Urosepsis

Urosepsis is a serious medical condition that can quickly become life-threatening. Understanding urosepsis is crucial for recognising its signs early and promptly receiving proper care. Let's explore the key aspects of urosepsis, including its causes and risk factors, symptoms, and effective treatments. We'll also discuss how doctors diagnose urosepsis, potential complications, and ways to prevent this dangerous condition. 

What is Urosepsis?

Urosepsis is a serious systemic condition that happens when a urinary tract infection (UTI) invades the bloodstream, causing sepsis. Sepsis is the body's life-threatening response to infection. It can bring tissue damage, organ failure & even death if not treated promptly.

In urosepsis, the infection typically starts in the lower urinary tract (bladder or urethra) and then progresses to the kidneys. This progression is known as pyelonephritis. The bacteria and their components from the urogenital tract trigger an inflammatory response in the patient's body, acting as exogenous pyrogens on eukaryotic target cells.

Causes and Risk Factors of Urosepsis

The primary cause of urosepsis is bacteria entering the urinary tract. This can occur through various means, including: 

• Sexual activity
• Poor hygiene
• Urinary catheters (both indwelling and external catheters)

Several factors increase the risk of developing urosepsis:

• Age: Adults over 65 are more vulnerable.
• Gender: Women are more prone to urosepsis due to their shorter urethras.
• Chronic Conditions: Diabetes, kidney disease, and bladder conditions raise the risk.
• Weakened Immune System: HIV/AIDS, chemotherapy, or organ transplant recipients are more susceptible.
• Recent Hospitalisation or Surgery: These can expose individuals to hospital-acquired infections.
• History of UTIs: Frequent or chronic UTIs increase the likelihood of urosepsis.
• Urinary Retention: The inability to fully evacuate the bladder can lead to bacterial growth.

Symptoms of Urosepsis

Urosepsis symptoms can vary based on the severity of the infection and how far it has spread. Initially, individuals with urosepsis often experience symptoms of a urinary tract infection (UTI). These may include: 

• A sudden and intense need to urinate more frequently
• Pain or burning sensation while urinating
• Cloudy or bloody urine
• Pressure in their lower abdomen

As the infection progresses and urosepsis develops, more severe symptoms appear. These can include:

• High fever 
• A dangerously low body temperature
• Extreme fatigue, nausea, and vomiting
• Pain near the kidneys, located on the lower sides of the back
• Trouble breathing or breathing rapidly, taking more than 22 breaths per minute. 
• Changes in heart rate (palpitations or a rapid heartbeat)
• Weak pulse
• Brain fog or unusual anxiety levels
• Less or no urine 

Complications

Urosepsis can lead to severe complications if not treated promptly and effectively. These may include:

• Organ Damage or Failure: The infection can affect vital organs like the heart, liver & kidneys, leading to reduced organ function. 
• Septic Shock: This condition occurs when blood pressure drops dangerously low, affecting blood flow to vital organs.
• Pus: Collections of pus near the kidneys or prostate
• Scar Tissue: The creation of scar tissue in the urinary tract

Diagnosis of Urosepsis

• Physical Evaluation: The initial evaluation includes a thorough physical examination, paying attention to symptoms like flank pain, dysuria, and urinary retention. Doctors also check for signs of systemic inflammatory response syndrome (SIRS), such as abnormal body temperature, rapid heart rate, and increased respiratory rate.
• Laboratory Tests:  
  • A urinalysis and urine culture 
  • Blood analyses, including a complete blood count (CBC), comprehensive metabolic panel, and blood cultures, help assess organ function and identify the causative bacteria.
  • Procalcitonin (PCT) measurement for diagnosing severe sepsis. 
• Imaging studies: 
  • Ultrasonography is the first-choice imaging
  • Computed tomography (CT) scans can identify findings that are not easily visualised with ultrasound.

Treatment for Urosepsis

Treating urosepsis requires prompt and aggressive intervention to prevent life-threatening complications. Treatment includes:

• Antibiotics: intravenous administration typically within one hour of diagnosis. 
• Intravenous Fluids: IV fluids, often containing minerals like sodium, help maintain blood pressure and support organ function. 
• Vasopressors: In cases where fluids alone are insufficient to stabilise blood pressure, vasopressors such as norepinephrine may be administered.
• Source Control: This involves addressing any underlying issues in the urinary tract that may be causing or exacerbating the infection. For instance, a stent may be inserted to relieve the obstruction if a ureteral stone is present.
• Additional Supportive Measures: These can include supplemental oxygen or, in extreme situations, mechanical ventilation to assist breathing. 
• Corticosteroids: Some patients might also receive corticosteroids if their blood pressure remains unstable despite other interventions.

When to See a Doctor

Contact your doctor promptly:

• If you suspect you have a UTI
• If you experience a very high temperature, feel hot and shivery, or have a low temperature below 36°C.
• If you feel confusion, drowsiness, pain in the lower abdomen or back just under the ribs, and visible blood in your urine.
• If there is difficulty breathing, a rapid heart rate or palpitations, a weak pulse, fever and chills, or an inability to urinate. 

Prevention

Preventing urosepsis starts with avoiding urinary tract infections (UTIs). This includes:

• Staying Hydrated: Drinking plenty of fluids keeps bladder tissue healthy and dilutes urine, lowering the concentration of bacteria in the bladder. 
• Proper Bathroom Habits: It's important to empty your bladder regularly, ideally four to eight times daily, to prevent bacteria from thriving in stagnant urine. After using the toilet, always wipe from front to back. This simple activity can avoid spreading bacteria from the anal region to the urethra.
• Maintaining Good Hygiene is Essential: Wash or shower daily, keeping the genital area clean and dry. Frequent changing is necessary for individuals using incontinence pads to prevent bacterial growth.
• Sexual Activity: To minimise this risk, urinate soon after sexual intercourse to flush out any bacterial pathogens that may have entered the urethra. It's also advisable to wash the genital area before and after sexual intercourse.
• Dietary Changes: Vegetarian diets have been linked to a lower risk of developing UTIs, particularly in women. 

Conclusion

Looking after your urinary health is key to avoiding urosepsis. Simple steps like drinking plenty of water, practising good hygiene, and seeing a doctor when you notice UTI symptoms can make a big difference. By taking these precautions and being aware of the potential risks, you can protect yourself and your loved ones from this potentially dangerous condition.

FAQs

1. How common is urosepsis?

Urosepsis is a significant health concern, accounting for 9–31% of all sepsis cases. As the person ages, the incidence of urosepsis is likely to rise. It's estimated that nearly 25% of sepsis cases originate from the urogenital tract. While urosepsis can affect anyone, it's more common in men than in women.

2. How does a UTI turn into urosepsis?

Urinary tract infections (UTIs) can turn into urosepsis if left untreated or inadequately treated. The infection typically starts in the lower urinary tract and spreads to the kidneys. From there, infection can enter the bloodstream, causing a systemic response. 

3. What are the three stages of urosepsis?

Urosepsis typically progresses through three stages:

• Systemic Inflammatory Response Syndrome (SIRS): This initial stage is characterised by high or low body temperature, rapid heart rate, and increased respiratory rate.
• Severe Sepsis: This stage involves organ dysfunction, such as decreased urine output, sudden changes in mental state, or difficulty breathing.
• Septic Shock: The most severe stage, marked by a significant drop in blood pressure despite fluid resuscitation, leading to organ failure.

4. Is urosepsis curable?

Urosepsis is treatable, but early diagnosis and prompt treatment are crucial. With appropriate care, many patients recover. 

5. Can urosepsis be treated at home?

Urosepsis requires immediate hospital care and cannot be treated at home. It's a medical emergency that needs intravenous antibiotics, fluid resuscitation, and close monitoring. 

6. How long is the treatment for urosepsis?

The duration of treatment for urosepsis typically ranges from 10 to 14 days. However, in cases where patients show a delayed response to treatment, this period may be extended to 21 days. 

7. Is urosepsis painful?

Urosepsis can cause significant discomfort. Individuals often experience pain in the lower abdomen or flank area. Other symptoms include fever, chills, and general body aches. The severity of pain can vary and depends on the extent of the infection and individual factors.

8. Can urosepsis cause kidney damage?

Yes, urosepsis can lead to kidney damage. As the infection spreads to the kidneys, it can cause inflammation and tissue damage. In severe cases, this can result in acute kidney injury or even long-term kidney dysfunction.

Dr. Vipin Sharma

M.S. (General Surgery), MCh Urology, DrNB Urology, Fellowship in Reconstructive Urology
CARE CHL Hospitals, Indore

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