Lecture 7

Question 1

UTI in dogs vs cats

Answer 1

UTI is common in dogs but NOT in cats

*NOT synonymous for bladder infection

Question 2

Primary route for UTI

Answer 2

Ascending infection (also need motility, adherence and colonization)

*hematogenous spread is not common

Question 3

Bacterial virulence factors

Answer 3

Motility
Adhesins
Capsular antigens- inhibit phagocytosis
Hemolysis- iron scavenging
Plasmids- promote abx resistance and can be passed to other bacteria
Split urea and damage epithelium

Question 4

Host defenses

Answer 4

Micturition
Anatomy
Mucosal barrier
Urine

Question 5

How does normal micturition help defend

Answer 5

Adequate flow
Complete emptying
Frequent voiding

Question 6

Anatomic barriers that defend against UTI

Answer 6

Urethral length
Urethral high pressure zone (inhibit reflux)
Urothelium (microplicae)
Urethral and ureteral peristalsis
Prostatic secretions
Ureterovesical flap valves prevents backflow of urine back into ureter and kidney

Question 7

Mucosal barriers

Answer 7

Glycosaminoglycans- inhibits adherence
Immunoglobulins
Cell exfoliation
Commensal bacteria- distal urethra

Question 8

Urine properties that defend against bacteria

Answer 8

PH
Osmolality
Urea (except urease producing bacteria)
Tamm-horsfall protein
Low MW carbs

Question 9

Lower UTI clin signs

Answer 9

Pollakiuria
Stranguria
Hematuria
Strong odor
Normal appetite and attitude unless prostate is involved

Question 10

Upper UTI signs

Answer 10

Variable and non specific
Anorexia 
Lethargy
“Back pain”
PU/PD

Question 11

PE of lower UTI

Answer 11

Caudal ab pain
Thickened bladder
Palpation may stimulate stranguria
Everything else normal

Question 12

PE of upper UTI

Answer 12

Depressed
Fever
T-L pain
+/- large kidneys

Question 13

Diagnostic evaluation if suspect UTI

Answer 13

UA
Culture/sensitivity

If recurrent or systemic signs, look at CBC/chem, rads, US

Question 14

CBC/chem of UTI

Answer 14

Normal or stress leukogram
**if there is leukocytosis then it is NOT just a bladder infection

Normal chem usually

Question 15

UA of UTI

Answer 15

Look at USG
Bacteria- doesn’t localize infection
Casts- if present suggests renal involvement; if not present it doesnt rule out renal involvement

Question 16

How to use culture/sensitivity results?

Answer 16

Pick abx that concentrates at place of interest 4x MIC minimum

Question 17

No predisposing factors found and typical lower UTI clinical signs

Answer 17

Uncomplicated bacterial cystitis

Question 18

Complicated UTI

Answer 18

Predisposing factors- ectopic ureters, neuro disease, cushings, neoplasia

If kidneys or prostate are involved

Can’t cure without correcting underlying problem

Question 19

Asymptomatic bacteriuria

Answer 19

Positive culture with no clinical signs

Common in cushings patients, chemo patients, and CKD patients

Question 20

Therapy for uncomplicated bacterial cystitis

Answer 20

10-14 days
Clinical signs resolve in 48-72 hrs but need to complete course
May need to treat 4-8 weeks for complicated UTI

Question 21

What are your options with mixed infections?

Answer 21

Option1- single abx to which both organisms are sensitive

Option 2- treat with 2 abx based on C/S

Option 3- treat dominant pathogen and then culture later to see if second pathogen is still present

Question 22

What could you use for frequent reinfection

Answer 22

Methenamine hippurate- urinary antiseptic
No resistance
Converted to formaldehyde
Requires acidic urine
Option as an alternative to prophylactic abx use