IBCC Episode 17 - Community Acquired Urosepsis

In this episode of The Internet Book of Critical Care Podcast, Josh and Adam discuss community-acquired urosepsis, emphasizing that it involves bacteria ascending to the kidneys, causing pyelonephritis and sepsis. They highlight the importance of urinalysis as a screening test, while noting its non-specificity, especially in neutropenic patients. The discussion covers clinical history, imaging evidence, and the need to exclude other potential sources of infection. They also address complications like urinary obstruction, the role of imaging (CT scans or POCUS) for diagnosis, and the importance of source control through drainage or stenting. Management includes sepsis resuscitation, tailored antibiotic use (Piperacillin Tazobactam, Meropenem, or Cefepime), and the avoidance of vancomycin unless specific conditions warrant it. The hosts underscore the necessity of Foley catheters for monitoring urine output and advocate for source control through urological interventions when obstruction is present. They caution against over-relying on urinalysis alone for diagnosis and advise against using fluoroquinolones due to increasing resistance.