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Radu VD, Costache RC, Onofrei P, Antohi L, Bobeica RL, Linga I, Tanase-Vasilache I, Ristescu AI, Murgu AM, Miftode IL, Stoica BA. Factors Associated with Increased Risk of Urosepsis during Pregnancy and Treatment Outcomes, in a Urology Clinic. Medicina (Kaunas) 2023; 59:1972. [PMID: 38004021 PMCID: PMC10673142 DOI: 10.3390/medicina59111972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Urosepsis is a significant cause of maternal and fetal mortality. While certain risk factors for urinary tract infections (UTIs) in pregnant women are well established, those associated with an elevated risk of urosepsis in pregnant women with upper UTIs remain less defined. This study aims to identify factors linked to an increased risk of urosepsis and examine urologic treatment outcomes in such cases. Materials and Methods: We conducted a retrospective analysis on 66 pregnant women diagnosed with urosepsis over a nine-year period. A control group included 164 pregnant women with upper UTIs, excluding urosepsis, admitted during the same timeframe. This study highlights factors potentially contributing to urosepsis risk, including comorbidities like anemia, pregnancy-related hydronephrosis or secondary to reno-ureteral lithiasis, prior UTIs, coexisting urological conditions, and urologic procedures. Outcomes of urologic treatments, hospitalization duration, obstetric transfers due to fetal distress, and complications associated with double-J catheters were analyzed. Results: Pregnant women with urosepsis exhibited a higher prevalence of anemia (69.7% vs. 50.0%, p = 0.006), 2nd-3rd grade hydronephrosis (81.8% vs. 52.8%, p = 0.001), and fever over 38 °C (89.4% vs. 42.1%, p = 0.001). They also had a more intense inflammatory syndrome (leukocyte count 18,191 ± 6414 vs. 14,350 ± 3860/mmc, p = 0.001, and C-reactive protein (CRP) 142.70 ± 83.50 vs. 72.76 ± 66.37 mg/dL, p = 0.001) and higher creatinine levels (0.77 ± 0.81 vs. 0.59 ± 0.22, p = 0.017). On multivariate analysis, factors associated with increased risk for urosepsis were anemia (Odds Ratio (OR) 2.622, 95% CI 1.220-5.634), 2nd-3rd grade hydronephrosis (OR 6.581, 95% CI 2.802-15.460), and fever over 38 °C (OR 11.612, 95% CI 4.804-28.07). Regarding outcomes, the urosepsis group had a higher rate of urological maneuvers (87.9% vs. 36%, p = 0.001), a higher rate of obstetric transfers due to fetal distress (22.7% vs. 1.2%, p = 0.001), and migration of double-J catheters (6.1% vs. 0.6%, p = 0.016), but no maternal fatality was encountered. However, they experienced the same rate of total complications related to double-J catheters (19.69% vs. 12.80%, p > 0.05). The pregnant women in both groups had the infection more frequently on the right kidney, were in the second trimester and were nulliparous. Conclusions: Pregnant women at increased risk for urosepsis include those with anemia, hydronephrosis due to gestational, or reno-ureteral lithiasis, and fever over 38 °C. While the prognosis for pregnant women with urosepsis is generally favorable, urological intervention may not prevent a higher incidence of fetal distress and the need for obstetric transfers compared to pregnant women with uncomplicated upper UTIs.
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Affiliation(s)
- Viorel Dragos Radu
- Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (V.D.R.); (R.C.C.)
- Urological Department, “C.I. Parhon” University Hospital, 700115 Iasi, Romania; (R.L.B.); (I.L.)
| | - Radu Cristian Costache
- Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (V.D.R.); (R.C.C.)
- Urological Department, “C.I. Parhon” University Hospital, 700115 Iasi, Romania; (R.L.B.); (I.L.)
| | - Pavel Onofrei
- Department of Morpho-Functional Sciences II, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
- Urological Department, Elytis Hope Hospital, 700010 Iasi, Romania
| | - Liviu Antohi
- Department of Anaesthesia and Intensive Care, “C.I. Parhon” University Hospital, 700115 Iasi, Romania;
| | - Razvan Lucian Bobeica
- Urological Department, “C.I. Parhon” University Hospital, 700115 Iasi, Romania; (R.L.B.); (I.L.)
| | - Iacov Linga
- Urological Department, “C.I. Parhon” University Hospital, 700115 Iasi, Romania; (R.L.B.); (I.L.)
| | - Ingrid Tanase-Vasilache
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
| | - Anca Irina Ristescu
- Department of Anaesthesia and Intensive Care, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
| | - Alina-Mariela Murgu
- Department of Mother and Child Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
| | - Ionela-Larisa Miftode
- Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
| | - Bogdan Alexandru Stoica
- Department of Biochemistry, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
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