Clinical features and risk factors for development of urinary tract infections in cats

Successful management of pelvic urethral strictures with balloon dilation in 3 cats

OBJECTIVE

To describe the successful management of pelvic urethral strictures in 3 young cats (1 after perineal urethrostomy, 1 after a third-time urethral obstruction, and 1 with prolonged lower urinary tract signs post-urethral obstruction) using balloon dilation and a short-term, indwelling urethral catheter.

CASE SUMMARIES

A 9-month-old neutered male domestic longhair cat with a urethral obstruction and a suspected congenitally narrowed urethra was treated via perineal urethrostomy. The cat later developed acute kidney injury, multidrug-resistant urinary tract infections, and a pelvic urethral stricture. A second case, a 2.3-year-old neutered male domestic shorthair cat, developed a stricture of the pelvic urethra after multiple obstructions and catheterizations. A third case, a 1.2-year-old neutered male domestic shorthair cat, had persistent and prolonged lower urinary tract signs after treatment for a urinary obstruction. The cat also had an abnormally small urethral opening and was ultimately found to have a proximal urethral stricture. The strictures in all 3 cases were successfully treated with a combination of fluoroscopic-guided balloon dilation and short-term indwelling urethral catheterization while managing any present infection.

NEW OR UNIQUE INFORMATION PROVIDED

To the authors' knowledge, this is the first published case series of successful balloon dilations paired with the use of a short-term indwelling urethral catheter in cats that developed urethral strictures after catheterization due to urinary obstructions. This procedure appears safe and well tolerated and appears to offer a long-term, cost-effective solution to urethral strictures at the level of the pelvis.

The impact of urine storage methods on the results of quantitative bacterial culture in dog and cat

Quantitative bacterial culture (QBC) is the gold standard for determining urinary tract infections. However, the majority of urine samples were sent to a lab for further bacterial culture. Therefore, the storage condition was vital to maintain the quality and accuracy of the urine samples. The main objective of our study was to examine the urine QBC outcomes of (1) immediate culture, (2) culture after urine sample storage at ambient temperature for 24 h, and (3) culture after urine sample storage at 4 °C for 24 hours. There were 49 feline samples and 30 canine samples included in this study. All QBC samples kept at ambient temperature and refrigerator were consistent with immediate QBC in cats. Eight positive results from immediate QBC were in accordance with refrigerated results in dogs. There were ten positive results in the room-temperature sample with two false-positive results. Our study showed that storing conditions at room temperature or refrigeration for 24 h does not impact the results of QBC in cat urine samples. For dog samples, chilled samples have a higher accuracy rate than room temperature samples, although the overall agreement was still satisfactory.

Bacteriuria in Cystocentesis Samples from Cats in the United Kingdom: Prevalence, Bacterial Isolates, and Antimicrobial Susceptibilities

Bacterial urinary tract infections (UTIs) have historically been reported to be uncommon in cats; however, recent studies showed a higher prevalence. Bacterial UTIs are one of the most common reasons for the use of antimicrobial drugs in veterinary medicine. Our aim was to investigate the prevalence of positive cultures in urine samples submitted to a UK laboratory for testing, as well as prevalence of bacterial species and their antimicrobial susceptibility to commonly used antibiotics. This was a retrospective analysis of positive cultures from feline urine samples collected by cystocentesis submitted over 14 months (January 2018-February 2019). A total of 2712 samples were reviewed, of which 425 documented a positive culture (15.7%) with a total of 444 bacterial isolates. E. coli (43.7%), other Enterobacterales (26.4%), Enterococcus species (14.9%) and Staphylococcus species (9.2%) were the most commonly isolated bacteria. E. coli most commonly showed resistance to cephalexin (20.7%) and amoxicillin (16.7%). Resistance was most commonly seen against amoxicillin (64.1%) and cephalexin (52.2%) in Enterobacterales. Enterococcus species most commonly showed resistance to trimethoprim/sulfamethoxazole (94.3%). Staphylococcus species most commonly showed resistance to amoxicillin (20%). This study showed significant resistance of bacteria found in feline urine samples in the UK to frequently used antibiotics.

Clinical differences in enterococcal bacteriuria compared with other bacteriuria in cats

OBJECTIVES

The clinical differences between Enterococcus species bacteriuria compared with other bacteria has been reported in a small number of cats. The objective of this study was to compare a large number of cats with Enterococcus species bacteriuria to cats with other bacteriuria and determine the clinical differences. It was hypothesized that enterococcal bacteriuria would be associated with subclinical bacteriuria and polymicrobial infections more than other bacteriuria, and that when local or systemic comorbidities were present, enterococcal bacteriuria would be more common.

METHODS

This retrospective case-control study compared case cats with enterococcal bacteriuria to control cats with other bacteriuria. Cats with enterococcal bacteriuria were age, year and weight matched with 1-2 control cats with any other bacteriuria.

RESULTS

Lower urinary tract clinical signs were statistically significantly more common in controls (n = 38/77 [49%]) compared with Enterococcus cases (n = 12/47 [25%]; P = 0.01). Specifically, control cats (n = 20/77 [26%]) were statistically significantly more likely to have gross hematuria compared with Enterococcus case cats (n = 3/47 [6%]; P = 0.01). Enterococcus cases were statistically significantly more likely to have a polymicrobial infection compared with controls (odds ratio 5.84, 95% confidence interval 1.33-34.70; P = 0.01).

CONCLUSIONS AND RELEVANCE

Enterococcus species are associated with subclinical bacteriuria and polymicrobial urinary tract infections in cats vs other bacteriuria.

Bacterial Isolates from Urinary Tract Infection in Dogs and Cats in Portugal, and Their Antibiotic Susceptibility Pattern: A Retrospective Study of 5 Years (2017-2021)

There are growing concerns regarding the rise of antimicrobial-resistant bacteria in companion animals. This study aimed to bring new insights into the current scenario of Portugal's antimicrobial resistance bacteria isolated from companion animals with urinary tract infections and is the first to be performed during a long period on a large scale. Of a total of 17472 urine samples analyzed, 12,166 (69.6%) (CI 12,200-12,200) were negative for bacterial growth, and 5306 (30.4%) (95% CI 5310-5310) had bacterial growth. Of the culture-positive samples, 5224 (96.6%) (95% CI 5220-5220) were pure cultures and 82 (3.2%) (95% CI 81.9-82.1) had mixed growth. Escherichia coli was the most frequently isolated bacteria (n=2360, 44.5%) (95% CI 2360-2360), followed by Proteus mirabilis (n=585, 11%) (95% CI 583-583), Enterococcus faecium (n=277, 5.2%) (95% CI 277-277) and Staphylococcus pseudintermedius (n=226, 4.3%) (95% CI 226-226). The overall susceptibility rates were low for erythromycin (45.3%) and clindamycin (51.3%), and high for aminoglycosides (96.3%), carbapenems (92.4%), trimethoprim-sulfamethoxazole (81.2%), and quinolones (79.9%). E. coli also showed considerable resistance to amoxicillin-clavulanic acid. The rates of multidrug-resistant bacteria are still high compared to the northern countries of Europe. This study's findings show the emergence of antibiotic resistance in the antibiotic agents commonly used in the treatment of UTIs in dogs and cats in Portugal.

Prevalence of bacteriuria in cats with neurogenic bladder

Urinary tract infections are defined as the adherence, multiplication, and persistence of an infectious agent within the urogenital system, causing an associated inflammatory response and clinical signs; instead, the presence of bacteria in urine as determined by positive bacterial culture (PUC) from a properly collected urine specimen, in the absence of clinical signs, is defined subclinical bacteriuria. Limited information on the prevalence of PUC in spinal cord injury cats affected by neurogenic bladder (NB) is available. On contrary, in NB dogs and humans the prevalence of bacteriuria is well documented. Moreover, while in humans information about bacteriemia associated with NB is already available, this aspect has never been studied in NB cats. The aim of this prospective study was to determine the prevalence of PUC in cats with NB, compared to animals affected by chronic kidney disease (CKD) and healthy cats. Furthermore, the prevalence of bacteriemia in cats with NB was evaluated. Fifty-one cats met the inclusion criteria: 12 cats were affected by NB, 22 had CKD and 17 were healthy. The prevalence of PUC was 58.33% and 18% in NB and CKD cat populations, respectively. All blood cultures were negative. The incomplete bladder emptying and the decreased resistance in the bladder wall could be considered predisposing elements to PUC in the NB feline population. The results of this study highlight, for the first time, an high prevalence of PUC in cats affected by NB, which was not found to be associated with bacteriemia.

Risk factors and clinical relevance of positive urine cultures in cats with subcutaneous ureteral bypass

Background

The objective of the study was to report the incidence and risk factors associated with positive urine bacterial cultures as well as long-term outcome in cats with subcutaneous ureteral bypass (SUB) devices.

Results

Medical records of cats that underwent SUB device placement were retrospectively reviewed. Signalment of the cat, laterality of the ureteral obstruction, surgery, anesthesia and hospitalization duration, bacterial culture results and follow-up data were retrieved.

Thirty-two cats met the inclusion criteria. Four cats (12.5%) had a positive intraoperative culture, with two of them being treated successfully. Ten cats out of 28 (35.7%) were documented with a positive urine culture during follow-up period, with a median time between discharge and identification of the first positive urine culture of 159 days (range 8–703 days). Bacteriuria resolved in 60% of cats (6/10). Escherichia coli was the most common organism, isolated in 4 out of 10 postoperative urine cultures. Overall, subclinical bacteriura was documented for 6 of 32 (18.8%) cats and 5 of 32 (15.6%) cats displayed clinicals signs suggestive of persistent UTI. One cat had subclinical bacteriuria. Three cats died during the follow-up period.

There was a significant difference between negative and positive urine bacterial culture groups in median hospitalization duration (5 days versus 6 days, P = 0.022) and in median body condition score (5/9 versus 4/9, P = 0.03). Cats with a longer hospital stay and with a lower body condition score were more likely to have a positive urine culture during follow-up period.

Conclusions

SUB device placement surgery is associated with complications such as chronic bacteriuria. Bacteriuria in our study resolved with appropriate antibiotic treatment in more than half of cats. Risk factors identified for positive urine culture were a longer hospitalization duration and a decreased body condition score.

Antimicrobial drug resistance profile of isolated bacteria in dogs and cats with urologic problems at Chiang Mai University Veterinary Teaching Hospital, Thailand (2012-2016)

The present study aimed to estimate the proportion of bacterial urinary tract infection (UTI) in dogs and cats, assess risks associated with bacterial UTI, and to determine bacterial isolates' antimicrobial susceptibility and resistance pattern from the urinary tract of dogs and cats with urologic problems. The medical records from animals visiting Chiang Mai University Small Animal Veterinary Teaching Hospital between January 2012 and December 2016 were reviewed. In total, 203 dogs and 49 cats with urinary tract diseases that had samples submitted for bacterial culture were identified;198 and 24 bacterial isolates were recovered from dogs' and cats' submitted samples, respectively. At least one episode of bacterial UTI was detected in 75.4% (95% CI: 69.4-81.3) of dogs and in 40.8% (95% CI: 26.6-55.1) of cats with UTI and submitted urine cultures. Of 242 submitted urinary samples from dogs and 60 urinary samples from cats, bacteria were identified in 74.0% (95% CI: 68.4-79.5) and 38.3% (95% CI: 26.0-50.6), respectively. The most common pathogen of bacteria positive cultured from dogs was Staphylococcus spp. (30.3%), followed by Escherichia coli (16.7%), and Proteus spp. (13.6%). For cats, the most common pathogen was Pseudomonas spp. (25.0%), followed by E. coli (20.8%) and Proteus spp. (16.7%). Staphylococcus spp. isolates from dogs and Proteus spp. isolates from cats were highly susceptible to Amoxicillin/clavulanic acid (AMC) at 88% and 75%, respectively. Of all isolated bacteria, 67.1% of the bacteria from dogs and 83.3% from cats were multidrug-resistant (MDR). The proportion of MDR-bacterial urinary tract infections in dogs and cats with urologic problems in this study was high. This observation raises concerns regarding the potential of zoonotic transmission of MDR-bacteria from these companion animals. The results suggested that AMC remains a good empirical drug for treating UTIs in dogs in this region.

Predicting Diagnosis of Australian Canine and Feline Urinary Bladder Disease Based on Histologic Features

Anatomic pathology is a vital component of veterinary medicine but as a primarily subjective qualitative or semiquantitative discipline, it is at risk of cognitive biases. Logistic regression is a statistical technique used to explain relationships between data categories and outcomes and is increasingly being applied in medicine for predicting disease probability based on medical and patient variables. Our aims were to evaluate histologic features of canine and feline bladder diseases and explore the utility of logistic regression modeling in identifying associations in veterinary histopathology, then formulate a predictive disease model using urinary bladder as a pilot tissue. The histologic features of 267 canine and 71 feline bladder samples were evaluated, and a logistic regression model was developed to identify associations between the bladder disease diagnosed, and both patient and histologic variables. There were 102 cases of cystitis, 84 neoplasia, 42 urolithiasis and 63 normal bladders. Logistic regression modeling identified six variables that were significantly associated with disease outcome: species, urothelial ulceration, urothelial inflammation, submucosal lymphoid aggregates, neutrophilic submucosal inflammation, and moderate submucosal hemorrhage. This study demonstrated that logistic regression modeling could provide a more objective approach to veterinary histopathology and has opened the door toward predictive disease modeling based on histologic variables.

Subclinical bacteriuria and surgical site infections in dogs with cranial cruciate ligament disease

OBJECTIVE

To determine the prevalence of subclinical bacteriuria (SBU) in dogs with cranial cruciate ligament (CCL) disease, the clinical variables and clinicopathologic data associated with SBU, and the incidence of surgical site infections (SSI) in dogs with and without SBU.

STUDY DESIGN

Prospective, clinical cohort study.

ANIMALS

One hundred fifty-five dogs with CCL disease.

METHODS

Dogs had a urinalysis, sediment examination, and aerobic urine culture performed. Age, breed, sex, body weight, body condition score, clinical history, and physical examination findings were recorded. Dogs with SBU were not treated for bacteriuria or with postoperative antibiotics. Standard perioperative antimicrobials were provided for all dogs. Dogs that received nonsteroidal anti-inflammatory drugs were not excluded. Dogs that underwent an osteotomy were followed for at least 1 year to determine incidence of SSI. Outcomes and variables associated with SBU were assessed.

RESULTS

In 155 dogs with CCL disease, the prevalence of SBU was 6.5%, and SBU occurred exclusively in female dogs (11.4%). The incidence of SSI was 22.3% (25/112). Two of six dogs with SBU and 23/106 dogs without SBU developed SSI. Organisms isolated from SSI were different from those isolated from urine.

CONCLUSION

The prevalence of SBU in dogs with CCL disease was similar to that in other studies in which SBU was evaluated in various populations of dogs.

CLINICAL SIGNIFICANCE

Screening for and treatment of SBU may not be beneficial prior to tibial osteotomy for CCL disease. Additional studies are required to determine whether dogs with SBU have a greater risk of SSI.

Subclinical bacteriuria in a mixed population of 179 middle-aged and elderly cats: a prospective cross-sectional study

OBJECTIVES

Subclinical bacteriuria (SBU) is the presence of bacteria in urine with no clinical evidence of lower urinary tract disease. The aims of this study were to investigate if being overweight and/or obesity predispose cats to SBU, to investigate previously reported risk factors and to determine the prevalence of SBU in a prospectively sampled cohort of middle-aged and elderly cats.

METHODS

Cats aged ⩾6 years presenting to the University Hospital for Companion Animals in Copenhagen from 2015-2019 for causes unrelated to the lower urinary tract were eligible for enrolment. Body condition scoring was performed on a 9-point scale. Overweight was defined as a body condition score (BCS) ⩾6 and obese as a BCS ⩾8. The correlation between SBU and the variables of sex, healthy/diseased, age, BCS and comorbidities (chronic kidney disease, diabetes mellitus, hyperthyroidism, hepatic disorders and gastrointestinal disease) were analysed by binominal logistic regression.

RESULTS

In total, 179 cats ranging from 6-20 (median 10) years of age were included. SBU was identified in 11/179 cats (6.1%). Being overweight was not a significant risk factor (overweight/obese odds ratio [OR] 0.3, 95% confidence interval [CI] 0.06-1.6, relative risk [RR] 0.3 [95% CI 0.05-1.3] vs lean; P = 0.2) and neither was obesity compared with lean and overweight cats (P = 0.99). Female sex (OR 6.2 [95% CI 1.3-30], RR 4.7 [95% CI 1.5-12] vs male; P = 0.02) and the presence of hepatic disease (OR 7.5 [95% CI 1.4-39], RR 5.3 [95% CI 1.3-12]; P = 0.02) were significant risk factors.

CONCLUSIONS AND RELEVANCE

The prevalence of SBU in cats is low, and being overweight/obese was not identified as a predisposing factor. The increased risk associated with hepatic disease has not been previously reported, and further studies are needed to confirm this finding.

Hyperthyroidism is not a risk factor for subclinical bacteriuria in cats: A prospective cohort study

Background

Subclinical bacteriuria is defined as a positive bacterial urine culture in the absence of clinical evidence of urinary tract infection (UTI). Studies have reported that hyperthyroid cats have UTIs (mostly subclinical) with prevalence rates of 12%‐22%. Consequently, clinicians consider hyperthyroidism a risk factor for development of subclinical bacteriuria, and many recommend urine culture when evaluating hyperthyroid cats.

Objectives

To compare the prevalence of subclinical bacteriuria (based on positive urine culture) in untreated hyperthyroid cats to that in euthyroid cats of similar age and sex.

Animals

Three hundred and ninety‐three hyperthyroid cats presented for radioiodine treatment and 131 euthyroid cats (≥7 years of age) presented for routine examination. Cats with signs of lower urinary tract disease were excluded.

Methods

Prospective cohort study. Both hyperthyroid and euthyroid cats had urine collected by cystocentesis for complete urinalysis and culture. Data pertaining to age, sex, body condition, and serum thyroxine and creatinine concentrations also were acquired. Logistic regression was performed to evaluate for potential risk factors for subclinical bacteriuria.

Results

Hyperthyroid cats showed a low prevalence of subclinical bacteriuria (4.3%), which did not differ from that found in euthyroid cats (4.6%). Of the signalment factors evaluated, only female sex was a significant risk factor (odds ratio [OR], 6.9; P = .002). Furthermore, positive urine cultures were more likely in specimens with dilute urine concentration (<1.035), pyuria, or microscopic bacteriuria.

Conclusions and Clinical Importance

Hyperthyroid cats are not at risk for subclinical bacteriuria. In the absence of lower urinary tract signs, no clinical benefit exists in routinely performing urine cultures when evaluating hyperthyroid cats.

Retrospective analysis of diagnoses and outcomes of 45 cats with micturition disorders presenting as urinary incontinence

Background

In contrast to dogs, the causes and outcomes of urinary incontinence (UI) in cats are largely unknown.

Objectives

To determine the causes, identify comorbid conditions, and assess outcomes of cats with micturition disorders presenting as UI.

Animals

Forty‐five cats with UI.

Methods

Retrospective study. Medical records of cats presented from January 2006 to December 2017 were searched using 45 keywords related to UI. History, presenting complaint, and physical examination findings were used to confirm a diagnosis. Cases were categorized based on functional and anatomic localizations.

Results

Forty‐five cats met inclusion criteria. Spinal cord disease was the most common cause of UI (n = 18), followed by urethral (n = 17), bladder (n = 9), and ureteral (n = 1) disorders. Proportions of voiding and storage phase disorders were similar (53% and 47%, respectively). However, voiding‐phase disorders were observed more frequently in males and younger‐aged cats (P < .03). Urinary tract infection was detected in 11 of 28 (39%) cats. Outcomes were available in 38/45 cases; 16 cats (42%) regained continence, 3 (8%) improved with treatment, and 19 (50%) remained incontinent or were euthanized. Multiple variable logistic regressions indicated that spinal cord disease was significantly more likely to be associated with poor outcomes compared to bladder or urethral disorders (P < .04).

Conclusions and Clinical Importance

Urinary incontinence in cats was associated with a variety of congenital and acquired disorders that affected both phases of micturition with similar frequency. Incontinent cats with spinal cord disorders were common and warrant a more guarded prognosis than do cats with bladder or urethral disorders.

Urinary tract infection and subclinical bacteriuria in cats: A clinical update

PRACTICAL RELEVANCE

Urinary tract infection (UTI) is an important cause of feline lower urinary tract disease (FLUTD), particularly in female cats older than 10 years of age. In addition to cats with typical clinical signs of FLUTD or upper UTI, many cats have subclinical bacteriuria, but the clinical relevance of this is currently uncertain. UTIs are one of the most important indications for antimicrobial use in veterinary medicine and contribute to the development of antimicrobial resistance. Adherence to treatment guidelines and confinement to a few first-line antimicrobial agents is imperative to avoid further deterioration of the antimicrobial resistance situation. The decision to treat with antimicrobials should be based on the presence of clinical signs, and/or concurrent diseases, and the results of urine culture and susceptibility testing.

CLINICAL CHALLENGES

Distinguishing between cats with bacterial cystitis, and those with idiopathic cystitis and concurrent clinical or subclinical bacteriuria, is challenging, as clinical signs and urinalysis results may be identical. Optimal treatment of subclinical bacteriuria requires clarification as there is currently no evidence that demonstrates a beneficial effect of routine treatment. Management of recurrent UTIs remains a challenge as evidence for most alternatives used for prevention in cats is mainly anecdotal, and no preventive treatment modality is currently recommended.

EVIDENCE BASE

This review draws on an extensive literature base in veterinary and human medicine, including the recently updated guidelines of the International Society for Companion Animal Infectious Diseases for the diagnosis and management of bacterial urinary tract infections in dogs and cats. Where published evidence is lacking, the authors describe their own approach; notably, for the bacteriuric cat with chronic kidney disease.

Risk factors for positive urine cultures in cats with subcutaneous ureteral bypass and ureteral stents (2010-2016)

Background

Ureteral stent and subcutaneous ureteral bypass (SUB) placement are commonly used for managing ureteral obstructions. Urinary tract infection (UTI) is a recognized complication.

Objectives

To determine postoperative incidence of positive urine cultures in cats undergoing ureteral stent and SUB placement and to identify risk factors associated with positive urine cultures.

Design

Retrospective study.

Animals

Forty‐three cats that underwent 48 surgical events.

Procedures

Medical records were reviewed. Cats were included if urine cultures were performed before and after surgery. Variables were compared to identify risk factors.

Results

Urine cultures were positive postoperatively pre‐discharge in 5/20 (25%) cats. Median duration of follow‐up post‐discharge was 209 days (range, 11‐2184 days), with a total of 143 urine cultures performed in cats post‐discharge. Of these, 16 (11%) were positive in 12/48 (25%) cats. Nine different bacteria were identified; Enterococcus spp. (n = 8) predominated as monomicrobic or mixed infections. In 14/16 instances of positive urine cultures, affected cats had lower urinary tract signs, signs of pyelonephritis or both. Cats that received antibiotics postoperatively were significantly less likely to have a positive urine culture compared to those that did not (odds ratio, 0.2, 95% confidence interval, 0.05, 0.8, P = 0.02). Chronic kidney disease, renal implant type and postoperative urinary catheterization were not associated with positive urine cultures.

Conclusions and Clinical Relevance

Postoperatively, occurrence of positive urine cultures was similar to previous reports. Subclinical bacteriuria was less common than UTI. Postoperative urinary catheterization has been speculated to increase risk of bacteriuria, but this was not the case in this cohort.

Prevalence of feline urinary tract pathogens and antimicrobial resistance over five years

The aim of this retrospective study was to document the prevalence of bacterial species in cats with significant bacteriuria and to compare their antimicrobial susceptibilities over five years. One hundred sixty-nine positive urine cultures from 150 cats were included. Fifty-five per cent showed clinical signs, while 40 per cent had subclinical bacteriuria. Escherichia coli, Staphylococcus species, Enterococcus species, Streptococcus species and Proteus mirabilis accounted for 50.5 per cent, 22.9 per cent, 15,1 per cent, 3.6 per cent and 2.6 per cent, respectively. Enterococcus species was significantly more common in cats with subclinical bacteriuria. Enterococcus species and Proteus mirabilis isolates were resistant to a significantly higher number of antimicrobials than other isolates. Applying the formula to select rational antimicrobial therapy, bacterial isolates were most likely to be susceptible to imipenem, nitrofurantoin, gentamicin and amoxicillin clavulanic acid. Over the study period, only minor differences were noted for the antimicrobial impact factors (IFs) between years and between cats with and without clinical signs. The cumulative IF increased significantly compared with the previous 10 years. Empirical treatment of bacterial cystitis should be avoided whenever possible and, if needed, based on the locally determined bacterial spectrum and antibiotic susceptibility.

Bakterielle Harnwegsinfektionen bei Katzen

Ziel: Ermittlung der Prävalenz prädisponierender Begleiterkrankungen (BE) bei Katzen mit bakteriellen Harnwegsinfektionen (HWI) und der Prävalenz von Bakterienspezies bei verschiedenen BE sowie deren Sensibilität gegenüber den bei HWI häufig eingesetzten Antibiotika Doxycyclin, Trimethoprim-Sulfamethoxazol (TMS), Amoxicillin-Clavulansäure (AMC), Cephalothin und Enrofloxacin. Material und Methoden: In die retrospektive Studie wurden Katzen mit positiver Urinkultur im Zeitraum 2003–2009 eingeschlossen. Basierend auf den Daten der Krankenakten erfolgte eine Einteilung in vier Gruppen: Katzen mit systemischen prädisponierenden BE, Katzen mit lokalen prädisponierenden BE, Katzen mit Harnblasendauerkathetern (HBDK) und Katzen ohne dokumentierte BE. Zur Ermittlung der wahrscheinlichen Effektivität der Antibiotika wurden deren antimikrobielle Impact-Faktoren berechnet. Ergebnisse: In die Studie gingen 194 Katzen mit 219 bakteriellen Isolaten ein. Davon wiesen 78,4% (152/194) eine BE auf. 49,5% (96/194) hatten eine systemische BE und 28,9% (56/194) hatten eine lokale BE oder einen HBDK. Katzen mit systemischen BE waren signifikant älter als Katzen der anderen Gruppen und häufiger weiblich als Katzen mit lokaler BE und HBDK. Mehr als 50% der Katzen mit systemischer BE zeigten keine klinischen Symptome einer Erkrankung des unteren Harntrakts. Escherichia (E.) coli, gefolgt von Streptococcus spp., Staphylococcus spp. und Enterococcus spp. waren die am häufigsten vorkommenden Isolate. Dabei lag der Anteil der E.-coli-Isolate bei Katzen mit systemischer BE signifikant höher, während bei Katzen mit HBDK und Katzen mit anderen lokalen BE der Anteil an Streptococcus- und Staphylococcus-spp.-Isolaten signifikant höher war. Bei Katzen mit lokaler BE und Katzen mit HBDK ergaben sich niedrigere antimikrobielle Impact-Faktoren als bei Katzen der anderen Gruppen. Schlussfolgerung und klinische Relevanz: Ein Großteil der Katzen mit HWI leidet unter einer prädisponierenden BE. Katzen mit systemischer BE zeigen häufig keine Symptome einer Erkrankung des unteren Harntrakts. AMC und TMS waren in dieser Katzenpopulation die Antibiotika mit den höchsten antimikrobiellen Impact-Faktoren.

EXTENDED-SPECTRUM BETA-LACTAMASE-PRODUCING ESCHERICHIA COLI AND KLEBSIELLA PNEUMONIAE ISOLATES FROM THE URINE OF DOGS AND CATS SUSPECTED OF URINARY TRACT INFECTION IN A VETERINARY TEACHING HOSPITAL

Extended-spectrum [Formula: see text]-lactamase (ESBL)-producing microorganisms often cause severe infections; they have only limited therapeutic alternatives and have emerged in both human and veterinary medicine. Companion animals have prolonged contact with humans and could serve as a reservoir for ESBL strains. Information regarding ESBL producers in companion animals is rather limited compared to that regarding humans. Therefore, the objective of this study was to screen for ESBL producers in Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis in urine samples collected from dogs and cats in which urinary tract infection was suspected in a veterinary teaching hospital in Taipei, Taiwan. In addition, bla genes, multilocus sequence typing (MLST) analysis, and antibiotic susceptibility testing were performed on these ESBL producers. From December 2011 to March 2013, disc tests of cefotaxime and ceftazidime, with and without clavulanic acid, were performed on 60 E. coli, 22 [Formula: see text]. pneumoniae, and 18 P. mirabilis samples isolated from urine; 2 E. coli and 5 K. pneumoniae samples with the ESBL phenotype were identified. CTX-M-15 was the most frequently found bla gene. CTX-M-14, SHV-11, SHV-12, and SHV-28 were also identified. MLST analysis did not detect a predominant ST type in either E. coli or [Formula: see text]. pneumoniae; nonetheless, K. pneumoniae ST15 and ST11, which are zoonotic agents of public health concern, were detected in our study. All ESBL-producing bacteria exhibited a multidrug-resistant phenotype. The occurrence of ESBL-producing E. coli and K. pneumoniae in companion animals underscores the importance of ESBL screening and epidemiological study in veterinary hospitals.

Feline urinary tract pathogens: prevalence of bacterial species and antimicrobial resistance over a 10-year period

The purpose of this retrospective study was to identify bacterial species in cats with bacterial urinary tract infections (UTIs) and to investigate their antimicrobial susceptibilities over a 10-year period. Three hundred and thirty cultures from 280 cats were included in the study. The mean age of affected cats was 9.9 years; female cats with bacterial UTIs were significantly older than male cats with UTIs. The most common pathogen identified was Escherichia coli (42.3 per cent), followed by Streptococcus species (19.3 per cent), Staphylococcus species (15.6 per cent), Enterococcus species (6.6 per cent) and Micrococcaceae (5.8 per cent). Forty specimens (12.1 per cent) yielded growth of more than one isolate. Streptococcus and Enterococcus isolates were resistant to a significantly higher number of antimicrobial agents than E coli and Staphylococcus species isolates. Applying the formula to select rational antimicrobial therapy, bacterial isolates were most likely to be susceptible to nitrofurantoin, amoxicillin clavulanic acid, enrofloxacin and gentamicin. The antimicrobial impact factor for nitrofurantoin increased significantly over the 10-year period, whereas there was no significant change in antimicrobial impact factors for doxycycline, trimethoprim-sulfamethoxazole, gentamicin, enrofloxacin, cephalothin and amoxicillin clavulanic acid. The detected changes in in vitro antimicrobial efficacy could help to develop hospital-specific guidelines for antimicrobial use to prevent the further development of resistance in feline uropathogens.

Plasma exogenous creatinine clearance in clinically healthy cats: comparison with urinary exogenous creatinine clearance, tentative reference intervals and indexation to bodyweight

Glomerular filtration rate (GFR) is considered to be the best indicator of overall kidney function. The major objectives of this study were to compare plasma exogenous creatinine clearance (PECC) with a reference method, to establish reference intervals (RIs) for PECC and to assess the effects of indexation of GFR to bodyweight (BW) in cats. PECC was compared with urinary clearance of exogenous creatinine (UECC) in six clinically healthy domestic shorthair cats (experiment 1). Tentative RIs were determined according to current guidelines and the effects of indexation to BW and of covariables on GFR were assessed in 43 clinically healthy cats of various breeds (experiment 2). PECC was 15% higher than UECC (P <0.01), but the two estimates were strongly correlated (r(2)=0.97, P = 0.001). RIs for PECC were 6.4-21.3 mL/min or 1.2-4.9 mL/min/kg. The absolute (i.e. non-indexed) GFR value was not dependent on BW. Thus, indexation of GFR to BW in cats would not standardize the GFR value, but could introduce bias in clinical interpretation. Significant effects of breed, plasma protein concentration and plasma albumin concentration on GFR were demonstrated. Plasma concentrations of urea and creatinine, when assessed separately, were also weakly correlated with GFR in healthy cats. These combined findings contribute to a better understanding of renal function assessment in cats.

AAFP and ISFM Guidelines for diagnosing and solving house-soiling behavior in cats

RATIONALE

These Guidelines have been developed by the American Association of Feline Practitioners (AAFP) and the International Society of Feline Medicine (ISFM) as a resource for veterinary practitioners who want to better understand and manage the important clinical condition of house-soiling in their feline patients. The Guidelines offer straightforward, practical solutions that, in most cases, will help veterinarians and cat owners prevent, manage or entirely remediate feline house-soiling behavior.

EVIDENCE BASE

The Guidelines include scientifically documented information when it is available. However, because research is often lacking, some recommendations reflect the accumulated clinical experience of the authors.

Feline CKD: Diagnosis, staging and screening - what is recommended?

PRACTICAL RELEVANCE

Feline chronic kidney disease (CKD) is frequently encountered by veterinarians. Timely diagnosis and staging may facilitate the initiation of adequate therapy and improve the prognosis for patients.

CLINICAL CHALLENGES

Feline CKD is diagnosed based on the presence of compatible clinical signs and renal azotaemia, which implies that urinalysis (particularly urine specific gravity) is mandatory to confirm the diagnosis. Although the diagnosis of advanced feline CKD and associated complications is usually straightforward, based on complete blood and urine examination, all routine blood and urine tests have their limitations in detecting early CKD. Therefore, diagnosing early or non-azotaemic CKD is much more challenging. Although determination of glomerular filtration rate (GFR) would be ideal to identify early kidney dysfunction, practical limitations hamper its routine use in clinical practice.

PATIENT GROUP

CKD is typically a disease of aged cats, but may affect cats of all ages. Conclusive breed and sex predispositions for feline CKD are not reported.

AUDIENCE

This review is directed at practising veterinarians and provides an overview of the required diagnostic tests, the classification system established by the International Renal Interest Society, and the importance of and possible techniques for early detection of CKD.

EVIDENCE BASE

Staging of cats with CKD is essential as it directs management and provides a prognostic guide. Given that diagnosis at early disease stages is associated with more prolonged survival times, simple, inexpensive and accurate methods for early CKD diagnosis are needed. Techniques currently under investigation include limited sampling strategies to estimate GFR, clearance marker cut-off concentrations to identify cats with low GFR, new indirect GFR markers and urinary biomarkers.

Routine health screening: findings in apparently healthy middle-aged and old cats

STUDY RATIONALE

Veterinary practitioners often perform geriatric health screening in cats. Unfortunately, scientific information regarding clinical and laboratory abnormalities and normal blood pressure values in elderly cats is scarce. This prospective study evaluated routine health screening tests in apparently healthy middle-aged and old cats.

PROTOCOL

One hundred cats of 6 years and older underwent blood pressure measurement, physical examination, blood and urine analysis, indirect fundoscopy and bilateral Schirmer tear tests.

FINDINGS

Mean systolic blood pressure (SBP) was 133.6 ± 21.5 mmHg. Increased SBP (>160 mmHg) was observed in eight cats, submandibular lymphadenopathy in 32, gingivitis in 72, heart murmur in 11, thyroid goitre in 20, increased creatinine in 29, hyperglycaemia in 25, increased total thyroxine in three, feline immunodeficiency virus positivity in 14, crystalluria in 41, borderline proteinuria in 25 and overt proteinuria in two. Mean tear production was very similar for both eyes and none of the cats had ocular lesions secondary to hypertension.

CLINICAL SIGNIFICANCE

Old cats (>10 years) had significantly higher SBP, heart rate, murmur frequency, thrombocyte count, urine protein:creatinine ratio and serum urea and bilirubin concentrations, and significantly lower body condition score, haematocrit, albumin and total calcium concentrations than middle-aged cats (6-10 years). The common occurrence of physical examination and laboratory abnormalities in apparently healthy old cats underlines the need for regular health checks and the development of age-dependent laboratory reference intervals.