When Urinary Tract Infections Become Severe
Most UTIs can be cleared with extra fluids and antibiotics. But left untreated, some can turn deadly.
When actress Tanya Roberts died in January, it was a shock to learn that the cause was a urinary tract infection (UTI) that spread throughout her body. UTIs are the most common outpatient infection in the United States and they're more common in women, especially as they age. But for a routine bladder infection to turn into a life-threatening condition is not common.
Roberts, who starred in "A View to a Kill," "That '70s Show" and "Charlie's Angels," knew something was wrong but she didn't know what it was, said her publicist Mike Pingel. When he confirmed her death on the Charlie's Angels fan club site, Pingel wrote that Roberts' infection had "spread to her kidney, gallbladder, liver and then bloodstream." She was 65 when she died.
Urinary tract infections can be more harmful in older people and harder to diagnose.
For a bladder infection to get so serious that it develops into sepsis — a life-threatening response to infection — as it did for Roberts, suggests complicating factors were at play.
"Somebody might have either ignored the early warning signs of a UTI or have other medical issues that makes it harder to fight off the infection, like a poor immune system, as an example," says Dr. Suzette Sutherland, director of female urology at the University of Washington School of Medicine and a member of the American Urological Association.
"There is most likely more to [Roberts'] story than we'll ever know," adds Sutherland, who points out that most bladder infections can resolve either with aggressive hydration or a short course of antibiotics.
Bladder infection, known as cystitis, is the most common type of UTI, according to the National Institutes of Health (NIH). Other parts of the urinary tract that can get infected are the urethra, ureters and kidneys.
The NIH says most infections in women are caused by bacteria from the bowel that reach the urethra and bladder, while most infections in men are the result of problems that restrict normal urine flow, such as an enlarged prostate.
Urinary tract infections can be more harmful in older people and harder to diagnose.
"If you feel there's something wrong, mask up and go to the doctor. The fear of getting one thing (COVID) is no reason to keep from getting other things checked out."
"If they are older, they don't always get the classic symptoms, the burning when you go to the bathroom, the feeling that you're not emptying your bladder, this nagging feeling that you have to go," Sutherland says.
Roberts thought she had contracted COVID-19, said Pingel, but her test result came back negative. "Unfortunately, when she collapsed, it was too late by that point," he noted, saying that her organs were "shutting down."
She collapsed on Christmas Eve while walking her dogs near her Hollywood Hills home. Roberts had not been diagnosed with a UTI when she went to the hospital, added Pingel.
Dr. Stephanie Kielb, a urologist at Northwestern Memorial Hospital in Chicago, says it could be easy to mistake COVID-19 for the symptoms of a severe UTI, especially when the bladder infection has progressed to the kidneys or if it starts as a bacterial strain that causes kidney infections.
"The signs of COVID – nausea, GI symptoms, fever – sound similar," she says.
The majority of UTI cases, though, do have local symptoms, she says, and if those symptoms don't clear "within a day or so," Kielb recommends getting a urine culture.
Over the summer, studies showed that some people were delaying or avoiding medical care due to the pandemic. The situation improved with the widespread use of telemedicine, according to Sutherland. "We can see [through telemedicine] if there is an issue here that warrants going into the office," she says.
"The hard thing about a celebrity story is everyone is running to the doctor and saying, 'I don't want to die, I need antibiotics.' We need to make sure people who have irritative voiding symptoms don't have other problems."
Dr. Karen Molander, an emergency medicine physician at Mills-Peninsula Medical Center in Burlingame, Calif. and board chair of the Sepsis Alliance, describes sepsis as "the body's overwhelming response to infection – whether it be a bacteria, virus, fungus or parasite for example."
If if it is caught early, when there are no signs of organ injury such as heart damage, lung damage or kidney damage, it is easy to treat, she says.
But if there is organ damage and the patient is in septic shock, they are at a higher risk for dying "despite all our interventions," Molander adds. "Average mortality from severe sepsis is around four percent at some hospitals, but septic shock is still approaching thirty to fifty percent at some hospitals," says Molander. Severe sepsis occurs when one or more of your body's organs are damaged. Septic shock is characterized by a life-threatening drop in blood pressure that can damage additional organs and cause respiratory failure.
Recommendations for preventing UTIs, from The American Urological Association and a consortium of other groups, include:
- Stay hydrated. Drink plenty of water, which increases urination, thereby flushing out bladder bacteria. How much should you drink? Enough to keep your urine looking light yellow-to-clear.
- Wipe properly. Women should wipe from front to back after using the toilet. Wiping from back to front may increase the risk of getting UTIs through contamination.
- Women should use topical vaginal estrogen. Most often used in the form of a cream, estrogen helps peri-and post-menopausal women maintain the health of their vagina, which helps to prevent vaginal and urinary tract infections.
- Use oral probiotics. Regular probiotic use helps maintain the normal healthy bowel flora.
The American Urological Association's recommendations also include drinking cranberry juice, with studies showing that proanthocyanidins, or PACs, the active ingredients in cranberries, may help prevent bladder infections.
"PACs are compounds that give red, blue or purple colors to many fruits," says Sonya Angelone, a nutrition consultant based in San Francisco and spokesperson for the Academy of Nutrition and Dietetics. These active ingredients can help prevent E. coli from adhering to the lining of the bladder and urinary tract by altering the surface of the bacteria.
Just make sure that the cranberry juice is pure and unsweetened, Angelone advises. "It is a little bitter, but you just need a little and can get used to it. Or add some to bubbly water," she says.
Some urologists recommend supplements containing PACs, but not all such supplements are considered equal. Studies show that some don't have enough of the active ingredient, which Sutherland says should be at least 35 milligrams in a dose.
Pingel hopes that Roberts' passing sends a message: "If you feel there's something wrong, mask up and go to the doctor. The fear of getting one thing [COVID-19] is no reason to keep from getting other things checked out," he says.
Still, Sutherland says people can err in the other direction – a problem in light of overprescribing of antibiotics.
"The hard thing about a celebrity story is everyone is running to the doctor and saying, 'I don't want to die, I need antibiotics,'" she explains. "We need to make sure people who have irritative voiding symptoms don't have other problems."
