Prevalence of Certain Microorganisms in Cancer Patients with Urosepsis and Literature Review

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Urosepsis management is challenging, especially in immunocompromised oncology patients. In this retrospective study, we characterized the urosepsis cases in oncology patients between 2019 and 2023. Of the 337 cases, males were the most affected group (p = 0.039). Similar to other studies Escherichia coli was the most common cause of urosepsis in our oncology patients. None of the analyzed variables showed any statistical significance associated with urosepsis. These include type of tumor (liquid or solid), nephrostomy, double J stent, Diabetes Mellitus, length of stay, and presence of a central line. Our study was the first study from Palestine that looked at urosepsis in oncology patients. The overall challenge in urosepsis in our oncology patients remains to be the emergence of antimicrobial resistance in the isolated urosepsis pathogens. Introduction Urosepsis, a severe systemic infection resulting from a urinary tract infection (UTI) that has spread to the bloodstream, represents a critical healthcare challenge worldwide. It is characterized by a dysregulated host response to infection, leading to organ dysfunction and high mortality rates. Despite advances in medical knowledge and technology, urosepsis remains a significant cause of morbidity and mortality, especially in vulnerable populations such as the elderly and immunocompromised individuals, such as cancer patients taking chemotherapy and transplant patients.[ 1 ] In 20–30% of sepsis cases, the infection originates from a urinary tract infection [ 2 ], the most common cause are members of the Enterobacterales species family including Escherichia coli with a prevalence of 52%, Proteus species, Enterobacter species, Klebsiella species, and Pseudomonas aeruginosa [ 3 ]. The mortality rate is 20–42% in severe sepsis cases.[ 2 ] Sepsis is one of the frequent complications in cancer patients, which leads to increased morbidity and mortality and it’s more challenging to manage especially due to emerging antimicrobial resistance. Studies have found that patients with sepsis who have an underlying malignant disease have a 30% increase in mortality compared to other sepsis patients.[ 4 ] It was found that most of urosepsis cases occur due to urolithiasis (42.9% of cases) followed by prostatic adenoma (24.9%) and urologic cancer 18%, other cases had urologic diseases that led to sepsis. [ 5 ] Diagnosis of sepsis includes 2 main criteria, which constitutes of demonstration of an infection through clinical picture or microbiological testing, and systemic inflammatory response syndrome (at least 2 of the following body temperature ≥ 38°C or ≤ 36°C, tachycardia: ≥ 90bpm, tachypnea: ≥ 20 breaths per min, respiratory alkalosis: paCO 2 ≤ 32 mm Hg, leukocyte count: leukocytosis ≥ 12/nL or leukopenia ≤ 4/nL). Demonstration of an infection based on general signs includes (Fever > 38.3°C, Hypothermia 90/min, Tachypnea > 30/min, Impaired neurological status, Edema or positive fluid balance (> 20 mL/kg/d), Hyperglycemia (blood sugar > 120 mg/dL) in the absence of previously diagnosed diabetes mellitus) and organ dysfunction can be demonstrated through any of the following points (Arterial hypoxemia (paO2/FiO2 < 300), Acute oliguria 1.5, Thrombocytopenia 4 mg/dL, Ileus) [ 3 ] In this study, we are exploring the potential risk factors, and possible factors that can increase the risk of urosepsis in cancer patients, such as demographic factors including gender and age, type of tumor (liquid or solid), nephrostomy, double J stent, Diabetes Mellitus, length of stay and presence of a central line. Methodology Study Design This retrospective quantitative research aimed to determine the prevalence of certain microorganisms in cancer patients with urosepsis. A total of 400 patients with positive urine cultures from May 2019 to December 2023 were initially included. However, after excluding cases with a positive blood culture with a different microorganism than the urine culture, the final sample size used in the analysis was 337. Data on suspected predisposing factors such as age, gender, cancer type (solid or liquid), diabetes mellitus (DM), Foley catheterization, length of stay in hospital, nephrostomy, central line, and DJ stent were collected from patient files. The analysis was conducted using the Statistical Package for the Social Sciences (SPSS). Urine and blood cultures: Urine cultures were performed according to the American Society of Microbiology (ASM) proceedings. A urine culture was considered positive if the bacterial colony-forming units (CFU) / mL on sheep blood agar plates (SBA) were greater than 50,000. Blood cultures were also collected according to the ASM proceedings and processed in the Versa Trek (USA) automated blood culture machine. Study Design: Retrospective Quantitative Research Data Collection Period: May 2019 to December 2023 Setting: Augusta Victoria Hospital, Jerusalem. Sample Size: Initially 400 patients with positive urine cultures, final analysis included 337 patients Inclusion Criteria: Hospitalized Cancer patients with urosepsis and positive urine cultures Exclusion Criteria: Patients with positive blood cultures of a different microorganism Data Collection Method: Review of patient files Variables Studied: Age Gender Microorganisms causing urosepsis Cancer type (solid or liquid) Diabetes mellitus (DM) Foley catheterization Length of stay in hospital Nephrostomy Central line DJ stent Data Analysis: Descriptive statistics (frequencies, percentages) and inferential statistics (chi-square test, logistic regression) using SPSS Ethical Considerations: Patient confidentiality and compliance with data protection regulations Limitations: Retrospective design, reliance on available data in patient files, potential confounding factors Results: The study aims to determine the prevalence of microorganisms in cancer patients with urosepsis and their association with possible risk factors predisposing to bacteremia. Results Total number of patients with positive urine cultures were 400 from May 2019 until December 2023. The sample size used in analysis was 337 as cases with a positive blood culture of a different microorganism were excluded. Out of the 337 cases, there were 155 males and 182 females, it is shown in Fig. 1 . Cases were classified to 2 age groups, 147 patients were in the group of 60 years or more, and 190 cases were in the group of 59 years or less, it is shown in Fig. 2 . Patients were classified to 2 groups based on length of stay period, 197 cases were in the group of less than 14 days, and 140 cases were in the 14 days or more group, it is shown in Fig. 3 . Patients were classified based on their malignancy status to solid, liquid and no malignancy, 205 cases had solid tumor, 34 had liquid tumor, and 98 had no malignancy, it is shown in Fig. 4 . Predisposing factors including Diabetes Mellitus (DM), Foley catheter, Nephrostomy, DJ stent and central line were checked. 118 patients had DM vs 219 with no DM, 178 had foley catheter vs 159, 36 had nephrostomy vs 301, 15 had DJ stent vs 322 and 65 had a central line vs 272, it is shown in Fig. 5 . Table 1 below studies 9 suspected predisposing factors that can lead to having same microorganism in blood as in urine, the percentages out of the 337 cases are mentioned as well as the P-value that was used to study the significance of the results. Suspected predisposing factors Percentage of cases with same microorganism in blood as in urine P-value Gender Male: 11% Female: 4.9% 0.039 Age group 59 or less: 5.8% 60 or more: 10.2% 0.132 Length of stay Less than 14 days: 6.1% 14 days or more: 10% 0.185 Malignancy status Liquid: 2.9% Solid: 9.3% No malignancy: 6.1% 0.432 DM Yes: 6.8% No: 8.2% 0.637 Foley catheter Yes: 9% No: 6.3% 0.354 Nephrostomy Yes: 11.1% No: 7.3% 0.503 DJ stent Yes: 13.3% No: 7.5% 0.325 Central line Yes: 12.3% No: 6.6% 0.122 Table 1 : Suspected predisposing factors of having same microorganism in blood as in urine It is shown in Fig. 6 , the count of positive blood culture results vs positive urine culture for the 6 most common microorganisms found in our sample. Discussion Urosepsis is one of the most common healthcare problems with a major impact on healthcare system, affecting millions each year. After extensive analysis, it appears that there is little literature regarding the prevalence of this condition in the Palestinian territories, negatively impacting our assessment of the effect of this infection. The management of urosepsis requires a multidisciplinary approach, involving prompt recognition, appropriate antimicrobial therapy, and supportive care. However, the diagnosis and treatment of urosepsis are often complicated by various factors, including the increasing prevalence of antibiotic-resistant bacteria, delayed recognition of the condition, and challenges in implementing evidence-based guidelines in clinical practice. Urosepsis is a serious condition that can affect individuals of all ages, but older adults, particularly those over 65 years old, are more susceptible to it. The average age of individuals affected by urosepsis ranges from 59.85 to 72 years old, with a significant percentage being over 65 years old [ 3 , 6 ]. As the population ages, the incidence of urosepsis is expected to rise due to factors like urological comorbidities associated with aging and indwelling bladder catheter use [ 3 ]. Additionally, the combination of being over 65 years old and female is highlighted as a significant risk factor for developing urosepsis [ 7 ]. In a study, it was found that 79.21% of patients with urosepsis were female, highlighting gender as a notable factor in this condition. Additionally, the study showed that older age, with an average of 72.02 years, and a high percentage of patients over 65 years old (76.24%), were common characteristics among individuals diagnosed with urosepsis [ 6 ]. The length of stay in the hospital is a crucial factor in the context of urosepsis. Studies have shown that the incidence of urosepsis is correlated with the length of stay in the intensive care unit, with an average of 16.3 ± 1.9 days for patients affected by this condition [ 8 ]. In the case of healthcare-associated urinary tract infections (HAUTI), it was found that the expected extra length of stay due to these infections was around four days, indicating a significant impact on hospitalization duration [ 9 ]. Additionally, a study highlighted that the longer the length of stay, the higher the urinary tract infection (UTI) rate, with infected patients having a median length of stay of 18 days compared to 10 days for non-infected patients [ 10 ]. Malignancy status can be a contributing factor to urosepsis. Patients with cancer are among those more likely to develop urosepsis, highlighting the importance of considering malignancy status in the context of this severe condition [ 1 ]. The literature does not provide direct information on the relationship between liquid and solid tumors and the incidence or outcomes of urosepsis. However, patients with solid tumors, particularly those involving the urogenital tract, can be at increased risk for urosepsis due to factors such as obstructive uropathy, which is common in patients with solid tumors. Obstructive uropathy can lead to urinary stasis, bacterial colonization, and potentially the development of complicated urinary tract infections that may progress to urosepsis [ 11 ]. In contrast, liquid tumors, or hematological malignancies such as leukemia, non-Hodgkin lymphoma, and multiple myeloma, are associated with an increased risk of sepsis due to the immunosuppressive effects of the malignancy itself and the treatments used, such as chemotherapy [ 4 ]. Although literature lacks any details about the relationship of liquid tumors and urosepsis specifically, the general increased risk of sepsis in these patients suggests that they may also be more susceptible to urosepsis. Diabetes mellitus (DM) is associated with an increased susceptibility to infection and sepsis, including urosepsis. [ 12 ]. The pathogenesis of sepsis in diabetic patients involves abnormalities in the host immune response, particularly in neutrophil function and humoral immunity, which are often attributed to the effects of hyperglycemia [ 13 ]. These immune defects can predispose diabetic patients to a higher risk of infections that can progress to sepsis. The use of Foley catheters, or indwelling urinary catheters, is significantly associated with an increased risk of developing catheter-associated urinary tract infections (CAUTIs), which can progress to urosepsis. Patients with catheter-associated UTIs are nearly three times more likely to develop bacteremia than those without catheter-associated UTIs [ 14 ]. In a retrospective observational study, the incidence of urosepsis in patients with nephrostomy tubes has been reported to be 14.2%, which is significantly higher compared to 2.62% in patients without nephrostomy tubes. This indicates that the presence of a nephrostomy tube is a significant risk factor for the development of urosepsis in patients with chronic kidney disease (CKD) and urinary tract infections (UTIs) [ 15 ]. A research studying the risk of central line associated bloodstream infections has found a 2–14 episodes per 1000 hospitalization days, on average 3 to 5 per 100 central venous uses. However no studies in the literature have linked the risk of developing urosepsis in patients with a central line. [ 16 ] In this research, we included all patients who had a positive urine culture over a five-year period, a urine culture was considered positive in case of growth of 50,000 colony forming units (CFUs) or more. Only those who had positive blood cultures with the same isolates as urine culture were selected. Several independent and co-dependent factors were studied, but only gender was found to have a significant association with urosepsis; Chi-square test was used to study the association of gender with the risk for developing blood-stream infection of urinary origin. Male patients more frequently developed blood-stream infections (BSI) originating from the urinary tract, a significant P -value of 0.039. In contrast to our study, female gender is considered an independent association with the development of urosepsis, as reported in a Japanese study from 2021, which showed a significantly higher incidence in females [ 17 ]. However, a Nigerian study from 2021, agreed with our study and contrasted general consensus by concluding that males were at a higher risk for invasive urinary tract infections. This might be attributed to the additional risk imposed by benign prostatic hyperplasia and strictures [ 18 ], also UTI in males is considered complicated in all cases which may also explain their increased risk of urosepsis. Age group subdivided into 2 categories, category 1 included patients younger than 60 years old and category 2 included patients aged 60 years and older. This factor was analyzed through Chi-square test, results showed that patients in category 2 had a higher risk of ureosepsis, with no statistically-significant contribution. Interestingly, Fabbian et al reported that females were more prone to having urosepsis, with that tendency increasing after the age of 60. Older women, however, had fewer complications when compared to men of the same age[ 19 ]. According to their length of stay (LOS), patients were assigned two categories: patients with a LOS of 14 days or more, and patients who spent less than 14 days. According to Chi-square test, there was no statistically significant difference between the two categories ( P = 0.185) but patients with a higher LOS had an increased risk of urosepsis, this may be attributed to the small sample size. This is in contrast to a Canadian study that reported multiple cases of sepsis in patients hospitalized for prolonged period of time (> 29 days)[ 20 ]. Our analysis concluded that the type of malignancy (hematological vs solid) or lack of malignancy did not constitute a risk factor for developing urosepsis ( P = 0.432). Huang et al. found no statistically significant association between being immunocompromised due to the presence of malignancy and risk for encountering urosepsis. Marin et al. conduced a prospective study with blood stream infection to identify the different characteristics among patients with neutropenia with solid malignancies vs those with hematologic malignancies. He concluded that patients with hematological malignances were significantly younger, they were more prone to infections in case they had a vascular access or indwelling urinary catheter, and had received previous antibiotic therapy more frequently. However, comorbidities were seen more frequently in patients with solid tumors, so the urinary tract as a source of blood-stream infection was more frequently seen in patients with solid tumors, while those with hematologic malignancies were more susceptible to infection due to venous access [ 21 ]. In our research, 9.3% of the studied sample had the same organism isolated from both urine culture and blood culture, compared to 2.9% of those with hematological malignancy and 6.1% of patients without any kind of malignancies. Gudiol et al found that the urinary tract is the most common source for blood stream infection in patients with solid tumors, especially Gram-negative bacilli. However, the incidence of blood-stream infection is still lower to that in patients with hematologic malignancies[ 22 ]. A systematic review by Peach et al found that, out of six reviewed studies, only one study reported significant association between diabetes mellitus and urosepsis [ 14 ]. This is in rhyme with our study which found no significant association between diabetes mellitus and the risk for acquiring a blood stream infection through urinary tract. Kizilbash et al found that patients with urinary catheters were three times more vulnerable to acquiring blood-stream infections of urinary origin. The probability was half as likely in patients with external catheters, that is, nephrostomy tubes, compared to those with indwelling catheters[ 23 ]. Shigemura et al found that indwelling catheters increased the risk for urosepsis by four folds[ 24 ]. A study in Indonesia concluded that the risk for acquiring urosepsis in patients following double J stent placement increased in female, older patients and it was directly associated with the length of installation[ 25 ]. The association between having a urinary catheter and developing urosepsis was analyzed using Chi-square test, while the association between nephrostomies and double J stents on one hand, and urosepsis on the other was studied using Fischer test. Even though all these factors increased the risk of developing urosepsis, no statistical significance was found through these analyses. In his review, Gudiol et al found that Gram-negative bacilli were the most common cause of blood-stream infection of urinary origin, with Escherichia coli , Pseudomonas aeruginosa , and Klebsiella pneumoniae being the most common isolates. Resistant organisms were seen more frequently in patients with urinary instrumentation[ 22 ]. In our study, we used the Mann-Whitney U test to study the distribution of isolates in positive urine culture compared to those found in both urine and blood cultures. The most common isolate was Escherichia coli , followed by Klebsiella pneumoniae and Proteus mirabilis . Escherichia coli was more likely to spread to blood stream, compared to other isolates. Conclusion Male sex was the main risk factor for blood-stream infection of urinary origin. Gram-negative bacilli were the main culprit, with Escherichia coli being the most common isolate. As the first conclusion contradicts previous studies, further studies with larger population and randomization is recommended to avoid possible confounders. As well as other factors including urinary catheterization and solid versus liquid tumors ca be studied in a larger sample size. Declarations Ethics approval and consent to participate Ethics approval was obtained from Augusta Victoria Hospital Ethical Committee, and consent to participate was waived due to the retrospective nature of the study. Funding Not applicable. No funding was received for this research. Conflicts of interest/Competing interests The authors declare that they have no conflicts of interest. Availability of data and material The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Consent for publication Not applicable. Authors' contributions I.B. designed the study, conducted the data analysis, and drafted the manuscript. D.S. contributed to data collection and interpretation. A.Sh. and H.R. data collection, M.Y. data analysis, M.H. manuscript review and writing, A.S. provided critical revisions and approved the final version of the manuscript. All authors read and approved the final version of the manuscript. 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Urolithiasis. 2021;49:477–84. (PDF) Presentation,Risk factors, Microbiological pattern and Management of Urosepsis in a Tertiary Hospital in Nigeria. https://www.researchgate.net/publication/353270010_PresentationRisk_factors_Microbiological_pattern_and_Management_of_Urosepsis_in_a_Tertiary_Hospital_in_Nigeria. Accessed 6 Jun 2024. Fabbian F, De Giorgi A, López-Soto PJ, Pala M, Tiseo R, Cultrera R, et al. Is female gender as harmful as bacteria? analysis of hospital admissions for urinary tract infections in elderly patients. J Womens Health (Larchmt). 2015;24:587–92. Huang YWY, Alleyne A, Leung V, Chapman M. Urosepsis Due to Extended-Spectrum β-Lactamase–Producing Escherichia coli: A Retrospective, Single-Centre Review of Risk Factors and Clinical Outcomes. Can J Hosp Pharm. 2018;71:119. Marin M, Gudiol C, Ardanuy C, Garcia-Vidal C, Calvo M, Arnan M, et al. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4539788","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":315890204,"identity":"84441241-fea6-4d5b-b2be-dc52c1e2ca86","order_by":0,"name":"Ibrahim Bsharat","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIiWNgGAWjYBACNgkGBmYGA4YEBgkwv0YORB54QLyWhGPGYC0J+KwBa2GAa2FObADTeHTwSfc+/FxQsC1Pfnbzsw8/f7Clzw87/BBoi52cbgMOh8kcN5aeYXC72ODOMeOZPQkyuRtvpxkAtSQbmx3A5Zc0Bmkeg9uJGyQSjBl4EthyN85OAGk5kLgNtxbm3yAt82ekf2b8k8Ccbjg7/QMhLWxgWxpu5Bgz8yQwJ8hL5xCwReYYmzUPyC83coqZZdKOGW6Qzik4kGCA2y/ys9uYb/P8uZ0nPyN9M+Mbmxp5+dnpmz98qLCTw6UFExiAVRoQqxxsbwMpqkfBKBgFo2AkAACbQF3Jr7lKeQAAAABJRU5ErkJggg==","orcid":"","institution":"Augusta Victoria Hospital – East Jerusalem","correspondingAuthor":true,"prefix":"","firstName":"Ibrahim","middleName":"","lastName":"Bsharat","suffix":""},{"id":315890205,"identity":"6c82c297-3639-48b7-9f3e-b32ed7bddd79","order_by":1,"name":"Dana Sadaqa","email":"","orcid":"","institution":"Augusta Victoria Hospital – East Jerusalem","correspondingAuthor":false,"prefix":"","firstName":"Dana","middleName":"","lastName":"Sadaqa","suffix":""},{"id":315890206,"identity":"41e38864-c316-4ba9-997b-4f3aa5261fa4","order_by":2,"name":"Ayman Shoeibat","email":"","orcid":"","institution":"Augusta Victoria Hospital – East Jerusalem","correspondingAuthor":false,"prefix":"","firstName":"Ayman","middleName":"","lastName":"Shoeibat","suffix":""},{"id":315890207,"identity":"74242749-a87a-476d-984b-3799a9adfe32","order_by":3,"name":"Hammam Rjoub","email":"","orcid":"","institution":"Augusta Victoria Hospital – East Jerusalem","correspondingAuthor":false,"prefix":"","firstName":"Hammam","middleName":"","lastName":"Rjoub","suffix":""},{"id":315890209,"identity":"0ce3fc0d-2995-4237-9a37-d979890a03df","order_by":4,"name":"Mohammad Yaish","email":"","orcid":"","institution":"Augusta Victoria Hospital – East Jerusalem","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"","lastName":"Yaish","suffix":""},{"id":315890210,"identity":"f0753538-e7d9-4f34-9744-7b37a65675f0","order_by":5,"name":"Hasan Arafat","email":"","orcid":"","institution":"Augusta Victoria Hospital – East","correspondingAuthor":false,"prefix":"","firstName":"Hasan","middleName":"","lastName":"Arafat","suffix":""},{"id":315890211,"identity":"95c22a96-f46c-4755-b346-8d817c3ca808","order_by":6,"name":"Musa Hindiyeh","email":"","orcid":"","institution":"Augusta Victoria Hospital – East Jerusalem","correspondingAuthor":false,"prefix":"","firstName":"Musa","middleName":"","lastName":"Hindiyeh","suffix":""},{"id":315890212,"identity":"88fe0c68-4a37-4cb3-84d7-81d26085aab5","order_by":7,"name":"Ali Sabateen","email":"","orcid":"","institution":"Augusta Victoria Hospital – East Jerusalem","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"","lastName":"Sabateen","suffix":""}],"badges":[],"createdAt":"2024-06-06 10:52:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4539788/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4539788/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":63641165,"identity":"3e33b08c-65b7-448e-9248-d6f7dcbbcb6d","added_by":"auto","created_at":"2024-08-30 13:00:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":403681,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4539788/v1/61c9e637-291c-4787-9dd8-85adbe611ac3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of Certain Microorganisms in Cancer Patients with Urosepsis and Literature Review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUrosepsis, a severe systemic infection resulting from a urinary tract infection (UTI) that has spread to the bloodstream, represents a critical healthcare challenge worldwide. It is characterized by a dysregulated host response to infection, leading to organ dysfunction and high mortality rates. Despite advances in medical knowledge and technology, urosepsis remains a significant cause of morbidity and mortality, especially in vulnerable populations such as the elderly and immunocompromised individuals, such as cancer patients taking chemotherapy and transplant patients.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] In 20\u0026ndash;30% of sepsis cases, the infection originates from a urinary tract infection [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], the most common cause are members of the \u003cem\u003eEnterobacterales\u003c/em\u003e species family including \u003cem\u003eEscherichia coli\u003c/em\u003e with a prevalence of 52%, \u003cem\u003eProteus\u003c/em\u003e species, \u003cem\u003eEnterobacter\u003c/em\u003e species, \u003cem\u003eKlebsiella\u003c/em\u003e species, and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The mortality rate is 20\u0026ndash;42% in severe sepsis cases.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Sepsis is one of the frequent complications in cancer patients, which leads to increased morbidity and mortality and it\u0026rsquo;s more challenging to manage especially due to emerging antimicrobial resistance. Studies have found that patients with sepsis who have an underlying malignant disease have a 30% increase in mortality compared to other sepsis patients.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] It was found that most of urosepsis cases occur due to urolithiasis (42.9% of cases) followed by prostatic adenoma (24.9%) and urologic cancer 18%, other cases had urologic diseases that led to sepsis. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eDiagnosis of sepsis includes 2 main criteria, which constitutes of demonstration of an infection through clinical picture or microbiological testing, and systemic inflammatory response syndrome (at least 2 of the following body temperature\u0026thinsp;\u0026ge;\u0026thinsp;38\u0026deg;C or \u0026le;\u0026thinsp;36\u0026deg;C, tachycardia: \u0026ge; 90bpm, tachypnea: \u0026ge; 20 breaths per min, respiratory alkalosis: paCO\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;\u0026le;\u0026thinsp;32 mm Hg, leukocyte count: leukocytosis\u0026thinsp;\u0026ge;\u0026thinsp;12/nL or leukopenia\u0026thinsp;\u0026le;\u0026thinsp;4/nL). Demonstration of an infection based on general signs includes (Fever\u0026thinsp;\u0026gt;\u0026thinsp;38.3\u0026deg;C, Hypothermia\u0026thinsp;\u0026lt;\u0026thinsp;36\u0026deg;C, Tachycardia\u0026thinsp;\u0026gt;\u0026thinsp;90/min, Tachypnea\u0026thinsp;\u0026gt;\u0026thinsp;30/min, Impaired neurological status, Edema or positive fluid balance (\u0026gt;\u0026thinsp;20 mL/kg/d), Hyperglycemia (blood sugar\u0026thinsp;\u0026gt;\u0026thinsp;120 mg/dL) in the absence of previously diagnosed diabetes mellitus) and organ dysfunction can be demonstrated through any of the following points (Arterial hypoxemia (paO2/FiO2\u0026thinsp;\u0026lt;\u0026thinsp;300), Acute oliguria\u0026thinsp;\u0026lt;\u0026thinsp;0.5 mL/kg/h (\u0026ge;\u0026thinsp;2h, Creatinine rise by (\u0026ge;\u0026thinsp;0.5 mg/dL, Coagulopathy INR\u0026thinsp;\u0026gt;\u0026thinsp;1.5, Thrombocytopenia\u0026thinsp;\u0026lt;\u0026thinsp;100/nL, Hyperbilirubinemia total bilirubin\u0026thinsp;\u0026gt;\u0026thinsp;4 mg/dL, Ileus) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn this study, we are exploring the potential risk factors, and possible factors that can increase the risk of urosepsis in cancer patients, such as demographic factors including gender and age, type of tumor (liquid or solid), nephrostomy, double J stent, Diabetes Mellitus, length of stay and presence of a central line.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cstrong\u003eStudy Design \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective quantitative research aimed to determine the prevalence of certain microorganisms in cancer patients with urosepsis. A total of 400 patients with positive urine cultures from May 2019 to December 2023 were initially included. However, after excluding cases with a positive blood culture with a different microorganism than the urine culture, the final sample size used in the analysis was 337. Data on suspected predisposing factors such as age, gender, cancer type (solid or liquid), diabetes mellitus (DM), Foley catheterization, length of stay in hospital, nephrostomy, central line, and DJ stent were collected from patient files. The analysis was conducted using the Statistical Package for the Social Sciences (SPSS).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUrine and blood cultures:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUrine cultures were performed according to the American Society of Microbiology (ASM) proceedings. A urine culture was considered positive if the bacterial colony-forming units (CFU) / mL on sheep blood agar plates (SBA) were greater than 50,000. Blood cultures were also collected according to the ASM proceedings and processed in the Versa Trek (USA) automated blood culture machine. \u0026nbsp;\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eStudy Design:\u003c/strong\u003e Retrospective Quantitative Research\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eData Collection Period:\u003c/strong\u003e May 2019 to December 2023\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSetting:\u003c/strong\u003e Augusta Victoria Hospital, Jerusalem.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSample Size:\u003c/strong\u003e Initially 400 patients with positive urine cultures, final analysis included 337 patients\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eInclusion Criteria:\u003c/strong\u003e Hospitalized Cancer patients with urosepsis and positive urine cultures\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eExclusion Criteria:\u003c/strong\u003e Patients with positive blood cultures of a different microorganism\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eData Collection Method:\u003c/strong\u003e Review of patient files\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eVariables Studied:\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eAge \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Gender \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMicroorganisms causing urosepsis \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCancer type (solid or liquid) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Diabetes mellitus (DM)\u003c/li\u003e\n \u003cli\u003eFoley catheterization \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Length of stay in hospital\u003c/li\u003e\n \u003cli\u003eNephrostomy \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Central line \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;DJ stent\u003c/li\u003e\n\u003c/ul\u003e\n\u003col start=\"9\"\u003e\n \u003cli\u003e\u003cstrong\u003eData Analysis:\u003c/strong\u003e Descriptive statistics (frequencies, percentages) and inferential statistics (chi-square test, logistic regression) using SPSS\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eEthical Considerations:\u003c/strong\u003e Patient confidentiality and compliance with data protection regulations\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eLimitations:\u003c/strong\u003e Retrospective design, reliance on available data in patient files, potential confounding factors\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The study aims to determine the prevalence of microorganisms in cancer patients with urosepsis and their association with possible risk factors predisposing to bacteremia.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Results","content":"\u003cp\u003eTotal number of patients with positive urine cultures were 400 from May 2019 until December 2023. The sample size used in analysis was 337 as cases with a positive blood culture of a different microorganism were excluded.\u003c/p\u003e \u003cp\u003eOut of the 337 cases, there were 155 males and 182 females, it is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eCases were classified to 2 age groups, 147 patients were in the group of 60 years or more, and 190 cases were in the group of 59 years or less, it is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePatients were classified to 2 groups based on length of stay period, 197 cases were in the group of less than 14 days, and 140 cases were in the 14 days or more group, it is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePatients were classified based on their malignancy status to solid, liquid and no malignancy, 205 cases had solid tumor, 34 had liquid tumor, and 98 had no malignancy, it is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePredisposing factors including Diabetes Mellitus (DM), Foley catheter, Nephrostomy, DJ stent and central line were checked. 118 patients had DM vs 219 with no DM, 178 had foley catheter vs 159, 36 had nephrostomy vs 301, 15 had DJ stent vs 322 and 65 had a central line vs 272, it is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ebelow studies 9 suspected predisposing factors that can lead to having same microorganism in blood as in urine, the percentages out of the 337 cases are mentioned as well as the P-value that was used to study the significance of the results.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuspected predisposing factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePercentage of cases with same microorganism in blood as in urine\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale: 11%\u003c/p\u003e \u003cp\u003eFemale: 4.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 or less: 5.8%\u003c/p\u003e \u003cp\u003e60 or more: 10.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.132\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than 14 days: 6.1%\u003c/p\u003e \u003cp\u003e14 days or more: 10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.185\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalignancy status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiquid: 2.9%\u003c/p\u003e \u003cp\u003eSolid: 9.3%\u003c/p\u003e \u003cp\u003eNo malignancy: 6.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes: 6.8%\u003c/p\u003e \u003cp\u003eNo: 8.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.637\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFoley catheter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes: 9%\u003c/p\u003e \u003cp\u003eNo: 6.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.354\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNephrostomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes: 11.1%\u003c/p\u003e \u003cp\u003eNo: 7.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.503\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDJ stent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes: 13.3%\u003c/p\u003e \u003cp\u003eNo: 7.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral line\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes: 12.3%\u003c/p\u003e \u003cp\u003eNo: 6.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: Suspected predisposing factors of having same microorganism in blood as in urine\u003c/p\u003e \u003cp\u003eIt is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, the count of positive blood culture results vs positive urine culture for the 6 most common microorganisms found in our sample.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eUrosepsis is one of the most common healthcare problems with a major impact on healthcare system, affecting millions each year. After extensive analysis, it appears that there is little literature regarding the prevalence of this condition in the Palestinian territories, negatively impacting our assessment of the effect of this infection. The management of urosepsis requires a multidisciplinary approach, involving prompt recognition, appropriate antimicrobial therapy, and supportive care. However, the diagnosis and treatment of urosepsis are often complicated by various factors, including the increasing prevalence of antibiotic-resistant bacteria, delayed recognition of the condition, and challenges in implementing evidence-based guidelines in clinical practice.\u003c/p\u003e \u003cp\u003eUrosepsis is a serious condition that can affect individuals of all ages, but older adults, particularly those over 65 years old, are more susceptible to it. The average age of individuals affected by urosepsis ranges from 59.85 to 72 years old, with a significant percentage being over 65 years old [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. As the population ages, the incidence of urosepsis is expected to rise due to factors like urological comorbidities associated with aging and indwelling bladder catheter use [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Additionally, the combination of being over 65 years old and female is highlighted as a significant risk factor for developing urosepsis [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn a study, it was found that 79.21% of patients with urosepsis were female, highlighting gender as a notable factor in this condition. Additionally, the study showed that older age, with an average of 72.02 years, and a high percentage of patients over 65 years old (76.24%), were common characteristics among individuals diagnosed with urosepsis [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe length of stay in the hospital is a crucial factor in the context of urosepsis. Studies have shown that the incidence of urosepsis is correlated with the length of stay in the intensive care unit, with an average of 16.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 days for patients affected by this condition [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the case of healthcare-associated urinary tract infections (HAUTI), it was found that the expected extra length of stay due to these infections was around four days, indicating a significant impact on hospitalization duration [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Additionally, a study highlighted that the longer the length of stay, the higher the urinary tract infection (UTI) rate, with infected patients having a median length of stay of 18 days compared to 10 days for non-infected patients [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMalignancy status can be a contributing factor to urosepsis. Patients with cancer are among those more likely to develop urosepsis, highlighting the importance of considering malignancy status in the context of this severe condition [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe literature does not provide direct information on the relationship between liquid and solid tumors and the incidence or outcomes of urosepsis. However, patients with solid tumors, particularly those involving the urogenital tract, can be at increased risk for urosepsis due to factors such as obstructive uropathy, which is common in patients with solid tumors. Obstructive uropathy can lead to urinary stasis, bacterial colonization, and potentially the development of complicated urinary tract infections that may progress to urosepsis [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn contrast, liquid tumors, or hematological malignancies such as leukemia, non-Hodgkin lymphoma, and multiple myeloma, are associated with an increased risk of sepsis due to the immunosuppressive effects of the malignancy itself and the treatments used, such as chemotherapy [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Although literature lacks any details about the relationship of liquid tumors and urosepsis specifically, the general increased risk of sepsis in these patients suggests that they may also be more susceptible to urosepsis.\u003c/p\u003e \u003cp\u003eDiabetes mellitus (DM) is associated with an increased susceptibility to infection and sepsis, including urosepsis. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The pathogenesis of sepsis in diabetic patients involves abnormalities in the host immune response, particularly in neutrophil function and humoral immunity, which are often attributed to the effects of hyperglycemia [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. These immune defects can predispose diabetic patients to a higher risk of infections that can progress to sepsis.\u003c/p\u003e \u003cp\u003eThe use of Foley catheters, or indwelling urinary catheters, is significantly associated with an increased risk of developing catheter-associated urinary tract infections (CAUTIs), which can progress to urosepsis. Patients with catheter-associated UTIs are nearly three times more likely to develop bacteremia than those without catheter-associated UTIs [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn a retrospective observational study, the incidence of urosepsis in patients with nephrostomy tubes has been reported to be 14.2%, which is significantly higher compared to 2.62% in patients without nephrostomy tubes. This indicates that the presence of a nephrostomy tube is a significant risk factor for the development of urosepsis in patients with chronic kidney disease (CKD) and urinary tract infections (UTIs) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA research studying the risk of central line associated bloodstream infections has found a 2\u0026ndash;14 episodes per 1000 hospitalization days, on average 3 to 5 per 100 central venous uses. However no studies in the literature have linked the risk of developing urosepsis in patients with a central line. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn this research, we included all patients who had a positive urine culture over a five-year period, a urine culture was considered positive in case of growth of 50,000 colony forming units (CFUs) or more. Only those who had positive blood cultures with the same isolates as urine culture were selected. Several independent and co-dependent factors were studied, but only gender was found to have a significant association with urosepsis; Chi-square test was used to study the association of gender with the risk for developing blood-stream infection of urinary origin. Male patients more frequently developed blood-stream infections (BSI) originating from the urinary tract, a significant \u003cem\u003eP\u003c/em\u003e-value of 0.039. In contrast to our study, female gender is considered an independent association with the development of urosepsis, as reported in a Japanese study from 2021, which showed a significantly higher incidence in females [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, a Nigerian study from 2021, agreed with our study and contrasted general consensus by concluding that males were at a higher risk for invasive urinary tract infections. This might be attributed to the additional risk imposed by benign prostatic hyperplasia and strictures [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], also UTI in males is considered complicated in all cases which may also explain their increased risk of urosepsis.\u003c/p\u003e \u003cp\u003eAge group subdivided into 2 categories, category 1 included patients younger than 60 years old and category 2 included patients aged 60 years and older. This factor was analyzed through Chi-square test, results showed that patients in category 2 had a higher risk of ureosepsis, with no statistically-significant contribution. Interestingly, Fabbian et al reported that females were more prone to having urosepsis, with that tendency increasing after the age of 60. Older women, however, had fewer complications when compared to men of the same age[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to their length of stay (LOS), patients were assigned two categories: patients with a LOS of 14 days or more, and patients who spent less than 14 days. According to Chi-square test, there was no statistically significant difference between the two categories (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.185) but patients with a higher LOS had an increased risk of urosepsis, this may be attributed to the small sample size. This is in contrast to a Canadian study that reported multiple cases of sepsis in patients hospitalized for prolonged period of time (\u0026gt;\u0026thinsp;29 days)[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur analysis concluded that the type of malignancy (hematological vs solid) or lack of malignancy did not constitute a risk factor for developing urosepsis (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.432). Huang et al. found no statistically significant association between being immunocompromised due to the presence of malignancy and risk for encountering urosepsis. Marin et al. conduced a prospective study with blood stream infection to identify the different characteristics among patients with neutropenia with solid malignancies vs those with hematologic malignancies. He concluded that patients with hematological malignances were significantly younger, they were more prone to infections in case they had a vascular access or indwelling urinary catheter, and had received previous antibiotic therapy more frequently. However, comorbidities were seen more frequently in patients with solid tumors, so the urinary tract as a source of blood-stream infection was more frequently seen in patients with solid tumors, while those with hematologic malignancies were more susceptible to infection due to venous access [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our research, 9.3% of the studied sample had the same organism isolated from both urine culture and blood culture, compared to 2.9% of those with hematological malignancy and 6.1% of patients without any kind of malignancies. Gudiol et al found that the urinary tract is the most common source for blood stream infection in patients with solid tumors, especially Gram-negative bacilli. However, the incidence of blood-stream infection is still lower to that in patients with hematologic malignancies[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. A systematic review by Peach et al found that, out of six reviewed studies, only one study reported significant association between diabetes mellitus and urosepsis [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This is in rhyme with our study which found no significant association between diabetes mellitus and the risk for acquiring a blood stream infection through urinary tract.\u003c/p\u003e \u003cp\u003eKizilbash et al found that patients with urinary catheters were three times more vulnerable to acquiring blood-stream infections of urinary origin. The probability was half as likely in patients with external catheters, that is, nephrostomy tubes, compared to those with indwelling catheters[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Shigemura et al found that indwelling catheters increased the risk for urosepsis by four folds[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. A study in Indonesia concluded that the risk for acquiring urosepsis in patients following double J stent placement increased in female, older patients and it was directly associated with the length of installation[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The association between having a urinary catheter and developing urosepsis was analyzed using Chi-square test, while the association between nephrostomies and double J stents on one hand, and urosepsis on the other was studied using Fischer test. Even though all these factors increased the risk of developing urosepsis, no statistical significance was found through these analyses.\u003c/p\u003e \u003cp\u003eIn his review, Gudiol et al found that Gram-negative bacilli were the most common cause of blood-stream infection of urinary origin, with \u003cem\u003eEscherichia coli\u003c/em\u003e, \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e, and \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e being the most common isolates. Resistant organisms were seen more frequently in patients with urinary instrumentation[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In our study, we used the Mann-Whitney U test to study the distribution of isolates in positive urine culture compared to those found in both urine and blood cultures. The most common isolate was \u003cem\u003eEscherichia coli\u003c/em\u003e, followed by \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e and \u003cem\u003eProteus mirabilis\u003c/em\u003e. \u003cem\u003eEscherichia coli\u003c/em\u003e was more likely to spread to blood stream, compared to other isolates.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eMale sex was the main risk factor for blood-stream infection of urinary origin. Gram-negative bacilli were the main culprit, with \u003cem\u003eEscherichia coli\u003c/em\u003e being the most common isolate. As the first conclusion contradicts previous studies, further studies with larger population and randomization is recommended to avoid possible confounders. As well as other factors including urinary catheterization and solid versus liquid tumors ca be studied in a larger sample size.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval was obtained from Augusta Victoria Hospital Ethical Committee, and consent to participate was waived due to the retrospective nature of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. No funding was received for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest/Competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI.B. designed the study, conducted the data analysis, and drafted the manuscript. D.S. contributed to data collection and interpretation. A.Sh. and H.R. data collection, M.Y. data analysis, M.H. manuscript review and writing, A.S. provided critical revisions and approved the final version of the manuscript. All authors read and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWagenlehner FME, Pilatz A, Weidner W, Naber KG. Urosepsis: Overview of the Diagnostic and Treatment Challenges. Urinary Tract Infections: Molecular Pathogenesis and Clinical Management. 2016;:135\u0026ndash;57.\u003c/li\u003e\n\u003cli\u003eQiang X-H, Yu T-O, Li Y-N, Zhou L-X. Prognosis Risk of Urosepsis in Critical Care Medicine: A Prospective Observational Study. 2016. https://doi.org/10.1155/2016/9028924.\u003c/li\u003e\n\u003cli\u003eMarkus Dreger N, Degener S, Ahmad-Nejad P, W\u0026ouml;bker G, Roth S. M E D I C I N E Urosepsis-Etiology, Diagnosis, and Treatment. https://doi.org/10.3238/arztebl.2015.0837.\u003c/li\u003e\n\u003cli\u003eGudiol C, Albasanz-Puig A, Cuervo G, Carratal\u0026agrave; J. Understanding and Managing Sepsis in Patients With Cancer in the Era of Antimicrobial Resistance. Front Med (Lausanne). 2021;8.\u003c/li\u003e\n\u003cli\u003eSernyak PS, Denisov VK, Guba GB, Zakharov V V., Chernobrivtsev PA, Berko EM, et al. [The diagnosis of urosepsis]. Urol Nefrol (Mosk). 1990;55:9\u0026ndash;13.\u003c/li\u003e\n\u003cli\u003eSheng Y, Zheng W long, Shi Q fang, Zhang B yu, Yang G yao. Clinical characteristics and prognosis in patients with urosepsis from intensive care unit in Shanghai, China: a retrospective bi-centre study. BMC Anesthesiol. 2021;21:1\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eShaikh N, Umm-E-Amara, Hassan J, Qazi Z, Chanda A, Mahemood Z, et al. Urosepsis: Flow is Life. Clinical Management of Shock - The Science and Art of Physiological Restoration. 2018. https://doi.org/10.5772/INTECHOPEN.82262.\u003c/li\u003e\n\u003cli\u003eRosser CJ, Bare RL, Meredith JW. Urinary tract infections in the critically ill patient with a urinary catheter. Am J Surg. 1999;177:287\u0026ndash;90.\u003c/li\u003e\n\u003cli\u003eMitchell BG, Ferguson JK, Anderson M, Sear J, Barnett A. Length of stay and mortality associated with healthcare-associated urinary tract infections: a multi-state model. J Hosp Infect. 2016;93:92\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eAl-Hazmi H. Role of duration of catheterization and length of hospital stay on the rate of catheter-related hospital-acquired urinary tract infections. Res Rep Urol. 2015;7:41.\u003c/li\u003e\n\u003cli\u003eRolston KVI. Infections in Cancer Patients with Solid Tumors: A Review. Infect Dis Ther. 2017;6:69\u0026ndash;83.\u003c/li\u003e\n\u003cli\u003eLiu J, Yang Q, Lan J, Hong Y, Huang X, Yang B. Risk factors and prediction model of urosepsis in patients with diabetes after percutaneous nephrolithotomy. BMC Urol. 2021;21.\u003c/li\u003e\n\u003cli\u003eKoh GCKW, Peacock SJ, Van Der Poll T, Wiersinga WJ. The impact of diabetes on the pathogenesis of sepsis. Eur J Clin Microbiol Infect Dis. 2012;31:379\u0026ndash;88.\u003c/li\u003e\n\u003cli\u003ePeach BC, Garvan GJ, Garvan CS, Cimiotti JP. Risk Factors for Urosepsis in Older Adults: A Systematic Review. Gerontol Geriatr Med. 2016;2:233372141663898.\u003c/li\u003e\n\u003cli\u003eDimitrijevic Z, Paunovic G, Tasic D, Mitic B, Basic D. Risk factors for urosepsis in chronic kidney disease patients with urinary tract infections. Sci Rep. 2021;11:14414.\u003c/li\u003e\n\u003cli\u003eEggimann P, Pittet D. Central line sepsis in intensive care units: overview and update. Curr Anaesth Crit Care. 1999;10:14\u0026ndash;20.\u003c/li\u003e\n\u003cli\u003eKino M, Hayashi T, Hino D, Nakada T, Kitoh H, Akakura K. Patients\u0026rsquo; poor performance status is an independent risk factor for urosepsis induced by kidney and ureteral stones. Urolithiasis. 2021;49:477\u0026ndash;84.\u003c/li\u003e\n\u003cli\u003e(PDF) Presentation,Risk factors, Microbiological pattern and Management of Urosepsis in a Tertiary Hospital in Nigeria. https://www.researchgate.net/publication/353270010_PresentationRisk_factors_Microbiological_pattern_and_Management_of_Urosepsis_in_a_Tertiary_Hospital_in_Nigeria. Accessed 6 Jun 2024.\u003c/li\u003e\n\u003cli\u003eFabbian F, De Giorgi A, L\u0026oacute;pez-Soto PJ, Pala M, Tiseo R, Cultrera R, et al. Is female gender as harmful as bacteria? analysis of hospital admissions for urinary tract infections in elderly patients. J Womens Health (Larchmt). 2015;24:587\u0026ndash;92.\u003c/li\u003e\n\u003cli\u003eHuang YWY, Alleyne A, Leung V, Chapman M. Urosepsis Due to Extended-Spectrum \u0026beta;-Lactamase\u0026ndash;Producing Escherichia coli: A Retrospective, Single-Centre Review of Risk Factors and Clinical Outcomes. Can J Hosp Pharm. 2018;71:119.\u003c/li\u003e\n\u003cli\u003eMarin M, Gudiol C, Ardanuy C, Garcia-Vidal C, Calvo M, Arnan M, et al. Bloodstream infections in neutropenic patients with cancer: differences between patients with haematological malignancies and solid tumours. J Infect. 2014;69:417\u0026ndash;23.\u003c/li\u003e\n\u003cli\u003eGudiol C, Aguado JM, Carratal\u0026agrave; J. Bloodstream infections in patients with solid tumors. Virulence. 2016;7:298\u0026ndash;308.\u003c/li\u003e\n\u003cli\u003eKizilbash QF, Petersen NJ, Chen GJ, Naik AD, Trautner BW. Bacteremia and mortality with urinary catheter-associated bacteriuria. Infect Control Hosp Epidemiol. 2013;34:1153\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eShigemura K, Tanaka K, Osawa K, Arakawa S, Miyake H, Fujisawa M. Clinical factors associated with shock in bacteremic UTI. Int Urol Nephrol. 2013;45:653\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eRahawarin IU, Wibisono . Incidence Rate of Urosepsis Complication in Patient with Post DJ Stent Placement at Dr. Moewardi General Hospital Surakarta from January to March 2017: A Retrospective Study. Asian Journal of Research and Reports in Urology. 2021;4:67\u0026ndash;74.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4539788/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4539788/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eUrosepsis, is a severe systemic infection resulting from a urinary tract infection (UTI) that has spread to the bloodstream. Urosepsis management is challenging, especially in immunocompromised oncology patients.\u003c/p\u003e\n\u003cp\u003eIn this retrospective study, we characterized the urosepsis cases in oncology patients between 2019 and 2023. Of the 337 cases, males were the most affected group (p = 0.039). Similar to other studies \u003cem\u003eEscherichia coli\u003c/em\u003e was the most common cause of urosepsis in our oncology patients. None of the analyzed variables showed any statistical significance associated with urosepsis. These include type of tumor (liquid or solid), nephrostomy, double J stent, Diabetes Mellitus, length of stay, and presence of a central line.\u003c/p\u003e\n\u003cp\u003eOur study was the first study from Palestine that looked at urosepsis in oncology patients. The overall challenge in urosepsis in our oncology patients remains to be the emergence of antimicrobial resistance in the isolated urosepsis pathogens.\u003c/p\u003e","manuscriptTitle":"Prevalence of Certain Microorganisms in Cancer Patients with Urosepsis and Literature Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-29 00:10:00","doi":"10.21203/rs.3.rs-4539788/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"feeb866f-0db2-4110-a1ef-5f2b43d3a0d0","owner":[],"postedDate":"June 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-30T12:52:00+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-29 00:10:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4539788","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4539788","identity":"rs-4539788","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}