Overview of Urosepsis

When Urinary Tract Infections Lead to Sepsis

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Urosepsis is a condition where a urinary tract infection (UTI) leads to a systemic infection that spreads throughout the body through the bloodstream. The severe effect of this systemic infection is referred to as sepsis.

As many as 25% of individuals who develop sepsis are found to have had a UTI as the source of the condition.

Urosepsis is very serious and can quickly become life-threatening. Even with rapid diagnosis and treatment, urosepsis can 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.

Man in hospital gown holding urine sample
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Development of Urosepsis

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 UTIs are considered lower urinary tract infections and affect the bladder (cystitis) and urethra (urethritis). Kidney (pyelonephritis) and ureter infections are less common, and they are typically more severe and can be potentially more harmful than lower UTIs.

Early identification of a UTI, along with proper treatment, is the best way to prevent urosepsis. It is possible to develop urosepsis without first having symptoms of a UTI or seeking treatment.

UTI Symptoms

There are common signs and symptoms of a UTI, and you can experience any combination of them. For example, some people may have a fever, while others can feel normal but may notice a change in the appearance of their urine.

The most common signs and symptoms of a UTI include:

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

Symptoms of urosepsis are similar to the symptoms of sepsis, and can include fevers, rapid heart rate, hypotension (low blood pressure), rapid breathing, and difficulty breathing.

Risk Factors for Urosepsis

Anyone who has a UTI can develop urosepsis, but certain factors can make it more likely.

These factors increase the risk of urosepsis:

  • Having surgery
  • Weakened immune system
  • Having a kidney transplant
  • Chronic illness
  • Recent diagnosis of UTI
  • History of recurrent UTI
  • History of urosepsis
  • Urinary tract disorders
  • Advanced age
  • Diabetes
  • Frequent catheterization
  • Recent catheterization
  • Inability to fully empty the bladder
  • Indwelling (long-term) catheter

Why Urosepsis Is More Common After Surgery

There are multiple reasons why urosepsis is common after surgery. You may have a urinary catheter in place during your surgery, and it may stay in place for hours or days after your procedure.

The placement of the catheter is done using a sterile technique. However, a catheter is a foreign body, which means that it is susceptible to bacterial contamination.

Certain types of surgery increase the risk of infection even further. Surgery that takes place in or near the urinary tract increases the risk of a subsequent UTI or urosepsis. Surgeries such as kidney transplants, prostate surgeries, and bladder surgeries are known to increase the risk of urosepsis.

Treatment

If you develop a UTI or urosepsis while you have a urinary catheter in place, your catheter will likely be removed and replaced with a new one (if you still need one). The catheter that is removed may be sent to the lab to identify the type of infection.

In all cases, antibiotic therapy is necessary to treat urosepsis. Blood culture and sensitivity are sometimes done to determine which antibiotics will be most effective. Most people experience improvement of signs and symptoms within 72 hours of antibiotic therapy.

An ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI)may be needed to identify the source of the infection.

The treatment of urosepsis is largely dependent on the severity of the illness. If you have minor symptoms, you may be effectively treated at home with antibiotics.

However, urosepsis may progress to septic shock. If you have signs of this complication, which can include confusion and organ failure, you may need to be admitted to the Intensive Care Unit, Treatment can include IV antibiotics, management of blood pressure, and assisted ventilation.

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