The role of imaging of the urinary tract in patients with urosepsis

Summary Objectives The aim of this study was to provide recommendations for imaging of patients with urosepsis in order to detect urological complications that need intervention, as well as conditions that predispose to renal infection. Methods We reviewed the medical records of 221 adults admitted to a Danish university hospital from 2005 to 2009 with community-acquired bacteremia with a urinary tract focus. Results Major abnormalities were found in 37 out of 115 (32%) patients. The two most common major abnormalities were hydronephrosis (17%) and urolithiasis (6%). Predictors of a major abnormality were diabetes with complications and any of the following: renal disease, pre-existing urological abnormality, or nephrolithiasis. Gender, age, blood pressure, fever, malignant disease, liver disease, neurological disease, prostatic disease, chronic indwelling urinary catheter, C-reactive protein, and white blood cell count did not show a statistically significant association with major abnormalities. Conclusions A large proportion of patients scanned in this study had a clinically important radiological finding. A positive history of diabetes with complications, renal disease, urolithiasis, or a structural urological abnormality in uroseptic patients may be particularly helpful in identifying those for whom an imaging procedure should be performed.