Bloodstream Infection from UTI (Urosepsis)
I would like information about urosepsis. What are all the ways one gets it, can it cause death, and how can it be treated?
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First, sepsis is defined as a severe, potentially fatal illness caused by infection. You may see other definitions, but this is the one I use. "Urosepsis" is an imprecise term denoting sepsis from a urinary source.
While most people think of urinary-tract infections as mild, self-limited infections, they can occasionally be severe. A urinary-tract infection generally begins after bacteria ascend to the bladder through the urethra (the opening in the body through which urine passes). If symptoms occur, the patient usually complains of burning and the need to urinate frequently. If the infection is confined to the bladder (a condition called cystitis), there is generally no fever or other whole-body symptoms. In some cases, the infection travels further, affecting the kidneys. This infection, called pyelonephritis, may occur in the absence of the symptoms described above.
Pyelonephritis is a more severe illness than cystitis, causing fever and flank pain.
In some patients with pyelonephritis, the illness progresses even further, with spread of the bacteria into the bloodstream. Such an illness can be fatal without prompt antibiotic therapy. Once the bacteria enter the bloodstream, the blood pressure can fall, depriving various organs of oxygen, including the heart and the brain. At some point, the patient may need strong medications called vasopressors to keep the blood pressure up, and ventilator support to keep the lungs working. The most important aspect of treatment is prompt antibiotic therapy.
Urosepsis can occur in anyone, but elderly women are most at risk. A few factors predispose people to severe urinary-tract infections. One is having an indwelling urinary catheter, also known as a Foley catheter. These are used when a patient is unable to urinate on his or her own. Another risk factor for these infections is kidney stones. In fact, experts usually recommend a sonogram (ultrasound) of the kidneys in all cases of urosepsis to exclude this possibility.
In young healthy women, the vast majority of urinary infections are mild. More than 80 percent actually resolve without any treatment. However, I recommend seeking treatment in all suspected cases of urinary tract infections, to avoid the rare risk of serious complications.
by Harold Oster
