Urosepsis is a systemic inflammatory reaction of the entire organism resulting from a bacterial infection originating in the urinary tract. With an incidence of 3 in 1000, urosepsis leads to severe septic disease, which is life-threatening to the highest degree, with a mortality of 50 to 70 percent.
What is urosepsis?
Urosepsis is the term used to describe a systemic inflammatory reaction of the organism that originates from an infection of the urinary tract and is generally due to an obstruction of urinary flow. As a result of colonization of the bloodstream by bacterial pathogens of the urogenital tract, the pathogens enter the blood system of the affected person and trigger the symptoms characteristic of urosepsis. The first signs of urosepsis are fever, chills, general feeling of illness and pain. Other characteristic symptoms of urosepsis include tachycardia (rapid heartbeat), tachypnea (increased respiratory rate), hypotension (decreased blood pressure), cyanosis (livid skin discoloration), and oliguria (decreased urine output). In addition, in the advanced stages of urosepsis, the affected person may experience increasing clouding of consciousness.
Causes
Urosepsis is due to bacterial infection with toxin (toxin-forming) pathogens of the genitourinary tract, such as Escherichia coli (over 50 percent), Klebsiella, Enterobacter, or Proteus. In this case, the bacterial pathogens enter the bloodstream from the urinary tract and cause sepsis (“blood poisoning”). The toxins formed by the bacteria or dead bacteria cause damage to the endothelium (vascular skin) as well as a systemic inflammatory reaction of the entire organism. Factors favoring this process are, in particular, urinary outflow obstructions (prostatic hyperplasia, ureteral stenosis, ureteral calculi, congenital strictures), as a result of which a backwater occurs, which facilitates the transfer of the pathogens into the bloodstream. Drug therapies with immunosuppressants (including chemotherapy), diabetes mellitus, malignant tumors (ureteral tumor), liver cirrhosis, and renal or prostatic abscesses, renal pelvic inflammation, and disseminated pathogen invasion after endoscopic procedures are other factors that can promote urosepsis.
Symptoms, complaints, and signs
Because of the systemic infection of the human body, urosepsis closely resembles blood poisoning. Rapid-onset symptoms of influenza, such as chills, intense fatigue, and sudden onset of fever, are among them. Another common feature with septic shock is warm-looking skin that turns bluish later in the course of the illness. This cyanosis (blueness) is particularly prominent on the lips. Constriction of the veins leads to cold fingertips and toes. As a result, the heart reacts to the physical state of emergency with tachycardia. In combination with complete absence and apathy, this symptomatology indicates a serious emergency with danger to the victim’s life. Patients generally suffer from an increased respiratory rate and a noticeable drop in blood pressure readings. However, individual characteristics also exist that are not consistent with classic sepsis. For example, urosepsis causes severe pain in the region of the urinary and genital organs. Blockages in the flow of urine and conspicuously small amounts of urine when going to the toilet suggest a severely inflammatory process. However, these complaints are not yet necessarily associated with a life-threatening septic shock. Suspicion already provides sufficient reason to examine a patient closely. Urosepsis is always considered a potentially fatal complication of bacterial infections. If no treatment is given, or if it is given at a later stage, the chances of survival decrease dramatically. Circulatory collapse resulting in death from multiple organ failure is then inevitable in many cases.
Diagnosis and course
Urosepsis is diagnosed on the basis of characteristic symptoms. In addition, determination of the cause and focal identification are central to the diagnosis. For example, urinary retention or a [renal abscess]] can be detected by ultrasonography.In the course of a blood analysis, leukocytosis (increased leukocyte count) or, in the later course, leukocytopenia (low leukocyte count) as well as thrombocytopenia (low platelet count), which leads to pronounced coagulation disorders, can be detected. If an elevated procalcitonin level (above 10 ng/ml), which functions as a sepsis marker, is present, the diagnosis is considered confirmed. A blood culture can be used to determine the specific pathogen. Vital signs (pulse, respiratory rate, urinary output, blood pressure, vigilance) are significant indicators of prognosis and initiation of intensive care measures. The prognosis and course of urosepsis depend significantly on the time of diagnosis and initiation of therapy. If left untreated, urosepsis leads to septic shock associated with multiorgan failure, with a high probability (50 to 70 percent) of death.
Complications
Urosepsis can cause various health problems as it progresses. A typical complication of acute bacterial infection is failure of organ function. Initially, however, urosepsis causes less serious complications. For example, those affected suffer from fever and cardiovascular symptoms, which can lead to circulatory collapse, heart failure and other complications if not treated. Fluid loss can lead to dehydration and subsequently to impaired consciousness and eventually dehydration. If urosepsis progresses further, complete sepsis may occur. The general condition of the affected person then deteriorates rapidly, resulting in multiple organ failure, septic settling in the brain, and other, life-threatening complications. Complications can also occur during treatment of urosepsis. When antibiotics are prescribed to patients, there is always a risk of side effects, such as headache, muscle and limb pain, gastrointestinal discomfort and skin irritation. In the event of an overdose or prolonged use, the drug can cause permanent organ damage. Any pre-existing conditions or medications taken concomitantly may lead to drug interactions. If a catheter or ureteral stent is inserted, this can promote inflammation and major infections. Injury to surrounding tissue structures is also possible.
When should you see a doctor?
Urosepsis requires prompt treatment by a physician. It can even lead to the death of the patient due to this disease in the worst case, so the affected person should see a doctor at the first signs and symptoms of the disease. The earlier urosepsis is recognized and treated, the better the further course is usually. A doctor should be consulted if the patient suffers from a very high and severe fever and also chills. In this case, the fever does not disappear on its own and cannot be reduced by medication. In many cases, the affected person is very tired and listless and can no longer participate in everyday life. Furthermore, a very small amount of urine during urination may also indicate urosepsis and should be examined by a physician. This disease is usually examined and treated by a urologist. Whether a complete cure will occur cannot be universally predicted.
Treatment and therapy
Urosepsis is generally treated both causally and with antibiotic therapy. Depending on the underlying cause of the disease, this may require surgery in the urogenital tract. For example, if urinary retention is present, it can be relieved by retrograde ureteral splinting, within which a thin catheter is inserted to drain urine from the renal pelvis into the affected ureter. In addition, in the absence of coagulation disorders, a percutaneous nephrostomy (renal fistula) may be used to remove the obstruction. For this purpose, the urine stagnated in the renal pelvis is drained to the outside via a small tube. If urosepsis is accompanied by abscesses, which may be present in pyelonephritis (inflammation of the renal pelvis), prostatitis (inflammation of the prostate) or epididymitis (inflammation of the epididymis), these are also drained via a puncture or mini-incision to relieve the pressure.Even before the pathogen culture is evaluated, a calculated antibiotic therapy (cephalosporins, aminoglycoside, fluoroquinolones, carbapenems, acylaminopencillins) is started, which is subsequently adapted to the antibiogram (resistance determination) or the specific pathogens present. In addition, the circulation should be stabilized by hypercolloidal infusions (plasma expanders), which counteract volume loss. Infusion therapy also compensates for fluid balance and promotes urinary excretion. A derailment of the acid-base balance can be balanced with the help of hydrogen carbonates. If no improvement in symptoms can be detected, intensive medical measures may be required to treat urosepsis and, in the case of organ failure, ventilation and hemofiltration (renal replacement therapy).
Prevention
Urosepsis can be prevented by early diagnosis and timely initiation of therapy and consistent treatment of the underlying disease.
Follow-up care
Follow-up of urosepsis must be done very conscientiously by an expert physician. Urosepsis represents a potentially life-threatening complication caused by bacteria-originally in the genitourinary tract-that have entered the bloodstream. Depending on the course of urosepsis, healing and recovery varies and is individual. If the urosepsis could be treated early with antibiotics and stabilizing measures, one can finally assume a complete healing of the affected person. Long-term follow-up is therefore not to be expected after treatment has been completed. The specialist must ensure that all bacteria in the bloodstream have disappeared and thus no recurrence of urosepsis can occur due to renewed multiplication of remaining bacteria. The patient’s general condition may still be weakened in the initial period after urosepsis; this must be observed and, if necessary, treated by the patient’s responsible family physician in a supportive and cooperative manner. It is important to allow a certain recovery period after urosepsis in order to stabilize the patient’s general condition as best as possible. If urosepsis could be treated without complications, long-term damage is not to be assumed and no drug or further invasive therapy is required in the follow-up.
Here’s what you can do yourself
At the latest when this diagnosis is suspected, the affected patient should be immediately admitted to the nearest hospital. Sepsis – blood poisoning – is always a life-threatening disease that cannot be treated with simple home remedies. It does not matter from where the pathogens entered the bloodstream, as in this case from the draining urinary tract. As soon as patients have problems passing water and also excrete only a small amount of fluid, medical advice is indicated. While these problems need not, they can lead to life-threatening urosepsis. The relatives of the affected patient should also keep an eye on the course of the disease, because urosepsis in the early stages can also lead to apathy and apathy. The sick person is then no longer able to call the emergency physician himself and be admitted to a hospital. As a rule, an antibiotic is prescribed for the treatment of urosepsis, which must still be taken when the immediate danger to life has passed. Further medical measures, such as surgery, infusion therapy or even dialysis, must also be agreed to. In addition, the patient should take care to maintain adequate hygiene during convalescence to avoid reinfection. A healthy lifestyle helps the body to survive the serious illness. This includes sufficient sleep as well as a diet rich in vitamins but low in fat.
