Urosepsis

A Urosepsis is a systemic inflammatory reaction of the whole organism due to a bacterial infection originating in the urinary tract. With an incidence of 3 in 1000, urosepsis leads to a severe septic disease, which is extremely life-threatening with a mortality of 50 to 70 percent.

What is urosepsis?

As Urosepsis is a systemic inflammatory reaction of the organism that starts from an infection of the lower urinary tract and is usually due to an obstruction of the urine flow.

As a result of the colonization of the bloodstream by bacterial pathogens in the urogenital tract, the germs get into the blood system of the person affected and trigger the symptoms characteristic of urosepsis.

The first signs of urosepsis are fever, chills, a general feeling of illness and pain. In addition, tachycardia (rapid heartbeat), tachypnea (increased respiratory rate), hypotension (decreased blood pressure), cyanosis (livid skin discoloration) and oliguria (decreased urine production) are characteristic symptoms of urosepsis. In addition, in the advanced stage of urosepsis, the affected person may become increasingly clouded in consciousness.

causes

A Urosepsis is due to a bacterial infection with toxins (poisonous substances) forming pathogens of the urogenital tract such as Escherichia coli (over 50 percent), Klebsiella, Enterobacter or Proteus.

Here, the bacterial pathogens penetrate the urinary tract into the bloodstream and cause sepsis ("blood poisoning"). The toxins or dead bacteria formed by the bacteria cause damage to the endothelium (vascular skin) and a systemic inflammatory reaction of the entire organism.

Factors favoring this process are, in particular, urinary outflow disorders (prostatic hyperplasia, ureteral stenosis, ureteral stone, congenital strictures), as a result of which a backflow occurs, which makes it easier for the pathogens to enter the bloodstream.

Drug therapies with immunosuppressants (including chemotherapy), diabetes mellitus, malignant tumors (ureteral tumor), cirrhosis of the liver and kidney or prostate abscesses, inflammation of the renal pelvis and a delayed invasion of pathogens after endoscopic interventions are further factors that can promote urosepsis.

Symptoms, ailments & signs

Due to the systemic infection of the human body, urosepsis is very similar to blood poisoning. Rapid symptoms of [[flu9] such as chills, intense fatigue and sudden fever are included. Other similarities with septic shock are warm-looking skin, which later turns bluish in color.

This cyanosis is particularly evident on the lips. A narrowing of the veins leads to cold fingertips and toes. As a result, the heart reacts to the physical emergency with a tachycardia. In combination with complete absence and indifference, these symptoms indicate a serious emergency with a life threatening condition for the victim.

Patients generally suffer from an increased respiratory rate and a noticeable drop in blood pressure values. However, there are also individual characteristics that are not in line 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 noticeably small amounts of urine when using the toilet suggest a highly inflammatory process.

However, these symptoms are not necessarily associated with life-threatening septic shock. The suspicion provides sufficient grounds for a detailed examination of a patient. Urosepsis is always considered a potentially fatal complication of bacterial infections. If there is no rescue therapy or if it only takes place at a later stage, the chances of survival drop dramatically. A circulatory collapse resulting in death from multiple organ failure is then inevitable in many cases.

Diagnosis & course

A Urosepsis is diagnosed based on the characteristic symptoms. The diagnosis also focuses on determining the cause and identifying the focus.

For example, urinary stasis or a [kidney abscess]] can be detected using an ultrasound examination. As part of a blood analysis, leukocytosis (increased leukocyte count) or later leukocytopenia (low leukocyte count) and thrombocytopenia (low platelet count), which leads to pronounced coagulation disorders, can be detected.

If there is an elevated procalcitonin value (above 10 ng / ml), which acts as a sepsis marker, the diagnosis is considered confirmed. The specific pathogen can be determined via a blood culture. The vital parameters (pulse, respiratory rate, urine output, blood pressure, vigilance) are important indicators for the prognosis and initiation of intensive care measures.

The prognosis and course of urosepsis depend significantly on the time of diagnosis and the start of therapy. If left untreated, urosepsis leads to septic shock, which is associated with multiple organ failure and has a high probability (50 to 70 percent) of death.

Complications

Urosepsis can cause various health problems over time. A typical complication of acute bacterial infection is the failure of organ functions. Initially, however, urosepsis causes less serious complications.

Those affected suffer, for example, from fever and cardiovascular problems, which, if not treated, can lead to circulatory collapse, heart failure and other complications. The loss of fluids can lead to dehydration, which can lead to impaired consciousness and ultimately dehydration. If the urosepsis continues, complete blood poisoning can occur.

Then the general condition of the person concerned deteriorates rapidly and it comes to multiple organ failure, septic colonization in the brain and other, life-threatening complications. Complications can also arise when treating urosepsis. If antibiotics are prescribed to patients, there is always the risk of side effects, such as headache, muscle and limb pain, gastrointestinal complaints and skin irritation.

In the event of an overdose or prolonged use, the drug can cause permanent organ damage. Any previous illnesses or medication taken concomitantly can lead to interactions. Inserting a catheter or a ureteral stent can promote inflammation and major infections. Injuries to the surrounding tissue structures are also possible.

When should you go to the doctor?

Prompt treatment by a doctor is necessary for urosepsis. In the worst case, this disease can even lead to the death of the patient, so that the person affected should consult a doctor as soon as the first signs and symptoms of the disease appear. The earlier the 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 from chills. The fever does not go away on its own and cannot be reduced with medication. In many cases, those affected are very tired and listless and can no longer participate in everyday life. Furthermore, a very small amount of urine when urinating can indicate urosepsis and should be examined by a doctor.

This disease is usually examined and treated by a urologist. Whether there will be a complete healing cannot be universally predicted.

Treatment & Therapy

A Urosepsis is usually treated on the one hand causally and on the other hand as part of antibiotic therapy. Depending on the underlying cause of the disease, this may require operations in the urogenital tract. If, for example, there is an obstruction of the urine, this can be remedied by a retrograde ureteral splint, inside which a thin catheter is guided to drain the urine from the renal pelvis into the affected ureter.

In addition, if there are no coagulation disorders, a percutaneous nephrostomy (renal fistula) can be used to remove the obstruction. For this purpose, the urine that has built up in the renal pelvis is drained to the outside via a small tube. If the urosepsis is accompanied by abscesses, which can be present in pyelonephritis (inflammation of the kidney pelvis), prostatitis (inflammation of the prostate) or epididymitis (inflammation of the epididymis), these are also drained through a puncture or mini-incision for relief.

Even before the pathogen culture is evaluated, a calculated antibiotic therapy (cephalosporins, aminoglycosides, fluoroquinolones, carbapenems, acylaminopencillins) is started, which is then 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 the loss of volume. Infusion therapy also compensates for the fluid balance and promotes urine excretion. A derailment of the acid-base balance can be compensated with the help of hydrogen carbonates.

If there is no improvement in the symptoms, intensive care measures may be required to treat urosepsis and, in the case of organ failure, ventilation and haemofiltration (renal replacement therapy).

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prevention

One Urosepsis can be prevented by an early diagnosis and a timely start of therapy as well as consistent treatment of the underlying disease.

Aftercare

The aftercare of urosepsis must be carried out very conscientiously by a specialist doctor. Urosepsis is a potentially life-threatening complication caused by bacteria - originally in the urogenital tract - which have entered the bloodstream. Depending on the course of the urosepsis, the healing and recovery is different and individual.

If the urosepsis could be treated early with antibiotics and stabilizing measures, one can ultimately assume a complete healing of the person affected. Long-term follow-up care is therefore not to be expected after the treatment has been completed. The specialist must ensure that all bacteria in the bloodstream have disappeared and that the urosepsis cannot flare up again due to the renewed multiplication of the remaining bacteria.

The general condition of the patient can still be weakened in the first time after urosepsis, this must be observed and, if necessary, can also be treated with support and in cooperation with the responsible family doctor of the person concerned. After urosepsis, it is important to have a certain recovery time in order to stabilize the general condition of the patient as well as possible.

If the urosepsis could be treated without complications, no long-term damage can be assumed and no drug or further invasive therapy is necessary in the follow-up care.

You can do that yourself

If this diagnosis is suspected at the latest, the affected patient should be admitted to the nearest hospital immediately. Sepsis - blood poisoning - is always a life-threatening illness that cannot be cured with simple home remedies. It does not matter from where the pathogens entered the bloodstream, as in this case from the urinary tract.

Medical advice is indicated as soon as patients have problems urinating and excreting only a small amount of fluid. These problems do not have to, but can lead to life-threatening urosepsis. The relatives of the affected patient should also pay attention to the course of the disease, because early urosepsis can also lead to apathy and apathy. The sick are then no longer able to call the emergency doctor themselves and be admitted to a hospital.

As a rule, an antibiotic is prescribed for the treatment of urosepsis, which must also be taken when the immediate danger to life has passed. Other medical measures such as surgery, infusion therapy or even dialysis must be approved.

In addition, the patient should ensure adequate hygiene during the period of convalescence in order to avoid reinfection. A healthy lifestyle will help the body survive serious illness. This includes adequate sleep as well as a diet rich in vitamins but low in fat.