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

The clinical and diagnostic features of 155 cats with urinary tract infection (UTI) and 186 controls with negative urine culture/s were characterized retrospectively (signalment, clinical signs, urinalysis, urine culture, concurrent diseases, lower urinary tract diagnostic/therapeutic procedures). Multivariable logistic regression was used to identify risk factors associated with UTI. Cats of all ages were affected by UTI with no sex/breed predisposition. Lower urinary tract signs were absent in 35.5% of cats with UTI. Pyuria and bacteriuria had sensitivities of 52.9% and 72.9%, and specificities of 85.5% and 67.7% for detection of UTI, respectively. Risk factors significantly associated with increased odds of UTI were urinary incontinence [odds ratio (OR) = 10.78, P = 0.0331], transurethral procedures (OR = 8.37, P <0.0001), urogenital surgery (OR = 6.03, P = 0.0385), gastrointestinal disease (OR = 2.62, P = 0.0331), decreased body weight (OR = 0.81, P = 0.0259) and decreased urine specific gravity (OR = 0.78, P = 0.0055). Whilst not independently significant, renal disease and lower urinary tract anatomic abnormalities improved statistical model performance and contributed to UTI.     

Polypoid cystitis in 17 dogs (1978-2001)

Polypoid cystitis is a rare disease of the urinary bladder in dogs characterized by inflammation, epithelial proliferation, and development of a polypoid mass or masses without histopathologic evidence of neoplasia. Medical records of 17 dogs with polypoid cystitis were reviewed to determine the clinical and laboratory features of this disorder and to assess treatment and outcome. Most affected dogs (15/17) were female and presented for evaluation of hematuria or recurrent urinary tract infection (UTI). Proteus spp were the most common bacterial isolates (12/52 or 23.1%) identified when all urine samples obtained for culture at any time during the course study were considered. Other commonly isolated organisms included Escherichia coli , Staphylococcus spp, and Enterococcus spp. Several dogs (7/17) also had cystic calculi at some time during the course of their disease. Most of the masses (11/14) were located cranioventrally in the bladder as opposed to transitional cell carcinoma, which has a predilection for the bladder neck or trigone area. It is unknown whether persistent or recurrent UTI predisposes to polyp formation or if polyps predispose to UTI. Surgery and removal of all polyps was the most efficacious treatment in dogs of this study. The question of whether or not polyps represent preneoplastic lesions remains unanswered and constitutes an area for future investigation.     

An isolated cryptococcal urinary tract infection in a cat

A male domestic shorthaired cat was presented for evaluation of stranguria and pollakiuria. A cryptococcal urinary tract infection (UTI) was diagnosed cytologically and via fungal culture. No evidence of systemic involvement was found. Chronic renal failure was a concurrent disease in this cat. Treatment consisted of oral fluconazole. Clinical signs resolved after 2 weeks of therapy, and fluconazole was discontinued after 6 months when negative urine culture results indicated resolution of the infection. This case demonstrates that correct identification of cryptococcal UTI allows for administration of therapy that can be associated with resolution of clinical signs.     

Incidence of catheter-associated urinary tract infection among dogs in a small animal intensive care unit

OBJECTIVE: To determine incidence of and possible risk factors for catheter-associated urinary tract infection (UTI) among dogs hospitalized in an intensive care unit and compare results of bacterial culture of urine samples with results of bacterial culture of catheter tips. DESIGN: Prospective study. ANIMALS: 39 dogs. PROCEDURE: A standard protocol for aseptic catheter placement and maintenance was used. Urine samples were obtained daily and submitted for bacterial culture. When possible, the urinary catheter tip was collected aseptically at the time of catheter removal and submitted for bacterial culture. Bacteria that were obtained were identified and tested for antimicrobial susceptibility. RESULTS: 4 of the 39 (10.3%) dogs developed a UTI. The probability of remaining free from UTI after 1 day in the intensive care unit was 94.9%, and the probability of remaining free from UTI after 4 days was 63.3%. Bacteria isolates were generally common urinary tract pathogens and were susceptible to most antimicrobials. Specific risk factors for catheter-associated UTI, beyond a lack of antimicrobial administration, were not identified. Positive predictive value of bacterial culture of urinary catheter tips was only 25%. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that placement of an indwelling urinary catheter in dogs is associated with a low risk of catheter-associated UTI during the first 3 days after catheter placement, provided that adequate precautions are taken for aseptic catheter placement and maintenance. Results of bacterial culture of urinary catheter tips should not be used to predict whether dogs developed catheter-associated UTI.     

Prevalence and characterization of urinary tract infections in dogs with surgically treated type 1 thoracolumbar intervertebral disc extrusion

OBJECTIVE: To determine the prevalence of urinary tract infections (UTI), factors that correlate positively with UTI, and whether identified UTI are most likely community- or hospital acquired in dogs with surgically treated type 1 thoracolumbar intervertebral disc (IVD) extrusions. STUDY DESIGN: Prospective cross-sectional clinical study. SAMPLE POPULATION: Dogs (n=92) that were surgically treated for a thoracolumbar extradural compressive spinal cord lesion that was consistent with type 1 IVD extrusion. METHODS: Dogs were evaluated for bacterial lower UTI when possible by cystocentesis and urine culture before surgery, and 48-72, 96-120 hours, and 7 days after surgery while hospitalized. Paraparesis, confirmation of thoracolumbar extruded nucleus pulposus, and informed owner consent were required for study inclusion. Urine specimens (n=297) were cultured and both objective and subjective clinical data were obtained. RESULTS: Prevalence of UTI in dogs with surgically treated type 1 thoracolumbar IVD extrusion was 27% (25 dogs). Temporal prevalence of UTI was 15% (13/89) before surgery, 12% (11/91) at 2-3 days, 16% (12/76) at 4-5 days, and 20% (8/41) at 7 days after surgery. Statistically significant factors affecting UTI prevalence included neurologic and urinary status, sex, administration of perioperative antibiotics, and amount of time body temperature was <35 degrees C during anesthesia. CONCLUSION: UTI are common in dogs with surgically treated type 1 thoracolumbar IVD extrusion. Females, dogs that cannot ambulate or voluntarily urinate, dogs not administered perioperative cefazolin, and dogs whose body temperature falls <35 degrees C during anesthesia have a higher incidence of UTI. CLINICAL RELEVANCE: All dogs with surgically treated type 1 thoracolumbar IVD extrusion should be monitored for the presence of UTI; however, close attention should be paid to females and dogs that cannot ambulate or voluntarily urinate.     

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.     

A herd level analysis of urinary tract infection in dairy cattle

Cystitis, urethritis and pyelonephritis in cattle most commonly result from ascending urinary tract infection with Corynebacterium renale, Corynebacterium cystidis, Corynebacterium pilosum or Escherichia coli. We describe the clinical, bacteriological, clinical-pathological and epidemiological findings in a dairy cattle herd with urinary tract infection (UTI). Blood and urine samples from 17 calves and 19 cows were submitted to laboratory examinations. Depression, muscle wasting, weakness and frequent urine dribbling were the main characteristics of UTI in calves. Affected cows showed weight loss and an abrupt reduction in feed intake and milk production. Enlargement of the left kidney and loss of normal lobulation were evident on rectal examination. E. coli was the most frequent cause of UTI but C. renale, alpha-haemolytic Streptococcus spp., Proteus spp. Pseudomonas aeruginosa, Klebsiella spp. and Oligella urethralis were isolated as well. Differences in total protein and several protein fractions were found between affected and healthy animals.     

Recurrent and persistent urinary tract infections in dogs: 383 cases (1969-1995)

Laboratory records of bacterial urine cultures from 383 dogs with recurrent or persistent urinary tract infections (UTI) diagnosed at the University of California Veterinary Medical Teaching Hospital (VMTH) between 1969 and 1995 were reviewed retrospectively to characterize the bacteria involved and their association with age, gender, and breed of dogs affected. Sixty-eight breeds and a mixed-breed group were represented. Escherichia coli was the most common isolate, although mixed-bacterial infections were seen in 58% of the female and 55% of the male dogs. Recurrent and persistent UTI were most prevalent in middle-aged to older German shepherd dogs, miniature/toy poodles, and Labrador retrievers, with no apparent sex predilection. Criteria fitting recurrent and persistent UTI were present in 0.3% of all dogs seen at the VMTH during this 26-year period.     

Candida spp. urinary tract infections in 13 dogs and seven cats: predisposing factors,treatment, and outcome

Records from 20 animals (13 dogs, seven cats) with Candida spp. urinary tract infections were reviewed. Six Candida spp. were isolated; Candida albicans was the most common isolate. Concurrent diseases or nonantifungal drugs administered within 1 month of isolation included antibiotics (n=16), corticosteroids (n=6), diabetes mellitus (n=4), nonurogenital neoplasia (n=3), and noncandidal urogenital disease (n=14). All animals had sources of local or systemic immune compromise that likely predisposed to infection. Of five animals with resolution of infection, three did not receive specific antifungal treatment. The authors conclude that correction of predisposing conditions is likely critical for management of Candida spp. urinary tract infection.     

Results of vulvoplasty for treatment of recessed vulva in dogs.

The results of vulvoplasty were evaluated in 34 dogs that underwent surgery at the University of Wisconsin Veterinary Medical Teaching Hospital between 1987 and 1999. Case records were evaluated, and clients were interviewed by telephone. The most common clinical signs of a juvenile or recessed vulva at initial examination were perivulvar dermatitis in 59% (20/34) of dogs and urinary incontinence and chronic urinary tract infection (UTI), each present in 56% (19/34) of dogs. Other common complaints included pollakiuria, irritation, and vaginitis. Most dogs developed clinical signs before 1 year of age. All dogs except one bichon frise were medium to giant breeds, suggesting that vulvar conformation may be related to growth rate or body conformation; prior ovariohysterectomy did not appear to be an influencing factor. Eighty-two percent of owners rated the outcome of the surgery as at least satisfactory. The incidence of urinary incontinence was reduced by vulvoplasty; however, it remained the most common residual sign after surgery, suggesting a multifactorial etiology. The incidences of UTI, vaginitis, and external irritation were greatly reduced after surgery.     

Antibiotic sensitivity profiles do not reliably distinguish relapsing or persisting infections from reinfections in cats with chronic renal failure and multiple diagnoses of Escherichia coli urinary tract infection

Older cats with chronic renal failure (CRF) commonly develop urinary tract infections (UTI). Uropathogenic Escherichia coli (UPEC) is identified as the causal agent of UTI in most affected cats. Infections are often complicated, and UPEC infections may persist or recur in these cats. Antibiotic sensitivity profiles have been used to distinguish relapsing or persisting UTI from reinfection by different clones of the same species. However, the accuracy with which antibiograms discriminate different urinary E coli clones in cats is uncertain. We studied 17 cystocentesis-derived UPEC isolates collected from 5 cats with stable CRF and multiple diagnoses of UTI. UTIs were classified as relapses versus persistent infections or reinfections using antibiograms determined by Kirby-Bauer discs and Etests. Subsequently, clonality of UPEC isolates was determined by pulsed-field gel electrophoresis (PFGE). A comparison of PFGE results with antibiograms indicated that antibiotic resistance patterns varied considerably within several individual E coli clones. Both antibiotic susceptibility tests differentiated between relapsing or persistent infections and reinfections with only 58% overall efficiency. Thus, antibiotic sensitivity profiles cannot be relied upon to distinguish between persisting or relapsing infections as compared to reinfections in cats with CRF and multiple diagnoses of E coli UTI.     

In vitro antimicrobial activity of nitrofurantoin against Escherichia coli and Staphylococcus pseudintermedius isolated from dogs and cats

Minimum inhibitory concentrations (MIC) of nitrofurantoin were determined by agar dilution in 269 canine and feline isolates of Escherichia coli and Staphylococcus pseudintermedius, two of the most common bacterial species associated with urinary tract infection (UTI) in small animals. The MIC90 for E. coli and S. pseudintermedius were 32 and 16 μg/ml, respectively. All isolates, including multidrug-resistant strains of known genetic background, displayed MICs below the drug concentrations reported in canine urine following oral administration of nitrofurantoin. Preliminary data on mutant prevention concentration (MPC) and many years of nitrofurantoin usage in human medicine suggest that emergence of resistant mutants during treatment is not a critical issue for this drug. The study provides species-specific data on nitrofurantoin MIC distribution that can be used for setting dog- and cat-specific breakpoints. Although nitrofurantoin is not an appropriate first-line agent for empirical treatment of canine UTI due to toxicity and poor pharmacokinetic properties, it may be indicated for treatment of UTI caused by multidrug-resistant bacteria, which are otherwise difficult to treat using conventional veterinary antimicrobial agents.     

Urinary Tract Infection in Dogs with Thoracolumbar Intervertebral Disc Herniation and Urinary Bladder Dysfunction Managed by Manual Expression,Indwelling Catheterization or Intermittent Catheterization

Objective— To evaluate risk factors for lower urinary tract infection (UTI) in dogs with intervertebral disc disease (IVDD) that had manual expression (ME), indwelling catheterization (IDC) or intermittent catheterization (ITC) for urinary bladder management. Study Design— Randomized‐clinical trial. Animals— Dogs (n=62) treated with urinary bladder dysfunction requiring surgery for IVDD and control dogs (n=30) that had surgery for reasons other than IVDD. Methods— Treated dogs were randomly assigned to ME, IDC, or ITC. Urine was collected for culture and antimicrobial susceptibility testing before and after treatment. Incidence and risk factors for UTI were evaluated. Bacterial isolates and antimicrobial resistance patterns were described. Results— Mean (±SD) time to urination was significantly longer for IDC dogs (7.4±2.75 days) than ME dogs (4.2±2.63) and ITC dogs (4.9±3.12). Thirteen treated dogs (21%) and no control dogs developed UTI: 4/25 (16%) ME, 8/25 (32%) IDC, and 1/12 (8%) ITC. Enterobacter sp. was most frequently isolated (4/13; 31%). Duration of treatment was the only risk factor for UTI and each additional day of treatment increased the risk of UTI 1.5 times. Conclusion— For dogs with acute IVDD, the duration of required urinary bladder management establishes the risk of UTI, not the urinary bladder management technique. Clinical Relevance— Duration of treatment for urinary bladder dysfunction is a risk factor for UTI in dogs recovering from acute IVDD. Treatment for urinary bladder management should be limited where possible and no method of treatment is preferred. For dogs managed by IDC, voluntary urination might occur before clinically suspected.     

Genotypic identification of Pseudomonas aeruginosa strains isolated from patients with urinary tract infection

BackgroundNumerous nosocomial infections including urinary tract infection (UTI) have been reported to be linked to Pseudomonas aeruginosa (P. aeruginosa). This bacterium is one of the most common pathogen colonized in the urinary tract. The main purpose of this study was to evaluated the presence of antibiotic resistance genes and also the most frequent genotype patterns of P. aeruginosa in the patients with UTI hospitalized in different wards of hospitals.Materials and methodsIn this study, 70 strains of P. aeruginosa isolated of urine samples from the patients with UTI were assessed. The isolated strains were genotyped using Multiple-Locus Variable Number Tandem Repeat Analysis (MLVA) method. We have also analyzed the presence of TEM and SHV resistant genes in the isolates.ResultsA total of 70 P. aeruginosa strains was isolated from the UTI patients. Based on MLVA method, 61 various genotypes of P. aeruginosa were identified which grouped into two main clusters and 4 sub-clusters. Moreover, approximately 80% and 70% of isolated strains carried the TEM and SHV resistance genes, respectively.ConclusionOur findings showed that the majority of patients hospitalized in different wards of hospitals have experienced the urinary tract infection caused by P. aeruginosa. According to the genotyping results, a high diversity of the P. aeruginosa population was observed in the patients with UTI. Our results can provide a better understanding of the P. aeruginosa genotype distribution and epidemiology of infection, which can be applied as basic data for future antibiotic therapies.     

Trimethoprim in combination with a sulfonamide for oral treatment of canine urinary tract infections.

Trimethoprim, in combination with sulfadiazine or sulfamethoxazole was administered orally for 7 to 14 days to 84 dogs with urinary tract infections (UTI). The daily dosage of 26.4 mg/kg (12 mg/lb) was divided into 2 equal parts and administered at about 12-hour intervals. Response to treatment, based on negative urine culture during or after therapy, was 37 of 45 (82%) for UTI caused by Escherichia coli, 11 of 15 (73%) UTI caused by Proteus mirabilis, 8 of 12 (67%) UTI caused by Klebsiella pneumoniae, 6 of 6 (100%) UTI caused by Staphylococcus aureus, and 5 of 9 (56%) UTI caused by Streptococcus spp. These 5 species comprised 88% of the bacteria isolated from the dogs in this study.     

Ultrasonographic characterization of the urinary bladder in sows with and without urinary tract infection

The urinary bladders of sows (n=10) without urinary tract infection (UTI) were longitudinally transrectally scanned after emptying and refilling with 200, 400, 600 and 800mL saline, and a volume dependence was found for bladder depth (BD), dorsal (dWT) and ventral wall thicknesses (vWT), wall regularity (WR) and mucosal wall surface (mWS). When another 31 sows without and 15 with UTI (as defined on the basis of high bacterial count and macroscopic/biochemical urine abnormalities) were compared for these parameters using BD as volume equivalent, no differences were found. Sows with UTI more often had moderate to high amounts of sediment than animals without UTI. Ultrasonographic assessment of dWT, vWT, WR and mWS of the urinary bladder of sows requires knowledge of bladder volume, and BD may be used as a volume equivalent. However, the parameters are inappropriate for the diagnosis of UTI as defined in this study, while moderate/high amounts of sediment seem to be indicative. Sediment can be visualized by transrectal scanning, but this is also possible using the transcutaneous route.     

The influence of prepartal bacteriuria on the reproductive performance of the sow

In a Slowakian indoor pig production unit, with high prevalence of vaginal-vulval discharges, the sows were subjected one day prefarrowing to urine analysis. Sows suffering urinary tract infection (UTI) were assigned to an UTI group (group 1, n = 384), the remaining sows were classified as free of UTI and were assigned to group 2 (n = 1099). Total born litter size, liveborn litter size, weaning litter size and the occurrence of periparturient diseases, reasons for sow cullings at weaning, subsequent weaning to estrus intervals, conceptions- and farrowing rate, next total born- and lifeborn litter size and the occurrence of periparturient diseases were evaluated. UTI having sows had smaller (p < 0.05) total born litter size (11.71 +/- 1.11) when compared to the healthy animals (12.97 +/- 1.25). Liveborn litter size was significantly (p < 0.01) lower in group 1 (10.21 +/- 0.81 vs. group 2: 11.31 +/- 1.21). The occurrence of periparturient diseases revealed highly significant (p < 0.001) differences between the groups (group one 26.24% vs. group two 4.64%). Weaning litter size showed significant (p < 0.05) differences between group 1 (9.21 +/- 1.02) and 2 (10.11 +/- 0.37). More (p < 0.05) sows were culled post-weaning in the UTI group, compared to the healthy animals. Causes of post-weaning cullings differed between the groups: all sows of the group one had the pathological signs of swine urogenital disease at culling, while the majority of sows of the group 2 were culled due to locomotor problems and chronic mastitis. Subsequent weaning to estrus intervals, conceptions-, and farrowing rate and next total born litter size differed significantly (p < 0.05) between the groups, next lifeborn litter size (p < 0.01) and the occurrence of periparturient diseases (p < 0.001) were high significantly better in the healthy than in the UTI suffering group of sows. Implications: antepartal UTI might be the sign of swine urogenital disease and might negatively influence the sows reproductive performance.     

Diagnosis of urinary tract infections.

Urinary tract infections (UTIs) are a common cause of urinary tract disease and may be associated with systemic disease. Diagnosis cannot be made on urinalysis and other findings alone. A urine culture is the "gold standard" for diagnosis of UTI. Antimicrobial susceptibility testing performed as part of a urine culture aids in selection of appropriate treatment for patients with confirmed bacterial UTI.     

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.