Urinary Tract Infections

Question 1

How many pets with indwelling catheters will get UTIs?

Answer 1

30-50%

Especially dangerous if having steroids or if kidney disease is present, or if being diuresed

Question 2

Which viruses may be associated with UTIs?

Answer 2

Canine Canine adenovirus type I
Canine herpesvirus
Feline Feline coronavirus Feline calicivirus
Feline immunodeficiency virus Bovine herpesvirus-4
Feline leukemia virus
Feline foamy (syncytium-forming) virus

Question 3

How may pyelonephritis present

Answer 3

Acute pyelonephritis - signs of severe systemic illness (eg, uremia, fever, painful kidneys, possible nephromegaly, and/or sepsis).
Chronic pyelonephritis usually has a more insidious presentation: slowly progressive azotemia that may not be associated with uremia, progressive kidney damage, and ultimately, renal failure if untreated. Bacterial pyelonephritis may be associated with hematuria only

Question 4

What are the types of complicated infection?

Answer 4

(1) involvement of the upper urinary tract and/or prostate, (2) an underlying comorbidity that alters the structure or function of the urinary tract, such as an endocrinopathy or chronic kidney disease (CKD), or (3) recurrent infection
Most cats have complicated UTIs

Question 5

What co-morbidities can increase the risk of a UTI?

Answer 5

Endocrinopathies - Diabetes mellitus, hyperadrenocorticism, hyperthyroidism
CKD
Urinary or reproductive tract anatomic abnormality
Immunocompromised
Neurogenic bladder
Pregnancy

Question 6

What is a relapsing recurrent infection?

Answer 6

Recurrence within weeks to months of a successfully treated infection
Sterile bladder during treatment
Same organism

Question 7

What causes a relapsing recurrent infection?

Answer 7

Failure to eradicate the inciting cause
Deep-seated niche
Pyelonephritis
Prostatitis
Bladder submucosa
Stone
Neoplasia

Question 8

What is a refractory/ persistent infection?

Answer 8

Persistently positive culture with original pathogen despite in vitro antimicrobial susceptibility
No elimination of bacteriuria during or after treatment

Question 9

What causes a refractory/ persistent infection?

Answer 9

Rare
Failure of host defenses
Structural abnormality
Patient/client incompliance
Abnormal metabolism/excretion of antimicrobial

Question 10

What is a reinfection?

Answer 10

Recurrence with different organism

Variable time course after previous infection

Question 11

What causes a reinfection?

Answer 11

Poor systemic immune function - Endocrinopathy/ Immunosuppressed
Loss urine antimicrobial properties - Glucosuria/ Dilute urine
Anatomic abnormality
Physiologic predisposition
Neurogenic bladder
Urinary incontinence

Question 12

What is a superinfection?

Answer 12

Infection with different pathogen during treatment of the original infection

Question 13

What can cause a superinfection?

Answer 13

Neoplasia
Catheter
Cystotomy tube

Question 14

What are appropriate first line ABs for uncomplicated UTIs?

Answer 14

amoxicillin, cephalexin, or trimethoprim-sulfamethoxazole

Question 15

What are appropriate first line ABs for prostatitis?

Answer 15

Enrofloxacin or TMPS

Question 16

How do you treat pyelonephritis?

Answer 16

Parenteral therapy should be continued until patients will eat and drink normally and azotemia is no longer improving with intensive therapy; infections should then be treated as complicated UTIs, with a minimum of 6 to 8 weeks of antibiotics and regular monitoring for recurrence of infections during and following therapy. Chronic pyelonephritis should be treated as complicated UTIs as well, but patients do not usually require hospitalization at initial diagnosis.

Question 17

How do you treat prosatitis?

Answer 17

The blood-prostate barrier is compromised with acute prostatitis and an appropriate antimicrobial should be selected based on culture and sensitivity. Treat as a complicated UTI for a minimum of 4 weeks.

For chronic, trimethoprim-sulfamethoxazole, chloramphenicol, and enrofloxacin (but not ciprofloxacin) are excellent choices. Antimicrobials are given for a minimum of 6 to 8 weeks. Culture of prostatic fluid should be performed before and after discontinuation of antimicrobials

Also castrate

Question 18

What would be the ideal way to monitor treatment of a complicated UTI?

Answer 18

Optimal duration of therapy is unknown. Antimicrobials are usually administered for a minimum of 3 to 6 weeks. Urine should be evaluated with culture in the first week of treatment for response to therapy, before discontinuing therapy, 5 to 7 days and 1 month after therapy discontinuation.

Question 19

What is emphysematous cystitis?

Answer 19

accumulation of air within the bladder wall and lumen secondary to infection with glucose-fermenting bacteria. Most cases are due to E coli infection, but Proteus spp, Clostridum spp, and Aerobacter aerogenes have also been reported.
Emphysematous cystitis most commonly develops in dogs and cats with diabetes mellitus