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UTIs can lead to deadly sepsis for men and women and shouldn’t be dismissed as ‘ladies disease’, experts warn

Undiagnosed or untreated urinary tract infections (UTIs) can lead to deadly sepsis and should not be dismissed as “benign” or a “nuisance”, experts have warned.

The UK Sepsis Trust estimates that in 2020 around 245,000 people will have been admitted to hospital with any kind of sepsis.

And around 20 per cent of sepsis cases in the UK are believed to be due to UTIs although the NHS does not keep an official public record.

Urosepsis is more likely to affect elderly or vulnerable patients but young people can suffer too in rare cases, according to experts.

Leading medics and scientists have told i that UTIs should not be “dismissed as a benign ladies’ disease” and should be taken seriously by doctors and patients to help prevent infections from becoming urosepsis.

Dr Ron Daniels, executive director of the UK Sepsis Trust and vice president of the Global Sepsis Alliance, estimated that up to 1 in 20 UTIs could be giving rise to sepsis.

“It’s huge, it’s astonishing,” he told i, adding that the risk of sepsis from UTI depended greatly on age and risk factor.

“UTIs are seen as quite a benign infection. There are plenty of people out there, particularly women, who rarely go through a year without a UTI, and it’s just seen as a nuisance.

“There is a need to heighten awareness of the risk of developing sepsis. People also don’t expect men to get UTIs. The male population need educating that this is a problem in men as well, and they need to be watchful.”

He urged people to “trust their instincts” if suffering from a urinary tract infection.

“Many people who have had a UTI before know if it doesn’t feel right, it takes much longer than normal to feel better,” he said. “Go to 111 and ask if it could be sepsis.”

Dr Catriona Anderson, an expert in treating chronic urinary tract infections, warned that a dismissal of UTIs could make it harder to spot life-threatening sepsis cases.

“There’s still a problem with taking the illness seriously,” she said, noting that some fellow GPs had been shocked by the severity of a UTI once they contracted one themselves.

She added: “The majority of medical professionals do not even realise the extent of the ignorance around UTIs.”

Asked if the dismissal of an infection could lead to patients missing the key signs of sepsis, Dr Anderson said “absolutely”.

‘I suffered from life-threatening sepsis after incorrect treatment for a UTI – things needs to change’

Chronic UTI sufferer Joanne McKinlay, 37, spent a week in hospital with sepsis following incorrect treatment for a UTI. (Photo: Supplied)

Joanne McKinlay, 37, said she was misdiagnosed with an incurable condition known as interstitial cystitis at the age of 25 and eight years later was rushed to hospital with urosepsis after a missed infection in her bladder spread to her bloodstream.  

She began suffering from urosepsis after undergoing a bladder procedure called hydrodistention which is used to treat interstitial cystitis. Ms McKinlay became extremely unwell and was in hospital for a week on strong antibiotics to treat the urosepsis.

The mother-of-two said that after recovering from the sepsis she was diagnosed with a chronic urinary tract infection by a specialist.

She said that members of her online UTI support group, of which there are more than 12,000, have suffered from sepsis “as a result of wrong diagnosis and treatment for UTI.”

Ms McKinlay, from Lancashire, also said that many parents of children with UTIs turned to the group for support as they struggled to get the help they need.

Joanne, who now raises awareness of chronic UTIs and urosepsis, also said that she “worries deeply” for elderly people who may be living in care homes with undetected UTIs and are more likely to be hospitalised with sepsis and lose their lives.

“Urosepsis can be avoided if a UTI is treated correctly from the onset and not left with three day courses of antibiotics and outdated tests that are missing 25-35 per cent of patients.” she said. “What are the medical professionals going to do about it?”

“Sepsis is one of the biggest killers in the UK and I believe from the numbers I see from my group that many start from the bladder. It’s time they looked at the true numbers and made changes.”

i previously revealed that thousands of women in the UK are suffering with life-changing chronic urinary tract infections that can last for months or even years due to failures in diagnosis and treatment.

Dr Anderson has seen the risks first hand. After discussing the signs of urosepsis during a radio interview, she was later told that a listener had recognised the symptoms in an elderly neighbour, called an ambulance and potentially saved their life.

Dr Anderson warned that if a UTI patient feels “generally unwell, if they feel light-headed and dizzy, and notices they’re short of breath, if they’ve got a racing heartbeat or fluttering and someone says they look pale, they may have sepsis.”

She added: “People should also look out for behavioural changes; it does cloud your thinking and makes you confused or drowsy, and can make people aggressive, especially in the elderly.”

The Royal College of GPs said that while UTIs were common, they were taken “extremely seriously” by General Practitioners because of the risks of “more significant complications.”

“GPs will use their expertise and knowledge to deliver the most appropriate care and advice, including arranging suitable tests and prescribing antibiotics if necessary,” Professor Martin Marshall, Chair of the Royal College of GPs and a GP in East London, said.

“GPs will always be on the lookout for signs or symptoms that suggest sepsis or further infection to the kidneys, such as high or low temperature, confusion and blood in the urine, and they are well trained to provide the most appropriate care quickly.”

Sepsis risk ‘depends on age and vulnerability’

Experts stress the prevalence of urosepsis varies greatly depending on age group and risk category with the elderly and babies most vulnerable.

Dr Anderson treats predominantly young women for chronic, subacute infections and said cases of urosepsis are rare in these patients unless the kidneys are involved.

But she added: “We do see more devastating urinary infections and urosepsis in the extremes of life i.e. babies and the elderly.

“Unfortunately the way that older people commonly lose the nerve function that conveys the marked pain UTIs can cause, masks the alarm system the body has to alert the patient that infection is gaining a foothold, so the elderly often do not realise they are falling ill with urosepsis until they are too confused and or drowsy to organise themselves into getting appropriate care.

“Babies have immature immune systems and are not able to communicate pain as clearly as older children so they are also vulnerable.”

Dr Fergus Hamilton of the University of Bristol said it is difficult to define the number of deaths linked to UTI-induced sepsis.

“It’s like defining deaths from Covid; is it of Covid or with Covid?” said Dr Hamilton. “One common cause of death is pneumonia, but if you have cancer and the last thing you get is pneumonia, it’s not really the thing that kills you. It’s still quite rare for young people to get severe sepsis infection and die, luckily, but it is a major killer in the UK.”

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Dr Mahableshwar Albur, a hospital consultant in North Bristol NHS trust and member of the Project Sepsis research group, said that understanding the relationship of UTIs and sepsis was also difficult because of the lack of reporting of UTI infections.

“UTI is a different beast in different populations; we don’t see hundreds of young women coming in and dying as a consequence of sepsis. It does happen, but it’s rare,” he said. “But we see that in the elderly population, if they develop a UTI it can become sepsis and some sadly succumb to it.”

He said that working out the proportion of UTIs which go on to become sepsis is difficult because not everyone seeks medical attention for an infection and some get better without treatment.

“Ron’s point is absolutely relevant here; don’t underestimate UTIs as a benign ‘ladies disease’, it should be taken seriously,” he added.

Early treatment for UTIs could prevent them from becoming sepsis but there are divides within the medical community over when and how antibiotics should be administered.

“We’re caught between a rock and a hard place,” said Dr Albur.

“As clinicians, you don’t want to miss UTIs or allow them to become sepsis, and we will do everything we can by giving antibiotics and keeping infection at bay. But that’s one side of the story, the other side is antibiotic resistance.”

What is sepsis and how do I spot it?

Sepsis is a dysregulated immune response to infections which can be life-threatening.

When you get an infection, your immune system’s job is to fight it. However, with sepsis, it overreacts and the body’s response can damage its own tissues and organs.

Sepsis is more likely to affect older people, people younger people, and those with risk factors, because our body is less good at controlling its immune responses in these cases.

The UK Sepsis Alliance has this acronym for detecting the signs of sepsis, and recommend urgently attending A&E if you present them.

Slurred speech or confusion

Extreme pain in muscles or joints

Passing no urine in a day

Severe breathlessness

It feels like I’m going to die

Skin mottled, discoloured or pale

The UK Sepsis Trust is urging the NHS to create a patient register for those suffering from urosepsis and severe infection, in order to boost understanding and prevent serious illness.

“It wouldn’t necessarily head-count the people who present to their GP with symptoms of a UTI and get better with antibiotics, but it’s really important we look at the people admitted to hospital with infection,” Dr Daniels said.

“We should track those people to get a really granular understanding of what’s happening to them. We need to start to understand what works, who needs antibiotics more regularly, but also look at their recovery profile and the risk factors for recurrent infection.”

Dr Daniels suggests using NHS data to map their progress and reaction to treatment as well as asking patients to self-report factors including how active they are being and how well they feel.

“If we get these datasets to talk to each-other, we can start to really understand what a person who’s at risk of developing an infection tomorrow or next week looks like,” he said.

“This is about identifying red flags, identifying who’s at risk so that we can get them in early so they might get away with shorter courses of antibiotics and narrower spectrum antibiotics. So it’s about using antibiotics more wisely, as well as improving quality of life and outcomes for patients.”

An NHS spokesperson said: “The NHS follows clear guidance from NICE on the treatment of UTIs and NHS organisations offer expert-led follow up clinics to both men and women who need them.

“NHS staff are also provided with detailed information and training to ensure that they can provide the best possible treatment to patients.”



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