obstruction to the flow of urine was due to urinary calculi (65%), tumours in 21%, gestation in 5%, urinary tract anomalies in 5% and surgical interventions in 4% of their patients [6]**.** Other risk factors for urosepsis are old age, female gender, immunosuppression, steroid therapy, chronic renal failure and prolonged surgical time [7]**.** In elderly bedbound patients, the urinary catheter is the foremost cause for urosepsis. Healthcare-associated infection frequency vary according to geographical location of the countries; prevalence of healthcare-associated infections is 4% in the United States of America, 6% in the

Community-acquired urosepsis when presents with urosepsis from the community. It accounts for 7% of all sepsis cases. It is more frequent in females and has a shorter ICU stay. Mainly caused by Gram-negative bacteria and 63% had *E. coli* with 41% having bacteraemia. Yang et al. have shown that ESBL-producing *E. coli* and

Prolonged urinary catheterization is a

Gram-negative bacteria in 66% and

Removal of urinary catheter is the source

common aetiology

control

pseudomonas

Gram-negative in 21%

*K. pneumoniae* (ESBL-EK) accounted for 20.7% of the pathogens causing

**Community-acquired urosepsis Hospital-acquired urosepsis**

Board-spectrum antibiotics depend on local antibiogram Initial antibiotics should cover

*Differences between community-acquired urosepsis and hospital-acquired urosepsis.*

formation and organ dysfunction [4]**.**

**2. Epidemiology**

**3. Classification**

are common aetiology

[12]

**Table 1.**

**178**

nephrostomy

There are risk factors for both community- and hospital-acquired urosepses. Community-acquired urosepsis occurs mainly in patients with obstructive uropathy, genitourinary tract structural abnormalities and carcinoma of the urinary bladder, whereas the hospital-acquired urosepsis occurs in catheterized elderly patients, on immunosuppression therapy [13, 14]**.**
