7 Symptoms of Sepsis from UTI in the Elderly

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UTI is one of the most common causes of sepsis in the elderly. About 25% of the cases of sepsis are due to urinary tract infections (reference).

The elderly are more liable to complicated UTIs, including pyelonephritis (kidney infection), sepsis, and septic shock.

In this article, I will simplify the suspicious symptoms of sepsis in the elderly with UTI.

Quick insights:

• UTI is one of the most common causes of sepsis in the elderly.
• Complicated UTIs occur when bacteria spread to the kidneys or bloodstream, leading to fever and chills, kidney pain, mental changes, muscle aches, fast heartbeats, shortness of breath, cold and clammy skin, and other symptoms.
• Elderly patients may not be able to express or feel fever, so it is important to measure temperature using a thermometer.
• Behavioral and mental symptoms are warning signs of possible sepsis from UTI, but they can also occur with uncomplicated UTI, especially in elderly people with an underlying brain condition.
• The following groups are at higher risk of developing complicated UTIs: those with stones in the urinary bladder, kidney, or ureter; obstruction inside the urinary tract; male gender; pregnancy; diabetes mellitus; chronic kidney disease; immunosuppressive medications; and patients with spinal cord or neurological diseases.

Symptom	Uncomplicated UTI	Complicated UTI
Fever	Rare	Common
Flank Pain	No	Yes
Confusion	Rare	Common
Muscle Aches	Rare	Common
Fast Heartbeats	Rare	Common
Shortness of Breath	Rare	Common
Cold and Clammy Skin	Rare	Common

[1] Fever & chills.

A simple UTI (confined to the urinary bladder) typically doesn’t lead to fever. A fever is a sign of a complicated UTI.

A complicated UTI occurs when the bacteria spreads to the kidneys or bloodstream. It can result in a fever and chills.

The elderly patient may not be able to express or feel the fever. He may feel cold or have chills or rigors. So, it is important to measure the temperature using a thermometer.

The presence of fever in elderly patients with UTI doesn’t always mean sepsis. However, you should take it seriously, and a doctor should exclude the possibility of urosepsis.

[2] Flank (kidney pain).

The flanks are the area on both sides of your body between the abdomen and the back. Urinary tract infections that spread from the bladder to the kidney cause flank pain.

Kidney infection (leading to flank pain) is a warning sign of potential sepsis. Simple UTI (cystitis) doesn’t lead to flank pain in the elderly.

[3] Mental changes (confusion, mood swings, etc.).

Many elderly people have aging-related mental disorders such as dementia or Alzheimer’s disease. Subclinical (asymptomatic) early-stage dementia or Alzheimer’s disease is even more common.

When an elderly with symptomatic or subclinical (asymptomatic) brain disease, the condition may get worse.

Many elderly people with UTI may present with behavioral and mental symptoms such as:

• Confusion.
• Sleep disturbances.
• Aggression.
• Delusions.
• Memory loss.
• Hallucinations.
• Anxiety.
• Appetite loss.
• Paranoia.

Although these behavioral and mental symptoms are a warning sign of possible sepsis from UTI, they can also occur with simple, uncomplicated UTI (cystitis), especially in elderly people with an underlying brain condition (reference).

In severe cases, sepsis from UTI leads to a profound affection of the mental state up to deep confusion or coma.

[4] Generalized aches and extreme fatigue.

When the bacterial toxins from UTI spread into the bloodstream, generalized and severe muscle aches typically develop in the elderly.

The pain and fatigue may be severe, leading to the inability to perform simple daily activities or frequent falling.

[5] Fast heartbeats.

As we illustrated before, simple UTIs don’t cause fever. However, in the cases of sepsis from UTI, the heartbeats are typically faster than normal (faster than 90 beats per minute) due to several factors such as:

• Fever.
• Irritation of the heart muscles and nerves by bacterial toxins.
• Low or borderline blood pressure (resulting in a reflex increase in heart rate).

The healthy elderly are not aware of their heartbeats under normal circumstances. If sepsis from UTI occurs, the elderly patient becomes aware of his heartbeats and typically describes it as (palpitations).

[6] Shortness of breath.

In moderate to severe cases of sepsis from UTI in the elderly, dyspnea (shortness of breath) may develop.

The elderly patient with urosepsis typically complains of rapid breaths, uncomfortable awareness of his breaths, and difficulty taking breaths.

Shortness of breath occurs due to several factors, such as organ failure, low blood pressure, extreme muscle fatigue, etc.

[7] Cold and clammy skin.

Sepsis leads to a decrease in blood pressure inside the blood vessels. As a reflex, the blood shifts from the skin to maintain blood flow to the internal organs.

This results in a pale, cold, and clammy appearance of the skin.

[8] Other symptoms of sepsis from UTI.

Other possible symptoms of sepsis from UTI in the elderly may include:

• Peeing too little urine (up to acute kidney failure).
• Severe shortness of breath, cough, expectoration, and bluish skin (a condition called acute respiratory distress syndrome that occurs secondary to sepsis from UTI).
• Vomiting or diarrhea.
• Skin rashes.
• Jaundice and dark urine (in severe cases, liver failure may also occur.
• High white blood cells.

Note that the symptoms of sepsis from UTI are typically present with the normal UTI symptoms such as:

• Dysuria (pain during urination).
• Urinary frequency.
• Frequent waking up to pee at night (nocturia).
• Sudden urge to pee (urgency).
• Bladder pain (suprapubic pain).
• Blood in the urine (hematuria).
• Cloudy (turbid urine).

[Bounus] Who is at higher risk of sepsis from UTI?

The following groups are at higher risk of developing complicated UTIs when they catch an infection.

• Presence of Stones in the Urinary bladder, kidney, or ureter.
• Obstruction inside the urinary tract (commonly ureteric, caused by a stone or a structure).
• Male gender.
• Pregnancy.
• Diabetes mellitus.
• Chronic kidney disease (deteriorated kidney function).
• Immunosuppressive medications.
• Patients with spinal cord or neurological diseases (neurogenic bladder).

• Evidence-based
• Written by a doctor.

MD, Internal Medicine and Nephrology specialist.

Dr. Esraa A. MagidAuthor

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