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Urosepsis – Treatment, Pathophysiology, Symptoms, Causes, Diagnosis

What is Urosepsis?

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Urosepsis is an infection of the blood stream as a result of a urinary tract infection complication. Untreated urinary tract infections (UTI) may cause bacteria and other pathogens to enter the blood stream.

Urosepsis is more common in the elderly due to the reduced immune system and the occurrence of metabolic conditions such as diabetes. Women are also more at risk of developing it due to a higher incidence of UTI as a result of a short and wide urethra. Patients with urinary tract obstruction may also have severe urinary tract infections which lead to urosepsis.

urosepsis pathophysiology

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Signs and Symptoms

Urosepsis results in various signs and symptoms which involve the urinary system as well as the systemic affectation such as the following:

  • Frequent urination – Urinary frequency is observed during the acute phase of urinary tract infection. Frequency results from the irritation of the urethra, leading to a frequent urge to urinate.
  • Dysuria or painful urination – The irritation and inflammation of the urethra causes pain whenever urine is passed. Burning sensation may also be felt.
  • Hematuria or blood in the urine – The inflammation may cause urinary bleeding. The presence of blood in the urine means that the infection has ascended to the upper urinary tract.
  • Flank pain – Pain may be felt in the lower back or the flank area due to underlying inflammation of the kidneys, distending the space that radiates to the back.
  • Fever – Fever is a classic sign of infection that may be experienced after the onset of UTI. Persistent high fever occurs when the infection has spread to the blood stream.
  • Oliguria or decreased output or urine – The kidneys become unable to efficiently form urine due to inflammation and infection. More severe kidney affectation may lead to anuria or absence of urination.
  • Chills – Chills along with very high fever are also experienced. Chills are a sign of systemic infection.
  • Tachycardia or increased heart rate – Tachycardia is experienced by patients with urosepsis due to affectation of the organ. Furthermore, any infection increases the metabolic rate, thereby increasing the heart rate. Sepsis also causes the pulse to become weak or thready.
  • Increased respiratory rate – Breathing is affected when severe infection occurs and leads to septic shock.
  • Hypotension – A severe decrease in the blood pressure signifies septic shock which may lead to cardiovascular collapse.
  • Hypothermia – When septic shock occurs, very high fever is usually followed by hypothermia due to severe dilation of the blood vessels, which allows heat to escape from the body.
  • Change in mental status – Reduced perfusion to the brain as well as spread of infection to the blood stream lead to changes in mentation. Patients may become lethargic and develop coma when treatments are not instituted immediately.

Pathophysiology of Urosepsis

UTI is an infection that occurs anywhere in the urinary tract. This condition usually causes difficult or painful urination accompanied with burning sensations in the urethra. The infection can ascend to the upper urinary tract, such as in the bladder, ureters, and kidneys.

Once the infection reaches the kidneys, the bacteria cause damage to the nephrons, leading to pyelonephritis characterized by pain in the flank or lower back.

Further progression of the infection causes the bacteria to spread into the systemic circulation. Once it reaches the blood, it can cause systemic infection. The heart may also be affected and may lead to poor cardiac pumping.

The brain is further affected when a decreased blood supply goes to the organ. The affectation of the brain leads to changes in the mental status.

Causes of Urosepsis

The cause of urosepsis is a bacterial infection of the urinary tract or prostate that spreads to the blood. Specific causes include the following:

  • Use of indwelling catheters – Prolonged use of indwelling catheters may cause microorganisms to enter the urinary tract through the drainage bag. Improper emptying of the bag may cause microorganisms to enter and ascend to the catheter and inside the urinary tract. Methycillin-resistant Staphylococcus aureus (MRSA) as well as Pseudomonas aeroginosa are hospital-acquired infections as a result of poor, prolonged  use of indwelling catheters.
  • Benign prostatic hyperplasia – Benign prostatic hyperplasia (BPH) is the enlargement of the prostate, which impedes urinary flow. When urine accumulates in the bladder, it may cause proliferation of microorganisms.
  • Presence of kidney stones – Kidney stones also promote growth of bacteria in the urinary tract due to urine accumulation.
  • Urinary tract infections caused by E. coli – E. coli is a natural flora of the intestines. However, when it spreads to the adjacent urinary meatus, it may cause infection. People with poor perineal hygiene may acquire this.
  • Sexually transmitted diseases – Chlamydia may also cause urosepsis when the bacteria spread to the urethra, subsequently entering the blood stream.

Certain people also have a higher risk of developing urinary tract infections which will lead to urosepsis. Risk factors for urosepsis include the following:

  • Diabetes mellitus
  • Immunocompromised states
  • Advanced age
  • Female gender
  • Fecal incontinence
  • Immobility
  • Pregnancy
  • Incomplete bladder emptying

Diagnosis of Urosepsis

Diagnosis starts with a urinalysis to assess the presence of bacteria in the urinary tract. A blood test may then be done to determine the presence of bacterial proliferation when signs of sepsis occur. Blood cultures are also done to determine the exact microorganism that causes the disease.

Treatment of Urosepsis

Treatment of urosepsis involves eradicating the causative microorganism as well as reducing the symptoms. These include:

Antibiotic therapy

Antibiotic therapy is very essential in the treatment of urosepsis. Antibiotics are given via the intravenous route in order to speed up recovery. The treatment may be continued by using oral antibiotic,s and patients should be instructed to finish the whole course of therapy to prevent re-infection and drug tolerance. The specific antibiotic depends on the type of microorganism that causes the infection.

Intravenous fluids

IV fluids are administered to maintain the integrity of the vascular system and to reverse hypotension.

Oxygen therapy

For patients with respiratory compromise, oxygen therapy is given to prevent hypoxia,  especially of the brain.

Cardiotonic and vasopressor drugs

Drugs such as dopamine increase the blood pressure to normal levels. The health care provider usually does drug titration in order to achieve a desired blood pressure level.

Complications of Urosepsis

Complications of urosepsis involve the following:

  • Septic shock
  • Disseminated intravascular coagulation
  • Renal, perirenal, or prostatic abscesses
  • Kidney failure or damage
  • Scarring
  • Shock may cause the death of the patient due to cardiovascular collapse.

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