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What Is Urosepsis?

Medically Reviewed by Dan Brennan, MD on June 07, 2021

Urosepsis is when an untreated urinary tract infection (UTI) spreads to your kidney. It’s a form of sepsis, which is your body’s potentially life-threatening response to an infection.

Urosepsis can be fatal if not treated properly. Read on to learn more about what urosepsis is, how it’s diagnosed, and more.

What Is Urosepsis?

Urosepsis is when an untreated UTI spreads through your urinary tract to your kidney (pyelonephritis) and causes sepsis. It can also be caused by a bladder infection (cystitis), although cystitis rarely causes sepsis by itself.

A UTI is when your urinary tract is infected. This can be caused by bacterial or fungal infections and is typically easy to treat. You can get a UTI through sexual activity, unsanitary conditions, or wiping after going to the washroom.

Sepsis is an often dangerous condition that happens when your body damages its own tissues while responding to infection. In some cases, sepsis may develop into septic shock, which is a dramatic drop in blood pressure that can lead to organ dysfunction and death.

Even though most people recover from mild sepsis, the mortality rate for septic shock is around 40%. Having severe sepsis will also make you more likely to develop infections in the future.

Symptoms and Diagnosis

Symptoms of urosepsis depend on which part of your urinary tract is infected, how far your UTI has spread, and how far it's progressed.

UTI symptoms. Before your UTI develops into sepsis, you’ll have different symptoms depending on which part of your urinary tract is infected.

If you have cystitis, or inflammation of the bladder, you may have symptoms including:

  • Sudden and frequent urination
  • Pain in your lower abdomen
  • Blood in your urine ( hematuria)

If you have a fever and other symptoms like fatigue and chills, your UTI may have spread beyond the bladder.

If you have a kidney infection (pyelonephritis), meanwhile, you may have symptoms including:

  • Pain in your flank (area between your upper belly or abdomen area and the back)
  • Nausea and vomiting
  • Fever
  • Chills
  • Pain in your lower spine (costovertebral angle tenderness)

Urosepsis symptoms. Once it's confirmed you have a UTI and sepsis, it likely means you have urosepsis.

If you have the following symptoms, you may have sepsis:

  • Respiratory (breathing) rate is equal to 22 breaths per minute or higher
  • Systolic blood pressure is equal to or less than 100 millimeters of mercury (mm Hg)
  • Abnormal white blood cell count (either too high or too low)

Severe sepsis symptoms include:

  • Organ failure, such as kidney (renal) dysfunction resulting in less urine
  • Low platelet count
  • Changes in mental status

In some cases, sepsis may turn into septic shock, which is a drastic drop in blood pressure that can increase the risk of death. Signs of septic shock include:

  • Needing medication to maintain systolic blood pressure equal to or greater than 65 mm Hg.
  • High levels of lactic acid in your blood, which means your cells aren’t using oxygen in the right way

When To See a Doctor

Urosepsis usually happens when you’ve been hospitalized or have been recently hospitalized. However, you can get urosepsis if you have a UTI, regardless of whether or not you’ve been to a hospital. 

If your UTI hasn’t been responding to treatment, talk to your doctor. Certain symptoms such as rapid breathing and confusion require immediate care.

Treatment

Early goal-directed therapy (EGDT) can reduce the mortality rate of sepsis. The treatment guidelines include:

  • Rapidly giving you antibiotics to get rid of the suspected infection source
  • Supportive care, such as stabilizing your lungs and flow of blood
  • Additional supportive therapies

The doctor will give you the antibiotics within one hour of a confirmed diagnosis after blood and urine cultures have been collected. The goal is to decrease the mortality rate of sepsis. Your survival rate will decrease by 8% each hour antibiotics are delayed after the first six hours.

Antibiotics used to treat sepsis often include:

  • Piperacillin with a beta-lactamase inhibitor
  • Third-generation cephalosporin
  • Fluoroquinolone

Other ways to treat sepsis include intravenous (IV) fluids at a minimum of 30 milliliters per kilogram. Your doctor may also give you vasopressors such as norepinephrine, which keep your blood pressure from dropping.

If you have another condition affecting your urinary tract, it needs to be treated as soon as possible. For instance, if you have a ureteral stone (calculus) that’s causing urosepsis, your doctor will put in a stent.

Prevention

To prevent urosepsis, talk to your doctor immediately if you think you have a UTI. Get it treated as soon as possible. The longer you delay treating your UTI, the more likely you are to develop urosepsis, septic shock, renal failure, and death.

WebMD Medical Reference

Sources

SOURCES:

EmCrit: Internet Book of Critical Care (IBCC): “Community acquired urosepsis.”

Mayo Clinic: “Sepsis.”

Mount Sinai: "Flank pain."

Porat, A.; Bhutta, B.; Kesler, S. Urosepsis. StatPearls Publishing, 2021.

Sepsis Alliance: “Urinary Tract Infections.”

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