Urinary tract disorders

Question 1

What is the most common cause of UTI’s?

Answer 1

Bacterial

Question 2

Are dogs or cats more likely to have a UTI?

Answer 2

Dogs

Question 3

Are UTI’s more commonly upper or lower?

Answer 3

Lower

Question 4

What are the 2 most common pathogens that cause UTI in dogs and cats?

Answer 4

E.coli

Staphylococcus

Question 5

Are bacterial UTI’s predominantly aerobic or anaerobic?

Answer 5

Aerobes almost exclusively

Question 6

How do most bacterial infections enter the urinary tract?

Answer 6

Ascend the urethra

Question 7

How can you easily determine what antibiotics you should use for a bacterial infection?

Answer 7

Look at morphology under microscope and gram stain

Cocci or gram positive
- Amoxicillin-clav
Rods or gram negative
- Trimethoprim sulfa, enrofloxacin

Question 8

Why should you do a gram stain or look at bacterial morphology before choosing what antibiotics?

Answer 8

Because the 2 most common causes e.coli and Staphylococcus respond to different antibiotics
Also it is quick, easy and cheap to do

Question 9

What antibiotics should you use for a e.coli or Staphylococcus UTI?

Answer 9

E.coli - Trimethoprim sulpha, enrofloxacin

Staphylococcus - Amoxicillin-clavulanate

Question 10

List some complicating local features of a UTI?

Answer 10

Urinary calculi
Urinary tract neoplasia
Strictures/ diverticulae
Motility/ urinary emptying disorders
Prostatic or other genital disease
Upper UT involvement

Question 11

What 5 disorders can cause systemic immunosuppression and be a complicating feature of a UTI?

Answer 11

Hyperadrenocorticism 
-Cushing's
Diabetes mellitus
Systemic neoplasia
Various infectious agents
Inherited immunodeficiencies

Question 12

What are the 2 possibilities for the cause of recurrent UTI’s?

Answer 12

Reinfection with a different organism

Relapse or persistence
-Didn’t get rid of it in the first place

Question 13

How do you diagnose a UTI?

Answer 13

Compatible clinical signs
Confirmed by 
-Cystocentesis urine sampling
-Urine sediment microscopic exam (Pyuria, Bacteruria, rods vs coci)
-Culture and sensitivity

Question 14

How can you differentiate bacteria in a urine sample as opposed to just debris?

Answer 14

If there is bacteria then they will all look the exact same

Question 15

What is the link between MIC determination and treating UTI’s?

Answer 15

MIC is a disc inhibition test which tests antibiotics at the standard dose concentration in blood
-However many antibiotics are excreted by the kidneys and therefore will have a higher concentration in urine compared to blood

Question 16

Describe a treatment strategy for an uncomplicated lower UTI?

Answer 16

Choose antibiotic
-Ideally on basis of sensitivity
Treat for 14 days*
Wait for 10-14 days after finishing antibiotics
Re-check urine sediment or urine culture to check that relapse has not occurred
-Monitor for recurrence of signs

Question 17

Even though you have treated a patient with culture-sensitive antibiotics and the owner has done so for the right amount of time, the patient has returned a positive urine sample for UTI. What 3 things could be happening?

Answer 17

Contamination of sample
-Cystocentesis vs. free catch

Mistaking normal debris for an infection
-Debris vs. bacteria

Forming a biofilm or a ‘pod’ inside the epithelial lining of the bladder