Bacterial cystitis

Question 1

Give a definition of feline lower urinary tract disease

Answer 1

FLUTD is a spectrum of diseases with similar clinical signs (e.g., dysuria, hematuria, pollakiuria, periuria) often with behavioral changes such as aggression and perineal over-grooming

There are multiple potential underlying causes and a thorough investigation may be required

Question 2

Give the major potential causes of lower urinary tract disease in cats and their approximate frequency

Answer 2

Feline idiopathic cystitis: 50-70%
Urolithiasis: 10-25%
Uretheral obbstruction: 20-30%
Bacterial cystitis: 2-10%
Anatomical defects (e.g., urethral stricture): <10%
Neoplasia: <2%

Question 3

What is important to check when investigating a cat for FLUTD

Answer 3

Some cats that present with apparent clinical signs suggesting a medical disorder of the lower urinary tract are found to have a behavioural problem (i.e., inappropriate urination rather than pollakiuria)

Careful history taking together with information about sites and quantities of urine being passed are important

Urinalysis should always be performed in cases suspected to have behavioral inappropriate urination to help rule out urinary tract disease

Question 4

How frequent is bacterial cystitis in cats

Answer 4

Bacterial cystitis is less common in cats than in dogs with most surveys suggesting that it is rare (<2-3% of cases of FLUTD)

Some studies suggest that up to 12% or more of first-opinion cases may have bacterial cystitis

Bacterial UTIs are rare in healthy cats

Question 5

What are the risk factors for bacterial cystitis

Answer 5

Older cats

Any cat with a disease diluting their urine

Cats with diabetes mellitus

Any cat undergoing urethral catheterization

Cats that have had perineal urethrostomy

Female cats

Question 6

Which exam is very important when suspecting bacterial cytitis and what would you expect to find

Answer 6

Routine sediment analysis of a urine sample collected by cystocentesis is extremely valuable

In most cases of bacterial cystitis, it will reveal pyuria and bacteriuria

Bacterial culture will confirm the diagnosis and allow selection of the most appropriate antibiotic

Question 7

With which diseases bacterial UTIs can be clinically silent

Answer 7

Diabetes mellitus

Chronic kidney disease

Hyperthyroidism

Therefore, it is important to routinely check for them with bacterial culture in cats that are at risk

Question 8

What is the main causes of UTIs

Answer 8

Bacteriological studies indicate that most UTIs are associated with a single bacterial species and typically with species associated with the gastrointestinal tract or the commensal flora associated with the distal urinary tract

Thus ascending infections (via the urethra) are considered to be the most common sources of UTIs

Question 9

Explain why the urine of a healthy cat is not favorable to bacterial infection

Answer 9

Healthy cats have concentrated urine of high osmolality which represents a good innate defence

Question 10

Describe the classic clinical signs associated with UTI

Answer 10

classic clinical signs associated with UTI include:
- pollakiuria
- dysuria
- hematuria
- sometimes stranguria

These signs are all strognly suggestive of urinary tract disease and inflammation but do not suggest either the cause of the disease nor the specific anatomical site(s) affected within the urinary tract

Additional signs that may be seen in uncomplicated cases of UTI include:
- nocturia
- abdominal discomfort
- altered urine odor and appearance

Question 11

Describe the clinical signs classically encountered with a upper UTI

Answer 11

Renal involvement (pyelonephritis) with the infection may result in more profound systemic signs such as:
- pyrexia
- lethargy
- vomiting
- inappetence
- PU/PD

But, low-grade chronic pyelonephritis may be asymptomatic

Question 12

Which precaution should be taken for urine culture

Answer 12

Cysteocentesis is the recommended method for collection of urine as contamination with bacteria from the lower urogenital tract is avoided

Ideally, urine samples should be refrigerated and cultured within 6 hours to avoid changes in bacterial types and numbers

Question 13

What are the most common organisms involved in feline bacterial cystitis

Answer 13

E. coli (the most common)

Staphylococcus intermedius

Streptococcus

Proteus

Question 14

What is the definition of an uncomplicated UTI

Answer 14

An uncomplicated UTI means there is no structural, functional or neurological abnormality in the affected cat

Question 15

What is a complicated UTI

Answer 15

A complicated UTI is a UTI with a complicating factor such as relapsing, recurrent UTI, host complicating factors (e.g., diabetes, CKD, urolithiasis) or involvement of the upper urinary tract

Question 16

Explain the reasons for an apparent failure of therapy to resolve a UTI

Answer 16

There are three possible reasons for an apparent failure:
- persistent infection
- relapse
- re-infection

Question 17

Give a definition for “persistent infection”

Answer 17

In this situation, the UTI is never eliminated by the antimicrobial therapy:
- poor owner compliance
- incorrect choice of antimicrobial
- poor absorption of the drug
- inappropriate dose
- inappropriate frequency of administration

Question 18

Give a definition for a “relapse” of UTI

Answer 18

The infection is apparently resolved, but infection with the same organism recurs within a very short period

This most likely occurs as a result of incomplete elimination of the organism
- often occurs as a result of a persistent nidus of infection (e.g., pyelonephritis, infected urolithiasis)

Question 19

How would you manage a relapsing UTI

Answer 19

Investigating a cause for relapsing

A minimum of 6 weeks of antibiotherapy based on culture and sensitivity

Evaluation of urine cultures both during and after therapy

Question 20

Give a definition of re-infection

Answer 20

Infection occurs again within a short period of time, but with a different organism

This suggests an underlying defect that is predisposing to repeat infections

Question 21

How would you manage a re-infection

Answer 21

Careful search for any interference with the innate defense mechanisms or evidence of immunosuppression (e.g., glucocorticoid use)