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Small Animal Med. I > UTI - Green > Flashcards

UTI - Green Flashcards

1
Q

Signs of Lower Urinary Tract Inflammation (LUTI)

A
  • Hematuria
  • Dysuria
  • Decreased volume of urination
  • Urge incontinence
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2
Q

What is NOT a DDX for Hematuria, Pollakiuria & Stranguria in a DOG?

A

Idiopathic cystitis!

(ONLY CATS)

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3
Q

DDX for LUTD signs?

A
  • Bacterial UTI (dogs > cat)
  • Urolithiasis
  • Neoplasia (dogs > cat)
  • Idiopathic cystitis (CATS only)
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4
Q

What % of dogs will have at least one bacterial UTI during their life?

Recurrence rate?

A
  • 14% of dogs
  • 75% will be a single episode UTI ⇒ 25% will have multiple episodes
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5
Q

Which cats get UTIs?

(NB: UTIs are rare in cats ⇒ 0.1 to 1%)

A
  • More common in old cats w/ chronic renal dz (dilute urine)
  • 50% of cats > 10 yrs that present with LUTD signs have UTIs
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6
Q

What causes Bacterial UTIs?

A
  • Mostly monomicrobic ⇒ one organism only
  • E. coli is the most common uropathogen in dogs & cats
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7
Q

Which bacteria are commonly associated w/ UTIs?

A
  • Gram (-) ⇒ 75%
    • E. coli ( > 50%)
    • Proteus
    • Klebsiella
    • P. aeruginosa
  • Gram (+) ⇒ 25%
    • Staph aureus/intermedius
    • Enterococcus
    • *Strep *
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8
Q

What is the most common origin of bacteria causing a UTI?

A

Ascending from bowel flora

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9
Q

What are normal host defenses against UTIs?

A
  • Urine of healthy animals inhibits bacT growth
    • Urea and ammonia content of normal urine
    • High osmolality of urine (esp. cats)
    • Urine acidity
  • Normal voiding ⇒ “Hydrokinetic washout”
  • Urethra
    • Mid-urethral high pressure zone ⇒ females
    • Length & distance of urethral meatus from anus ⇒ males
  • Bladder urothelium
    • Glycoaminoglycans prevent attachement
  • Ureter ⇒ directs urine flow
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10
Q

Which region of the kidney is more susceptible to infection?

A

Renal medulla > cortex

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11
Q

What are the 3 requirements to develop a UTI?

A
  1. Exposure to a sufficient # of uropathogens
  2. Urothelial receptors for uropathogens
  3. Failure of normal host urinary defenses
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12
Q

What percentage of dogs w/ Hyperadrenocorticism will get a UTI?

(endogenous corticosteroids)

A

46%

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13
Q

What % of dogs on long term corticosteroids therapy (> 6 mo) will get a UTI?

How should you monitor for this?

A
  • 40%
  • Urine culture (NOT UA)
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14
Q

What percentage of dogs/cats with DM get a UTI?

A
  • Dogs ⇒ 37%
  • Cats ⇒ 12%
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15
Q

What % of our SA patients will get a UTI when they have an indwelling urinary catheter?

A

50%

w/in days of indwelling cathether placement

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16
Q

What % of female dogs will get a UTI with a single urinary catheterization?

Time frame?

A

20% w/in 3 d. of catheterization

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17
Q

Any animal with _________ should be screened for a UTI.

A

Urinary Incontinence

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18
Q

What diseases contribute to UTIs in CATS?

A
  • CRF ⇒ 30% of CRF cats will get a UTI
  • Hyperthyroidism ⇒ 12% of hyperthyroid cats will get a UTI
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19
Q

What is the most important SCREENING test for UTIs?

A

U/A

20
Q

What is the GOLD STANDARD test for UTIs?

How do you get your sample?

A

Urine Culture

Cycsto!

21
Q

What amt of culture growth indicates a UTI on a Quantitative Urine Culture (via cysto)?

A

> 1,000 cfu/mL = a UTI

22
Q

What type of information is useful from a urine culture on VOIDED urine?

A

“No growth” is the only useful info provided

(rest is useless as may have been contamination)

23
Q

Does the absence of Pyuria rule out a UTI?

A

NO!!!

Pyuria = Inflammation

ø Pyruia = still possible UTI

24
Q

What makes a UTI Complicated?

A
  • Recurrence of > 2 episodes/yr
  • Known metabolic or anatomic predisposing factors
  • Recent ABX TX (w/in 2 mo.)
  • TX w/ immunosuppressive drugs (steroids)
25
Q

What is the most important factor for the eradication of UTI?

A

Urine conc. of antimicrobial drugs

26
Q

Where do antimicrobial drugs need to be concentration for renal or prostate infections?

A

In the tissues

27
Q

Which 3 drugs should you not reach for to TX a K9 UTI caused by E. coli?

A
  • Amoxicillin
  • Ampicillin
  • Chloramphenicol
28
Q

Which drug should you reach for first to TX a K9 UTI?

Second?

Third?

A
  1. Cephalexin ⇒ kills all but Psuedomonas & Strep. viridans
  2. Amoxicillin/Clavulanate (Clavamox) ⇒ kills all but Klebsiella & Psuedomonas
  3. Gentamicin ⇒ kills everything but can only give IV & isn’t kidney friendly
29
Q

What are the only 2 drugs that will TX a K9 UTI caused by Pseudomonas?

A
  • Enrofloxican
  • Gentamicin
30
Q

What are the only 3 drugs that will TX a K9 UTI caused by Klebsiella?

A
  • Cephalexin
  • Enrofloxacin
  • Gentamicin
31
Q

Why may the Kirby-Bauer Metod for susceptibility be misleading for a UTI?

A
  • Urine conc. of an ABX may be 10-100 times higher than the blood conc. of the same drug.
    • KBM disks reflect achievable ABX blood conc.
  • “S” is accurate
    • “R” may or may not be accurate
32
Q

Which susceptibility testing method is better for UTIs?

A

MIC provides more info

(minimal inhibitory conc)

33
Q

List the “1st Line” Urinary Antimicrobials for UTIs.

A
  • Amoxicillin
  • Trimethoprim-sulfonamide
  • 1st Gen. Cephalosporins ⇒ Cephalexin or Cefadroxil
34
Q

List the “2nd Line” Antimicrobials for UTIs.

A
  • Amoxicillin/clavulanate (Clavamox®)
    • NOT if you have a prostatitis
  • Vet. approved Fluoroquinolones
    • Enrofloxacin (Baytril®)
    • Marbofloxacin (Zeniquin®)
    • DO NOT exceed 5 mg/Kg/d in Cats ⇒ retinal damage & acute blindness
      *
35
Q

List the “3rd Line” Antimicrobials for UTIs

(for highly resistant organisms)

A
  • 3rd Gen. Cephalosporins
    • Ceftiofur
    • Cefixime
    • Cefpodoxim (Simplicef®)
    • Cefovecin (Convenia®) ⇒ only if all other TX fail
  • Aminoglycosides
    • Amikacin
    • Gentamicin
36
Q

What is the duration of TX for an Uncomplicated UTI?

A

ABXs for 14-21 d.

37
Q

Supportive care for UTIs?

A
  • Try to increased H2O intake ⇒ promote polyuria
  • Correct any know predisposing factors, metabolic or anatomic
38
Q

How can you determine whether or not you’ve successfully treated a UTI?

A
  • Document sterile urine on a UC
  • Ideally:
    • UC 3-4 d after beginning TX
    • UC 5-7 d. after finishing TX
    • UC 1-3 mo. after finishing TX to insure sterility of urine
39
Q

How can UTI Therapy fail?

A
  • ABX not given ⇒ O compliance
  • Highly resistant or sequestered organism
  • Failure to ID & manage host predispositions
    • Urachal remnant
    • Bladder calculi
    • Bladder tumor
    • Prostatic disease
    • Perivulvar conformation
    • Polypoid cystitis
  • Failure of intrinsic host defense mechanisms
    • Urinary rentention
40
Q

54% of recurrent UTIs are due to ____________.

What can this suggest?

A
  • Reinfection w/ a different organisms ⇒ responds to appropriate ABXs
  • Multiple reinfections suggest impaired host defenses
41
Q

46% of recurrent UTIs are due to ___________.

What does this suggests?

A
  • Relapse w/ same organism ⇒ d. to wks post-TX. ⇒ original infxn was never eradicated
  • Suggests a deep-seated infxn or re-seeding from an adjacent infxn.
42
Q

How do you TX a recurrent or persistent UTI?

A
  • Long-term ABXs for better tissue penetration ⇒ 30-60 d.
  • Search for the predisposing factor.
43
Q

Which Imaging Studies are good to use for a diagnostic approach

to recurrent or persistent UTI?

A
  • Plain Rads
  • Contrast Rads ⇒ double contrast cystogram
  • U/S
44
Q

What is another good diagnostic tool for recurrent or persistent UTIs?

A

Cystoscopy

45
Q

What is the prophylatic TX for recurrent UTIs?

Major problem w/ this approach?

A
  • Chronic TX w/ low doses of antimicrobials OR Intermittent use of antimicrobials for 6 months or more
    • 1/3 to 1/2 of the total daily dose given once at night
      • Amoxicillin or Clavamox ⇒ Gram +
      • Nitrofurantoin ⇒ Gram -
  • Emergence of highly resistent organisms
46
Q

What are your big concerns with prophylactic TX of recurrent UTIs

w/ Nitrofurantoin (Macrodantin®)?

A
  • Adverse Effects:
    • Anorexia/vomiting
    • Thrombocytopenia ⇒ wipes out the BM
    • Liver failure
    • Myasthenia-like syndrome
47
Q

How should you check if your prophylactic TX for recurrent UTIs is working?

When can you stop meds?

A
  • UC monthly to insure that urine remains sterile & drugs are working
  • Stop TX once urine remains sterile for 6 consective months

Small Animal Med. I (18 decks)

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