Bacterial UTI (dogs \> cat) Urolithiasis Neoplasia (dogs \> cat) Idiopathic cystitis (CATS only)

UTI - Green Flashcards by Linde Saunders

Signs of Lower Urinary Tract Inflammation (LUTI)

Hematuria
Dysuria
Decreased volume of urination
Urge incontinence

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

Idiopathic cystitis!

(ONLY CATS)

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DDX for LUTD signs?

Bacterial UTI (dogs > cat)
Urolithiasis
Neoplasia (dogs > cat)
Idiopathic cystitis (CATS only)

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

Recurrence rate?

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

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Which cats get UTIs?

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

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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What causes Bacterial UTIs?

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

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Which bacteria are commonly associated w/ UTIs?

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

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

Ascending from bowel flora

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What are normal host defenses against UTIs?

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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Which region of the kidney is more susceptible to infection?

Renal medulla > cortex

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What are the 3 requirements to develop a UTI?

Exposure to a sufficient # of uropathogens
Urothelial receptors for uropathogens
Failure of normal host urinary defenses

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

(endogenous corticosteroids)

46%

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

How should you monitor for this?

40%
Urine culture (NOT UA)

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

Dogs ⇒ 37%
Cats ⇒ 12%

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

50%

w/in days of indwelling cathether placement

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

Time frame?

20% w/in 3 d. of catheterization

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Any animal with _________ should be screened for a UTI.

Urinary Incontinence

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What diseases contribute to UTIs in CATS?

CRF ⇒ 30% of CRF cats will get a UTI
Hyperthyroidism ⇒ 12% of hyperthyroid cats will get a UTI

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What is the most important SCREENING test for UTIs?

U/A

What is the GOLD STANDARD test for UTIs?

How do you get your sample?

Urine Culture

Cycsto!

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

> 1,000 cfu/mL = a UTI

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

“No growth” is the only useful info provided

(rest is useless as may have been contamination)

Does the absence of Pyuria rule out a UTI?

NO!!!

Pyuria = Inflammation

ø Pyruia = still possible UTI

What makes a UTI Complicated?

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

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

Urine conc. of antimicrobial drugs

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

In the tissues

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

* Amoxicillin * Ampicillin * Chloramphenicol

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

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

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

* Enrofloxican * Gentamicin

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

* Cephalexin * Enrofloxacin * Gentamicin

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

* 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

**Which susceptibility testing method is better for UTIs?**

**MIC provides more info** | (minimal inhibitory conc)

List the "**1^st Line" Urinary Antimicrobials** for UTIs.

* **Amoxicillin** * **Trimethoprim-sulfonamide** * **1^st Gen. Cephalosporins** ⇒ Cephalexin or Cefadroxil

List the "**2^nd Line**" Antimicrobials for UTIs.

* **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 *

List the "**3^rd Line" Antimicrobials** for UTIs (for highly resistant organisms)

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

What is the duration of TX for an Uncomplicated UTI?

ABXs for 14-21 d.

Supportive care for UTIs?

* Try to increased H₂O intake ⇒ promote polyuria * Correct any know predisposing factors, metabolic or anatomic

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

* 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

How can UTI Therapy fail?

* 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

54% of recurrent UTIs are due to \_\_\_\_\_\_\_\_\_\_\_\_. What can this suggest?

* _Reinfection_ w/ a _different_ organisms ⇒ responds to appropriate ABXs * Multiple reinfections suggest impaired host defenses

46% of recurrent UTIs are due to \_\_\_\_\_\_\_\_\_\_\_. What does this suggests?

* *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.

How do you TX a recurrent or persistent UTI?

* Long-term ABXs for better tissue penetration ⇒ **30-60 d.** * Search for the predisposing factor.

Which **Imaging Studies** are good to use for a diagnostic approach to recurrent or persistent UTI?

* Plain Rads * Contrast Rads ⇒ double contrast cystogram * U/S

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

Cystoscopy

What is the prophylatic TX for recurrent UTIs? Major problem w/ this approach?

* 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

What are your big concerns with prophylactic TX of recurrent UTIs w/ **Nitrofurantoin (Macrodantin®)**?

* Adverse Effects: * Anorexia/vomiting * **Thrombocytopenia ⇒ wipes out the BM** * Liver failure * Myasthenia-like syndrome

How should you check if your prophylactic TX for recurrent UTIs is working? When can you stop meds?

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