What is Urosepsis (Urine Infection)?
Sepsis is a medical condition that results from an overactive and uncontrolled response to an infection by the body. This response causes a series of abnormal changes in the body’s functions and chemistry, which can lead to severe organ damage and even death. Urosepsis is a type of sepsis that starts in the urinary and reproductive system.
What Causes Urosepsis (Urine Infection)?
The bacteria most often responsible for urinary tract infections (UTIs), which can then lead to a severe condition called urosepsis, is Escherichia coli, making up 50% of cases. This is followed by Proteus, Enterobacter, and Klebsiella, each comprising 15% of cases. Pseudomonas aeruginosa contributes to 5% of cases, while gram-positive bacteria also account for 15% of UTIs.
Risk Factors and Frequency for Urosepsis (Urine Infection)
In the U.S, it seems that sepsis cases have been on the rise for the past 30 to 40 years, though, luckily, the overall number of deaths due to sepsis has gone down. Unfortunately, death rates from urosepsis (a type of sepsis that starts from a urinary tract infection) are still rather high with an estimated 30% to 40% of patients not surviving. The condition is also becoming harsher and is frequently accompanied by severe lung distress (known as ARDS), acute kidney damage, and a dangerous blood clotting disorder (termed DIC).
Signs and Symptoms of Urosepsis (Urine Infection)
Urosepsis is a condition where an infection in the urinary system spreads to the bloodstream. This condition can cause different symptoms based on where the infection started. Each part of the urinary tract that can get infected presents differently. Common symptoms can include pain during urination, frequent and urgent urination, blood in urine and fever. Read on to discover some specific symptoms for certain parts of the urinary system.
- Cystitis (bladder infection): Symptoms may include painful urination, frequent and urgent urination, lower abdominal pain, blood in urine, fever, chills, and extreme fatigue.
- Pyelonephritis (kidney infection): Usual symptoms are fever, chills, side and back pain, tenderness in the upper back region and nausea or vomiting. Sometimes it may also show bladder infection symptoms. Pain can also be felt in the upper tummy or lower abdominal area.
- Acute bacterial prostatitis (prostate infection): Symptoms can include fever, chills, painful urination, pain in the lower pelvic area, and unclear urine. Patients might also have difficulty urinating properly. During a physical exam, the prostate area might be swollen and painful.
Other factors might increase the risk of getting urosepsis, such as a history of frequent urinary tract infections, kidney stones, a weakened immune system, or long-term use of a catheter.
Testing for Urosepsis (Urine Infection)
Diagnosing urosepsis involves looking for signs of both sepsis (a severe body-wide infection) and a urinary tract infection (UTI). These signs could include abnormal body temperature and heart rate, or changes in breathing and white blood cell count. If sepsis becomes severe, it may start to affect the functioning of organs. For instance, you might see less urine output suggesting kidney issues, a sudden change in mental state indicating problems with the brain, or a low platelet count.
On the other hand, signs of a complex UTI could include symptoms like painful urination, pain in the side of your body, any signs of difficulty in passing urine, as well as specific medical imaging and lab test results.
If a doctor thinks you might have urosepsis, they’ll likely run a series of tests including a urine test, a complete blood count, a comprehensive metabolic panel, blood cultures, and a lactate level test. This helps them check if any organs are being affected.
One common cause of urosepsis could be blockage of the urinary tract. Using ultrasound, doctors can identify 93% of usual causes of urosepsis like hydronephrosis (a condition where the kidney swells due to urine not draining properly) or a prostate abscess (a pocket of pus in the prostate). However, the use of ultrasound depends on the availability of an experienced professional to perform it.
Computed tomography (CT) scans are also a useful tool for diagnosing urosepsis. It’s available round the clock and doesn’t require a professional to operate it. This makes the CT scan a popular choice when urosepsis is suspected. Plus, it can help spot certain subtle signs that might not be easily seen with an ultrasound.
Treatment Options for Urosepsis (Urine Infection)
In recent years, cases of urinary tract infections (UTIs) that are resistant to multiple drugs have become more common. This problem is believed to be due to the overuse of antibiotics used routinely to treat UTIs even before a definitive diagnosis is reached; this is usually confirmed only after 2-3 days through a urine culture.
Studies have shown that prompt and aggressive treatment reduces deaths resulting from sepsis, a severe and often fatal illness caused by infection. Even though some aspects of early goal-directed therapy (EGDT) for sepsis management have recently been questioned, the main guidelines remain the same. This includes quickly starting broad-spectrum antibiotics chosen based on the predicted infection source, providing supportive care like stabilizing the patient’s heartbeat and breathing, and incorporating other treatments as needed.
When sepsis is diagnosed, the objective is to get antibiotics into the patient’s system within an hour. However, it’s necessary to collect urine and blood samples for culturing before starting the antibiotics. It has been observed that any delay in giving antibiotics after the initial six hours can decrease survival rates by 8% each hour. The choice of antibiotics depends on local susceptibility patterns but often includes drugs like third-generation cephalosporins, piperacillin combined with a beta-lactamase inhibitor, or a fluoroquinolone. It’s important to note that patients with sepsis often have impaired kidney and liver function, which may affect how their bodies process antibiotics.
Besides early antibiotic treatment, other critical parts of managing sepsis include promptly replenishing fluids in the body using crystalloid solutions and using drugs called vasopressors like norepinephrine, epinephrine, and vasopressin to maintain an adequate blood pressure. Controlling blood sugar levels is also recommended, with the use of corticosteroids and blood products being more of a gray area, as opinions differ among experts.
If a patient has an identifiable complicating factor like a blockage in the urinary tract, it should be treated as soon as possible. This treatment can include inserting a catheter to release stored urine or placing a stent to bypass a blockage caused by a stone in the urinary tube, which could cause a severe form of sepsis known as urosepsis.
What else can Urosepsis (Urine Infection) be?
Urosepsis is a condition that covers a range of infections in the urinary and genital areas of the body. These infections can show different symptoms based on where exactly the infection is located and how severe it is. Identifying the specific cause of the infection is crucial in order to treat it effectively. Some of the potential causes are:
- An infection in the urinary tract
- Cystitis, which is an inflammation of the bladder
- Pyelonephritis, a type of kidney infection
- Acute bacterial prostatitis, which is a bacterial infection of the prostate
- A prostatic abscess, which is a pocket of pus in the prostate
- A renal abscess, or a pocket of pus in a kidney
- Urolithiasis, which means having stones in the urinary tract
Possible Complications When Diagnosed with Urosepsis (Urine Infection)
Urosepsis is a condition that can be managed with timely treatment. But, if not treated on time, it could lead to serious health problems like kidney failure, septic shock (a severe infection that leads to dangerously low blood pressure), and even death.
Preventing Urosepsis (Urine Infection)
People who are at a higher risk of getting urinary tract infections should be encouraged to get medical attention quickly if they start experiencing symptoms. These individuals should also understand the importance of following their doctor’s instructions when it comes to taking their prescribed medicine.
