Risk factors for septic shock in older patients with urinary tract infection

Backgrounds: Few studies have addressed the risk factors for the development of septic shock in older patients with urinary tract infections. We decided to investigate whether a similar risk exists in in older patients.

Methods: A total of 1478 older patients (492 men, 986 women) aged 65 years or older (mean age 85.1 years) who were hospitalized and treated for urinary tract infections were included in this study, and factors contributing to the development of septic shock in these patients, including in terms of the causative pathogens and treatments employed, were investigated through a retrospective review of the patients' medical charts.

Results: Underlying urinary tract infection with urolithiasis was found as the most significant risk factor for the development of septic shock (p < 0.01). Patients with urolithiasis were more frail, had higher urinary pH and calcium levels, and showed a higher frequency of infections caused by antimicrobial-resistant and rare bacteria. Cluster analysis revealed a higher incidence of death, septic shock, urolithiasis, and frailty in the patient group treated with carbapenem and/or MRSA agents.

Conclusion: Septic shock was associated with a high risk of death in older patients with urinary tract infections, and urolithiasis was identified as an independent risk factor for the development of septic shock. Urolithiasis was also associated with frailty, suggesting that prevention of frailty may indirectly improve the prognosis of patients with septic shock secondary to urinary tract infections.