Urosepsis

Urosepsis eshte semundje e rende e cila ndodh kur nje infeksion fillon ne traktin urinar dhe
perhapet ne qarkullimin e gjakut. Nese nuk te trajtohet uregjentisht mund te jete
kercenuese per jeten. Urosepsis eshte SIRS ndaj infeksionit bacterial te traktit urinar me
simptome te rrezikshme per jeten perfshire edhe.
Shkaktaret
Urosepsis eshte komplikim qe ndodh te disa persona qe kane pasur pyelonephritis. Nuk
eshte e njohur se pse infeksioni perhapet edhe ne gjarkullimin e gjakut, ndersa faktoret qe e
rrisin rrezikun per urosepse jane: Mosha e shtyre, diabeti, Imunosupresioni ,psh nga
kemotherapia, nefrolitiaza, Foley catheter, cystoscopy.
Etiologjia e urosepses
Infeksionet e traktit urinar : Pyelonephritis, renal abscess,infected hydronephrosis, bacterial
prostatitis, epididymitis, fournier's gangrene . Bakteriet pergjegjese jane: E. coli, Klebsiella,
Enterobacter, Serratia, Proteus, Pseudomonas, Enterococcus.
Shkaktaret tjere (Differential Diagnosis)
1. Infeksionet kardiake: Endocarditis. Bakteriet pergjegjese: Streptococcus viridans,
Enterococcus, Staphylococcus, Pseudomonas, Candida
2. Infeksionet respiratore : Pneumonia, pleural empyema, mediastinitis, abscessi
pulmonar . Spectri i bakterieve: Pneumococcus, Staphylococcus, anaerobes ne rastet
e aspirimit, enterobacteria,tuberculosis, Candida, Aspergillus,
3. Infections of the digestive tract: Peritonitis, liver abscess, cholecystitis, cholangitis,
necrotizing pancreatitis. Spectri i bakterieve: E. coli, Enterobacter, Salmonella,
Campylobacter, anaerobes, Enterococcus, Staphylococcus,
4. Infections of the ENT tract: Tonsillitis, oral cavity floor phlegmone. Bacterial spectrum:
Streptococcus pyogenes, Staph. aureus ...
5. Infections of the CNS: Meningococcal meningitis (sometimes with WaterhouseFriedrichsen syndrome).
6. Dermal infections: Erysipel, impetigo, dermal abscess. Bacterial spectrum:
Streptococcus, Staphylococcus.
7. Nosocomial infections: Catheter associated infections (central venous catheters,
bladder catheter), implants, wound infection, pneumonia. Diverse bacterial spectrum.
Shenjat dhe Simptomat e Urosepsis
Symptomat lokale: Local symptoms varen nga shkaku themelor i infeksionit: dhimbje ne
ije, ndjeshmeri abdominale, dhimbje scrotale
Symptomet gjenerale : temperature, te dridhura, hyperventilim, tachycardia and
hypotensioni jane symtome klasike. Hypothermia eshte tregues per prognose te rende.
Symptomet tjera jane demtime te vetedijes, confusion, oliguria ose anuria.
Diagnosis of Urosepsis
1. Shenjat Vitale: Frekuenca kardiake, tensioni arterial, frekuenca respiratore, diureza,
dhe vigjilenca jane parametra te rendesishem per vleresimin e prognozes
2. Hemokultura: Marrja e gjakut duhet bere para dhenies se antibiotikeve.
3. Kulturat lokale dhe urinokulturat: varesisht nga vendi ku dyshohet infeksioni:
urinokultura, pusi nga abscessi , sputum, faeces, secret i abscesit, lengu
cerebrospinal, Ideale para se te fillohet trajtimi me antibiotic.
4. Laboratory tests: Blood count, clotting tests with AT III and fibrinogen, CRP, liver
tests, creatinine, blood gas analysis. Possibly procalcitonin as a marker for sepsis.
5. Imaging in Urosepsis: Ultratingulli i organeve urogjenitale, abdominal CT dhe
rengengrafi e toraxit. Depending on the clinical situation further imaging such as CCT
or echocardiography might be necessary.
Trajtimi i urosepses
Causal Treatment of Urosepsis

If possible, specific treatment of the diagnosed infection should be started as soon as

possible:
Renal abscess: percutaneous or surgical drainage.
Infected hydronephrosis: internal drainage (DJ, MJ) or percutaneous nephrostomy.
Bacterial prostatitis: suprapubic urinary diversion. In case of abscess formation: perineal
percutaneous drainage or transurethral unroofing of the abscess.
Fournier's gangrene: wide excision of the necrotic tissue.
Epididymitis with abscess: orchiectomy
Antibiotic Therapy for Urosepsis
After obtaining blood cultures and local cultures (see above), a calculated parenteral
antibiotic therapy is begun: e.g. Amoxicillin/clavulanic acid in combination with
gentamicin, cephalosporins of the 3rd generation or reserve antibiotics such as imipenem or
meropenem if a difficult resistance situation is suspected. Anaerobic infections are possible
in peritonitis, wound infection or Fournier's gangrene and may require the use of e.g.
metronidazole.
Intensive Care Treatment of Urosepsis
Volume and oxygen therapy in sepsis:
Aggressive volume therapy, control for sufficient oxygen carriers and vasopressor therapy at
the beginning of urosepsis improve the prognosis. The aim is to achieve a balance between
oxygen consumption and oxygen transport within six hours; this is controlled via the
normalization of the central venous oxygen saturation, lactate concentration, base excess
(BE) and pH. Important is a liberal volume therapy and the transfusion of packed red blood
cells in anemia.
Catecholamins:
If the substitution of volume, oxygen and hemoglobin is not effective enough to reach a
balance between oxygen consumption and oxygen transport, the administration of
vasoactive and positive inotropic agents such as noradrenaline and adrenaline is necessary.
Corticosteroids and sepsis:
Corticosteroids in a physiological dose may advantageous in urosepsis, especially with
persistent shock and long-term ventilation. An postulated explanation for the benefit of
corticosteroids is a relative steroid deficiency due to reduced sensitivity of the steroid
receptor under vasopressor treatment.
Treatment of organ failure:
Mechanical ventilation and renal replacement therapy (hemofiltration) are often necessary.