urology

Urosepsis

Urosepsis is a UTI causing systemic sepsis. Obstructive urosepsis (stone, prostatic enlargement) requires emergency urology decompression — antibiotics alone are insufficient. Treat with Sepsis 6 protocol, identify obstruction on CT KUB, and…

Sepsis 6 + Urology Escalation

The pathway

1 · Initiate Sepsis 6

As for any sepsis: O₂, blood cultures x2, IV antibiotics within 1 hour, IV fluids, lactate, urinary catheter for UO monitoring.

2 · Send MSU

Mid-stream urine for culture and sensitivity. Do NOT delay antibiotics for MSU result.

3 · CT KUB

All urosepsis with loin pain: CT KUB to rule out obstruction. Obstructed kidney + sepsis = surgical emergency.

4 · Urology if obstruction

Obstructive urosepsis: emergency decompression. Percutaneous nephrostomy (radiology) or retrograde ureteric stent (urology). Do not delay.

5 · Monitor renal function

U&E 12-hourly. AKI common. Stop NSAIDs, nephrotoxic antibiotics if AKI develops.

6 · Step down antibiotics

48h: review cultures. De-escalate to oral antibiotics guided by sensitivities. Total course: 7–14 days depending on source.

Drugs

Drug	Dose	Route	Notes
Co-amoxiclav	1.2g	IV	8-hourly. First-line per most UK trusts. Check local guidelines.
Gentamicin	5mg/kg	IV OD	Add for severe sepsis. Monitor levels. Avoid if AKI or known nephrotoxicity risk.
0.9% NaCl / Hartmann's	500ml	IV	Bolus if haemodynamically compromised. Target MAP >65, UO >0.5ml/kg/hr.
Trimethoprim	200mg	PO BD	Step-down when clinical improvement + sensitivities known. 7–14 day course.

When to escalate

Obstructed kidney on CT — urology same day regardless of time, emergency decompression,Septic shock (MAP <65 despite fluid) — ITU, vasopressors,AKI not improving after source control — nephrology, consider RRT,No improvement at 48h — broaden antibiotics per microbiology, repeat imaging

Reference: EAU Urological Infections Guidelines 2023 / Surviving Sepsis Campaign 2021

This page is the reference half

The app adds what a web page cannot: a VINDICATE differential builder, worked on-call scenarios with full A–E findings, recall practice, and all of it offline.