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

1. 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.
2. Dosing Considerations:
   • Adjust for renal function (common in septic patients).
   • Monitor drug levels (e.g., aminoglycosides, vancomycin).
3. 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.