Urosepsis: Urinary Tract Infection Gone Bad

When Urinary Tract Infections Lead to Sepsis

urosepsis, UTI
Urinary Tract Infections Can Lead to Urosepsis.

What is a UTI?

To understand urosepsis is it is important to understand a urinary tract infection.

A urinary tract infection, commonly known as a UTI, is an infection that affects a portion of the urinary tract.  The urinary tract includes the kidneys, the ureters, the bladder, and the urethra.   An infection in any of these can cause discomfort, pain, the urge to urinate frequently and a fever. 

Most urinary tract infections take place in the bladder (cystitis) and urethra (urethritis), kidney (pyelonephritis) infections are less common but are typically more severe in nature.


What is Urosepsis?

Urosepsis is a condition where a urinary tract infection spreads from the urinary tract to the bloodstream, causing a systemic infection that circulates through the body through the bloodstream.  This type of blood infection is referred to as sepsis. As many as 25% of individuals who develop sepsis are found to have had an initial urinary tract infection as the source of the condition.

Urosepsis is very serious and can quickly progress to a life-threatening infection.  Even with rapid diagnosis and treatment, urosepsis can still develop into an infection that is difficult to control with medication and supportive treatment.  In the most severe cases, sepsis can lead to multi-system organ failure.

Early identification of a urinary tract infection, along with proper treatment, is the best way to prevent urosepsis.  It is possible for a patient to develop urosepsis without identifying symptoms of a urinary tract infection or seeking treatment.


Signs and Symptoms of a Urinary Tract Infection

The signs and symptoms of a urinary tract infection can vary from person to person.  Some individuals may have a fever, while others feel normal but find that the appearance of their urine has changed.  The most common signs and symptoms of a urinary tract infection include:

  • Burning during urination
  • Pelvic pain or pressure
  • Urine with a strong odor
  • Frequent urge to urinate
  • Discolored urine

Why is Urosepsis More Common After Surgery?

There are multiple reasons why urosepsis is more common in surgery patients.  Many patients have a urinary catheter in place while they are in surgery, and it may stay in place for hours or days after surgery.  The placement of the catheter is done using sterile technique; however, having the catheter in place still increases the risk of infection as it is a foreign body.

For other surgery patients, it is the type of surgery that increases the risk of infection.  Surgery that takes place in or near the urinary tract increases the risk of a subsequent urinary tract infection.  Surgeries such as kidney transplant, prostate surgeries and bladder surgeries are known to increase the risk of urosepsis.

Risk Factors for Urosepsis

  • Surgical patients
  • Weakened immune system
  • Kidney transplant recipients
  • Chronic illness
  • Recent diagnosis of UTI
  • History of recurrent UTI
  • History of urosepsis
  • Urinary tract disorders
  • Elderly
  • Diabetic
  • Frequent catheterization
  • Recent catheterization
  • Inability to fully empty the bladder
  • Indwelling (long term) catheter

Treatment of Urosepsis?

If the patient has a urinary catheter in place, the catheter is typically removed and a new one put in place.  The catheter that is removed may be sent to the lab in an effort to determine the source of the infection.

In all cases, antibiotic therapy is necessary to treat the infection. A blood culture and sensitivity is typically done to determine the best antibiotic(s) for the individual.  Most patients see a notable improvement in condition within 72 hours of antibiotic therapy.

In the effort to identify the source of the infection, the urosepsis patient may have an ultrasound performed, endoscopy, a CT scan or MRI.

The treatment of urosepsis is largely dependent on the severity of the illness.  Some patients with a relatively minor case may be effectively treated at home with antibiotics.  Other patients with sepsis may progress to septic shock.  For those patients, admission to the Intensive Care Unit, IV antibiotics and significant life support including assisted ventilation may be necessary, along with medication to maintain the blood pressure.

Approach to a Patient with Urosepsis. Journal of Global Infectious Disease. Accessed September, 2014.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2840933/

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