CHEST Guidelines-Usefulness-of-Ultrasound-to-Help-Solve-Severe-Seps

Usefulness-of-Ultrasound-to-Help-Solve-Severe-Seps

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This document discusses the role of ultrasound in diagnosing and managing severe sepsis in a 65-year-old male patient. The patient presented with a fever, fatigue, and severe sepsis, likely due to a urinary tract infection, alongside a chronic illness background including schizophrenia, hypertension, and benign prostatic hyperplasia. A suprapubic catheter was in place, though the patient reportedly experienced no discomfort or visible dysfunction.<br /><br />In the emergency department, laboratory tests revealed acute kidney injury and a neutrophil-predominant leukocytosis. Despite broad-spectrum antibiotic treatment, further diagnostics were necessary. Point-of-care ultrasonography, which is utilized to assess volume status and shock etiology, indicated bilateral hydronephrosis. This raised suspicion for a bladder outlet obstruction caused by improper suprapubic catheter drainage, demonstrating the importance of ultrasonography in guiding diagnosis and treatment.<br /><br />The renal ultrasound's findings prompted a bladder ultrasound that confirmed incomplete drainage due to a non-functioning catheter, likely obstructed by purulent urine. Upon urgent urological intervention replacing the catheter, 600 mL of purulent urine was expelled, supporting the diagnosis. The patient’s sepsis, identified as being caused by Proteus mirabilis, resolved with appropriate antibiotic treatment, allowing for a stable discharge.<br /><br />The document underscores the utility of whole-body ultrasonography in diagnosing septic patients, suggesting that ultrasonography of the kidneys and bladder should be a standard assessment for those with presumed sepsis and acute kidney injury. It emphasizes the importance of evaluating Foley catheter placements when ultrasound reveals a distended bladder to determine the cause of obstruction.

Keywords

ultrasound

sepsis diagnosis

urinary tract infection

acute kidney injury

point-of-care ultrasonography

hydronephrosis

bladder outlet obstruction

suprapubic catheter

Proteus mirabilis

urological intervention