{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T09:09:09Z","timestamp":1779700149469,"version":"3.53.1"},"reference-count":21,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T00:00:00Z","timestamp":1778284800000},"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 common cause of sepsis in adults and is associated with substantial morbidity and mortality, particularly when urinary obstruction delays timely source control. The roles of diagnostic uncertainty at presentation, microbiological phenotypes (including multidrug resistance), and biomarkers in shaping management pathways and outcomes warrant further evaluation. Materials and Methods: This retrospective, single-center, observational study included 154 consecutive adult patients hospitalized for urosepsis. Sepsis was defined according to the Sepsis-3 criteria. Baseline clinical modifiers at admission were encoded as binary variables (e.g., malignancy, urinary tract obstruction\/altered anatomy, immunocompromised status, acute kidney injury [AKI], and diagnostic uncertainty). Microbiology was standardized into pathogen groups (Gram-negative, Gram-positive, or no isolate), infection complexity (mono- vs. polymicrobial), and multidrug-resistant organism (MDRO) status. Procedures were categorized as no procedure, urinary tract decompression, or other source controls. Biomarkers (C-reactive protein [CRP], procalcitonin [PCT], and creatinine) were analyzed at admission and, when available, during hospitalization. The primary outcomes were in-hospital mortality, ICU admission, and absence\/delay of source control. Results: The median age was 68 years, and 60.4% of patients were male. The in-hospital mortality and ICU admission rates were 7.1% and 3.9%, respectively. Diagnostic uncertainty was present in 9.8% and was associated with a higher likelihood of no invasive intervention (86.7% vs. 43.9%, p = 0.002) and a lower rate of urinary tract decompression (13.3% vs. 45.3%, p = 0.01). Gram-negative pathogens predominated (50.0%), and MDROs were identified in 18.2% and were associated with prior urological interventions (53.6% vs. 24.6%, p = 0.003) and higher admission PCT levels (8.6 vs. 3.2 ng\/mL, p = 0.04). Bacteremia was associated with mortality (14.5% vs. 2.2%, odds ratio [OR] 7.64, p = 0.007). Mortality was higher in Gram-positive infections (21.7% vs. 4.6%, OR 5.79, p = 0.012) and in patients with AKI at admission (25.0% vs. 5.7%; OR, 5.54; p = 0.043). Conclusions: Urosepsis exhibits distinct clinical and microbiological phenotypes that influence its management and outcomes. Diagnostic uncertainty at presentation was associated with reduced early source control measures, whereas MDRO infections were clustered with prior urological interventions and higher systemic inflammatory burdens. Bacteremia, Gram-positive pathogens, and AKI at admission were associated with an increased in-hospital mortality risk. These findings support a multidimensional early assessment strategy integrating clinical presentation, microbiological risk, biomarkers, and rapid evaluation of obstruction to facilitate timely source control.<\/jats:p>","DOI":"10.3390\/medicina62050925","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T08:06:26Z","timestamp":1779696386000},"page":"925","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Management and Outcomes of Urosepsis in Relation to Diagnostic Complexity and Microbiological Profile"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1346-7731","authenticated-orcid":false,"given":"Marcin","family":"Talaga","sequence":"first","affiliation":[{"name":"Department of General, Functional and Oncological Urology, Military Institute of Medicine\u2014National Research Institute, 128 Szaser\u00f3w Street, 04-141 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Z\u0105bkowski","sequence":"additional","affiliation":[{"name":"Department of General, Functional and Oncological Urology, Military Institute of Medicine\u2014National Research Institute, 128 Szaser\u00f3w Street, 04-141 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5583-3606","authenticated-orcid":false,"given":"Kamil","family":"Ciechan","sequence":"additional","affiliation":[{"name":"Warsaw Bar Association, 15\/16 \u017bytnia Street, 01-014 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawe\u0142","family":"J\u0119drzejczyk","sequence":"additional","affiliation":[{"name":"Gen Clinic, 44\/U1 Wilhelma Roentgena Street, 02-781 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8688-4171","authenticated-orcid":false,"given":"Tomasz W.","family":"Kaminski","sequence":"additional","affiliation":[{"name":"Hemostasis and Thrombosis Program, Versiti Blood Research Institute, Milwaukee, WI 53226, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Syry\u0142o","sequence":"additional","affiliation":[{"name":"Department of General, Functional and Oncological Urology, Military Institute of Medicine\u2014National Research Institute, 128 Szaser\u00f3w Street, 04-141 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1111\/j.1464-410X.2009.08427.x","article-title":"The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: Results from the Epidemiology of LUTS (EpiLUTS) study","volume":"104","author":"Coyne","year":"2009","journal-title":"BJU Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1016\/S1474-4422(15)00070-8","article-title":"Lower urinary tract dysfunction in the neurological patient: Clinical assessment and management","volume":"14","author":"Panicker","year":"2015","journal-title":"Lancet Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1002\/nau.10052","article-title":"The standardisation of terminology of lower urinary tract function: Report from the Standardisation Sub-Committee of the International Continence Society","volume":"21","author":"Abrams","year":"2002","journal-title":"Neurourol. 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