Definition:
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. When the source is a urinary tract infection (UTI), it is often termed urosepsis.
Pathophysiology:
- Begins with a lower UTI (cystitis) or upper UTI (pyelonephritis).
- Bacteria (commonly E. coli, Klebsiella, Proteus) invade urinary tract → bacteremia.
- Triggers systemic inflammatory response → cytokine storm, vasodilation, capillary leak.
- Leads to hypotension, tissue hypoperfusion, and multi-organ dysfunction.
Clinical Features:
- Local symptoms: dysuria, frequency, flank pain, fever (may be absent in elderly).
- Systemic signs: hypotension, tachycardia, tachypnea, confusion, oliguria.
- Severe cases: septic shock (persistent hypotension despite fluids).
Pharmacist’s Role in Management:
- Empiric Antibiotic Therapy (early, within 1 hour of recognition):
- Broad spectrum IV (depending on local resistance & risk factors).
- Common choices: piperacillin–tazobactam, cefepime, meropenem (if ESBL suspected), ± aminoglycoside.
- De-escalate based on cultures.
- Dosing Considerations:
- Adjust for renal function (common in septic patients).
- Monitor drug levels (e.g., aminoglycosides, vancomycin).
- Supportive Therapy:
- IV fluids (initial: 30 mL/kg crystalloid).
- Vasopressors (norepinephrine if refractory hypotension).
- Monitor urine output, lactate.
Key Pharmacist Notes:
- Sepsis from UTI is one of the most common causes in elderly, catheterized, or immunocompromised patients.
- Time to antibiotics is a strong predictor of mortality.
- Always review cultures for narrowing therapy and prevent resistance.