Introduction:
Community-acquired urosepsis is a severe, potentially life-threatening infection originating from the urinary tract and will spread to the bloodstream. It is a type of sepsis caused by infection. It occurs when the bacteria, commonly Escherichia coli (E.coli) from UTI or urinary tract infection, enter the bloodstream, which results in infection and organ dysfunction. It occurs due to medical conditions like urinary tract abnormalities, obstruction, urinary catheterization, or compromised immune system. If the infection is not treated properly, then it will spread to the other organs, including the kidneys, and can progress into urosepsis.
What Are the Causes and Risk Factors of Community-Acquired Urosepsis?
Some of the common causes of community-acquired urosepsis include the following:
-
Urinary Tract Infection (UTI) - Urinary tract infection is one of the common causes of this urosepsis. Escherichia coli is the primary bacteria that cause urinary tract infections. When the treatment for urinary tract infection is not done effectively, the bacteria can spread to the kidney, resulting in urosepsis.
-
Urinary Tract Obstruction - A condition in which there is an obstruction in the urine flow in the urinary tract is called urinary tract obstruction. It can increase the risk of causing urosepsis. Some of the examples that cause urinary tract obstruction include urinary tract abnormalities, enlarged prostate in men, kidney stones, and tumors. This obstruction will create a stagnant environment in which there is a proliferation of bacteria which can result in infection.
-
Catheterization - Urinary catheters can increase the risk of developing infections in the urinary tract, and they can progress into urosepsis. Catheters act as a direct pathway for the bacteria, which help in entering the urinary tract and also the bloodstream.
-
Weak Immune System - People with weak immune systems have a higher risk of developing infections like urinary tract infections and urosepsis. Some of the conditions that can weaken the immune system include autoimmune disorders, human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS), and some medications like immunosuppressants.
-
Age - As age increases, the chance of developing urosepsis also increases. Elderly patients can develop infections and urosepsis abnormalities.
-
Gender - Females are more prevalent to develop urosepsis compared to males.
-
Recent Urinary Procedure - Recent urinary procedures involving the urinary tract, like urological intervention or urinary tract surgeries, can introduce bacteria, which will increase the chance of developing urosepsis.
What Are the Signs and Symptoms of Community-Acquired Urosepsis?
Some of the commonly seen signs and symptoms of community-acquired urosepsis include the following:
-
High Fever - It can result in a high fever, typically about 38 degree Celsius or 100.4 degrees Fahrenheit. The fever will persist even after the use of antipyretic medications.
-
Shivering and Chills - There can be intense and uncontrollable shivering and chills due to the response of the body to the infection.
-
Rapid Heartbeat - Abnormally fast heart rate or tachycardia is a commonly seen symptom associated with urosepsis. This is done to compensate for the systemic infection.
-
Low Blood Pressure - There will be low blood pressure or hypertension which can cause lightheadedness, dizziness, and in severe cases, even shock.
-
Altered Mental Status - When the infection spreads to different organs, there will be altered mental status, like disorientation, confusion, or a change in the mental state. There can also be symptoms like confusion, delirium, and even loss of consciousness.
-
Rapid Breathing - Rapid breathing or tachypnea can be seen in urosepsis in order to meet the oxygen demand of the body.
-
Decreased Urine Output - It can impair the function of the kidney, which will result in reduced urine production. So there will be less frequency of urination and reduced volume of urine.
-
Gastrointestinal Symptoms - Gastrointestinal symptoms like diarrhea, vomiting, and nausea can be caused because of systemic infection and due to the inflammatory response of the body.
-
Discomfort or Pain - Patients can experience discomfort in the pelvis or lower abdomen and pain in the abdominal region. It can be diffused or localized.
-
Signs of Organ Dysfunction - With the progression of the urosepsis, most of the organs will be affected, which leads to organ dysfunction. It can result in jaundice or yellowing of the sclera and the skin because of the involvement of the liver. If there is involvement in the lungs, then it can result in reduced oxygen levels and difficulty in breathing. It can also result in altered kidney function, which results in high creatinine levels.
How Is Community-Acquired Urosepsis Diagnosed?
Community occurred urosepsis is diagnosed by the following methods:
-
Evaluation of the medical history for knowing the symptoms of the patients, like abdominal pain, fever, or any recent urinary tract infection.
-
Physical examination to assess vital signs like blood pressure, heart rate, temperature, and respiratory rate will be taken.
-
Laboratory tests like blood cultures, complete blood count (CBC), urine analysis, and blood gas analysis will be performed.
-
Imaging studies like renal ultrasonography and computer tomography (CT) scan will be done to get detailed imaging of the urinary tract.
How Is Community-Acquired Urosepsis Treated?
The community-acquired urosepsis is treated by the following method:
-
Intravenous antibiotic therapy is the main treatment for urosepsis. Broad-spectrum antibiotics are administered to cover potential pathogens like Escherichia coli. After the identification of the causative bacteria, a targeted antibiotic regime will be started. The duration will range from seven to 14 days, but it can vary depending on the patient's response to the treatment.
-
Supportive care like oxygen therapy, nutritional support, hemodynamic support and fluid resuscitation will be given.
-
Identifying the etiology and taking an appropriate intervention helps in reducing the infection.
-
After the treatment process, the vital signs will be monitored carefully.
What Are the Preventive Strategies of Community-Acquired Urosepsis?
The preventive strategies for community-acquired urosepsis include the following:
-
Maintaining good hygiene is important in preventing UTIs. Regular hand washing and proper perineal hygiene are needed.
-
Adequate hydration helps in flushing out the bacteria present in the urinary tract and will decrease the risk of urinary tract infection.
-
Prompt or immediate treatment of the urinary tract infection helps in preventing the infection of urosepsis.
-
Management of the underlying conditions.
Conclusion:
In conclusion, community-acquired urosepsis is a potentially life-threatening infection that is caused when the bacteria from the urinary tract infection enter the bloodstream leading to sepsis. Immediate diagnosis and treatment are important for improving the outcome. Maintaining urinary tract health, practicing good hygiene, and immediately treating urinary tract infections and abnormalities are important in preventing community-acquired urosepsis.
