UTIs Are a Surprisingly Common Cause of Sepsis

A urinary tract infection (UTI) is one of the most common infections out there – and it’s typically resolved easily with a short course of antibiotics. But in some people, particularly older adults, a UTI can progress to something far more serious: urosepsis, a life-threatening condition that requires emergency care.

Joseph W. Henderson, MD, a urogynecologist at University Hospitals, explains what urosepsis is, who is at greatest risk and what families and caregivers need to know.

What Is Urosepsis?

A typical UTI is a manageable infection of the lower urinary tract, primarily the bladder and urethra. Common symptoms include: feeling the need to urinate more frequently or urgently, and feeling pain or burning while urinating.

Urosepsis can occur when a bladder infection spreads to the kidneys and the bacteria enters the bloodstream. “Sepsis is a kind of overreaction to an infection, causing various organs and systems throughout the body to become severely stressed,” Dr. Henderson explains. “It’s a medical emergency.”

Urosepsis causes roughly 25% of all sepsis cases, making a UTI one of the most common causes of this life-threatening condition. Certain people have a higher risk of developing a UTI:

• Women, especially postmenopausal women.
• Older adults.
• Men with prostate enlargement (BPH).
• People with kidney stones.
• Anyone who has undergone urinary tract procedures or hospitalization.

Anything that disrupts the normal flow of urine or the immune system creates conditions where bacteria can take hold and spread. People can get a UTI without these risk factors, making awareness of urosepsis important for everyone.

Symptoms of Urosepsis

Recognizing the difference between a UTI and urosepsis is critical, and not always obvious, especially in older adults who may not have the classic symptoms.

Signs that a UTI may be escalating to urosepsis include:

• Fever and chills.
• Low blood pressure or lightheadedness.
• Rapid heart rate or shortness of breath.
• Back or flank pain on one or both sides.
• Nausea or vomiting.
• Sudden confusion or altered mental status.

These symptoms, especially if they’re accompanied by urinary symptoms, warrant a trip to the emergency room. Urosepsis requires IV antibiotics and hospital monitoring, typically for at least 48 hours.

Diagnosis and Treatment

How do doctors diagnose a UTI versus urosepsis? A UTI is diagnosed by testing a urine sample for the presence of bacteria. If it’s positive, a course of antibiotics is typically enough to quickly improve symptoms and treat the infection.

When urosepsis is suspected, a blood test is done to determine if bacteria have entered the bloodstream, and check for any markers of inflammation or organ dysfunction. Imaging, such as a CT scan, may also be done to examine the kidneys or check for other blockages. Together, these tests help identify how far an infection has spread and the best course of treatment.

The Impact on Older Adults – and the Dementia Connection

Several age-related changes increase the risk of UTIs and urosepsis in older adults. Together, these factors make bladder infections more common and more difficult to resolve.

• General weakening of the immune system that comes with age.
• Incomplete bladder emptying.
• Structural changes in the urinary tract.
• Prior procedures and vaginal atrophy in postmenopausal women.

In older adults, cognitive and behavioral changes are sometimes the most obvious sign of a UTI. Confusion, disorientation, fatigue and unusual behavior can all be signs that an older adult has a UTI. “We’re not sure whether it’s caused by the bacteria itself or by an inflammatory response, but there can be mental status changes,” explains Dr. Henderson, including confusion and just feeling mentally cloudy. The good news is, these symptoms are reversible with treatment.

In addition, cognitive decline itself increases the risk of UTIs. As dementia progresses, the brain’s ability to control the bladder deteriorates, which can lead to incomplete emptying and incontinence, which increases the risk of a UTI.

The result is a cycle that can be difficult to break. “It’s not that chronic UTIs lead to dementia,” Dr. Henderson clarifies, “but a UTI can magnify those symptoms and worsen cognitive decline over time.”

For caregivers, any a sudden change in a loved one’s mental status – even without classic urinary symptoms – should prompt a call to the doctor.

Preventing UTIs: What Actually Works

Given the risks of urosepsis, people prone to recurrent UTIs – defined as two infections within six months or three within a year – should consider taking steps to prevent infection, including:

• Vaginal estrogen for postmenopausal women. After menopause, declining estrogen levels thin the vaginal tissues and harmful bacteria can more easily take hold. Vaginal estrogen helps rebuild the vaginal microbiome to protect against infection. “It’s a wonderfully safe and effective way of helping prevent infections,” Dr. Henderson says, noting that vaginal estrogen cuts recurrent UTIs in half.
• Cranberry supplements. Concentrated cranberry supplements, which are more powerful than cranberry juice, contain compounds called PACs that bind to certain bacteria and prevent them from attaching to the bladder wall. “It does nothing to treat an active infection, but there does appear to be evidence to support its use for prevention,” Dr. Henderson says.
• Avoiding unnecessary cleansers. Many people, especially women, with recurrent UTIs assume poor hygiene is the cause, and respond with soaps, wipes and other products – which can actually disrupt the natural vaginal environment and worsen the problem.
• Staying well hydrated and fully emptying the bladder. These simple habits can reduce the time bacteria have to grow in the bladder.
• Addressing underlying issues. For men with prostate enlargement or anyone with kidney stones or other abnormalities, treating the underlying condition is key to breaking the cycle of recurrent infection.

For most people, a UTI is a minor inconvenience. For older adults, it can be a medical emergency in the making. The good news is that with awareness, early action and the right preventive measures, urosepsis is largely avoidable – and that starts with taking a UTI seriously from the first symptom.

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The urologists and urogynecologists at University Hospitals provide expert diagnosis, treatment and prevention strategies for urological conditions of all kinds – from common infections to complex disorders.