Urological Emergencies in Clinical Practice стр.34

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pain: value of unenhanced helical CT. AJR 1996;166:97-101. Thomson JM, Glocer J, Abbott C, et al. Computed tomography versus

intravenous urography in diagnosis of acute flank pain from

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Chapter 4

Other Infective Urological Emergencies

Hashim Hashim and John Reynard

URINARY SEPTICAEMIA

Sepsis as a result of a urinary tract infection is a serious condition that can lead to septic shock and death. Septicaemia or sepsis is the clinical syndrome caused by bacterial infection of the blood, confirmed by positive blood cultures for a specific organism. There should be a documented source of infection with a systemic response to the infection. The systemic response is known as the systemic inflammatory response syndrome (SIRS) and is defined by as at least two of the following:

■ Fever (>38°C) or hypothermia (<36°C)

■ Tachycardia (>90 beats/min in patients not on beta-blockers)

■ Tachypnoea (respiratory rate >20/min or PaCO2 < 4.3 kPa or a requirement for mechanical ventilation)

■ White cell count >12,000 cells/mm3, <4000 cells/mm3, or 10% immature (band) forms

Severe sepsis or sepsis syndrome is a state of altered organ perfusion or evidence of dysfunction of one or more organs, with at least one of the following: hypoxaemia, lactic acidosis, oliguria, or altered mental status. Septic shock is severe sepsis with refractory hypotension, hypoperfusion, and organ dysfunction. This is a life-threatening condition.

There are many causes of urinary sepsis, but in the hospital setting the commonest causes from a urological perspective are the presence of or manipulation of indwelling urinary catheters, urinary tract surgery, particularly endoscopic [trans-urethral resection of the prostate (TURP), transurethral resection of bladder tumor (TURBT), ureteroscopy, percutaneous nephrolithotomy (PCNL)] and urinary tract obstruction, particularly that due to stones obstructing the ureter. In the National Prostatectomy Audit and the European Collaborative Study of Antibiotic Prophylaxis for TURP, septicaemia occurred in


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