Urosepsis - Causes, Symptoms, Diagnosis, and Treatment

Abstract:

Urosepsis occurs when urinary tract infections are left untreated for a long time. It is a life-threatening condition. Read the article to learn more.

What Is Urosepsis?

The human body consists of an immune system that works to fight infections and eliminate bacteria. When a person experiences an infection, the immune system of the body responds by releasing proteins and chemicals that help to fight the infection. However, when this response goes out of control, it results in a life-threatening condition known as sepsis. It usually happens when the infection is already present in the body. Sepsis can affect various organs of the body leading to their failure and, finally, death. As the name suggests, urosepsis is a type of sepsis that originates from the urinary tract. It is one of the most serious complications of a urinary tract infection, pyelonephritis (kidney infection), and cystitis (bladder infection). Sepsis is dangerous because it damages the healthy tissues of the body. It is important to treat urinary tract infections to get rid of urosepsis.

What Is a Urinary Tract Infection?

Urinary tract infection is a term used to describe the bacterial infection that can occur in any urinary tract organ. In the case of infection, these bacteria enter the urethra and reach up to the urinary bladder, ureters, and kidneys. The common causes of urinary tract infections in men are prostate gland enlargement, uncircumcised penis, and diabetes. As a result, the situation worsens and can cause permanent damage to the kidneys.

What Are the Causes of Urosepsis?

The most common cause of urosepsis is untreated urinary tract infection. So, it is important to understand the causes of urinary tract infections to know about urosepsis. The main cause of urosepsis and urinary tract infection is listed below:

• Bacterial Entry - The bacteria that cause urinary tract infections include Klebsiella pneumoniae, Proteus mirabilis, and Candida albicans. The mechanism by which these bacteria cause urosepsis has been described below:

  • The bacteria enter the urinary system through the urethra and initiate the disease process.

  • The body's immune system gets activated when the bacterial proteins interact with the body cells.

  • The production of neutrophils (the cells that fight bacteria) increases, resulting in inflammation.

  • When the body's inflammatory response goes out of control, the neutrophils fail to function, and the surrounding healthy cells get damaged, resulting in sepsis.

What Are the Risk Factors of Urosepsis?

Urosepsis is a severe condition that affects people of any age group. The risk factors of urosepsis have been described below:

1. Diabetes - Diabetics are at a higher risk of suffering from urinary tract infections compared to non-diabetics.

2. Children - Urinary tract infections are common in children because they have the habit of holding urine for a long time. If the urine remains in the body, it becomes a potential source of bacterial infection. Young children are unable to express their symptoms, so the condition goes unnoticed. As a result, the risk of urosepsis increases.

3. Old Age - There are common reasons for urinary tract infections in old age, including kidney stones, tumors, narrowing of the ureters, and walking difficulties. The urine does not flow through the body and becomes a potential source of bacterial infection.

4. Women - In women, the urethra is located close to the anus (the organ that allows the passage of stools), so the bacteria can quickly enter the urinary bladder through stools and cause infection.

5. Immunocompromised Disorders - People who are suffering from immunocompromised disorders like acquired immunodeficiency syndrome (AIDS) are at a higher risk of developing infections. It is because the immune system has failed to function in such people.

What Are the Symptoms of Urosepsis?

First, the patient experiences the symptoms of urinary tract infections and then urosepsis. The symptoms of urinary tract infections are listed below:

• Pain and burning sensation while urinating are the most commonly observed symptoms.

• Urinary incontinence or leakage of urine.

• Hematuria, or the presence of blood in the urine, is one of the most common findings.

If the infection has spread to the other organs, including the kidneys, the following symptoms are usually seen:

• The patient experiences sharp shooting pain in the lower back along with the abdominal region.

• The urine appears cloudy and smells bad.

• Vomiting and diarrhea are commonly seen.

• The infection is usually accompanied by fever.

• Pain in the area between the 12th rib and the spine (costovertebral angle).

If the infection has spread beyond the kidneys, that is, in the bloodstream, sepsis is confirmed. The patient experiences the following symptoms:

• The breathing rate goes above 22 breaths per minute. As a result, the patient experiences abnormal and rapid breathing.

• The systolic blood pressure is less than 100 millimeters of mercury (mm Hg) which is dangerous. Low blood pressure increases the risk of septic shock.

• The white blood cells are abnormally high or low in numbers.

• The patient is anxious all the time due to irregular heartbeat and breathing rates.

What Methods Are Used to Diagnose Urosepsis?

The diagnosis of urosepsis is based on the medical history, physical exam, laboratory, and imaging tests. The methods used to diagnose urosepsis have been described below:

1. Physical Examination - The doctor checks for the physical signs of urosepsis, like abdominal pain and costovertebral angle tenderness. The vitals like temperature, blood pressure, respiratory rate, and heart rate are also checked to see if the infection has spread beyond the urinary tract.

2. Laboratory Tests - The following laboratory tests are usually advised by the clinician to diagnose urinary tract infections and other urologic conditions:

   • Urinalysis - In this test, the patient collects urine in a container. The urine sample is finally sent to the laboratory for examination. The urine is examined visually and microscopically to detect blood, bacteria, crystals, and white blood cells. The presence of bacteria, pus, and white blood cells in the urine sample is usually indicative of infection.

   • Urine Culture - The urine sample is sent to the laboratory for examination under a microscope by the laboratory technician. Finally, the urine sample is left unattended for a few days to allow the bacteria to grow. This test helps to identify the exact bacterial strain that caused an infection. In the case of urosepsis, the bacteria multiply rapidly.

   • Complete Blood Count (CBC) - This is the most commonly prescribed test for urosepsis. The doctor recommends the patient undergo a complete blood count test to check the number of white blood cells and the general health of the kidneys. The white blood cell count is either too high or low in urosepsis.

3. Imaging Tests - The below-mentioned imaging tests are usually recommended to diagnose problems of the urinary tract:

   • Ultrasound - It is a diagnostic and imaging technique in which images of the urinary system are obtained, including the bladder. In this procedure, sound waves enter the body with the help of a transducer. The doctor can view the images obtained on the monitor. These images help to check the conditions affecting the kidneys, like hydronephrosis (swelling of the kidneys), stones, and tumors.

   • Computerized Tomography (CT) Scans - In this procedure, the patient is laid on a padded table that slides into a device wherein the X-rays are taken. This procedure effectively provides three-dimensional images of the internal organs so the problems of the urinary system can be easily detected. It is the method of choice if urosepsis is suspected.

How to Manage Urosepsis?

Urosepsis needs to be treated at the earliest to prevent further damage to the kidneys. The methods used to treat urosepsis are listed below:

• Early Goal-Directed Therapy (EGDT) - This therapy aims to reduce the death rate due to sepsis. The treatment guidelines followed under early goal-directed therapy (EGDT) are listed below:

  • The antibiotics are administered rapidly to eliminate the suspected source of infection.

  • Supportive care is provided to stabilize the lungs and allow the blood to flow normally.

  • Additional therapies to support the person.

• Antibiotics - The antibiotics are administered an hour after urosepsis has been confirmed by the blood and urine cultures. The aim is to save the life of the person. The survival rate decreases by eight percent each hour if the antibiotics are delayed after the first six hours. The following antibiotics are usually given:

  • Piperacillin with Tazobactam (Beta-lactamase inhibitor combination).

  • Third-generation Cephalosporin, mainly Cefixime.

  • Fluoroquinolones like Ciprofloxacin and Levofloxacin.

• Fluid Resuscitation Therapy - The doctor might also inject fluids into the body through the veins at the rate of 30 milliliters per kilogram. Low blood pressure is one of the most common symptoms of urosepsis. A vasopressor, mainly norepinephrine, is administered to control blood pressure.

• Surgery - Surgical intervention is required when urinary tract obstruction, stones, and tumors are the causes of urosepsis. If the patient is unable to pass urine, a tube known as a catheter is inserted into the urethra to drain the urine. Another tube known as a ureteral stent is inserted if the ureters are narrow and obstruct the flow of urine. If the kidney stones block the urine flow, they are broken into fragments with the help of lasers and removed.

What Are the Complications of Urosepsis?

Urosepsis can result in the following complications if left untreated for long:

1. If the urinary tract infection is left untreated, scarring of the kidneys occurs, which can cause permanent damage to the kidneys.

2. The kidneys get damaged due to urine retention, and the waste products and toxins accumulate in the body resulting in a rise in blood pressure or hypertension.

3. If the infection spreads to the bloodstream, other organs receive the infected blood and fail to function.

4. The patient might go into a state of shock (septic shock) as the blood pressure reduces drastically. Septic shock becomes a life-threatening condition if left untreated for a long time.

Conclusion:

Urosepsis is one of the major complications of urinary tract infections. It is commonly seen in women, diabetics, and immunocompromised individuals. It occurs because of the uncontrolled immune response of the body and untreated urinary tract infection. Urosepsis affects not only the organs of the urinary tract but also the other body organs. The condition becomes severe when the patient goes into septic shock due to a fall in blood pressure. The condition is not incurable but depends on how early it is diagnosed. Fever, fast and abnormal breathing, low blood pressure, and irregular heartbeat are some of the symptoms of urosepsis. The patient must consult the doctor immediately if these symptoms are noted. Early goal-directed therapy (EGDT) and fluid resuscitation therapy help to save the person from urosepsis.