Urosepsis

What is urosepsis?

Urosepsis is when a urinary tract infection (UTI) leads to sepsis. Sepsis occurs when your body has a life-threatening response to an infection. It’s a medical emergency that requires prompt treatment because it can lead to tissue damage, organ failure or death. Many different conditions can cause sepsis.

The urinary tract consists of your:

• Kidneys: Most people have two kidneys. They filter water and waste products from your blood, which becomes pee (urine).
• Ureters: Your ureters are thin tubes that carry pee from your kidneys to your bladder.
• Bladder: Your bladder is an organ that stores your pee.
• Urethra: Your urethra is a tube that carries pee from your bladder to the outside of your body.

Urosepsis typically happens because a bacterial infection from your lower urinary tract (bladder and urethra) spreads to your kidneys (pyelonephritis). You can also get a UTI from a fungal infection or without ever having symptoms of a UTI, but this is rare.

What is a UTI?

A UTI is an infection in your urinary tract. It most often happens when bacteria from your genital area enter your urethra. This can happen in a number of ways, like wiping yourself from back to front or from sexual activity. You can also get a UTI when bacteria normally found in your urinary tract multiply to an unhealthy level.

A healthcare provider treats UTIs with antibiotics. UTIs that go untreated or don’t fully resolve can spread to your kidneys and cause urosepsis.

UTIs are common and affect about 20% of women and people assigned female at birth (AFAB) at least once in their lives. Men and people assigned male at birth and children can also get UTIs, but they’re less common. Healthcare providers treat up to 10 million people for UTIs each year in the United States.

How common is urosepsis?

Urosepsis is one of the most common causes of sepsis. Up to 30% of all sepsis cases begin in the urinary tract.

What are the symptoms of urosepsis?

Symptoms can vary depending on the severity of the infection. Once an infection progresses to sepsis, you may have the following symptoms:

• Low blood pressure. Systolic blood pressure (the top number) reading of less than 100 mmHg (millimeters of mercury).
• High respiratory rate. Respiratory rate faster than 22 breaths per minute.
• Difficulty breathing.
• Rapid heart rate.

It’s important not to let infections go untreated. If you have symptoms of a UTI, get help from a healthcare provider.

Some signs of infection in your urinary tract include:

• Needing to pee more often, which can come on suddenly and intensely.
• Pain when you pee (dysuria).
• Blood in your pee (hematuria).
• Thick or cloudy pee.
• Pressure in your lower abdomen.
• Fever or chills.
• Nausea or vomiting.

What causes urosepsis?

The most common cause of urosepsis is an untreated or undertreated UTI. This happens when bacteria enter your lower urinary tract and spread through the rest of your urinary system. The bacteria multiply, and your immune system doesn’t fight it off.

A UTI can also develop when bacteria normally found in your urinary tract multiply to an unhealthy level.

How does a UTI turn into urosepsis?

Left untreated, the infection continues to spread through your urethra, bladder and, ultimately, your kidneys. This can lead to sepsis.

Sepsis is your body’s dangerous reaction to an infection. When you have an infection, your immune system works to try to fight it. But sometimes, your immune system stops fighting the infection and starts damaging your normal tissues and organs, leading to widespread inflammation throughout your body.

What are the three stages of urosepsis?

Urosepsis, and all forms of sepsis, can be divided into three stages: sepsis, severe sepsis and septic shock. Septic shock is the last and most dangerous stage of sepsis.

What are the risk factors for urosepsis?

Women and people AFAB and older adults are more at risk for developing urosepsis. Having a urinary catheter can also increase your risk for urosepsis because it can carry bacteria.

The main risk factor for urosepsis is having a UTI. Other risk factors for urosepsis include:

• Having another urinary tract condition or infection like cystitis (bladder infection).
• History of chronic UTIs or recent diagnosis of UTI.
• Having surgery where you needed a catheter.
• Having diabetes.
• Having an immune system disorder like HIV/AIDS.
• Having a weak immune system from chemotherapy, organ transplant or other medical condition.
• Being unable to empty your bladder fully.

What are the complications of urosepsis?

Urosepsis is serious. It’s important to get prompt treatment to avoid complications. These complications include:

• Organ damage.
• Organ failure.
• Septic shock.
• Death.

How is urosepsis diagnosed?

A healthcare provider diagnoses urosepsis after reviewing your health history, evaluating your symptoms and ordering blood tests. Some blood tests could include:

• Complete blood count or CBC: This determines how many white blood cells you have. A higher amount of white blood cells or having monocytes (a type of white blood cell) means you could have an infection.
• C-reactive protein: C-reactive protein in your blood can indicate inflammation.
• Blood culture: A blood culture can tell providers what type of bacteria or fungi is causing the infection. It can take several days to get the result of a blood culture, so healthcare providers can’t wait for these results to treat sepsis if they believe you have it.

Providers will request several additional tests to identify your infection and any organ damage. These tests may include:

• Urine test or urine culture to diagnose a UTI.
• Ultrasound to look at your urinary tract.
• CT scan to look at your kidneys.

How is urosepsis treated?

Antibiotics are the first line of defense for urosepsis and must be given quickly and promptly to get rid of the bacteria causing the infection. Healthcare providers use broad-spectrum antibiotics, which can treat several common bacteria. These are given through an IV (intravenous or in a vein) because they can get into your bloodstream faster. Getting antibiotics as soon as you get a diagnosis can improve your outcome.

IV fluids are a second treatment for sepsis. Your provider also gives fluids through a vein in your hand or arm. Typically, these fluids contain minerals like sodium. IV fluids keep your blood pressure from dropping too low and can help treat organ damage from urosepsis.

If fluids don’t increase your blood pressure, you may receive medication like vasopressin (Pitressin®) to raise it. You may receive corticosteroids if fluids and medication haven’t increased your blood pressure to a stable level.

Some people need supplemental oxygen through a face mask or nasal cannula. A breathing tube may be placed in your windpipe (trachea) to connect you to a breathing machine (ventilator) if you can’t breathe well on your own.

How can I prevent urosepsis?

Talk to a healthcare provider if you have any symptoms of a UTI. This is the best way to prevent urosepsis. Trying to prevent a UTI can also help. Some tips for preventing a UTI include:

• Wiping from front to back after using the bathroom.
• Washing your hands before and after using the bathroom.
• Not holding in your pee.
• Peeing after sex.
• Practicing good bathroom hygiene.

Don’t use products such as spermicides, douches, deodorant sprays or scented soaps.

What is the survival rate for urosepsis?

When caught early, most people with mild urosepsis have a good chance of survival. Studies vary, but on average, approximately 70% of people who have sepsis survive if they receive treatment.

When should I see my healthcare provider?

Contact a healthcare provider if you have symptoms of a UTI or continue to have symptoms of a UTI after treatment. This is the most common cause of urosepsis. Symptoms of a UTI include:

• Sudden urge to pee more often.
• Pain or burning when you pee.
• Blood in your pee or pee that’s thick or cloudy.
• Feeling like your bladder isn’t emptying after you pee.
• Fever, fatigue, nausea and other signs of infection.

When should I go to ER?

Go to your nearest emergency room if you experience symptoms like:

• Being unable to breathe.
• Fast heart rate or heart palpitations.
• Weak pulse.
• Fever and chills.
• Not being able to pee.

Is urosepsis worse than sepsis?

Urosepsis is a type of sepsis. It just means that the sepsis began in your urinary system.

What is the difference between UTI and urosepsis?

Urosepsis is a type of sepsis that begins in your urinary tract. A UTI is an infection of your urinary tract that can lead to urosepsis if left untreated.

A note from Cleveland Clinic

Urosepsis is a serious complication of a UTI. A UTI is a very common infection that mainly affects your urethra and bladder. Knowing the signs of a UTI and getting prompt treatment for a UTI are the best ways to prevent urosepsis. Changes in your pee are often the first symptom of a UTI. Good bathroom hygiene, such as wiping from front to back, and peeing after sex, are two ways to lower your UTI risk.