{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T05:16:24Z","timestamp":1787807784530,"version":"build-2784847793"},"reference-count":38,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,11,8]],"date-time":"2023-11-08T00:00:00Z","timestamp":1699401600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Urosepsis is a significant cause of maternal and fetal mortality. While certain risk factors for urinary tract infections (UTIs) in pregnant women are well established, those associated with an elevated risk of urosepsis in pregnant women with upper UTIs remain less defined. This study aims to identify factors linked to an increased risk of urosepsis and examine urologic treatment outcomes in such cases. Materials and Methods: We conducted a retrospective analysis on 66 pregnant women diagnosed with urosepsis over a nine-year period. A control group included 164 pregnant women with upper UTIs, excluding urosepsis, admitted during the same timeframe. This study highlights factors potentially contributing to urosepsis risk, including comorbidities like anemia, pregnancy-related hydronephrosis or secondary to reno-ureteral lithiasis, prior UTIs, coexisting urological conditions, and urologic procedures. Outcomes of urologic treatments, hospitalization duration, obstetric transfers due to fetal distress, and complications associated with double-J catheters were analyzed. Results: Pregnant women with urosepsis exhibited a higher prevalence of anemia (69.7% vs. 50.0%, p = 0.006), 2nd\u20133rd grade hydronephrosis (81.8% vs. 52.8%, p = 0.001), and fever over 38 \u00b0C (89.4% vs. 42.1%, p = 0.001). They also had a more intense inflammatory syndrome (leukocyte count 18,191 \u00b1 6414 vs. 14,350 \u00b1 3860\/mmc, p = 0.001, and C-reactive protein (CRP) 142.70 \u00b1 83.50 vs. 72.76 \u00b1 66.37 mg\/dL, p = 0.001) and higher creatinine levels (0.77 \u00b1 0.81 vs. 0.59 \u00b1 0.22, p = 0.017). On multivariate analysis, factors associated with increased risk for urosepsis were anemia (Odds Ratio (OR) 2.622, 95% CI 1.220\u20135.634), 2nd\u20133rd grade hydronephrosis (OR 6.581, 95% CI 2.802\u201315.460), and fever over 38 \u00b0C (OR 11.612, 95% CI 4.804\u201328.07). Regarding outcomes, the urosepsis group had a higher rate of urological maneuvers (87.9% vs. 36%, p = 0.001), a higher rate of obstetric transfers due to fetal distress (22.7% vs. 1.2%, p = 0.001), and migration of double-J catheters (6.1% vs. 0.6%, p = 0.016), but no maternal fatality was encountered. However, they experienced the same rate of total complications related to double-J catheters (19.69% vs. 12.80%, p &gt; 0.05). The pregnant women in both groups had the infection more frequently on the right kidney, were in the second trimester and were nulliparous. Conclusions: Pregnant women at increased risk for urosepsis include those with anemia, hydronephrosis due to gestational, or reno-ureteral lithiasis, and fever over 38 \u00b0C. While the prognosis for pregnant women with urosepsis is generally favorable, urological intervention may not prevent a higher incidence of fetal distress and the need for obstetric transfers compared to pregnant women with uncomplicated upper UTIs.<\/jats:p>","DOI":"10.3390\/medicina59111972","type":"journal-article","created":{"date-parts":[[2023,11,9]],"date-time":"2023-11-09T03:42:08Z","timestamp":1699501328000},"page":"1972","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Factors Associated with Increased Risk of Urosepsis during Pregnancy and Treatment Outcomes, in a Urology Clinic"],"prefix":"10.3390","volume":"59","author":[{"given":"Viorel Dragos","family":"Radu","sequence":"first","affiliation":[{"name":"Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy \u201cGr. T. Popa\u201d, 700115 Iasi, Romania"},{"name":"Urological Department, \u201cC.I. Parhon\u201d University Hospital, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radu Cristian","family":"Costache","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy \u201cGr. T. Popa\u201d, 700115 Iasi, Romania"},{"name":"Urological Department, \u201cC.I. Parhon\u201d University Hospital, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4975-3252","authenticated-orcid":false,"given":"Pavel","family":"Onofrei","sequence":"additional","affiliation":[{"name":"Department of Morpho-Functional Sciences II, Faculty of Medicine, University of Medicine and Pharmacy \u201cGr. T. Popa\u201d, 700115 Iasi, Romania"},{"name":"Urological Department, Elytis Hope Hospital, 700010 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liviu","family":"Antohi","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, \u201cC.I. Parhon\u201d University Hospital, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Razvan Lucian","family":"Bobeica","sequence":"additional","affiliation":[{"name":"Urological Department, \u201cC.I. Parhon\u201d University Hospital, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iacov","family":"Linga","sequence":"additional","affiliation":[{"name":"Urological Department, \u201cC.I. Parhon\u201d University Hospital, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4718-392X","authenticated-orcid":false,"given":"Ingrid","family":"Tanase-Vasilache","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Medicine and Pharmacy \u201cGr. T. Popa\u201d, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0622-8068","authenticated-orcid":false,"given":"Anca Irina","family":"Ristescu","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, University of Medicine and Pharmacy \u201cGr. T. Popa\u201d, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina-Mariela","family":"Murgu","sequence":"additional","affiliation":[{"name":"Department of Mother and Child Medicine, University of Medicine and Pharmacy \u201cGr. T. Popa\u201d, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4131-1019","authenticated-orcid":false,"given":"Ionela-Larisa","family":"Miftode","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy \u201cGr. T. Popa\u201d, 700115 Iasi, Romania"},{"name":"St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan Alexandru","family":"Stoica","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, University of Medicine and Pharmacy \u201cGr. T. Popa\u201d, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1007\/s40121-014-0037-7","article-title":"Pregnancy-Associated Severe Sepsis: Contemporary State and Future Challenges","volume":"3","author":"Oud","year":"2014","journal-title":"Infect. Dis. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1471-0528.2010.02847.x","article-title":"Saving Mothers\u2019 Lives: Reviewing maternal deaths to make motherhood safer: 2006\u20132008. 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