Oakley UTI 2 Flashcards
Do you need Blood work for urinary issues?
No except if
Systemic signs (pyelonephritis, obstruction?)
Or if urine specific gravity low (kidney issue?)
Bacterial Cystitis Treatment
Clinical signs secondary to inflammation
> NSAIDs if not contraindicated
> Start with NSAIDs if previous reaction to ATB
Broad Spectrum antibiotic
empirical UTI treatment
- what do we use?
- what do we avoid?
Large spectrum antibiotic treatment
> Amoxicilline 11-15mg/kg PO BID or TID
> TMS 15mg/kg PO q12h
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Avoid:
Using same ATB if reinfection
Fluoroquinolone and 3rd gen cephalosporin (overkill)
how long should we treat UTI with antibiotics?
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
general guidelines for treatment duration for bacterial cystitis, + reccurrent, and pyelonephritis
Bacterial cystitis (3 to 7 days?)
Recurrent bacterial cystitis (?? longer)
Pyelonephritis (4 to 6 weeks)
Bacteriuria definition
Positive urine culture
NO clinical signs
Also called “subclinical bacteriuria”
bacterial cystitis definition
Positive urine culture
Lower urinary tract clinical signs (pollakiuria, stranguria, dysuria)
sporadic bacterial cystitis defnition
Positive urine culture and clinical signs
Less than 3 episodes in the last 12 months
recurrent bacterial cystitis definition
Positive urine culture and clinical signs
> 3 episodes in the
last 12 months
Single recurrence in last 3 months
UTI- « Old school categories »
- uncomplicated vs complicated
Uncomplicated
Sporadic bacterial infection of bladder
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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…)
Prevalence of Bacterial Cystitis
Frequent in dogs
Common in females
Rare in intact males except when prostatitis
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Rare in cats
<2% lower urinary tract disease
Except : old cat with chronic renal failure
host defence mechanisms for UTI
Normal voiding
Bacteriostatic/bactericidal prostatic secretion
Length of urethra
Non pathogenic flora in vulva / prepuce
Low pH and high urea
Etiology and Pathogenesis for UTI
- organisms
E.Coli +++
> Staph, Strept, Enterococcus, Enterobacter,
Proteus, Klebsiella, Pseudomonas
Most commonly 1 organism
> 20-30% mixed bacterial infections (≥2)
Intestinal or cutaneous flora
how quickly should a dog improve clinically if being treated for UTI with appropriate antibiotic?
1to 2 days
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?
No, continue until finished
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?
Bacteria was able to evade treatment?
Bacteria could enter easily?
Did we treat long enough?
UTI relapse vs reinfection
“Relapses “
Infections by same species of bacteria
> Inefficient antibacterial treatment
> Prostatitis
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“ Reinfections “
Reinfected by another bacteria
Abnormal host defense
Interval between reinfections > 2 weeks
what do we do if we see a recurrence of a UTI in a dog?
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
What is the best method of urine collection for suspected UTI?
Cystocentesis
Cystocentesis advantages, contraindications
Advantages
Differentiates contaminants from pathogens
Selection of antimicrobial drugs
Contra-indications
Bladder tumor, thrombocytopenia, coagulopathy
Urine Collection: Catheterization
- better in males or females? broad process?
Easy in males
Prepare the prepuce
Sterile gloves and catheter
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Difficult in females
Sedation required
Ventral recumbency
Frozen catheter
how can we get a free catch urine smple for cats
Nosorb litter
Interpretation of Results of Urine Culture for
Cystocentesis
Catheterization (male, female)
Midstream voided
Cystocentesis
Dog ≥ 1000 cfu/mL
Cat ≥ 1000 cfu/mL
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Catheterization (male)
Dog ≥ 100,000 cfu/mL
Cat ≥ 100,000 cfu/mL
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Catheterization (Femelle)
Dog ≥ 100,000 cfu/mL
Cat unknown
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Midstream voided
- Not recommended for dog or cat
when are voided urine samples ok? when to analyze? what is interpretation based on?
Not ideal but necessary if cystocentesis contra-indicated…
Analysis within <12h after refrigeration
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Interpretation based on:
Level of growth
Bacterial species (common pathogens or not)
Pure growth or not
Urine cytology
Clinical signs
how to store urine samples, and how long for different collection methods
If not processed immediately, refrigerate the sample and culture performed within
24h of cysto samples
<12h of voided samples
important factor for interpreting urine culture
In the face of clinical response
what if we do a urine culture and it is intermediate sensitivity in vitro?
> If clinical response?
> If no clinical response?
Clinical response:
- Continue same ATB
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No clinical response
Discontinue 1st ATB
Start an alternative drug based on sensitivity
what if we do a urine culture and it is resistant in vitro?
> If clinical response?
> If no clinical response?
Clinical response:
- Continue same ATB
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No clinical response
Discontinue 1st ATB
Start an alternative drug based on sensitivity
what if we do a urine culture and it is sensitive in vitro?
> If clinical response?
> If no clinical response?
Clinical response:
- Continue same ATB
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No clinical response:
- compliance of owners?
- vomiting?
- reconsider diagnosis?
what do we do if we culture a multiresistant bacteria from urine?
Should not be a reason to treat or not to treat
If no clinical signs- no need to treat
Unless paralyzed or immunosuppressed patient
Recurrent Bacterial Cystitis
Should I repeat same antibiotic???
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
is long -term abx therapy needed for all recurent infections?
- re-infections vs relapsing
Re-infection (new pathogen)
Short (3-5 days) treatment
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Relapsing (same pathogen), persistent infection
Longer treatment (14 days) are indicated
Favour ATB penetrating in tissue (e.g. Amox/clavulanic acid)
when should we do an intra-therpy urine culture? what do we do if negative vs positive results?
Only when long treatment (>2 weeks)
Culture after 5 to 7d
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If negative results:
> can be used to decide when to stop
> BUT do not guarantee microbiological cure
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If positive results
> check compliance and +/- further diagnostics
when should we do a post-therapy urine culture? what can it tell us?
Only when long treatment (>2 weeks)
Culture 5-7d after d/c antibiotics
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Can help:
differentiate reinfection, relapse or persistent
infection
guide potential future diagnostic testing
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NOT an indication to treat or not to treat
prognosis
- bacterial cystitis, recurrent cystitis, pyelonephritis
Bacterial Cystitis: excellent
Recurrent cystitis: good if primary disease
treated
Pyelonephritis: guarded
Patient with Urinary Catheter, No clinical Signs
- should we give prophylactic abx?
- should we culture catheter tip when catheter removed?
NO ATB treatment as a prophylaxy!!!
When catheter removed no need to culture
the tip
> not predictive of development of catheter associated UTI
Patient with Urinary Catheter, With clinical Signs
- what do we see, what do we do?
Fever of unknown origin or bacteriemia
Gross or cytological abnormalities
> Hematuria
> Pyuria
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** 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
Preventative Measures for Recurrent UTI
- what have been used, do they work?
Lack of evidence to support
Pulse (intermittent)
Chronic low dose therapy
> May induce emergence of resistance
Cranberry supplement
Infusion
