Urosepsis

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is urosepsis?

Sepsis is a life-threatening bacterial infection of the blood; urosepsis is sepsis that complicates a urinary tract infection. Urosepsis requires treatment with antibiotics and may require supportive therapies such as intravenous fluids and oxygen. If undiagnosed or untreated, urosepsis can progress to septic shock, a serious and life-threatening condition complicated by dropping blood pressure, rapid heart and breathing rates, decreasing urine output, and alterations in mental status.

The urinary tract consists of the kidneys, ureters, bladder and urethra. The kidneys filter the blood, creating urine, which travels through the ureters to the bladder, where it is stored until it exits the body through the urethra. In the male, the prostate wraps around the urethra as it travels from the bladder to the penis. Most of the time, bacteria that cause urosepsis enter the body through the urethra and make their way to the prostate or kidney before entering the bloodstream.

Symptoms of uncomplicated urinary tract infections can include burning with urination, the need to go to the bathroom frequently or urgently, cloudy urine, and pelvic or lower abdominal discomfort. Fever may be present. If pyelonephritis (kidney infection) is present, back or abdominal pain, nausea and vomiting, high fever, shaking chills, night sweats, and fatigue may also occur. Any of these symptoms may precede the development of urosepsis.

Urosepsis is more common in women than in men, and is more likely to occur in the elderly or people who have weakened immune systems or conditions such as diabetes. Obstruction of the flow of urine by an enlarged prostate, kidney or bladder stones, tumors, or urethral scarring increases the risk of urosepsis, as does any condition that interferes with bladder emptying. Instrumentation of the urinary tract during surgeries, procedures, or catheterization increases the risk of infections that can lead to urosepsis.

Urosepsis is a life-threatening emergency. Seek immediate medical care (call 911) if you have symptoms of sepsis such as high fever (higher than 101 degrees Fahrenheit), rapid breathing, fast heart rate, weak pulse, profuse sweating, unusual anxiety, changes in mental status or level of consciousness, or decreased or absent urinary output.

Seek prompt medical care if you have symptoms suggestive of a urinary tract infection without symptoms of sepsis.

What are the symptoms of urosepsis?

Urosepsis shares many of the same symptoms as other types of sepsis, including rapid heart rate, rapid breathing, weak pulse, profuse sweating, unusual anxiety, changes in mental status or level of consciousness, and decreased or absent urinary output. Prior to the development of these symptoms, you may experience symptoms of a urinary tract infection.

Common symptoms of a urinary tract infection

Symptoms of a urinary tract infection vary from individual to individual. Common urinary tract infection symptoms include:

Serious symptoms that might indicate a life-threatening condition

Urosepsis can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms:

  • Change in level of consciousness or alertness, such as passing out or unresponsiveness

  • High fever (higher than 101 degrees Fahrenheit)

  • Low temperature (hypothermia; temperature 96.8 degrees Fahrenheit or lower)

  • Not producing any urine

  • Profuse sweating and unusual anxiety

  • Rapid heart rate (tachycardia)

  • Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing

  • Severe abdominal, pelvic, or back pain

  • Severe nausea and vomiting

  • Weak pulse

What causes urosepsis?

Urosepsis is caused by a bacterial infection of the urinary tract or prostate that spreads into the bloodstream. Even if you are in general good health, many of the bacteria that cause urosepsis can normally occur in your intestines.

What are the risk factors for urosepsis?

A number of factors increase the risk of developing urosepsis. Not all people with risk factors will get urosepsis. Risk factors for urosepsis include:

  • Advanced age

  • Compromised immune system due to such conditions as HIV and AIDS, taking corticosteroids, organ transplant, or cancer and cancer treatment

  • Diabetes

  • Fecal incontinence (inability to control stools)

  • Female gender

  • Immobility

  • Incomplete bladder emptying or urinary retention

  • Polycystic kidney disease

  • Pregnancy

  • Surgeries or procedures involving the urinary tract

  • Urinary tract obstruction by stones, an enlarged prostate, urethral scarring, or other causes

  • Use of catheters to drain urine

How is urosepsis treated?

The primary treatment for urosepsis is the use of antibiotics to get rid of the infection. Your treatment may also include supportive measures such as intravenous fluids, and oxygen therapy may be used. If your case is severe, medications may be used to increase your blood pressure and mechanical ventilation may be required.

Common treatments for urosepsis

Common treatments for urosepsis include:

  • Blood transfusions if necessary

  • Drainage of abscesses if present

  • Initial treatment with broad-spectrum antibiotics to fight the most likely infectious organisms

  • Intravenous fluids to maintain blood volume and blood pressure support

  • Lithotripsy to break up kidney or bladder stones if present

  • Mechanical ventilation if needed

  • Medications (vasopressors) to increase blood pressure

  • Monitoring and maintenance of blood sugar

  • Oxygen therapy to maintain blood oxygenation

  • Removal of any catheters or other devices that may be infected

  • Targeted antibiotic therapy to treat specific bacteria once culture results are available

What are the potential complications of urosepsis?

Your age and general health can play a role in your risk for potential complications. In some people, especially older adults, people with chronic diseases, and those with a weak immune system, complications of untreated urosepsis can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your doctor design specifically for you. Complications of urosepsis include:

  • Disseminated intravascular coagulation (DIC; a clotting disorder leading to the formation of multiple blood clots in the bloodstream)

  • Kidney damage

  • Kidney or other organ failure

  • Perirenal abscesses (collections of pus near the kidneys)

  • Prostatic abscesses (collections of pus in the prostate)

  • Renal abscesses (collections of pus in the kidneys)

  • Scarring of the urinary tract

  • Shock

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 19
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Sepsis. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001687/.
  2. Urinary tract infection - adults. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000521.htm.