Urinary Tract Infections Flashcards
Define the terms pyuria, hematuria, pollakiuria, and polyuria.
Pyuria: WBC in urine
Hematuria: RBC in urine
Pollakiuria: Frequent but small amounts of urination
Polyuria: Urinating large amounts
What do most UTIs develop from?
A breach in host defenses. Usually bacterial in nature but could be viral, parasitic, fungal, or other
UTIs in dogs
More common in females than males. But 14% of dogs will get a UTI
UTIs in cats
Healthy cats RARELY get a UTI. It is usually a mucus crystalline plug and don’t need ABX. If they do get one it is concurrent with something else
What are some host defenses against UTIs
A. Normal micturition: frequent voiding of bladder
B. Anatomical features: urethral/ureteral peristalsis, renal blood supply/flow, ureteral vesicular glands
C. Mucosal defense: Pathogen associated molecular patterns or PAMPS activate innate immune responses
D. Properties of urine: pH, hyper-osmolarity
E. Systemic immune-competence
What are some clinical findings of a UTI?
- Variable depending on pathogen, site, and duration
- Pollakiuria
- Stranguria
- Polyuria
- Abdominal/kidney pain
What are some causes of polyuria from a UTI?
- Pyonephritis
- E. Coli UTI
What’s an important thing to do if there is a UTI present?
Look for an underlying cause
What should you examine on a reproductive exam?
- Anatomic like the vulva (hooded?), dermatitis, or vaginal stenosis/PU sites?
- Discharge or hair?
- Prostate enlargement
What two parts of the urinary tract are UTIs localized into?
Lower and upper
What structures are included in a lower UTI?
Bladder, Urethra, and Prostate
What structures are included in an upper UTI?
Ureter and Kidney
What signs or abnormality are present on a lower UTI?
A. Stranguria and pollakiuria
B. Gross hematuria at the end of micturition
C. Normal CBC
D. Urine will show pyuria, hematuria, proteinuria, and bactiuria
What signs or abnormality are present on an upper UTI?
A. Polyuria and polydipsia
B. Systemic infection signs
C. May have a leukocytosis on CBC
D. Urine will show pyuria, hematuria, proteinuria, bactiuria, and granular casts; get those out. Save the nehpron
How is urine collected for a UTI?
Cystocentesis is the gold standard but you could get it from catheterization or mid stream catch while voiding
Why is cyctocentesis the best method to collect urine for a sample?
It is the most sterile and will decrease the likelihood of a false positive bactiuria
What are the parts of a urinalysis?
USG
Dipstick - invalid leukocyte method for vets
Urine sediment - may still be quiet with bacteria
Urine culture - MUST do
How to diagnose based on a culture?
Qualitative - isolation or visualization of bacteria which is not recommended
Quantitative - determine the CFU per unit volume of urine to see how significant the bacteria are
CFU interpretation
Greater than 1000 CFUs from a cystocentesis is significant and warrants treatment.
What are the most common bacteria isolated from Dogs and Cats?
E. Coli and Staph
Which bacteria is found in the dog and is non-pathogenic/inherently resistant to most ABX?
Enterococcus
What are some predisposing causes of UTIs?
- Abnormal micturition
- Damage to mucosal barriers
- Underlying systemic disease
- Anatomic abnormalities
- Iatrogenic - indwelling catheters
What is the difference between a complicated and uncomplicated UTI?
- Uncomplicated UTI is where no structure, neurologic, or functional abnormality is identified
- Complicated UTI
- Sexually intact
- A predisposing cause
- An upper UTI
- Anything involving the kidneys
How do you treat an uncomplicated UTI?
- Amoxicillin is a first line
- Trimethoprim-sulfonamide but has side affects
- Treat for 7-14 days traditionally but may be 3-5 days with a high dose
How do you treat a complicated UTI?
Guide ABX choice by culture and sensitivity
How do you treat a sub clinical bacteriuria?
Unless they are immunocompromised, do not treat and let them resolve it on their own
When can you use a fluoroquinolone?
- The C+S says the bug is resistant to everything else
- There is a known pyelonephritis
What do you do with a complicated or recurrent UTI?
-Usually they are due to an underlying cause. Try to identify and fix
-If there is a continued re-infection or relapse, a 4-6 week therapy may be indicated
What does ultrasound do in a UTI case?
Assessment of tissue architecture
- Asses bladder thickness
- Radiolucent uroliths
- Neoplasia
- Dilated renal pelvises and other renal tissue
- Prostate
- Adrenal gland size (hyperadrenocorticism)
What is the definition of reinfection?
Recurrent UTI in 6 months after a successful treatment with a different organism. An underlying cause was likely not addressed
What is the definition of relapse?
Recurrent UTI in 6 months after a successful treatment with the same organism. Could be from:
Wrong ABX therapy, dose, resistance, bacterial sequestration
What are some reasons for poor response to therapy?
- Resistance
- Ineffective drug or inadequate treatment interval
- Lack of compliance
- Decreases drug absorption
- Bacterial sequestration
- Mixed infection
- Iatrogenic
- Underlying cause not addressed
What is subclinical bactiuria?
Urine positive with culture but does not have clinical or cytological evidence of UTI
Most likely don’t need to treat!
