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Urologic Sepsis/Shock *
Author(s) -
SENECA HARRY,
GRANT JOHN P.
Publication year - 1976
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1976.tb06799.x
Subject(s) - medicine , sepsis , mortality rate , septic shock , urinary system , metabolic acidosis , shock (circulatory) , antibiotics , intensive care medicine , surgery , microbiology and biotechnology , biology
At Columbia‐Presbyterian Medical Center during the six‐year period 1968–1973, there were 1236 cases of sepsis from Gramnegative pathogens; 124 of these originated in the urinary tract. Of these 124 patients, 19 died — a mortality rate of 15.3 percent. There were 205 deaths among the 1236 patients with sepsis from Gram‐negative organisms — a mortality rate of 16.6 percent. Previously, in the 1959–1964 and 1965–19067 periods, the mortality rates had been 56.3 percent and 19.6 percent respectively. The lowered mortality rate during 1968–1973 for urologic sepsis/shock was associated with improved management procedures: a) preventive measures such as postponement of urologic instrumentation and surgical intervention in patients infected with drug‐resistant urea splitters, until the infection is under control, with emergency surgical patients being treated by susceptibility‐tested drugs to control possible postoperative complications; b) early diagnosis and treatment of sepsis and immediate administration of bactericidal antibiotics parenterally; c) immediate restoration of fluid/electrolyte balance, with monitoring of renal and pulmonary functions and metabolic acidosis; and d) early administration of large pharmacologic doses of glucocorticoids, with monitoring of the microcirculation and use of β‐adrenergic isoproterenol.