Urosepsis: Symptoms, treatment, and complications

Urosepsis is a type of sepsis that is caused by an infection in the urinary tract. It is a complication that is often caused by urinary tract infections (UTIs) that have not been treated promptly or adequately.

Urosepsis is a serious complication that requires immediate medical care to prevent it from becoming potentially life-threatening. Anyone experiencing symptoms should seek emergency medical attention.

Symptoms

As urosepsis is a complication of a UTI, the majority of people with urosepsis will have symptoms of a UTI already.

The most common form of UTI is a bladder infection, with symptoms including the following:

• frequent urges to urinate
• a burning or itching sensation while urinating
• feeling that the bladder is full, even after urinating
• cloudy urine
• blood in the urine
• foul-smelling urine
• pain during sex
• pressure in the lower back or lower abdomen
• malaise, or a feeling of being generally unwell

In some cases, the infection can spread beyond the bladder, potentially reaching the kidneys and ureters. Urosepsis is a possible complication when the infection reaches these areas.

Alongside the UTI symptoms listed above, urosepsis may cause some more serious symptoms, which are common to other forms of sepsis. Anyone experiencing these symptoms should seek immediate medical care.

Symptoms of urosepsis include:

• pain near the kidneys, on the lower sides of the back
• nausea with or without vomiting
• extreme fatigue
• reduced urine volume or no urine
• trouble breathing or rapid breathing
• confusion or brain fog
• unusual anxiety levels
• changes in heart rate, such as palpitations or a rapid heartbeat
• weak pulse
• high fever or low body temperature
• profuse sweating

In serious cases, if left untreated, urosepsis may progress to severe sepsis, septic shock, or multi-organ failure.

If a person has severe sepsis, they produce little to no urine, may have difficulty breathing, and their heart may have difficulty functioning.

During septic shock, blood pressure drops extremely low, and the organs may begin to shut down. These symptoms are life-threatening and require immediate medical care.

Causes

UTIs can occur from bacteria entering through the urethra. The bacteria may reach the urethra in a variety of ways, such as sexual contact, poor personal hygiene, or pre-existing bladder conditions. Sometimes UTIs will develop due to existing bacteria in the bladder multiplying to an unhealthy level. Women are more prone to UTIs than men due to their urethra being shorter.

The bacteria can then spread from the urethra to the bladder, where they then multiply and cause the infection. If this is left untreated, complications such as urosepsis can occur.

Risk factors

Some groups of people are more at risk of developing urosepsis, such as women and older adults. People with open wounds or devices, such as catheters or breathing tubes, may also be more at risk of getting infections and UTIs, which in turn increases the risk of urosepsis.

Other risk factors for urosepsis include:

• diabetes
• being over 65 years old
• a compromised immune system from autoimmune disorders such as HIV or AIDS
• immunosuppression from certain drugs, organ transplant, or chemotherapy
• corticosteroid treatment
• history of urinary conditions
• catheter use 

Complications

Not everyone treated for urosepsis will have complications, particularly if it is treated effectively and quickly.

Possible complications of urosepsis include:

• collections of pus near the kidneys or prostate
• organ failure
• kidney damage
• scar tissue in the urinary tract
• septic shock

Treating urosepsis early and following the doctor’s treatment plan are crucial steps to avoid complications.

Diagnosis

A doctor may be able to diagnose urosepsis after confirming that the patient has a UTI, which is done through a urine sample. If a UTI has been left untreated or the doctor believes the infection may have spread, blood tests may be ordered to help diagnose urosepsis.

The doctor may also look for another source of infection that could be causing the sepsis – they may use a chest X-ray to examine the lungs, or a blood culture to identify bacteria in the bloodstream. The skin may also be examined for rashes or ulcerations. Other imaging tests may be completed, such as a CT scan or ultrasound.

Treatment

If they are caught in a timely manner, UTIs are easily treated with antibiotics and drinking plenty of fluids.

Urosepsis treatment, however, is not as simple as it may not respond to antibiotics alone. Antibiotics will likely be used to start the treatment in order to treat the initial UTI.

The patient’s response to the antibiotics will be monitored closely. If the patient has severe sepsis or septic shock, oxygen may be required.

Some people will need surgery to remove the source of an untreated infection entirely.

Vasopressors may be prescribed – these constrict the blood vessels and increase blood pressure in order to prevent the organs from shutting down due to septic shock.

Emergency hospitalisation in the intensive care unit may be required if urosepsis is not treated promptly. If it progresses and develops into septic shock, emergency medical care is needed.

Prevention

As urosepsis is often the result of an untreated UTI, it is essential to prevent UTIs wherever possible.

There are a variety of steps a person can take to help prevent UTIs, including:

• wiping from front to back after using the toilet
• washing the hands before and after using the toilet
• wearing cotton underwear
• drinking plenty of water daily
• urinating immediately after sexual activity
• not waiting longer than necessary to urinate

Anyone experiencing symptoms of a UTI should visit their doctor for diagnosis and treatment. Doing this quickly is key to avoiding complications such as urosepsis.

Outlook

Urosepsis is a serious and potentially life-threatening complication of a UTI. Being aware of the signs and symptoms may help people to understand the importance of getting prompt treatment for infections.

Anyone who thinks they have a UTI or other problem with their urinary tract should seek medical care.