What Is Urosepsis

Did you know that urine infections can become dangerous and spread up to the kidneys and around the whole body? Any infection has a chance of spreading into the bloodstream if left untreated, which can have serious health implications. One such example is urinary tract infections (UTIs). Understanding and recognising the symptoms of a UTI is vital to ensure rapid treatment and prevent serious complications, including urosepsis. 

Introduction 

Urinary tract infections (UTIs) are very common infections that occur within the urinary tract, usually as a result of bacteria in the genital area that enter through the urethra. There are a range of reasons that this may happen. Early diagnosis of a UTI allows for more rapid treatment, usually with antibiotics, which can prevent the spread of the infection and prevent a life-threatening illness known as urosepsis. 

Urosepsis is defined as a life-threatening response to an infection, in this case, a UTI. If urosepsis were to be left untreated, the body may start to shut down (multi-organ failure) and can even result in death. Therefore, early diagnosis and treatment are vital to ensure human health. 

Sepsis occurs when an infection is present within the body; the immune system is triggered and responds by releasing various chemicals to fight an infection. However, the body responds incorrectly to an infection occasionally, and the immune system is triggered against the body itself. 

Causes and risk factors 

Relationship with urinary tract infections (UTIs) 

When bacteria enter through the urethra, the tube that carries urine from the bladder outside your body, they can cause a UTI; if left untreated, these bacteria can continue to spread through the urinary tract until they reach the upper urinary tract, the bladder and the kidneys. As the infection progresses, the immune system is being triggered more and more, which may eventually result in urosepsis. 

Key factors leading to urosepsis

There are a number of risk factors for urosepsis as a result of anything that increases the level of bacteria within the urinary tract. 

1. Having a recent UTI or a history of chronic UTIs 
2. Having a catheter in place
3. Having diabetes 
4. Having a weakened immune system, e.g. in chemotherapy, AIDS 
5. Having a condition which causes an inability to empty the bladder fully

Clinical presentation

Recognising symptoms and signs

Urosepsis may be suspected in someone who has a history of UTI symptoms. Common symptoms include needing to pass urine more frequently, pain on passing urine, feeling the need to pass urine urgently, smelly or cloudy urine, lower abdominal pain, nausea or vomiting, and fevers. 

When a UTI progresses to urosepsis, there are various signs and symptoms to look out for [2]

• Low blood pressure 
• High respiratory rate 
• High heart rate 
• Difficulty breathing 
• Low energy / feeling weak
• Reduced urine output 
• Shaking / chills 
• Fevers 
• Rash

Diagnosis

Rapid diagnosis is vital for anyone with an infection as they risk developing sepsis. Given there is no definite criteria to diagnose sepsis, diagnosis is based on a range of examination findings and laboratory and imaging tests.³

Laboratory tests 

Initial investigations, particularly in a person with UTI symptoms, should include urinalysis and urine culture, which allows clinicians to determine whether there are bacteria within the urine which may be causing an infection. 

Blood tests should be carried out if a person requires hospitalisation to determine the patient's full blood count, which, again, is a good indicator of the presence of infection. A comprehensive metabolic panel and a blood lactate level can help to determine the presence of end-organ dysfunction. Undertaking blood cultures, which determine the presence of bacteria within the blood, is also incredibly useful in determining the cause of urosepsis.³ 

Imaging techniques 

Ultrasound may be useful in determining a specific cause of urosepsis; for example, an ultrasound scan of the abdomen may reveal hydronephrosis, an enlargement of the kidney. CT may be a better choice as it can reveal more information than an ultrasound scan.³

Treatment and management

Immediate interventions

When dealing with someone with urosepsis, immediate life-saving interventions need to take place. This includes giving supplemental oxygen if oxygen saturation is low, fluid replacement, and vasopressor drugs to increase arterial pressure and potential transfer to ITU.² 

Antibiotics and surgical approaches

Antibiotics should be started as soon as possible in order to target the infection. Longer waiting times are associated with becoming more unwell. Antibiotics should generally be given after blood and urine cultures have been taken; however, they should not be delayed whilst waiting for the results of these.³ Generally broad-spectrum antibiotics are used given they cover a wider range of bacteria that may be causing the disease, these may then be changed once culture results become available. 

Complications and long-term effects 

Organ dysfunction

Given urosepsis causes the immune system to attack the body, various organ systems can be implicated as a result. Examples of this include:³

1. Lungs - commonly cause respiratory distress
2. Kidneys - many patients suffer from acute kidney injury 
3. Coagulation system - higher risk of major bleeding
4. Liver - blockages to the liver flow 
5. Central nervous system - higher risk of encephalopathy and death 

Despite patients being treated for sepsis to reduce the effects of organ dysfunction, some patients may be left with long-lasting effects.

Post-sepsis syndrome

Survival following urosepsis, or sepsis in general, can result in a number of people who suffer from post-sepsis syndrome. This describes the long-term after-effects of urosepsis, which include a variety of effects.⁵ These include: 

• Immune system dysfunction 
• Cognitive deficit and mental health decline 
• Cardiovascular dysfunction and kidney disease 

These long-lasting effects that some people have following urosepsis increase morbidity and mortality and increase the likelihood of increased hospital admissions.⁵

Prevention

Preventing UTIs 

Preventing UTIs is the first vital step in preventing urosepsis. Prevention can be ensured by doing the following:⁶

• Ensuring you urinate after any sexual activity ensures you get rid of any bacteria which may have been introduced into the urinary tract 
• Drink plenty of water and ensure adequate hydration to ensure adequate urination 
• Take showers rather than baths as these reduce bacterial build-up 
• Avoid using strong soaps, sprays or products in the genital area 
• Wipe front to back when wiping after urinating if you have a vagina to avoid introducing bacteria from the back passage into the urethra. 

Antibiotic prophylaxis

Some people may have recurrent UTIs, which may be treated with an antibiotic to use as a preventative measure.⁷ These are only to be used when other measures have failed in order to reduce the amount of UTIs. The first choice of antibiotic used is usually trimethoprim. 

Conclusion 

In conclusion, urosepsis describes the life-threatening response to an untreated or inadequately treated urine infection. Recognising symptoms and signs in a timely manner is vital to reduce mortality. Some people who have been treated for urosepsis will have long-lasting effects such as organ dysfunction and post-sepsis syndrome, which can reduce quality of life. Preventing UTIs is the most vital step in preventing urosepsis, which can be achieved through a range of lifestyle measures. Finally, early treatment of UTI further helps to prevent the life-threatening effects of urosepsis.