Factors Associated with Increased Risk of Urosepsis during Pregnancy and Treatment Outcomes, in a Urology Clinic
<i>Background and Objectives:</i> Urosepsis is a significant cause of maternal and fetal mortality. While certain risk factors for urinary tract infections (UTIs) in pregnant women are well established, those associated with an elevated risk of urosepsis in pregnant women with upper UTIs...
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MDPI AG
2023-11-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/59/11/1972 |
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| author | Viorel Dragos Radu Radu Cristian Costache Pavel Onofrei Liviu Antohi Razvan Lucian Bobeica Iacov Linga Ingrid Tanase-Vasilache Anca Irina Ristescu Alina-Mariela Murgu Ionela-Larisa Miftode Bogdan Alexandru Stoica |
| author_facet | Viorel Dragos Radu Radu Cristian Costache Pavel Onofrei Liviu Antohi Razvan Lucian Bobeica Iacov Linga Ingrid Tanase-Vasilache Anca Irina Ristescu Alina-Mariela Murgu Ionela-Larisa Miftode Bogdan Alexandru Stoica |
| author_sort | Viorel Dragos Radu |
| collection | DOAJ |
| description | <i>Background and Objectives:</i> Urosepsis is a significant cause of maternal and fetal mortality. While certain risk factors for urinary tract infections (UTIs) in pregnant women are well established, those associated with an elevated risk of urosepsis in pregnant women with upper UTIs remain less defined. This study aims to identify factors linked to an increased risk of urosepsis and examine urologic treatment outcomes in such cases. <i>Materials and Methods:</i> We conducted a retrospective analysis on 66 pregnant women diagnosed with urosepsis over a nine-year period. A control group included 164 pregnant women with upper UTIs, excluding urosepsis, admitted during the same timeframe. This study highlights factors potentially contributing to urosepsis risk, including comorbidities like anemia, pregnancy-related hydronephrosis or secondary to reno-ureteral lithiasis, prior UTIs, coexisting urological conditions, and urologic procedures. Outcomes of urologic treatments, hospitalization duration, obstetric transfers due to fetal distress, and complications associated with double-J catheters were analyzed. <i>Results:</i> Pregnant women with urosepsis exhibited a higher prevalence of anemia (69.7% vs. 50.0%, <i>p</i> = 0.006), 2nd–3rd grade hydronephrosis (81.8% vs. 52.8%, <i>p</i> = 0.001), and fever over 38 °C (89.4% vs. 42.1%, <i>p</i> = 0.001). They also had a more intense inflammatory syndrome (leukocyte count 18,191 ± 6414 vs. 14,350 ± 3860/mmc, <i>p</i> = 0.001, and C-reactive protein (CRP) 142.70 ± 83.50 vs. 72.76 ± 66.37 mg/dL, <i>p</i> = 0.001) and higher creatinine levels (0.77 ± 0.81 vs. 0.59 ± 0.22, <i>p</i> = 0.017). On multivariate analysis, factors associated with increased risk for urosepsis were anemia (Odds Ratio (OR) 2.622, 95% CI 1.220–5.634), 2nd–3rd grade hydronephrosis (OR 6.581, 95% CI 2.802–15.460), and fever over 38 °C (OR 11.612, 95% CI 4.804–28.07). Regarding outcomes, the urosepsis group had a higher rate of urological maneuvers (87.9% vs. 36%, <i>p</i> = 0.001), a higher rate of obstetric transfers due to fetal distress (22.7% vs. 1.2%, <i>p</i> = 0.001), and migration of double-J catheters (6.1% vs. 0.6%, <i>p</i> = 0.016), but no maternal fatality was encountered. However, they experienced the same rate of total complications related to double-J catheters (19.69% vs. 12.80%, <i>p</i> > 0.05). The pregnant women in both groups had the infection more frequently on the right kidney, were in the second trimester and were nulliparous. <i>Conclusions:</i> Pregnant women at increased risk for urosepsis include those with anemia, hydronephrosis due to gestational, or reno-ureteral lithiasis, and fever over 38 °C. While the prognosis for pregnant women with urosepsis is generally favorable, urological intervention may not prevent a higher incidence of fetal distress and the need for obstetric transfers compared to pregnant women with uncomplicated upper UTIs. |
| first_indexed | 2024-03-09T16:38:43Z |
| format | Article |
| id | doaj.art-f35932cb6ffa460b8ae906b2c381c9de |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-09T16:38:43Z |
| publishDate | 2023-11-01 |
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| series | Medicina |
| spelling | doaj.art-f35932cb6ffa460b8ae906b2c381c9de2023-11-24T14:54:52ZengMDPI AGMedicina1010-660X1648-91442023-11-015911197210.3390/medicina59111972Factors Associated with Increased Risk of Urosepsis during Pregnancy and Treatment Outcomes, in a Urology ClinicViorel Dragos Radu0Radu Cristian Costache1Pavel Onofrei2Liviu Antohi3Razvan Lucian Bobeica4Iacov Linga5Ingrid Tanase-Vasilache6Anca Irina Ristescu7Alina-Mariela Murgu8Ionela-Larisa Miftode9Bogdan Alexandru Stoica10Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, RomaniaDepartment of Urology, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, RomaniaDepartment of Morpho-Functional Sciences II, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, RomaniaDepartment of Anaesthesia and Intensive Care, “C.I. Parhon” University Hospital, 700115 Iasi, RomaniaUrological Department, “C.I. Parhon” University Hospital, 700115 Iasi, RomaniaUrological Department, “C.I. Parhon” University Hospital, 700115 Iasi, RomaniaDepartment of Obstetrics and Gynaecology, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, RomaniaDepartment of Anaesthesia and Intensive Care, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, RomaniaDepartment of Mother and Child Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, RomaniaDepartment of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, RomaniaDepartment of Biochemistry, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania<i>Background and Objectives:</i> Urosepsis is a significant cause of maternal and fetal mortality. While certain risk factors for urinary tract infections (UTIs) in pregnant women are well established, those associated with an elevated risk of urosepsis in pregnant women with upper UTIs remain less defined. This study aims to identify factors linked to an increased risk of urosepsis and examine urologic treatment outcomes in such cases. <i>Materials and Methods:</i> We conducted a retrospective analysis on 66 pregnant women diagnosed with urosepsis over a nine-year period. A control group included 164 pregnant women with upper UTIs, excluding urosepsis, admitted during the same timeframe. This study highlights factors potentially contributing to urosepsis risk, including comorbidities like anemia, pregnancy-related hydronephrosis or secondary to reno-ureteral lithiasis, prior UTIs, coexisting urological conditions, and urologic procedures. Outcomes of urologic treatments, hospitalization duration, obstetric transfers due to fetal distress, and complications associated with double-J catheters were analyzed. <i>Results:</i> Pregnant women with urosepsis exhibited a higher prevalence of anemia (69.7% vs. 50.0%, <i>p</i> = 0.006), 2nd–3rd grade hydronephrosis (81.8% vs. 52.8%, <i>p</i> = 0.001), and fever over 38 °C (89.4% vs. 42.1%, <i>p</i> = 0.001). They also had a more intense inflammatory syndrome (leukocyte count 18,191 ± 6414 vs. 14,350 ± 3860/mmc, <i>p</i> = 0.001, and C-reactive protein (CRP) 142.70 ± 83.50 vs. 72.76 ± 66.37 mg/dL, <i>p</i> = 0.001) and higher creatinine levels (0.77 ± 0.81 vs. 0.59 ± 0.22, <i>p</i> = 0.017). On multivariate analysis, factors associated with increased risk for urosepsis were anemia (Odds Ratio (OR) 2.622, 95% CI 1.220–5.634), 2nd–3rd grade hydronephrosis (OR 6.581, 95% CI 2.802–15.460), and fever over 38 °C (OR 11.612, 95% CI 4.804–28.07). Regarding outcomes, the urosepsis group had a higher rate of urological maneuvers (87.9% vs. 36%, <i>p</i> = 0.001), a higher rate of obstetric transfers due to fetal distress (22.7% vs. 1.2%, <i>p</i> = 0.001), and migration of double-J catheters (6.1% vs. 0.6%, <i>p</i> = 0.016), but no maternal fatality was encountered. However, they experienced the same rate of total complications related to double-J catheters (19.69% vs. 12.80%, <i>p</i> > 0.05). The pregnant women in both groups had the infection more frequently on the right kidney, were in the second trimester and were nulliparous. <i>Conclusions:</i> Pregnant women at increased risk for urosepsis include those with anemia, hydronephrosis due to gestational, or reno-ureteral lithiasis, and fever over 38 °C. While the prognosis for pregnant women with urosepsis is generally favorable, urological intervention may not prevent a higher incidence of fetal distress and the need for obstetric transfers compared to pregnant women with uncomplicated upper UTIs.https://www.mdpi.com/1648-9144/59/11/1972pregnancyurosepsisupper UTIsfetal distressureteral catheterization |
| spellingShingle | Viorel Dragos Radu Radu Cristian Costache Pavel Onofrei Liviu Antohi Razvan Lucian Bobeica Iacov Linga Ingrid Tanase-Vasilache Anca Irina Ristescu Alina-Mariela Murgu Ionela-Larisa Miftode Bogdan Alexandru Stoica Factors Associated with Increased Risk of Urosepsis during Pregnancy and Treatment Outcomes, in a Urology Clinic Medicina pregnancy urosepsis upper UTIs fetal distress ureteral catheterization |
| title | Factors Associated with Increased Risk of Urosepsis during Pregnancy and Treatment Outcomes, in a Urology Clinic |
| title_full | Factors Associated with Increased Risk of Urosepsis during Pregnancy and Treatment Outcomes, in a Urology Clinic |
| title_fullStr | Factors Associated with Increased Risk of Urosepsis during Pregnancy and Treatment Outcomes, in a Urology Clinic |
| title_full_unstemmed | Factors Associated with Increased Risk of Urosepsis during Pregnancy and Treatment Outcomes, in a Urology Clinic |
| title_short | Factors Associated with Increased Risk of Urosepsis during Pregnancy and Treatment Outcomes, in a Urology Clinic |
| title_sort | factors associated with increased risk of urosepsis during pregnancy and treatment outcomes in a urology clinic |
| topic | pregnancy urosepsis upper UTIs fetal distress ureteral catheterization |
| url | https://www.mdpi.com/1648-9144/59/11/1972 |
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