Oakley UTI 2

Question 1

Do you need Blood work for urinary issues?

Answer 1

No except if
 Systemic signs (pyelonephritis, obstruction?)
 Or if urine specific gravity low (kidney issue?)

Question 2

Bacterial Cystitis Treatment

Answer 2

 Clinical signs secondary to inflammation
> NSAIDs if not contraindicated
> Start with NSAIDs if previous reaction to ATB
 Broad Spectrum antibiotic

Question 3

empirical UTI treatment
- what do we use?
- what do we avoid?

Answer 3

 Large spectrum antibiotic treatment
> Amoxicilline 11-15mg/kg PO BID or TID
> TMS 15mg/kg PO q12h
<><>
Avoid:
 Using same ATB if reinfection
 Fluoroquinolone and 3rd gen cephalosporin (overkill)

Question 4

how long should we treat UTI with antibiotics?

Answer 4

a big question, no definitive answer
- previously 2 weeks, now moving more to 7 or 5 days
> have seen same outcomes with shorter treatment durations
> 5 days can be a good starting point, prolong if needed
> minimum 3 days

Question 5

general guidelines for treatment duration for bacterial cystitis, + reccurrent, and pyelonephritis

Answer 5

 Bacterial cystitis (3 to 7 days?)
 Recurrent bacterial cystitis (?? longer)
 Pyelonephritis (4 to 6 weeks)

Question 6

Bacteriuria definition

Answer 6

 Positive urine culture
 NO clinical signs
Also called “subclinical bacteriuria”

Question 7

bacterial cystitis definition

Answer 7

 Positive urine culture
 Lower urinary tract clinical signs (pollakiuria, stranguria, dysuria)

Question 8

sporadic bacterial cystitis defnition

Answer 8

Positive urine culture and clinical signs
 Less than 3 episodes in the last 12 months

Question 9

recurrent bacterial cystitis definition

Answer 9

Positive urine culture and clinical signs
 > 3 episodes in the
last 12 months
 Single recurrence in last 3 months

Question 10

UTI- « Old school categories »
- uncomplicated vs complicated

Answer 10

Uncomplicated
 Sporadic bacterial infection of bladder
<><>
Complicated
 2-3 episodes of UTI per
year
 Defects in host defense mechanisms
 Any UTI in intact males  Presence of urinary
catheter or stent
 Systemic disorders (cushing, diabetes…)

Question 11

Prevalence of Bacterial Cystitis

Answer 11

Frequent in dogs
 Common in females
 Rare in intact males except when prostatitis
<><><>
Rare in cats
 <2% lower urinary tract disease
 Except : old cat with chronic renal failure

Question 12

host defence mechanisms for UTI

Answer 12

 Normal voiding
 Bacteriostatic/bactericidal prostatic secretion
 Length of urethra
 Non pathogenic flora in vulva / prepuce
 Low pH and high urea

Question 13

Etiology and Pathogenesis for UTI
- organisms

Answer 13

 E.Coli +++
> Staph, Strept, Enterococcus, Enterobacter,
Proteus, Klebsiella, Pseudomonas
 Most commonly 1 organism
> 20-30% mixed bacterial infections (≥2)
 Intestinal or cutaneous flora

Question 14

how quickly should a dog improve clinically if being treated for UTI with appropriate antibiotic?

Answer 14

 1to 2 days

Question 15

Your nurse calls back dog’s owner 24 hours afterstarting antibiotic- she is doing 100% - people are ectasic
Do you stop right away the antibiotic?

Answer 15

No, continue until finished

Question 16

dog comes back 1 month after…
recurrence of clinical signs of UTI….
 Do you manage it the same way?
> what questions should we ask ourselves about efficacy of last treatment?

Answer 16

 Bacteria was able to evade treatment?
 Bacteria could enter easily?
 Did we treat long enough?

Question 17

UTI relapse vs reinfection

Answer 17

“Relapses “
 Infections by same species of bacteria
> Inefficient antibacterial treatment
> Prostatitis
<><>
“ Reinfections “
 Reinfected by another bacteria
 Abnormal host defense
 Interval between reinfections > 2 weeks

Question 18

what do we do if we see a recurrence of a UTI in a dog?

Answer 18

 Urine culture indicated
 Results in 5 days
 Start antibiotic
 Same antibiotic or a new one? depends, tend to use same if it worked last time, but think about factors:
- compliance
- duration
- culture results

Question 19

What is the best method of urine collection for suspected UTI?

Answer 19

Cystocentesis

Question 20

Cystocentesis advantages, contraindications

Answer 20

Advantages
 Differentiates contaminants from pathogens
 Selection of antimicrobial drugs

Contra-indications
 Bladder tumor, thrombocytopenia, coagulopathy

Question 21

Urine Collection: Catheterization
- better in males or females? broad process?

Answer 21

Easy in males
 Prepare the prepuce
 Sterile gloves and catheter
<><>
Difficult in females
 Sedation required
 Ventral recumbency
 Frozen catheter

Question 22

how can we get a free catch urine smple for cats

Answer 22

Nosorb litter

Question 23

Interpretation of Results of Urine Culture for
Cystocentesis
Catheterization (male, female)
Midstream voided

Answer 23

Cystocentesis
Dog ≥ 1000 cfu/mL
Cat ≥ 1000 cfu/mL
<><>
Catheterization (male)
Dog ≥ 100,000 cfu/mL
Cat ≥ 100,000 cfu/mL
<><>
Catheterization (Femelle)
Dog ≥ 100,000 cfu/mL
Cat unknown
<><>
Midstream voided
- Not recommended for dog or cat

Question 24

when are voided urine samples ok? when to analyze? what is interpretation based on?

Answer 24

Not ideal but necessary if cystocentesis contra-indicated…
 Analysis within <12h after refrigeration
<><>
Interpretation based on:
 Level of growth
 Bacterial species (common pathogens or not)
 Pure growth or not
 Urine cytology
 Clinical signs

Question 25

how to store urine samples, and how long for different collection methods

Answer 25

If not processed immediately, refrigerate the sample and culture performed within  24h of cysto samples  <12h of voided samples

Question 26

important factor for interpreting urine culture

Answer 26

In the face of clinical response

Question 27

what if we do a urine culture and it is intermediate sensitivity in vitro? > If clinical response? > If no clinical response?

Answer 27

Clinical response: - Continue same ATB <><> No clinical response  Discontinue 1st ATB  Start an alternative drug based on sensitivity

Question 28

what if we do a urine culture and it is resistant in vitro? > If clinical response? > If no clinical response?

Answer 28

Clinical response: - Continue same ATB <><> No clinical response  Discontinue 1st ATB  Start an alternative drug based on sensitivity

Question 29

what if we do a urine culture and it is sensitive in vitro? > If clinical response? > If no clinical response?

Answer 29

Clinical response: - Continue same ATB <><> No clinical response: - compliance of owners? - vomiting? - reconsider diagnosis?

Question 30

what do we do if we culture a multiresistant bacteria from urine?

Answer 30

 Should not be a reason to treat or not to treat  If no clinical signs- no need to treat  Unless paralyzed or immunosuppressed patient

Question 31

Recurrent Bacterial Cystitis Should I repeat same antibiotic???

Answer 31

 If incomplete response to ATB at previous episode > investigate underlying causes  If reinfection (new pathogen) > look for predisposing factors  If relapsing, refractory, or persistent infection > check ATB dose, dose regimen, susceptibility pattern

Question 32

is long -term abx therapy needed for all recurent infections? - re-infections vs relapsing

Answer 32

Re-infection (new pathogen)  Short (3-5 days) treatment <><> Relapsing (same pathogen), persistent infection  Longer treatment (14 days) are indicated  Favour ATB penetrating in tissue (e.g. Amox/clavulanic acid)

Question 33

when should we do an intra-therpy urine culture? what do we do if negative vs positive results?

Answer 33

 Only when long treatment (>2 weeks)  Culture after 5 to 7d <><> If negative results: > can be used to decide when to stop > BUT do not guarantee microbiological cure <><> If positive results > check compliance and +/- further diagnostics

Question 34

when should we do a post-therapy urine culture? what can it tell us?

Answer 34

 Only when long treatment (>2 weeks)  Culture 5-7d after d/c antibiotics <><> Can help:  differentiate reinfection, relapse or persistent infection  guide potential future diagnostic testing <><>  NOT an indication to treat or not to treat

Question 35

prognosis - bacterial cystitis, recurrent cystitis, pyelonephritis

Answer 35

 Bacterial Cystitis: excellent  Recurrent cystitis: good if primary disease treated  Pyelonephritis: guarded

Question 36

Patient with Urinary Catheter, No clinical Signs - should we give prophylactic abx? - should we culture catheter tip when catheter removed?

Answer 36

 NO ATB treatment as a prophylaxy!!!  When catheter removed no need to culture the tip > not predictive of development of catheter associated UTI

Question 37

Patient with Urinary Catheter, With clinical Signs - what do we see, what do we do?

Answer 37

 Fever of unknown origin or bacteriemia  Gross or cytological abnormalities > Hematuria > Pyuria <><> ** U-culture** > **always indicated**  From a newly placed catheter (discard first ml)  Never from the collection bag  Not from the tip of the catheter > Treatment more successful if catheter removed

Question 38

Preventative Measures for Recurrent UTI - what have been used, do they work?

Answer 38

Lack of evidence to support  Pulse (intermittent)  Chronic low dose therapy > May induce emergence of resistance  Cranberry supplement  Infusion