**7. Complications**

The main complications of urosepsis are bacteraemia (23%), endotoxemia (34%) and septic shock up to 2.5%. The common organ involved is the kidney [24]**.**

### **7.1 Post-obstructive acute kidney injury**

Up to 10% of acute kidney injury (AKI) episodes are caused by urinary tract obstruction; in the elderly, it will increase to 22% of AKI. The mechanisms in the pathogenesis of obstructive nephropathy lead to renal vasoconstriction and progressive renal fibrosis; while renal vasoconstriction is reversible after the release of obstruction, renal fibrosis may result in irreversible loss of function. Postobstructive AKI rarely progresses to end-stage renal disease after the release of obstruction, but significant percentage (21%) of these patients have chronic renal impairment. The best time to release urinary obstruction in the setting of postobstructive AKI is not known; in patients with sepsis, it should be performed as an emergency. The renal outcome inversely correlated with elapsed time from admission to the release of obstruction, which could suggest that the release should be performed as an emergency even in the absence of sepsis [25]**.**


**Table 4.** *Complications of urosepsis.*

**6. Microbiology and microbial resistance in urosepsis**

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

[23] (**Table 3**).

**7. Complications**

*Bacteriology of urosepsis.*

**Table 3.**

**182**

Patients with prolonged and infected ureteric stents

**7.1 Post-obstructive acute kidney injury**

**Risk factors Common organism** Community-acquired urosepsis Gram-positive bacteria 15%

Hospital-acquired urosepsis Gram-positive bacteria 21%

resistance

*Candida* species

Urinary culture is not specific for diagnosis, but it rules out the origin of urosepsis if it is negative. It should be obtained at midstream and procedure immediately. Blood cultures must also be taken before administrating the antimicrobial agent, can be ones results are available. Blood cultures can be positive in up to 41% of the cultures [23]**.** About 93% of the patients admitted with community-acquired urosepsis had *E. coli* growth, whereas 66% of the hospital-acquired urosepsis patients grow *E. coli*. Interesting factor is that the urinary catheter-associated urosepsis is associated with Gram-positive infections. *Candida* infections are common in patients with stents in the urinary tract. In female patients, the *E.coli* urosepsis is common as compared to the male patients (92 and 60%, respectively)

Gram-negative bacteria 85%

Patients with diabetes mellitus *E. coli*, *Klebsiella pneumoniae*, *Proteus* and *Pseudomonas* causing

Gram-negative bacteria (66%) with increased frequency of ESBL, multidrug resistance fluoroquinolone resistance and aminoglycoside

emphysematous pyelonephritis, rarely *Candida* and *Cryptococcus*

The main complications of urosepsis are bacteraemia (23%), endotoxemia (34%) and septic shock up to 2.5%. The common organ involved is the kidney [24]**.**

Up to 10% of acute kidney injury (AKI) episodes are caused by urinary tract obstruction; in the elderly, it will increase to 22% of AKI. The mechanisms in the pathogenesis of obstructive nephropathy lead to renal vasoconstriction and

progressive renal fibrosis; while renal vasoconstriction is reversible after the release of obstruction, renal fibrosis may result in irreversible loss of function. Postobstructive AKI rarely progresses to end-stage renal disease after the release of obstruction, but significant percentage (21%) of these patients have chronic renal impairment. The best time to release urinary obstruction in the setting of postobstructive AKI is not known; in patients with sepsis, it should be performed as an emergency. The renal outcome inversely correlated with elapsed time from admission to the release of obstruction, which could suggest that the release should be

performed as an emergency even in the absence of sepsis [25]**.**
