• Nici Markus Dreger, Stephan Degener, Parviz Ahmad-Nejad, Gabriele Wöbker, and Stephan Roth.
• Department of Adult and Pediatric Urology, Witten/Herdecke University, HELIOS, Klinikum Wuppertal, Center for Research in Clinical Medicine (ZFKM), Institute for Microbiology and Laboratory Medicine, Witten/Herdecke University, Center for Research in Clinical Medicine (ZFKM), HELIOS Klinikum, Wuppertal, Department of Intensive Care Medicine, Witten/Herdecke University, HELIOS, Klinikum Wuppertal.
• Dtsch Arztebl Int. 2015 Dec 4; 112 (49): 837-47; quiz 848.

BackgroundSepsis is among the most common causes of death in Germany. Urosepsis accounts for 9-31% of all cases and has a mortality of 20-40%, which is low compared with that of sepsis in general. As the population ages, the incidence of urosepsis is likely to rise.MethodsReview of pertinent articles and guidelines retrieved by a selective search in PubMed.ResultsEnterobacteria and Gram-positive organisms are the pathogens that most commonly cause urosepsis. The diagnosis can and must be made early on the basis of the typical clinical features, altered vital signs, and laboratory abnormalities, so that timely treatment can be initiated. 80% of cases are due to obstructive uropathy. The diagnostic evaluation includes physical examination, blood cultures, urinalysis, procalcitonin measurement, and ultrasonography. In one study, each additional hour of delay in the treatment of urosepsis with antibiotics was found to lower the survival rate by 7.6%. Antibiotics should be chosen in consideration of local resistance patterns and the expected pathogen spectrum.ConclusionUrologists, intensive care specialists, and microbiologists should all be involved in the interdisciplinary treatment of urosepsis. Patients' outcomes have improved recently, probably because of the frequent use of minimally invasive treatments to neutralize foci of infection. New biomarkers and new treatments still need to be validated in multicenter trials.

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