A multicenter study of antimicrobial prescriptions for cats diagnosed with bacterial urinary tract disease

Efficacy of continuous education and determinants of antimicrobials prescription behavior in companion animal veterinarians from Quebec, Canada

Highly important antimicrobial use in veterinary companion animal medicine is frequent and in some cases unjustified. Establishing cautious and evidence-based prescription practices in veterinary companion animal medicine should be one of the key objectives of One Health antimicrobial stewardship initiatives. We aimed to (1) develop a training program on antimicrobial use in veterinary companion animal medicine in Quebec, Canada, (2) quantify the impact of this training on the use of highly important antimicrobials, and (3) identify the factors that could limit such an impact. A total of 54 veterinarians from 35 veterinary facilities participated in the study. Antimicrobials were identified from electronic medical records, prescription rates were calculated and a difference-in-differences estimation was used to compare prescription rates pre- and post-training in 2023, controlling for seasonal trends during the same period in 2022. Participating veterinarians prescribed on average 11.7 antimicrobial treatments per 100 consultations. Two thirds of the systemic antimicrobials prescribed by participants were antimicrobials of very high medical importance, according to Health Canada. Amoxicillin-clavulanic acid was the most often prescribed antimicrobial and accounted for approximately 22 % of all prescriptions. The training had a limited impact on overall prescription rates. However, a reduction of 55 % in prescription rate was observed for metronidazole, which is most often prescribed in canine patients with acute diarrhea. Interviews were conducted with 11 participating veterinarians to identify obstacles to the implementation of recommended prescription practices. The main obstacles identified were pet owner expectations, fear of therapeutic failure, lack of confidence in the recommendations and unavailability of therapeutic alternatives.

An Observational Study on the Diagnosis and Antibiotics Prescription in Cats with Lower Urinary Tract Disease by Veterinarians in Italy

Feline lower urinary tract disease (FLUTD) is a frequent diagnosis in cats, with bacterial causes constituting a minor percentage of cases. This observational study aimed to assess the diagnostic and therapeutic approaches to FLUTD among Italian veterinarians and explore variations in different workplaces. Data were collected via an anonymous survey completed by 317 veterinarians from small clinics (SC), large clinics (LC), and veterinary hospitals (VH). Results revealed that approximately half of respondents relied on clinical signs and urinalysis for diagnosis, while fewer incorporated abdominal ultrasound. Urine culture and sensitivity (UCS) testing was infrequently performed, primarily due to financial and logistical constraints, with higher compliance in VH practitioners. Antimicrobials were widely employed, with enhanced penicillins being the most prescribed class. The frequent empirical use of quinolones raises concern regarding gaps in antimicrobial stewardship. Despite some adherence to the ISCAID guidelines, discrepancies in diagnostic rigor, antimicrobial selection, and treatment duration were observed. Larger facilities demonstrated greater alignment with evidence-based practices, emphasizing the need for widespread education on appropriate antimicrobial use. This study underscores the importance of integrating guideline-based diagnostics and stewardship in managing feline urinary tract diseases.

Antimicrobial Prescription Practices and Stewardship in Washington State Small and Mixed Animal Veterinary Medicine

INTRODUCTION

Judicious antimicrobial use is essential for the continued treatment of infections in small and mixed animal veterinary medicine. To better support Washington (WA) State veterinarians in antimicrobial stewardship, we surveyed licensed small and mixed animal veterinarians and led group conversations regarding antimicrobial prescription practices.

METHODS

Survey questions included demographic information, factors influencing prescription practices and clinical cases. Responses were summarised and logistic regressions were performed to identify factors associated with antibiotic treatment choices. Group conversations, led by a licensed veterinarian, focused on resource gaps for veterinarians, management of clinical scenarios and interpretation of minimum inhibitory concentrations (MICs) and breakpoints. A systematic qualitative analysis of conversation transcripts identified key themes such as common barriers to stewardship.

RESULTS

Among 53 responses to clinical scenarios, veterinarians selected the most appropriate treatment choice, according to a veterinary microbiologist, 62% of the time. Variability was observed in culture and susceptibility practices and antibiotic choices. Survey respondents reported an influence of the client ability to medicate (92%), considerations of resistance (91%), client finances (75%) and availability of antimicrobials (75%) on their prescription decisions. There were no significant associations between opinions about contributing factors to antimicrobial resistance (AMR) or guidelines used and treatment choices in clinical scenarios. Among 15 veterinarians interviewed in group conversations, a systematic qualitative analysis of conversation transcripts revealed key themes, including reliance on human medicine as a resource and a lack of support for veterinarians in interpreting MICs and breakpoints.

CONCLUSIONS

The variability in veterinary antibiotic treatment decisions in this study suggests a need for further dissemination of standardised antimicrobial stewardship resources for veterinarians. Client-related challenges and the cost of culture and susceptibility are major barriers to stewardship. To address these barriers, it is necessary to provide standardised, easy-to-access guidance for veterinarians in interpreting MICs and breakpoints, as well as develop antimicrobial use resources for clients.

2025 iCatCare consensus guidelines on the diagnosis and management of lower urinary tract diseases in cats

PRACTICAL RELEVANCE

Lower urinary tract signs (LUTS) such as dysuria, haematuria, periuria, pollakiuria and stranguria can occur as the result of a variety of underlying conditions and diagnostic investigation is required to uncover the underlying cause and select appropriate treatment.

AIM

The '2025 iCatCare consensus guidelines on the diagnosis and management of lower urinary tract diseases in cats' provide an overview of the common presenting signs caused by underlying feline lower urinary tract (LUT) diseases in cats, which often are indistinguishable between different underlying causes. The Guidelines set out a diagnostic approach to affected cats before focusing on the most common causes of LUTS: feline idiopathic cystitis (FIC), urolithiasis, urinary tract infection and urethral obstruction. The aim is to provide practitioners with practical information on these problematic conditions.

CLINICAL CHALLENGES

The fact that LUTS are similar despite different underlying causes creates a diagnostic challenge. The most common cause of LUTS, FIC, is challenging to manage due to a complex pathogenesis involving organs outside the LUT. Urethral obstruction is a life-threatening complication of various underlying LUT diseases and recurrent LUTS can lead to relinquishment or euthanasia of affected cats.

EVIDENCE BASE

These Guidelines have been created by a panel of experts brought together by International Cat Care (iCatCare) Veterinary Society (formerly the International Society of Feline Medicine [ISFM]). Information is based on the available literature, expert opinion and the panel members' experience.

Medication compliance by cat owners prescribed treatment for home administration

BACKGROUND

Most veterinary literature examining medication compliance has described the phenomenon in dogs. The evidence available regarding factors affecting cat owner medication compliance is limited.

OBJECTIVES

Identify and describe factors associated with cat owners' noncompliance with veterinary recommendations for pet medications, as well as client-reported barriers and aids to administering medications prescribed by primary care veterinarians.

SUBJECTS

Cat owners presenting their animals for veterinary examination and treatment.

METHODS

A cross-sectional survey of cat owners' compliance with veterinary medication recommendations was performed from January 9, 2019, to July 18, 2020. A convenience sample of owners prescribed medication for their pets by veterinarians during or after elective veterinary examination was recruited to respond to questions regarding medication administration experience and compliance. Follow-up was obtained from owners to determine if the course of medication had been completed. Compliance data were analyzed descriptively, and logistic regression was performed.

RESULTS

Medication noncompliance was recorded for 39% (26/66) of cat owners. A quarter (16/66) reported challenges in administering medication to their pets; the most commonly cited reason was a resistant pet. Oral administration of antibiotics was significantly associated with noncompliance (P = .01). Clients with limited pet ownership experience were less likely to be noncompliant (P = .04).

CONCLUSIONS AND CLINICAL IMPORTANCE

Clients' inability to medicate their cats PO may have implications for clinical outcomes and antimicrobial stewardship. Alternatives to direct PO administration of solid-form medications in cats should be considered. Demonstrating administration techniques to all clients may improve compliance and influence clinical outcome.

Antimicrobial Use in Cats in a University Veterinary Hospital in Central Italy: A Retrospective Study

Background: Monitoring antimicrobial use is crucial for understanding current prescribing practices. Such information helps in establishing stewardship programs for effectively using antimicrobials and combating resistance to them. Objectives: This study describes how antimicrobials are prescribed at the Veterinary Teaching Hospital of the University of Pisa and compares how the internal medicine and intensive care units differ in their usage of antimicrobials. Methods: The study involved cats that were presented in the units in 2021 and 2022. Antimicrobial prescriptions were obtained via the hospital's management software (OCIROE). Results: In a population of 1164 non-surgical cats with 397 antimicrobials prescribed, the most prescribed ones were amoxicillin-clavulanic acid in the internal medicine unit and ampicillin in the intensive care unit. Twenty-five percent of all antimicrobials were Highest-Priority Critically Important Antimicrobials or Antimicrobial Advice Ad Hoc Expert Group Category B. The oral route was the main route of administration in the internal medicine unit, while parenteral was the most common route used in the intensive care unit. Most antimicrobials were prescribed to treat pathologic conditions affecting the urinary (39%), gastroenteric (21%), respiratory (13%), and integumentary (12%) systems. A diagnosis, accurate dosage, and the use of species-approved medications were recorded in the antimicrobial prescriptions. However, only 11% of these prescriptions were supported by antimicrobial susceptibility tests. Conclusions: These results suggest room for improvement, particularly in increasing the use of antimicrobial susceptibility testing to ensure more targeted antimicrobial therapy. Given the importance of antimicrobial resistance and the One Health approach, the study also highlights the need to consider the broader impact of antimicrobial use in animals, including the potential contribution to resistance in bacteria that affect both animal and human health.

Genotypic Characterization of Uropathogenic Escherichia coli from Companion Animals: Predominance of ST372 in Dogs and Human-Related ST73 in Cats

Extraintestinal pathogenic Escherichia coli (ExPEC) account for over 80% and 60% of bacterial urinary tract infections (UTIs) in humans and animals, respectively. As shared uropathogenic E. coli (UPEC) strains have been previously reported among humans and pets, our study aimed to characterize E. coli lineages among UTI isolates from dogs and cats and to assess their overlaps with human UPEC lineages. We analysed 315 non-duplicate E. coli isolates from the UT of dogs (198) and cats (117) collected in central Germany in 2019 and 2020 utilizing whole genome sequencing and in silico methods. Phylogroup B2 (77.8%), dog-associated sequence type (ST) 372 (18.1%), and human-associated ST73 (16.6%), were predominant. Other STs included ST12 (8.6%), ST141 (5.1%), ST127 (4.8%), and ST131 (3.5%). Among these, 58.4% were assigned to the ExPEC group and 51.1% to the UPEC group based on their virulence associated gene (VAG) profile (ExPEC, presence of ≥VAGs: papAH and/or papC, sfa/focG, afaD/draBC, kpsMTII, and iutA; UPEC, additionally cnf1 or hlyD). Extended-spectrum cephalosporin (ESC) resistance mediated by extended-spectrum β-lactamases (ESBL) and AmpC-β-lactamase was identified in 1.9% of the isolates, along with one carbapenemase-producing isolate and one isolate carrying a mcr gene. Low occurrence of ESC-resistant or multidrug-resistant (MDR) isolates (2.9%) in the two most frequently detected STs implies that E. coli isolated from UTIs of companion animals are to a lesser extent associated with resistance, but possess virulence-associated genes enabling efficient UT colonization and carriage. Detection of human-related pandemic lineages suggests interspecies transmission and underscores the importance of monitoring companion animals.

Prevalence of antibiotic use for dogs and cats in United States veterinary teaching hospitals, August 2020

BACKGROUND

Awareness of prescribing practices helps identify opportunities to improve antibiotic use (AU).

OBJECTIVES

To estimate AU prevalence in dogs and cats in U.S. veterinary teaching hospitals (VTHs) and identify antibiotic drugs commonly prescribed, indications for use, and evidence of bacterial infection.

ANIMALS

Medical record data were collected from dogs and cats examined at 14 VTHs.

METHODS

Data were collected from VTH medical records of dogs and cats examined by primary care, urgent care, emergency and critical care, internal medicine, and surgery services on a single day during August 13-September 3, 2020. Data included signalment; clinical service; inpatient or outpatient status; clinical conditions; diagnostic tests; evidence of bacterial infection; intended reason for AU; name and route of antibiotics prescribed.

RESULTS

Of 883 dogs and cats, 322 (36.5%) were prescribed at least 1 antibiotic. Among 285 antibiotics administered systemically intended for treatment of infection, 10.9% were prescribed without evidence of infection. The most common class of antibiotics presribed for systemic administration was potentiated penicillin for dogs (115/346, 33.3%) and cats (27/80, 33.8%). For dogs and cats, first-generation cephalosporins (93/346, 26.9% and 11/80, 13.8%, respectively) and fluoroquinolones (51/346, 14.7% and 19/80, 23.8%, respectively) was second or third most-prescribed. Common AU indications included skin, respiratory, and urinary conditions, and perioperative use.

CONCLUSIONS AND CLINICAL IMPORTANCE

Collaborative data collection provides a sustainable methodology to generate national AU prevalence estimates and bring attention to areas requiring additional research and detailed data collection. These efforts can also identify practice improvement opportunities in settings where future veterinarians are trained.

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.

Online survey of owners' experiences of medicating their cats at home

OBJECTIVES

The aim of this study was to use an online survey to obtain information from cat owners about their experiences of medicating their cats.

METHODS

An online survey containing 35 questions on experiences of medicating cats was circulated to cat owners globally.

RESULTS

In total, 2507 surveys from 57 countries were analysed; 1724 from 'cat owners' and 783 from 'cat owners+' (respondents with significant cat experience, including veterinary professionals). Around half (50.7%) of cat owners were 'sometimes' or 'never' provided with information or advice on how to administer medication; however, 91.8% of those given information found it 'somewhat' or 'very' useful. Around half (53.6%) of owners sought information from the internet about how to administer medication. Total cat owners (cat owners and cat owners+) administered liquids (61.3%), pastes (45.3%) or tablets (39.5%) directly into their cat's mouth; fewer (22.6-24.1%) hid these medications in food. Total cat owners rated tablets significantly harder to administer than liquids; 53.0% chose liquids as their first-choice formulation while 29.3% chose tablets. Insulin injections and 'spot-ons' were significantly easier to administer than any oral medications. Over half (51.6%) of owners reported that medicating their cat(s) had changed their relationship with them; 77.0% reported that their cat(s) had tried to bite or scratch them when medicating. Other challenges included the cat(s) spitting out tablets (78.7%), refusing medication in food (71.7%) and running away (52.7%). Of the owners who failed to complete a course of medication (35.4%), 27.8% stopped near the end of the course, while 19.3% stopped after a few doses, in both cases as medicating was too difficult.

CONCLUSIONS AND RELEVANCE

Owners appreciate being provided with information about the administration of medication. Frequent challenges when medicating cats include potential human injury and damage to the owner-cat relationship. Pharmaceutical companies should provide a range of formulations to ease compliance. Veterinary clinics should provide information/demonstrations and internet links when prescribing medications.

Prevalence and Antimicrobial Resistance of Bacterial Uropathogens Isolated from Dogs and Cats

Bacterial urinary tract infection (UTI) is a common diagnosis in companion animal practice and is one of the leading reasons for antimicrobial prescriptions. We analysed 1862 samples from the urinary tract of dogs and cats, submitted to a veterinary microbiological diagnostic laboratory in 2019 and 2020 in Germany. Susceptibility of 962 uropathogenic isolates to 15 antimicrobials, suggested as first- and second-line treatment options for UTI, was determined according to CLSI recommendations. Bacterial growth of uropathogens was detected in 43.9% of dog and in 38.5% of cat samples. Escherichia (E.) coli was the most frequently isolated pathogen (48.4%), followed by Enterococcus spp. (11.9%) and coagulase-positive staphylococci (CoPS; 11.5%). Females were more likely to exhibit a positive microbiological culture. Regarding first-line antibiotics, 93.4% of the most commonly isolated uropathogenic species were susceptible to the first-line antibiotics amoxicillin/clavulanic acid (AMC) and 87.6% to trimethoprim-sulfamethoxazole (SXT), while 76.1% showed decreased susceptibility to ampicillin (AMP). Multidrug resistance (MDR) was detected in 11.9% of E. coli, 50.4% of enterococci, and 42.7% of CoPS; 90.6% of these isolates were susceptible to nitrofurantoin (NIT). Our data indicate that empiric treatment of UTI with AMC or SXT could be recommended and is preferable to treatment with AMX. NIT should be considered for the treatment of MDR uropathogens.

Estimation of defined daily doses of antimicrobials for dogs and cats treated for bacterial cystitis

OBJECTIVE

To calculate prescribed daily doses (PDDs) for selected antimicrobials and evaluate application of defined daily doses (DDDs) using an antimicrobial purchasing dataset.

ANIMALS

Data from dogs and cats treated for bacterial cystitis at a veterinary practice network were evaluated.

PROCEDURE

A dataset containing antimicrobial prescriptions for dogs and cats diagnosed with bacterial cystitis was evaluated. Median dose and frequency and median weight of treated animals were used to calculate PDDs. To account for differences in use between dogs and cats, an adjusted DDD was calculated based on adjustment for proportional use in dogs versus cats.

RESULTS

PDDs for dogs and cats were determined and adjusted DDDs were calculated and applied to an antimicrobial purchasing dataset from 886 veterinary clinics, demonstrating the difference between mass-based and DDD data.

CONCLUSIONS

DDDs can be estimated using prescription datasets, accounting for differences in weights (between and within species) and relative use between dogs and cats. These can be applied to broader (sales, purchase) datasets to provide a more detailed understanding of how antimicrobials are used.

CLINICAL RELEVANCE

DDDs could be a useful measure for assessing mass-based antimicrobial use datasets as part of antimicrobial stewardship surveillance efforts.