What is urosepsis?
Sepsis is a life-threatening bacterial infection of the blood; urosepsis is sepsis that complicates a urinary tract infection. Urosepsis requires treatment with antibiotics and may require supportive therapies such as intravenous fluids and oxygen. If undiagnosed or untreated, urosepsis can progress to septic shock, a serious and life-threatening condition complicated by dropping blood pressure, rapid heart and breathing rates, decreasing urine output, and alterations in mental status.
The urinary tract consists of the kidneys, ureters, bladder and urethra. The kidneys filter the blood, creating urine, which travels through the ureters to the bladder, where it is stored until it exits the body through the urethra. In the male, the prostate wraps around the urethra as it travels from the bladder to the penis. Most of the time, bacteria that cause urosepsis enter the body through the urethra and make their way to the prostate or kidney before entering the bloodstream.
Symptoms of uncomplicated urinary tract infections can include burning with urination, the need to go to the bathroom frequently or urgently, cloudy urine, and pelvic or lower abdominal discomfort. Fever may be present. If pyelonephritis (kidney infection) is present, back or abdominal pain, nausea and vomiting, high fever, shaking chills, night sweats, and fatigue may also occur. Any of these symptoms may precede the development of urosepsis.
Urosepsis is more common in women than in men, and is more likely to occur in the elderly or people who have weakened immune systems or conditions such as diabetes. Obstruction of the flow of urine by an enlarged prostate, kidney or bladder stones, tumors, or urethral scarring increases the risk of urosepsis, as does any condition that interferes with bladder emptying. Instrumentation of the urinary tract during surgeries, procedures, or catheterization increases the risk of infections that can lead to urosepsis.
Urosepsis is a life-threatening emergency. Seek immediate medical care (call 911) if you have symptoms of sepsis such as high fever (higher than 101 degrees Fahrenheit), rapid breathing, fast heart rate, weak pulse, profuse sweating, unusual anxiety, changes in mental status or level of consciousness, or decreased or absent urinary output.
Seek prompt medical care if you have symptoms suggestive of a urinary tract infection without symptoms of sepsis.
What are the symptoms of urosepsis?
Urosepsis shares many of the same symptoms as other types of sepsis, including rapid heart rate, rapid breathing, weak pulse, profuse sweating, unusual anxiety, changes in mental status or level of consciousness, and decreased or absent urinary output. Prior to the development of these symptoms, you may experience symptoms of a urinary tract infection.
Common symptoms of a urinary tract infection
Symptoms of a urinary tract infection vary from individual to individual. Common urinary tract infection symptoms include:
Abdominal, pelvic or back pain or cramping
Bloody or pink-colored urine (hematuria)
Cloudy urine
Difficult or painful urination, or burning with urination (dysuria)
Fever and chills
Foul-smelling urine
General ill feeling
Pain during sexual intercourse
Urgent need to urinate
Serious symptoms that might indicate a life-threatening condition
Urosepsis can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms:
Change in level of consciousness or alertness, such as passing out or unresponsiveness
High fever (higher than 101 degrees Fahrenheit)
Low temperature (hypothermia; temperature 96.8 degrees Fahrenheit or lower)
Not producing any urine
Profuse sweating and unusual anxiety
Rapid heart rate (tachycardia)
Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing
Severe abdominal, pelvic, or back pain
Severe nausea and vomiting
Weak pulse
What causes urosepsis?
Urosepsis is caused by a bacterial infection of the urinary tract or prostate that spreads into the bloodstream. Even if you are in general good health, many of the bacteria that cause urosepsis can normally occur in your intestines.
What are the risk factors for urosepsis?
A number of factors increase the risk of developing urosepsis. Not all people with risk factors will get urosepsis. Risk factors for urosepsis include:
Advanced age
Compromised immune system due to such conditions as HIV and AIDS, taking corticosteroids, organ transplant, or cancer and cancer treatment
Diabetes
Fecal incontinence (inability to control stools)
Female gender
Immobility
Incomplete bladder emptying or urinary retention
Surgeries or procedures involving the urinary tract
Urinary tract obstruction by stones, an enlarged prostate, urethral scarring, or other causes
Use of catheters to drain urine
How is urosepsis treated?
The primary treatment for urosepsis is the use of antibiotics to get rid of the infection. Your treatment may also include supportive measures such as intravenous fluids, and oxygen therapy may be used. If your case is severe, medications may be used to increase your blood pressure and mechanical ventilation may be required.
Common treatments for urosepsis
Common treatments for urosepsis include:
Blood transfusions if necessary
Drainage of abscesses if present
Initial treatment with broad-spectrum antibiotics to fight the most likely infectious organisms
Intravenous fluids to maintain blood volume and blood pressure support
Lithotripsy to break up kidney or bladder stones if present
Mechanical ventilation if needed
Medications (vasopressors) to increase blood pressure
Monitoring and maintenance of blood sugar
Oxygen therapy to maintain blood oxygenation
Removal of any catheters or other devices that may be infected
Targeted antibiotic therapy to treat specific bacteria once culture results are available
What are the potential complications of urosepsis?
Your age and general health can play a role in your risk for potential complications. In some people, especially older adults, people with chronic diseases, and those with a weak immune system, complications of untreated urosepsis can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your doctor design specifically for you. Complications of urosepsis include:
Disseminated intravascular coagulation (DIC; a clotting disorder leading to the formation of multiple blood clots in the bloodstream)
Kidney damage
Kidney or other organ failure
Perirenal abscesses (collections of pus near the kidneys)
Prostatic abscesses (collections of pus in the prostate)
Renal abscesses (collections of pus in the kidneys)
Scarring of the urinary tract
Shock
