Understanding Urinary Tract Infections (UTIs) and Their Risks: Sepsis and Mortality

Urinary Tract Infections

Urinary tract infections (UTIs) are a common health problem, especially among women.  UTI’s affect millions of individuals every year.  UTI’s are often treatable with antibiotics. But occasionally, urinary tract infections are resistant to the first-line antibiotics commonly prescribed to treat the condition.  Other times, UTI’s progress rapidly and can lead to severe complications such as sepsis and even death.  A medical malpractice investigation may uncover the basis for a lawsuit if doctors or hospitals fail to provide proper treatment of a UTI or its complications and a patient suffers catastrophic injury or death as a result.

Risk Factors for Urinary Tract Infections

UTIs occur when bacteria enter the urinary tract, which includes the kidneys, ureters, bladder, and urethra.  A potential lawsuit involving the delayed diagnosis of a UTI typically involves the worst-case scenario when a UTI does not respond to initial antibiotics and progresses to bacteremia, sepsis or death.  Bacteremia is the presence of bacteria in the bloodstream. Bacteremia can lead to severe complications if not promptly treated.  This is the how a UTI can progress to a relatively harmless infection to a life-threatening blood infection:

Progression from UTI to Bacteremia

1. Localized Infection: A UTI typically starts as a localized infection in the urinary tract, often in the bladder (cystitis). Symptoms include frequent urination, a strong urge to urinate, burning sensation during urination, and lower abdominal pain.
2. Ascending Infection: If doctors do not properly treat a urinary tract infection, the infection can ascend from the lower urinary tract to the upper urinary tract, reaching the kidneys (pyelonephritis). This condition is more severe and presents with symptoms such as high fever, chills, flank pain, and nausea.
3. Spread to Bloodstream: From the kidneys, the bacteria can enter the bloodstream, leading to bacteremia. Bacteremia involves the presence of bacteria in the blood and can trigger a systemic inflammatory response.

Risk Factors for Developing Bacteremia from a UTI

Physicians must recognize situations when patients are at higher risk of bacteremia from a UTI.  Several factors can increase the risk of a UTI progressing to bacteremia:

1. Delayed or Inadequate Treatment: Not treating a UTI promptly can allow the infection to worsen and spread. Also, not all UTI’s respond to the broad-spectrum antibiotics commonly prescribed as the first treatment for UTI.  Some of the most common bacteria responsible for UTI have strains resistant to broad-spectrum antibiotics.  Antibiotic resistant strains of UTI causing bacteria are also common among patients who develop UTI in the healthcare setting, like hospitals or surgery centers.
2. Compromised Immune System: Individuals with weakened immune systems, such as those with diabetes, HIV/AIDS, or those undergoing chemotherapy, are at higher risk of developing bacteremia from UTI.
3. Elderly Population: Some older adults are more susceptible to bacteremia from UTI due to a generally weaker immune response and the presence of other comorbid conditions.
4. Structural Abnormalities: Anatomical abnormalities in the urinary tract, such as kidney stones or urinary retention due to an enlarged prostate, can impede the flow of urine and promote bacterial growth.
5. Catheter Use: Indwelling urinary catheters can introduce bacteria directly into the urinary tract and provide a pathway for the bacteria to enter the bloodstream.  Acutely ill hospitalized patients or people dependent on chronic use of an indwelling urinary catheter due to neurogenic bladder are among the patients who are at elevated risk for bacteremia from UTI.

Signs and Symptoms of Bacteremia

Doctors and nurses should find the clues to potential bacteremia through a careful medical history and basic vitals. Bacteremia resulting from a UTI can present with:

• High fever or chills
• Rapid heart rate (tachycardia)
• Rapid breathing (tachypnea)
• Low blood pressure (hypotension)
• Confusion or altered mental state
• General feeling of being unwell

The Mainstays of Life-Saving Treatment – Antibiotics and Careful Monitoring

When all or a combination of the signs and symptoms of bacteremia are present in a patient with a known or suspected urinary tract infection, doctors need to investigate this diagnosis and treat the bacteremia as soon as possible with appropriate antibiotics.  Doctors may need to order diagnostic tests to identify the source of infection.

Doctors should closely monitor patients with positive blood cultures and symptoms consistent with bacteremia. Many patients will need to be admitted to the hospital.  What begins as a UTI can quickly become a serious and potentially life-threatening medical condition.  Patients can deteriorate despite starting antibiotics.  That is why patients with bacteremia should remain under the watchful eye of a physician who can make sure the patient is getting better, not worse.

Here’s why careful treatment of bacteremia is so important and some of the standard forms of treatment doctors are expected to provide their patients:

1. Severity and Risk of Complications: Bacteremia can quickly lead to severe complications such as sepsis, septic shock, and organ failure, all of which are life-threatening and require immediate medical intervention. Sepsis is a life-threatening condition where the body’s response to infection causes widespread inflammation, leading to tissue damage, organ failure, and potentially death. Septic shock is a severe form of sepsis characterized by a significant drop in blood pressure, leading to inadequate blood flow to organs and tissues, resulting in multi-organ failure.
2. Need for Antibiotics: Effective treatment of bacteremia often involves IV antibiotics which are stronger and faster acting than oral antibiotics.  IV antibiotics are typically started in the hospital setting after consultation with a doctor specializing in the treatment of infectious diseases.  Prompt administration of antibiotics is critical to avoid progression of bacteremia into sepsis or worse. The choice of antibiotics depends on the type of bacteria identified and their antibiotic sensitivity. Broad-spectrum antibiotics are started immediately to cover a wide range of possible bacteria. Doctors may adjust the antibiotic regimen once specific bacterial culture results and sensitivities are available.
3. Source Control: Identifying and managing the source of infection is crucial. This may involve removing infected catheters or ureteral stents, draining abscesses, or treating underlying infections such as pyelonephritis, which is an infection in the kidney.
4. Monitoring and Supportive Care: Patients with bacteremia need close monitoring for signs of deterioration. This includes frequent vital signs checks, laboratory tests like blood cultures to gauge the effectiveness of antibiotic treatment, and potentially care to support breathing and circulation, including IV fluids, oxygen therapy, and medications to support organ function.

We have helped clients who have lost loved ones discharged from emergency departments despite signs and symptoms of bacteremia, or whose primary care doctors failed to escalate the patient’s care to a hospital.  In less than just 24 hours, a patient can lose the opportunity to overcome infection and progress to organ failure and death.

The lawyers of Lupetin & Unatin, LLC have successfully represented families who lost loved ones due to mismanagement of a UTI or underappreciation of the threat of bacteremia and sepsis.  Case results include the following:

• $900,000 settlement on behalf of the wrongful death beneficiaries of a woman who died shortly after doctors discharged her from an emergency department despite multiple signs of bacteremia and a urine culture positive for a dangerous infection; and,
• $750,000 settlement for the family of a women who died because emergency medicine doctors failed to appreciate signs and symptoms of sepsis related to a partially treated urinary tract infection and admit the patient to the hospital.

Conclusion

Urinary tract infections, while common and often treatable, pose significant risks if not effectively managed by doctors.  Recognizing the symptoms of bacteremia, obtaining proper lab tests, and considering the potential for progression to sepsis is crucial in preventing severe outcomes, including death.

If your loved one passed away suddenly or suffered permanent catastrophic injury from severe illness in what may have started as urinary tract infection, the Pittsburgh medical malpractice attorneys of Lupetin & Unatin can answer your questions.  We will gather the medical information we need to learn where during the process something went wrong and whether doctors or nurses overlooked important testing, failed to put together the signs and symptoms pointing to bacteremia or sepsis, or deprived your loved one of the urgent medical care they required to fight infection.