**1. Introduction**

The mortality from sepsis is reaching higher than prostatic and breast carcinoma; up to 31% of sepsis originated from the urogenital tract organs, and hence it is termed as urosepsis [1]. Urosepsis is a severe infection and 5% lead to severe sepsis, and it is an important aetiology for hospital-acquired infection and accounts for around 40% of the nosocomial infections [2]**.** About 5% of urosepsis patients complicate in severe sepsis and organ dysfunction; Patients with comorbidities are at a higher risk for urosepsis, severe sepsis and septic shock with a higher morbidity and mortality [3]**.** Hence, the early diagnosis and management is the key for better outcome. The presence of bacteria in the urogenital tract produces an overwhelming pro-inflammatory reaction involving macrophages and neutrophils by stimulating the cellular immunity, complement system and endothelial cells. the production of nitric oxide is triggered, which leads to a decreased vessel tone resulting in hypotension. This initial phase is followed by a counter regulatory anti-inflammatory response syndrome, leading to an immunosuppressive state, which accounts for the mortality in the longer course of sepsis. The activation of

compliment system causes coagulopathy and fibrinolysis leading to microthrombi formation and organ dysfunction [4]**.**

bacteraemic community-acquired urinary tract infections [10]. The 28-day mortal-

Hospital-acquired urosepsis is one of the healthcare provider-related sepses and

There are risk factors for both community- and hospital-acquired urosepses.

uropathy, genitourinary tract structural abnormalities and carcinoma of the urinary bladder, whereas the hospital-acquired urosepsis occurs in catheterized elderly

The combination of age more than 65 and female gender is a significant risk factor for the development of urosepsis. Bacteriuria is frequent in elderly population; more than 50% of geriatric females will have bacteriuria. A multicentre study showed that patients older than 65 years of age admitted with febrile UTIs were nearly 2.5 times

The diabetes, nephrocalcinosis and azotaemia (chronic kidney disease) are related to the increased incidence of urosepsis. van Nieuwkoop et al. reported an association between comorbid disease and urosepsis, where diabetes was significantly associated with an 80% increased risk for urosepsis. In diabetic patients, poor glycaemic control, autonomic neuropathy, higher urinary glucose, immune dysfunction and diabetic

The number of factors causing obstruction to the urinary flow increases the risk of urosepsis significantly. The congenital factors causing obstruction to the urinary flow are ureteric or urethral strictures, phimosis, ureterocele and polycystic kidney disease, whereas the acquired aetiological factor leading to urinary flow obstruction are calculi, prostatic hypertrophy, tumours of the urinary tract, trauma, pregnancy

These are the external factors that contribute to bacterial virulence, transmission of bacteria to host and compromise of host defences. This includes inappropriate and unnecessary antibiotic consumption, limited healthcare facilities and the lack of

Community-acquired urosepsis occurs mainly in patients with obstructive

more likely to develop bacteraemia than patients under the age of 65 [15].

microangiopathy facilitate bacterial adherence to uroepithelium [15].

acquired during the hospital stay. It was found in 31% of these patients; *E. coli* represents 58% of all isolations with a different resistance profile with resistance to ciprofloxacin, aminoglycosides and co-trimoxazole. The 28-day mortality in hospitalacquired urosepsis was 15% [10]**.** In contrast the hospital-acquired urosepsis with extended B-lactam enzyme had a significant higher mortality of 41% [10] (**Table 1**)**.**

ity was higher in the non-HCRI group (29%) [11].

patients, on immunosuppression therapy [13, 14]**.**

**3.2 Hospital-acquired urosepsis**

*DOI: http://dx.doi.org/10.5772/intechopen.82262*

**4. Risk factors**

*Urosepsis: Flow is Life*

**4.1 Age and gender**

**4.2 Comorbidities**

**4.3 Obstructive uropathy**

and the radiation therapy causing fibrosis [12].

**4.4 Environmental and host factors**

local surveillance programmes.

**179**

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

We will discuss urosepsis in the following subheadings.
