Antibiotics for UTIs in dogs and cats?: When to say “no”

dvm360, dvm360 June 2021, Volume 56,

A bacterial culture, the gold standard for detecting urinary tract infections can take days to produce visible results, causing doctors to prescribe antibiotics in the interim for pet symptom relief. Antech’s new FIRSTract produces results in just hours, helping to reduce overuse of antibiotics.

Imagine that a client pops into your clinic and says their dog just peed inside the house or their cat urinated outside the litter box and says their pet “needs an antibiotic.” The reflex assumption is urinary tract infection (UTI). “Sometimes, even if we know better, we give in and offer the antibiotic,” says Jen Ogeer, DVM, MSc, MBA, MA, vice president of medical affairs at Antech Diagnostics.

What the data show

Studies have revealed that 10% to 14% of dogs experience a UTI at some point in their life and over 4% of dogs with a UTI continue to have recurrent or persistent UTIs throughout their lives.1 Healthy cats have traditionally been considered more resistant to UTIs than dogs, partly because of their high urine concentration and high urine osmolality.2 Most studies evaluated the prevalence of bacterial UTIs in cats with clinical signs of idiopathic feline lower urinary tract disease (FLUTD).3-4 The estimated frequency varies from 1% to 4.9% to 8% to 33%.5-9

Put simply, veterinarians know FLUTD likely does not equate to a UTI because UTIs are typically rare in healthy and middle-aged cats and uncommon in dogs. Veterinarians also better understand the role stress plays in UTI-like symptoms, allowing us to correctly identify the signs as pandora’s syndrome,10 in which stress and an environment void of enrichment play a significant role.

“We also know we’re arguably dispensing too many antibiotics unnecessarily and contributing to the one health problem of antimicrobial resistance,” Ogeer adds.

Antech’s rapid urine culture

According to Michelle Frye, DVM, SM, owner of Echo Lane Animal Clinic, in Houston, Texas, veterinarians must gather a detailed history report from pet owners. She recommends asking questions about the duration, the frequency and location of the accidents, and urine color.

If it’s a suspected UTI, the next step begins with Antech’s FIRSTract test, the first reference laboratory automated assay for quick urine culture, delivering accurate and reliable results within hours.11

FIRSTract utilizes 500 µL of urine inoculated into a proprietary culture broth optimized for aerobic bacterial pathogen growth and incubated in a controlled and fully automated setting. During the incubation process, the samples are temperature-controlled and continuously mixed, minimizing sedimentation, flotation, and growth abnormalities typical of several microorganisms. Interference from erythrocytes, leukocytes, and dead cells is minimized by obtaining an initial baseline reading of turbidity. Light scatter is measured and assessed from the sample turbidity of the inoculated broth. Measurements are taken every 5 minutes and continually monitored for an exponential increase in turbidity that is consistent with the presence of any viable bacteria replicating in the patient urine sample.

Finessing the urine sample

Urine samples can be challenging to obtain, especially in fractious cats or nonadherent dogs. A sterile sample obtained by cystocentesis is the sample of choice for urine culture. If the animal recently voided or cystocentesis is not possible, a sample by urinary catheterization in males or a clean-catch, midstream voided sample are permissible.

“Traditional urine culture takes days to grow on an agar plate,” says Frye. “This is a long time for a pet to be suffering. Now I get the result in hours instead of days. I can figure out what the problem is much faster.”

Supplementary to this, Frye recommends using an ultrasound for collecting the urine sample by cystocentesis to visualize the bladder. Additionally, she advises using a sterile urine sample to check for bacteria, crystals, overall health, kidney disease, and endocrine disorders. Obtain specific urine gravity to potentially find cancer cells. There is also an additional benefit of using the ultrasound to quickly assess the bladder wall and look for any urinary stones or masses.

And, of course, simultaneously, perform a routine physical exam on the pet and blood work when needed.

“If the animal is urinating more frequently, I need to understand why,” says Frye. “I see concurrent disease sometimes, for example, UTIs with other conditions such as diabetes or kidney disease.”

Bottom line

For clients who want the instant antibiotic, Frye says it’s imperative that you educate them about the increasing problem of antibiotic resistance and how the “inappropriate use of antibiotics can contribute to the creation of ‘superbugs’ or multidrug-resistant bacteria that can require hospitalization and a very expensive treatment plan.”

“I think these conversations with the pet owner are critical and part of our jobs as veterinarians,” Frye adds. “I am so thankful that the urine culture has evolved to provide necessary results in a timely manner—that makes this discussion with the client much easier. And owners appreciate that infectious diseases are no longer trivial. Particularly with the pandemic, everyone knows infectious diseases haven’t just disappeared.”

Steve Dale, CABC, writes for veterinary professionals and pet owners, hosts 2 national radio programs, and has appeared on TV shows including Good Morning America and The Oprah Winfrey Show. He is on the dvm360® Editorial Advisory Board as well as the boards of the Human-Animal Bond Association and EveryCat Foundation. He appears at conferences around the world. For more information, visit stevedale.tv.

References

  1. Ling GV. Therapeutic strategies involving antimicrobial treatment of the canine urinary tract. J Am Vet Med Assoc. 1984;185(10):1162-1164.
  2. 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):18-22. doi:10.1016/j.tvjl.2009.12.006
  3. 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):211-216.
  4. Lekcharoensuk C, Osborne CA, Lulich JP. Epidemiologic study of risk factors for lower urinary tract diseases in cats. J Am Vet Med Assoc. 2001;218(9):1429-1435. doi:10.2460/javma.2001.218.1429
  5. Bailiff NL, Nelson RW, Feldman EC, et al. Frequency and risk factors for urinary tract infection 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
  6. Gerber B, Boretti FS, Kley S, et al. Evaluation of clinical signs and causes of lower urinary tract disease in European cats. J Small Anim Pract. 2005;46(12):571-577.doi:10.1111/j.1748-5827.2005.tb00288.x
  7. Kraijer M, Fink-Gremmels J, Nickel R. The short-term clinical efficacy of amitriptyline in the management of idiopathic feline lower urinary tract disease: A controlled clinical study. J Feline Med Surg. 2003;5(3):191-196.doi:10.1016/S1098-612X(03)00004-4
  8. 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
  9. 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
  10. 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
  11. Ogeer J, Andrews J, Hanel R. Antech’s FIRSTtract rapid urine culture demonstrates excellent performance and high sensitivity and specificity in comparison to standard urine culture results, Antech Diagnostics. 2020. Accessed May 6, 2021. https://www.antechdiagnostics.com/assets/site/downloads/FIRSTRACT-White-Paper.pdf
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