Imagine a customer comes into your clinic and says that their dog has just peed in the house or that their cat urinated outside the litter box and that their pet “needs an antibiotic”. The reflex assumption is a urinary tract infection (UTI). “Sometimes, even when we know better, we give in and offer the antibiotic,” said Jen Ogeer, DVM, MSc, MBA, MA, vice president of medical affairs at Antech Diagnostics.
What the data shows
Studies have shown that 10% to 14% of dogs will have a urinary tract infection at some point in their life, and over 4% of dogs with a urinary tract infection will continue to have recurrent or persistent urinary tract infections throughout their lives.1 Healthy cats are traditionally considered to be more resistant to urinary tract infections than dogs due in part to their high urinary concentration and high urinary osmolality.2 Most studies assessed the prevalence of bacterial urinary tract infections in cats with clinical signs of idiopathic cat idiopathic lower urinary tract disease (FLUTD) .3-4 The estimated frequency varies from 1% up to 4.9% up to 8% up to 33% .5-9
Simply put, veterinarians know that FLUTD is unlikely to equate to urinary tract infection, since urinary tract infections are usually rare in healthy and middle-aged cats and uncommon in dogs. Veterinarians also have a better understanding of the role stress plays in UTI-like symptoms, so we can correctly identify the signs as pandora syndrome 10, where stress and a non-enrichment environment play an important role.
“We also know that we may be shedding too many antibiotics unnecessarily and contributing to the only health problem of antibiotic resistance,” added Ogeer.
Antech’s rapid urine culture
According to Michelle Frye, DVM, SM, owner of the Echo Lane Animal Clinic in Houston, Texas, veterinarians must obtain detailed medical history reports from animal owners. She recommends asking questions about the duration, frequency and location of the accidents and the color of the urine.
When it comes to a suspected urinary tract infection, the next step begins with Antech’s FIRSTract test, the first automated reference laboratory assay for rapid urine culture that provides accurate, reliable results in hours. 11
FIRSTract uses 500 µl of urine inoculated into a proprietary culture broth that has been optimized for the growth of aerobic bacterial pathogens and incubated in a controlled and fully automated environment. During the incubation process, the samples are temperature-controlled and continuously mixed, which minimizes sedimentation, flotation and growth disturbances that are typical for several microorganisms. The interference of red blood cells, white blood cells and dead cells is minimized by obtaining an initial baseline value for turbidity. The light scattering is measured and evaluated on the basis of the sample turbidity of the inoculated broth. Measurements are taken every 5 minutes and are continuously monitored for an exponential increase in turbidity consistent with the presence of viable bacteria in the patient’s urine sample.
Finessing the urine sample
Collecting urine samples can be difficult, especially from fractured cats or non-adherent dogs. A sterile sample obtained by cystocentesis is the sample of choice for urine culture. If the animal has recently been voided or if cystocentesis is impossible, a specimen by urinary catheterization in males or a clean muzzle specimen in the middle of the stream is acceptable.
“Traditional urine culture takes days to grow on an agar plate,” says Frye. “It is a long time before a pet suffers. Now I get the result in hours instead of days. I can find out what the problem is much faster. “
In addition, Frye recommends using an ultrasound to collect the urine sample through cystocentesis to visualize the bladder. Additionally, she recommends using a sterile urine sample to check for bacteria, crystals, general health, kidney disease, and endocrine disorders. Obtain the specific gravity of the urine to find possible cancer cells. There is also an added benefit of using the ultrasound to quickly assess the bladder wall and check for urinary stones or masses.
And of course, if necessary, do a routine pet physical exam and blood test at the same time.
“If the animal urinates more often, I need to understand why,” says Frye. “I sometimes see illnesses occurring at the same time, for example urinary tract infections with other illnesses such as diabetes or kidney disease.”
Bottom line
For customers who want the antibiotic immediately, Frye says it is imperative that you educate them about the growing problem of antibiotic resistance and how “inappropriate use of antibiotics can contribute to the creation of” superbugs “or multi-resistant bacteria that can lead to hospitalization require and a very expensive treatment plan. “
“I think these conversations with the keeper are critical and part of our job as vets,” Frye adds. “I am so grateful that the urine culture has evolved in order to deliver the necessary results on time – that makes this discussion with the customer much easier. And the owners appreciate that infectious diseases are no longer trivial. With the pandemic in particular, everyone knows that infectious diseases have not simply disappeared. “
Steve Dale, CABC, writes for veterinarians and pet owners, hosts two national radio programs, and has appeared on television shows such as Good Morning America and The Oprah Winfrey Show. He is a member of the dvm360® Editorial Advisory Board as well as the boards of the Human-Animal Bond Association and the EveryCat Foundation. He performs at conferences around the world. More information is available at stevedale.tv.
References
- Ling GV. Therapeutic strategies for antimicrobial treatment of the canine urinary tract. J Am Vet Med Assoc. 1984; 185 (10): 1162-13. 1164.
- Litster A, Thompson M, Moss S, Trott D. Feline Bacterial Urinary Tract Infections: An Update on an Evolving Clinical Problem. Vet J. 2011; 187 (1): 18-13. 22. doi: 10.1016 / j.tvjl.2009.12.006
- Kruger JM, Osborne CA, Goyal SM, et al. Clinical evaluation of cats with lower urinary tract disease. J Am Vet Med Assoc. 1991; 199 (2): 211-21; 216.
- Lekcharoensuk C, Osborne CA, Lulich JP. Epidemiological study of risk factors for lower urinary tract disease in cats. J Am Vet Med Assoc. 2001; 218 (9): 1429- 1435. doi: 10.2460 / javma.2001.218.1429
- Bailiff NL, Nelson RW, Feldman EC, et al. Frequency and risk factors for urinary tract infections in cats with diabetes mellitus. J Vet Intern Med. 2006; 20 (4): 850-855, doi: 10.1892 / 0891-6640 (2006) 20[850:farffu]2.0.co; 2
- Gerber B., Boretti FS, Kley S. et al. Evaluation of the clinical signs and causes of lower urinary tract disease in European cats. J Small animation practice. 2005; 46 (12): 571-577.doi: 10.1111 / j.1748-5827.2005.tb00288.x
- Kraijer M., Fink-Gremmels J., Nickel R. The short-term clinical efficacy of amitriptyline in the treatment of idiopathic lower urinary tract disease in cats: A controlled clinical study. J Feline Med Surg. 2003; 5 (3): 191-196.doi: 10.1016 / S1098-612X (03) 00004-4
- Eggertsdóttir AV, Lund HS, Krontveit R, Sørum H. Bacteriuria in cats with feline lower urinary tract disease: A clinical study of 134 cases in Norway. J Feline Med Surg. 2007; 9 (6): 458-465.doi: 10.1016 / j.jfms.2007.06.003
- Sævik, Bente K., Trangerud C., Ottesen N., Sørum H., Eggertsdóttir AV. Causes of lower urinary tract disease in Norwegian cats. J Feline Med Surg. 2011; 13 (6): 410-417.doi: 10.1016 / j.jfms.2010.12.012
- Westropp J., Delgado M, Buffington T., Chronic Lower Urinary Tract Signs in Cats; Veterinary clinics small animal practice. 2019; 49 (2): 187-209.doi: 10.1016 / j.cvsm.2018.11.001
- Ogeer J., Andrews J., Hanel R. Antech’s FIRSTtract rapid urine culture shows excellent performance as well as high sensitivity and specificity compared to the standard results of urine culture, Antech Diagnostics. 2020. Accessed May 6, 2021. https://www.antechdiagnostics.com/assets/site/downloads/FIRSTRACT-White-Paper.pdf