1. Risk Factors for Urosepsis and Urosepsis-related Mortality in Older Adults
Brian C. Peach, MSN, RN, CCRN; Gerard J. Garvan, BS; Cynthia S. Garvan, PhD; Jeannie P. Cimiotti, PhD, RN, FAAN
Abstract
Introduction
Methods
Systematic search using numerous key terms and phrases was conducted using PubMed and CINAHL
Inclusion criteria: Studies that focused on urosepsis in older adults, studies published within the last 10 years
Exclusion criteria: Studies not published in English, sepsis studies that did not stratify the urosepsis group within their larger sample
The articles were reviewed and approved 4 members of the research team.
Articles assessed using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) criteria, and were scored on a 4-point Likert scale
Objective: The objective of this review of the literature was to identify all potential risk factors that predispose older adults to urosepsis and urosepsis-associated mortality, and synthesize the results.
Methods: A systematic search using numerous key
terms and phrases was conducted using the PubMed
and CINAHL databases. The articles were reviewed
and approved by the four members of the research
team. Articles that met inclusion criteria were
assessed using the STrengthening the Reporting of
OBservational studies in Epidemiology (STROBE)
criteria, and were scored on a 4-point Likert-type
scale by members of the research team.
Results: A total of 180 articles were identified in the search and six met inclusion criteria. The presence of an internal urinary catheter was associated with the development of both urosepsis and septic shock. While a number of factors were examined, functional dependency, number of comorbidities, and low serum albumin were associated with mortality across the studies included in this review.
Discussion: Little recent scientific evidence is available on urosepsis, its associated risk factors, and particularly those factors associated with urosepsis-related mortality in older adults. Despite the fact that urosepsis disproportionally affects older adults, little evidence exists for this population. More research is needed to better understand urosepsis in this vulnerable population if clinicians are to improve the care provided to older adults.
*Urosepsis is sepsis in which the urinary tract is the known or the strongly suspected source of infection.
*Approximately 25% of all adult sepsis cases are urosepsis1
*Urinary tract infection has been identified as the source in approximately 10% to 30% of all severe sepsis or septic shock cases 1.
*More than 60% of the patients who develop severe sepsis are older adults > 65 years of age 2.
*Older adults represent 12% of the U.S. population, but account for 65% of all sepsis cases in hospitals 3.
*Older adults are 13x more likely to develop sepsis and have a twofold higher risk of death from sepsis than other adults even when controlling for race, sex, comorbid conditions, and the severity of illness 4.
*Older adults are particularly predisposed to sepsis due to their many comorbidities, repeated and lengthy hospitalizations, reduced ability to fight infections, and their functional limitations related to aging 5.
*Despite changes in the management of sepsis, there is little recent evidence available on urosepsis, its associated risk factors, and particularly those factors associated with urosepsis-related mortality in older adults.
Results
180 articles identified
6 articles met inclusion criteria.
Presence of an internal urinary catheter was associated with development of both urosepsis and septic shock
Functional dependency, number of comorbidities, and low serum albumin were associated with mortality across all studies
Research Problem/Purpose
Discussion/Conclusions
Despite the fact that urosepsis disproportionally affects older adults, little evidence exists for this population. More research is needed to better understand urosepsis in this vulnerable population if clinicians are to improve the care provided to older adults.
The purpose of this review of the literature was to identify all potential risk factors that predispose older adults to urosepsis and urosepsis-related mortality, and to synthesize the results.