Frequency of urinary tract infection in catheterized dogs and comparison of bacterial culture and susceptibility testing results for catheterized and noncatheterized dogs with urinary tract infections

OBJECTIVE: To determine frequency of urinary tract infections (UTIs) in catheterized dogs that had intervertebral disk disease (IVDD) or disease other than IVDD and compare bacterial culture and susceptibility testing results for catheterized and noncatheterized dogs with UTIs. DESIGN: Retrospective cohort study. ANIMALS: 147 catheterized dogs (105 with IVDD and 42 with other diseases) and 99 noncatheterized dogs with UTIs. PROCEDURES: Medical records were reviewed for signalment, history, clinical problem, duration of urinary tract catheterization, administration of drugs, and urine bacterial culture and susceptibility testing results. RESULTS: Forty-two percent (44/105) of dogs with IVDD and 55% (23/42) of dogs with other diseases had UTIs; this difference was not significant. For catheterized dogs, the odds of UTI were increased by 20% for each year increase in age, 27% for each day increase in duration of catheterization, and 454% with antimicrobial administration. Escherichia coli and Proteus spp were more frequently isolated from noncatheterized dogs, whereas Enterobacter spp and Staphylococcus spp were more frequently isolated from catheterized dogs. There was no significant difference in frequency of 1, 2, or 3 isolates between groups. Proportions of antimicrobials to which the most frequently isolated bacteria were resistant were not significantly different between groups. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that urinary tract catheterization is a reasonable alternative for management of dogs with urinary bladder dysfunction, but that duration of catheterization should be minimized and indiscriminate antimicrobial administration to dogs with indwelling urinary catheters should be avoided.     

Persistent urinary tract infections and reinfections in 100 dogs (1989-1999)

A retrospective study was performed of 100 dogs with persistent urinary tract infections (UTIs) or reinfections presenting to the North Carolina State University (Raleigh, NC) Veterinary Teaching Hospital between 1989 and 1999. Criteria for selection included > or = 2 positive urine cultures within a 6-month period. Signalment, presence of predisposing disorders, urinalysis and urine culture results, and treatment strategies were extracted from the medical records. Dogs were a median age of 7 years when the UTI was 1st diagnosed. Dogs younger than 3 and older than 10 years were at increased and decreased risks, respectively, for reinfections or persistent UTIs. Spayed females were more common in the UTI population. More than half of the dogs were asymptomatic for a UTI at 1st presentation. Urine sediment examinations identified hematuria, pyuria, and bacteriuria in 47, 72, and 85% of the samples, respectively. The most commonly isolated organisms were Escherichia coli and Streptococcus/Enterococcus spp.; multiple isolates also were common. Of the isolates, 29.5% were resistant to achievable serum concentrations of all antibiotics commonly prescribed for PO administration. Dogs with abnormal micturition were more likely to have infections by organisms resistant to commonly prescribed antibiotics. Potentially predisposing disorders were identified in 71 dogs. A correction of these disorders was accomplished in 35% of these 71 dogs. Dogs given standard antibiotic therapy without addressing predisposing disorders experienced poor control of their UTIs; 74.5% of these dogs had an apparent disease-free interval (ADFI) of < 8 weeks. By comparison, dogs in which predisposing disorders were corrected or those that were treated with low-dose, long-term antibiotic regimens subjectively had better control.     

Nonenteric Escherichia coli isolates from dogs: 674 cases (1990-1998)

OBJECTIVE: To determine nonenteric sites associated with Escherichia coli isolates in dogs and the antimicrobial susceptibilities of the isolates. DESIGN: Retrospective study. SAMPLE POPULATION: 17,000 canine specimens. PROCEDURE: Medical records of 17,000 canine specimens submitted for bacteriologic culture were examined and the number of isolations of E coli was determined. For these cases, records were further examined with respect to body system involvement, sex, concurrent infection with other species of bacteria, and antimicrobial susceptibility. RESULTS: 674 E coli isolates (424 from urine, 62 from the skin, 52 from the respiratory tract, 45 from the ear, 43 from the female reproductive tract, 25 from the male reproductive tract, and 23 from other organ systems) were identified. There was a significantly higher proportion of isolates from urine specimens from spayed females than from sexually intact females or males. Escherichia coli was isolated in pure culture from 65.9% of the specimens. Most E coli isolates were susceptible to norfloxacin (90%), enrofloxacin (87.5%), gentamicin (90.7%), and amikacin (85.9%). CONCLUSIONS AND CLINICAL RELEVANCE: Most nonenteric E coli infections in dogs involve the urinary tract. Amikacin, gentamicin, norfloxacin, and enrofloxacin have the highest efficacy against canine E coli isolates. For E coli isolates from dogs, in vitro susceptibility to commonly used antimicrobial agents has remained fairly stable during the past decade.     

Antimicrobial susceptibility of Klebsiella spp. and Proteus spp. from various organ systems of horses, dogs and cats as determined in the BfT-GermVet monitoring program 2004-2006

A total of 120 isolates of Klebsiella spp. and Proteus spp. collected from horses and small animals (dogs and cats) were screened for their susceptibility to 24 different antimicrobial agents. Klebsiella spp. were included from infections of the genital tract (GT) of horses (36 isolates) and the urinary/genital tract (UGT) from dogs and cats (17 isolates), while Proteus spp. were from small animal (dogs and cats) infections of the UGT (37 strains) and the skin (incl. ear/mouth) (30 isolates). In Klebsiella spp. resistance appeared most frequently to ampicillin (53-67%), sulfamethoxazole (19-29%) and potentiated sulfonamides (trimethoprim/sulfamethoxazole 1/19 combination) (19-24%). A further 29% of enrofloxacin resistant Klebsiella isolates were observed for the UGT of small animals. From the GT of horses for this antimicrobial agent there was no isolate detected with a comparably high minimum inhibitory concentration (MIC) value. In Proteus spp. highest percentages of resistance occurred against tetracycline (90-92%). Due to drug efflux proteins, high MIC values against this antimicrobial agent have been frequently reported in literature. In Proteus spp. relevant resistance percentages also occurred for potentiated sulfonamides (27-37%), sulfamethoxazole (24-37%) and chloramphenicol (24-37%).     

Evaluation of catheter-associated urinary tract infections and multi-drug-resistant Escherichia coli isolates from the urine of dogs with indwelling urinary catheters

OBJECTIVE: To determine the frequency of urinary tract infections (UTIs) in dogs with indwelling urinary catheters in an intensive care unit (ICU) and the frequency of multi-drug-resistant (MDR) Escherichia coli UTIs in those dogs. DESIGN: Prospective study. ANIMALS: All dogs in the ICU with an indwelling urinary catheter from January 2003 through December 2003. PROCEDURES: Urine samples and rectal swab specimens were collected at admission and every 3 days until discharge from the hospital. Escherichia coli isolates from urine samples and rectal swab specimens and those from dogs that were temporally or spatially associated with dogs with MDR E coli UTIs underwent antimicrobial susceptibility testing. Pulsed-field gel electrophoresis was performed on MDR isolates from urine and rectal swab specimens. RESULTS: Urinary catheters were placed in 137 dogs. Twenty-six UTIs were diagnosed, 15 on the day of admission and 11 after 3 or more days of catheterization. Of 12 dogs with E coli UTIs, 6 were infected at admission and 6 acquired the infection in the ICU. Two MDR E coli UTIs were detected, 1 of which was acquired in the ICU. One MDR E coli urinary isolate had an electrophoresis pattern similar to that of rectal isolates from the same dog. Urinary E coli isolates were most frequently resistant to ampicillin and cephalothin. CONCLUSIONS AND CLINICAL RELEVANCE: The ICU-acquired MDR E coli UTI likely originated from the dog's intestinal flora during hospitalization. Dogs that have been referred from a community practice may have MDR E coli UTIs at the time of admission.     

Bacteriuria in the dog

The results of a retrospective study of 85 bacteriological cultures on urine samples from 64 dogs is presented. Fifty-three of the samples produced a pure growth of bacteria and Proteus spp was grown from 24 of those samples while Escherichia coli was grown from 13 samples and Staphylococcus spp from six samples. It was noted that a large majority of the Proteus spp isolates (87.5 per cent) were from females and conversely a large majority of the E. coli isolates 92.3 per cent came from males. A study of conditions concurrent with the urinary tract infection showed that many animals had underlying problems that could compromise the ability of their urinary tracts to withstand invasion by micro-organisms. The antibiotic sensitivity patterns of E. coli and Proteus spp are discussed and the value of various antimicrobial agents considered.     

Renal Calculi in Dogs and Cats: Prevalence, Mineral Type, Breed, Age, and Gender Interrelationships (1981–1993)

Three hundred seventeen specimens of urinary calculi of renal origin from 214 female dogs and 103 male dogs, and 71 specimens of urinary calculi of renal origin from 38 female cats and 33 male cats were submitted for mineral analysis between July 1, 1981, and December 31, 1993. Among dogs, 45 breeds were affected with renal calculi. Thirty-three breeds and a crossbred group were represented among females, but 8 breeds and the crossbred group accounted for 81% of the total. Among male dogs, 30 breeds and a crossbred group were represented, but 7 breeds and the crossbred group accounted for 69% of the total. Among cats, 10 breeds and a crossbred group were represented. Dogs and cats with renal calculi were older than those of 2 comparison population groups. More than one-half of the renal calculi in both dogs and cats were from the 1st known episode of urolithiasis. The risk of formation of renal calculi was found to be higher for cats than for dogs, when compared to other stone-forming cats and dogs (approximately 4.95 per 100 stone-forming cats and 2.88 per 100 stone-forming dogs). Among dogs, breeds at highest risk of developing renal calculi were Miniature Schnauzers, Shih Tzus, Lhasa Apsos, Yorkshire Terriers, and female Pugs. Also at high risk were male Dalmatians and male Basset Hounds. Among small dogs, females generally were at higher risk of developing renal calculi than were males. Regardless of size, terrier breed males generally were at higher risk of developing renal calculi. Breeds of dogs at low risk for development of renal calculi included crossbreds, German Shepherd Dogs, Labrador Retrievers, Golden Retrievers, and female Dachshunds. When only 1 kidney was involved, the risk of left renal calculus was greatest for both dogs and cats, but bilateral renal involvement was relatively common in both species (19% and 9%, respectively). Among dogs, specimens composed of 1 mineral substance (eg, struvite) occurred more often in males (58.3%) than in females (37.9%). Female dogs formed renal calculi containing struvite or oxalate more often than did males; males formed calculi containing urate more often than did females. Calculi containing oxalate, apatite, or some combination of these minerals predominated among cats; only 1 specimen from 38 female cats and only 4 specimens from 33 male cats contained neither oxalate nor apatite. Crossbred cats were significantly less likely to have renal calculi than were other breeds. A single renal calculus specimen was identified in several uncommon breeds including Tonkinese and Birman cats, and Affenpinscher, Clumber Spaniel, English Shepherd, and Field Spaniel dogs. No significant differences were observed between male and female dogs or between male and female cats with regard to mineral type of the specimen and the presence of urinary tract infection.     

Results of Quantitative Cultures of Urine by Free Catch and Catheterization from Healthy Adult Horses

Quantitative urine cultures were performed on 11 male and 11 female healthy adult horses. Urine was collected by free catch and catheterization using standard methods. Results showed that all samples collected by free catch contained less than 20,000 colony-forming units (CFU)/mL. All samples collected by catheterization contained 500 CFU/mL or less. A significant difference was found between collection methods ( P < .005), with catheterization having less contamination. In samples collected by free catch, females had significantly greater contamination than did males ( P < .03). Predominant bacterial species isolated included Streptococcus spp., Escherichia coli, Enterohacter sp., Bacillus sp., Staphylococcus spp., Diptheroids sp., Proteus spp., and Enterococcus sp. Many samples contained multiple bacterial species. Bacterial isolates were representative of the normal bacterial flora of the equine urogenital tract. This paper establishes reference values for quantitative urine culture results in healthy adult horses to aid in the diagnosis of urinary tract infections.     

Mycoplasma as a cause of canine urinary tract infection

Mycoplasmas were isolated from 60 specimens of urine obtained by cystocentesis from 41 dogs (23 males and 18 females) with urinary tract infection. Mycoplasmas were isolated in pure culture from 41 (68%) of the specimens, and were isolated in conjunction with one or more bacterial species from 19 (32%) specimens. Clinical signs of urinary tract infection were noted in 20 of 31 dogs in which mycoplasmas were isolated in pure culture, and numbers of WBC in the urine sediment were above the reported normal range in 22 of 25 urine specimens from those 20 dogs. Twenty-four of 29 mycoplasma isolates were found to be Mycoplasma canis, 4 were found to be M spumans, and 1 was identified as M cynos.     

Urine culture as a test for cure: why, when, and how?

Quantitative urine culture before initiation of antimicrobial therapy is considered to be the gold standard for diagnosis of bacterial urinary tract infections (UTIs). In addition to facilitating differentiation of harmless bacterial contaminants from bacterial pathogens,accurate identification of specific bacterial species aids in selection of antimicrobial drugs. It also facilitates differentiation of recurrent UTIs caused by relapses from recurrent UTIs caused by reinfections.Failure to perform bacterial urine cultures or failure to interpret results of urine cultures correctly may lead not only to diagnostic errors but to therapeutic failures as well.     

Urinary tract infections in cats with hyperthyroidism, diabetes mellitus and chronic kidney disease

The prevalence of urinary tract infections (UTIs) in cats with hyperthyroidism (n=90), diabetes mellitus (DM) (n=57) and chronic kidney disease (CKD) (n=77) was evaluated retrospectively. It was found to be 12% in cats with hyperthyroidism and DM, respectively, and 22% in cats with CKD. Associations between UTIs and clinical signs, biochemical markers in serum and urinalyses were investigated. Many of the cats with UTIs had no clinical signs of lower urinary tract disease or changes in their laboratory values indicative of infection. Therefore, a urinalysis alone should not be used to exclude UTIs in these cats. UTIs are relatively common in cats with hyperthyroidism, DM and CKD, and urine cultures are recommended as part of the basic diagnostic plan for cats suspected of suffering from these conditions.     

Resistance to gentamicin and amikacin of gram-negative organisms isolated from horses

Resistance of gram-negative bacteria to gentamicin has become an increasingly common problem among clinical isolates from human beings. Susceptibility of isolates from horses to gentamicin and amikacin was evaluated for the period from July, 1983 to June, 1985. All isolates of Escherichia coli, and species of Enterobacter, Klebsiella, Proteus, and Pseudomonas examined were susceptible to amikacin, except 2 of the 46 Pseudomonas isolates. In contrast, 13 to 50% of isolates were resistant to gentamicin. Escherichia coli, and Klebsiella, Proteus, and Enterobacter species isolates were highly significantly more susceptible to amikacin (P less than 0.01) than to gentamicin. Pseudomonas spp (P = 0.13) were not significantly different in susceptibility to the 2 drugs. There was significant variation among genera in their susceptibility to gentamicin (P = 0.002), primarily because of the frequency of resistance in isolates of Klebsiella spp and Proteus spp, compared with the other 3 organisms (E coli, Enterobacter spp, and Pseudomonas spp). There was no significant difference of susceptibility to amikacin among the genera studied (P = 0.06).     

Retrospective evaluation of urinary tract infection in 42 dogs with hyperadrenocorticism or diabetes mellitus or both

A retrospective study was performed to determine the proportion of dogs with hyperadrenocorticism or diabetes mellitus or both that had urinary tract infection (UTI) and to describe clinical and laboratory findings. Dogs with these endocrine disorders were included if results of quantitative urine culture were available and dogs were not receiving antimicrobials. Dogs with positive urine cultures were considered to have UTI and dogs with negative urine cultures were used as controls. Information including history, clinical signs, physical examination findings, and results of laboratory tests and urine culture was extracted from all records. Findings in dogs with UTI were compared with control dogs. There were 101 dogs with hyperadrenocorticism or diabetes mellitus or both that met inclusion criteria; 42 (41.6%) had UTI and 59 (58.4%) did not. UTI was present in 46% of dogs with hyperadrenocorticism, 37% of dogs with diabetes mellitus, and 50% of dogs with both endocrine disorders. There was no association between endocrine group and occurrence of UTI. Escherichia coli was the most common bacteria isolated, and cultures from 29 dogs (69%) showed growth of this organism. Of dogs with UTI, <5% had stranguria, pollakiuria, or discolored urine, whereas 60% had pyuria and 69% had bacteriuria. We conclude that UTIs are common in dogs with hyperadrenocorticism, diabetes mellitus, or both diseases. Clinical signs of UTI, however, are uncommon and results of urinalysis may be normal. Therefore, it is appropriate to recommend urine culture as part of the evaluation of dogs with these endocrine disorders.     

Canine bacterial urinary tract infections: new developments in old pathogens

Uncomplicated bacterial urinary tract infections (UTIs) occur commonly in dogs. Persistent or recurrent infections are reported less frequently. They typically occur in dogs with an underlying disease and are sometimes asymptomatic, especially in dogs with predisposing chronic disease. Escherichia coli is the organism most frequently cultured in both simple and complicated UTIs. Organisms such as Enterococcus spp. and Pseudomonas spp. are less common in uncomplicated UTI, but become increasingly prominent in dogs with recurrent UTI. The ability of bacteria to acquire resistance to antimicrobials and/or to evade host immune defence mechanisms is vital for persistence in the urinary tract. Antimicrobial therapy limitations and bacterial strains with such abilities require novel control strategies. Sharing of resistant bacteria between humans and dogs has been recently documented and is of particular concern for E. coli O25b:H4-ST131 strains that are both virulent and multi-drug resistant. The epidemiology of complicated UTIs, pathogenic traits of uropathogens and new therapeutic concepts are outlined in this review.     

Silica-Containing Urinary Calculi in Dogs (1981–1993)

Silica-containing urinary calculi obtained from 773 dogs and submitted by veterinarians throughout the United States were analyzed by quantitative crystallographic analysis to determine mineral composition. Specimens were composed of either multiple mineral layers (535 specimens) or 1 mineral layer (238 specimens). Most multiple-layer calculi were composed of 80% or greater silica (300 of 535, 56%) or 20% to 79% silica (184 of 535, 34%) in any mineral layer. Most 1–layer calculi were composed of 100% silica (212 of 238, 89%). Most dogs forming silica-containing calculi were of male gender (679 of 773, 88%). Bacterial cultures of calculus or urine or both were performed on 49% (376 of 773) of the specimens, and bacterial growth was obtained from 37% (139 of 376) of samples cultured. The prevalence of calculus-associated urinary tract infection was 35% (113 of 321) in males and 47% (26 of 55) in females. The gender prevalence for infection with Staphylococcus species was 16% (51 of 321) in males and 33% (18 of 55) in females. The breed and gender of dogs that formed calculi (silica population) were compared with the hospital population (Veterinary Medical Teaching Hospital [VMTH] population) and with a population of calculus-forming dogs (Stonelab population) to determine risk factors for silica calculus formation. For all breeds compared, the ratio of males to females was higher in the silica population. The German Shepherd Dog and Old English Sheepdog were significantly overrepresented when the silica population was compared with either the VMTH population or the Stonelab population. We conclude that male German Shepherd Dogs and Old English Sheepdogs are at increased risk for formation of silica-containing urinary calculi.     

Development of resistant bacteria isolated from dogs with otitis externa or urinary tract infections after exposure to enrofloxacin in vitro

Minimum inhibitory concentrations for enrofloxacin were determined for 63 bacterial isolates from dogs with otitis externa or urinary tract infections. Development of resistant mutants was determined after exposing the isolates to enrofloxacin in vitro for up to five serial passages. Results indicated that Pseudomonas aeruginosa and Enterococcus spp isolates exposed to enrofloxacin developed resistance rapidly, whereas Klebsiella, Proteus, and Streptococcus spp were less likely to develop resistance. Despite the presence of enrofloxacin pressure, no resistant bacteria developed in the Escherichia coli and staphylococcal isolates. In many isolates, susceptibility patterns changed from susceptible to intermediate.     

Gentamicin for treatment of resistant urinary tract infections in dogs.

Gentamicin was administered parenterally for 6 days to 43 dogs with urinary tract infections. The daily dosage of 6.6 mg/kg (3 mg/lb) was divided into equal parts and given IM or SC at 8-hour intervals. Dogs selected for treatment with gentamicin had urinary infections that had not responded to treatment with other antimicrobial agents or had bacterial isolates from urine that were resistant to several antimicrobial agents on in vitro susceptibility tests. Response to treatment, defined as negative urine culture on the last day of therapy or 4 to 14 days after completion of the therapeutic course, included 20 of 22 (91%) infections caused by Escherichia coli, 8 of 9 (89%) infections caused by Kebsiella pneumoniae, 6 of 7 (86%) infections caused by Proteus spp, and 6 of 7 infections caused by Pseudomonas spp. These four species comprised 84% of the bacteria isolated from the dogs in this study.     

In vitro susceptibilities of canine urinary bacteria to selected antimicrobial agents

Antimicrobial susceptibility tests were conducted on bacteria that were isolated from urine specimens collected by antepubic cystocentesis from dogs with urinary tract infections. Antimicrobics to which greater than or equal to 90% of these urinary bacteria were susceptible in vitro included trimethoprim-sulfamethoxazole (TMP-SMZ), nitrofurantoin, cephalexin, nalidixic acid, and gentamicin for isolates of Escherichia coli; ampicillin, TMP-SMZ, cephalexin, nalidixic acid, and gentamicin for isolates of Proteus mirabilis; ampicillin chloramphenicol, TMP-SMZ, nitrofurantoin, cephalexin, kanamycin, and gentamicin for isolates of coagulase-positive staphylococci; cephalexin, nalidixic acid, and gentamicin for isolates of Klebsiella pneumoniae; ampicillin, TMP-SMZ, and gentamicin for isolates of Streptococcus faecalis, Str faecium, and Str zymogenes; ampicillin, chloramphenicol, TMP-SMZ, and gentamicin for isolates of Str viridans; and ampicillin, chloramphenicol, TMP-SMZ, nitrofurantoin, cephalexin, kanamycin, and gentamicin for isolates of Str canis. No antimicrobial agent tested was effective in vitro at the 90% level for isolates of Pseudomonas aeruginosa, but gentamicin was closest, at 89%.     

Comparison of three techniques for the diagnosis of urinary tract infections in dogs with urolithiasis

OBJECTIVES: To identify an appropriate sampling technique(s) to accurately detect the bacteria causing urinary tract infections in dogs with urolithiasis. METHODS: Twenty-one dogs with urolithiasis were included in the study. Three types of samples were taken from each dog. Urine was collected by cystocentesis, and a urinary bladder mucosal biopsy and urolith were retrieved during cystotomy. The samples were then cultured on blood agar and MacConkey's agar to identify the bacteria associated with urinary tract infections. RESULTS: Bacterial urinary tract infection was found in 16 cases (76.19 per cent). The most prevalent bacteria found to cause urinary tract infection were Escherichia coli (n=7), followed by coagulase-positive Staphylococcus species (n=4), Klebsiella pneumoniae (n=2), Pseudomonas aeruginosa (n=2) and Proteus mirabilis (n=1). In the case of a positive urine culture, the same bacteria were also cultured from the urinary bladder mucosal biopsy alone or from both the urinary bladder mucosal biopsy and urolith. However, in the case of a negative urine culture, bacteria were found to be present in the urinary bladder mucosal biopsy or urolith cultures in 23.81 per cent of dogs. The uroliths that gave positive culture results were either infection-induced uroliths composed of struvite and calcium carbonate phosphate, ammonium acid urate only or metabolic uroliths composed of calcium oxalate and calcium phosphate, or calcium phosphate only. All the uroliths that gave negative culture results were metabolic uroliths composed of calcium oxalate and/or calcium phosphate, and uric acid and calcium phosphate. CLINICAL SIGNIFICANCE: When the culture from the urine obtained by cystocentesis is negative, cultures of urinary bladder mucosal biopsy and urolith are recommended in dogs with urolithiasis in order to accurately assess the microbiological status of the urinary tract.     

Bacterial culture results from liver, gallbladder, or bile in 248 dogs and cats evaluated for hepatobiliary disease: 1998-2003

BACKGROUND: Information is lacking on the prevalence and susceptibility patterns of bacterial isolates in dogs and cats with suspected hepatobiliary disease. OBJECTIVES: To characterize the prevalence, identity, and antimicrobial susceptibility of common hepatobiliary isolates from such patients. ANIMALS: Dogs and cats presented to the University of Wisconsin-Madison Veterinary Medical Teaching Hospital for which samples of bile, gallbladder, or liver were submitted for culture from 1998 to 2003, including 190 dogs (192 culture episodes) and 58 cats (61 culture episodes). METHODS: Cases were identified from the microbiology laboratory database. Data from patient medical records were extracted, including the history of antimicrobial administration, the presence of fever, the results of CBC and serum biochemistry, the presence of biliary obstruction or hepatobiliary inflammation, and the results of aerobic and anaerobic bacterial cultures and aerobic antimicrobial susceptibilities. RESULTS: Biliary cultures yielded a significantly higher percentage of positive results overall (30% [18 of 60]) than did hepatic cultures (7% [15 of 215]). In patients with cholecystitis, 62% (8 of 13) had positive biliary cultures. In patients with hepatic inflammation, 23% (7 of 30) had positive bile cultures, whereas only 6% (6 of 103) had positive hepatic cultures. Escherichia coli, Enterococcus spp., Bacteroides spp., Streptococcus spp., and Clostridium spp. were the most common true-positive isolates. More than 80% of Enterobacteriaceae were susceptible to ciprofloxacin or aminoglycosides, with only 30-67% susceptible to first-generation aminopenicillins and cephalosporins. Liver samples obtained by surgery or laparoscopy were more likely to yield positive cultures than those obtained by percutaneous needle biopsy.