Urosepsis is a serious condition that occurs when a urinary tract or other infection goes unchecked and bacteria invade the bloodstream and impact urinary tract structures.
When bacteria—often E. coli—enter the urinary tract, they can multiply rapidly and cause an infection that, left untreated, the can spread to the blood (sepsis) and impact structures in the urinary tract, leading to urosepsis.
Once blood has been contaminated, a person's body tries to fight off the infection and it can result in a rapid pulse, fever, chills, confusion, and ultimately organ failure. Immediate treatment is vital.
Treating Urosepsis and Septicemia
Antibiotics
Since urosepsis most frequently begins as a urinary tract infection (UTI), antibiotics are typically one of the first interventions. Broad spectrum antibiotics—which attack a wide variety of bacterial strains—are often administered until tests show which type of bacteria is to blame. Then, a targeted antibiotic can be prescribed to more effectively attack that specific microbe.
Blood Pressure Medications
Urosepsis can cause a dramatic drop in blood pressure of 20 points or more, something that can lead to dizziness and fainting. Severely high blood pressure can be life-threatening, so a physician may prescribe vasopressors (e.g. epinephrine or glucocorticoids) that cause the blood vessels to constrict and increase blood pressure.
Intravenous Fluids
IV fluids can also help raise 's blood pressure by increasing the amount of fluid the heart is pumping through the body.
Oxygen
Urosepsis affects more than the urinary tract; it can also impact a person's ability to breathe. When this is the case, the patient may be given a nasal cannula (thin tubes that are placed in the nostrils) to deliver extra oxygen to the body. In severe cases, mechanical ventilation or machine-assisted breathing may be necessary.
Additional Urosepsis Treatments
If urosepsis causes kidney failure, blood filtration must be done via dialysis treatments, which act like an artificial kidney to filter waste products from the blood.
If kidney stones or bladder stones have caused the urinary tract infection that led to urosepsis, high-energy shock waves can target and break them up from the outside of the body (extracorporeal lithotripsy). This can reduce pain and restore urinary flow, reducing the likelihood bacteria will continue to build up.
Another treatment that may be necessary is a blood transfusion. Urosepsis may affect the body's ability to clot blood, which stops bleeding. Because decreased clotting increases the risk for internal bleeding, blood or plasma transfusions may be administered to increase the blood's clotting capabilities.
Prognosis after Urosepsis
The sooner a patient seeks medical attention, the greater his chance of recovery. Initial sepsis symptoms, such as fever, flank pain, stomach upset, and tenderness near the kidneys, can give way to more serious symptoms like pulmonary edema that causes fluid to build up in the lungs and makes it difficult to breathe. The kidneys can start to shut down, followed by multi-symptom organ failure and internal bleeding.
When antibiotic therapy is initiated within an hour after a urosepsis-related drop in blood pressure is detected, the survival rate is 80 percent. Every hour of delay after that reduces the survival rate by eight percent, according to the Journal of Global Infectious Diseases. Immediate antibiotic treatment can improve symptoms within 48 to 72 hours, but patients usually remain on antibiotic therapy for two to three weeks.
References:
Raizada A, et al. (2009). Approach to a patient with urosepsis. Journal of Global Infectious Diseases.
