•These guidelines provide recommendations for the diagnosis and management of bacterial urinary tract infections in dogs and cats.•Sporadic bacterial cystitis, recurrent bacterial cystitis, ...pyelonephritis, bacterial prostatitis, and subclinical bacteriuria are addressed.•Issues pertaining to urinary catheters, medical dissolution of uroliths and prophylaxis for urological procedures are discussed.
Urinary tract disease is a common clinical presentation in dogs and cats, and a common reason for antimicrobial prescription. This document is a revision and expansion on the 2011 Antimicrobial Use Guidelines for Treatment of Urinary Tract Disease in Dogs and Cats, providing recommendations for diagnosis and management of sporadic bacterial cystitis, recurrent bacterial cystitis, pyelonephritis, bacterial prostatitis, and subclinical bacteriuria. Issues pertaining to urinary catheters, medical dissolution of uroliths and prophylaxis for urological procedures are also addressed.
Background
Bacterial urinary tract infections have been associated with comorbidities and increased antimicrobial resistance over time.
Objective
To identify bacterial species, antimicrobial ...susceptibility patterns and risk factors associated with antimicrobial resistance.
Animals
Three hundred sixty‐three positive urine cultures from 308 cats.
Methods
Bacterial species and antimicrobial susceptibility data from positive aerobic bacterial urine cultures from cats with growth of ≥103 colony forming units per milliliter (cfu/ml) were included. Medical records were reviewed, and bacteriuria was classified as sporadic bacterial cystitis, recurrent bacterial cystitis or subclinical bacteriuria (SBU). Multivariable logistic regression analysis was used to evaluate antimicrobial resistance risk factors.
Results
A total of 444 bacterial isolates from 363 bacteriuric episodes were identified. Escherichia coli (52%) and SBU (59%) were the most common organism and classification, respectively. When compared to other classifications of bacteriuria, Enterococcus spp. were more likely to be isolated from SBU episodes (P < .001), whereas E. coli was more likely to be isolated from sporadic bacterial cystitis episodes (P < .001). Recurrent bacterial cystitis was associated with an increased risk of antimicrobial resistance to amoxicillin/clavulanic acid (odds ratio OR, 3.9; 95% confidence interval CI, 1.3‐11.3). The percent susceptibilities of all bacterial isolates to commonly prescribed antimicrobials were amoxicillin/clavulanic acid (72%), cefazolin (49%), enrofloxacin (61%), and trimethoprim/sulfamethoxazole (75%). Multidrug resistance was highest for Enterococcus faecium isolates (65%).
Conclusions and Clinical Importance
No antimicrobial achieved >90% susceptible designation to all bacteria isolated highlighting the importance of performing urine culture and susceptibility testing, particularly for cats with recurrent bacterial cystitis.
Background
Urolithiasis is a common and often recurrent problem in dogs.
Objective
To evaluate trends in urolith composition in dogs and to assess risk factors for urolithiasis, including age, breed, ...sex, neuter status, urolith location, and bacterial urolith cultures.
Sample Population
A total of 10 444 uroliths and the dogs from which they were obtained.
Methods
The laboratory database at the UC Davis Gerald V. Ling Urinary Stone Analysis Laboratory was searched for all urolith submissions from dogs between January 2006 and December 2018. Mineral type, age, breed, sex, neuter status, urolith location, and urolith culture were recorded. Trends were evaluated and variables compared to evaluate risk factors.
Results
Calcium oxalate (CaOx) and struvite‐containing uroliths comprised the majority of all submissions from dogs, representing 47.0% and 43.6%, respectively. The proportion of CaOx‐containing uroliths significantly decreased from 49.5% in 2006 to 41.8% in 2018 (P = .006), with no change in the proportion of struvite‐containing urolith submissions. Cystine‐containing uroliths comprised 2.7% of all submissions between 2006 and 2018 and a significant nonlinear increase in this mineral type occurred over time (1.4% of all submissions in 2006 to 8.7% in 2018; P < .001). Of all cystine‐containing uroliths, 70.3% were from intact male dogs. Age, breed, and sex predispositions for uroliths were similar to those previously identified.
Conclusions and Clinical Importance
Although calcium oxalate‐ and struvite‐containing uroliths continue to be the most common uroliths submitted from dogs, a decrease in the proportion of CaOx‐containing uroliths and an increase in the proportion of cystine‐containing uroliths occurred during the time period evaluated.
Background
Idiopathic functional urinary outflow tract obstruction (iFUOTO) is an uncommon but life‐limiting disease whose etiology and clinical course of disease remain poorly understood.
Objective
...Characterize signalment, clinical signs, clinicopathologic findings, treatments, and propose a standardized response score for dogs with iFUOTO.
Animals
Thirty‐one client‐owned dogs diagnosed with iFUOTO.
Methods
Retrospective case series. Medical records from 2010 to 2021 were reviewed and findings recorded. Dogs were categorized based on the presence or absence of overt signs of neurological disease. Response to treatment was scored.
Results
Thirty‐one dogs were included. All dogs had stranguria and 14 (45%) had overflow urinary incontinence. Mean age of onset for signs was 6.9 years±8 months. Twenty‐four dogs (77%) were castrated males, 5 (16%) intact males, and 2 (6%) spayed females. Eight (26%) of dogs had overt neurological deficits. Follow‐up data were available for 29 dogs (median 38 days, range: 2‐1277). Final outcome scores were not significantly different among dogs with overt signs of neurological disease (median score 2.5; range: 0‐3) and those without (median score 1; range; 0‐3; P = .35). Treatments included alpha antagonists, skeletal muscle relaxants, parasympathomimetics, anti‐inflammatories, castration, temporary placement of a urethral catheter, or a combination of these.
Conclusions and Clinical Relevance
Multimodal treatment was frequently prescribed, but a standard outcome score is needed to evaluate the effectiveness of these therapies. Serial neurological examinations and monitoring of the dogs' dysuria are warranted.
Background
Urolithiasis is an important upper and lower urinary tract disease in cats that results in morbidity and mortality.
Objective
To describe trends in composition of uroliths in cats and ...evaluate risk factors related to age, breed, sex, urolith location, and bacterial urolith cultures.
Sample Population
A total of 3940 uroliths and the cats from which they were obtained.
Methods
The database of the UC Davis Gerald V. Ling Urinary Stone Analysis Laboratory was searched for all urolith submissions from cats between January 2005 and December 2018. Mineral type, age, breed, sex, and urolith location and culture results were recorded. Trends were evaluated and variables compared to evaluate risk factors.
Results
A significant decrease in the proportion of calcium oxalate (CaOx)‐containing uroliths occurred over time (P = .02), from 50.1% (204/407) of all submissions in 2005 to 37.7% (58/154) in 2018. In contrast, the proportion of struvite‐containing uroliths increased significantly (P = .002), from 41.8% (170/407) in 2005 to 54.5% (84/154) in 2018. The proportion of CaOx‐containing uroliths in the upper urinary tract was significantly higher compared to the proportion of other urolith types in the upper urinary tract. Urate‐containing uroliths were the third most common type (361/3940, 9.2%). Overall, sex and age predispositions were similar to those reported previously.
Conclusions and Clinical Importance
The decrease in the proportion of CaOx‐containing uroliths and increase in the proportion of struvite‐containing uroliths warrants investigation. Further education regarding the efficacy of medical dissolution of struvite‐containing uroliths is recommended.
Background
Cystourethroscopy and vaginoscopy (uroendoscopy) is often used in the diagnostic evaluation of dogs with lower urinary tract disorders (LUTD).
Objective/Hypothesis
To evaluate if ...uroendoscopy is warranted in dogs with various LUTD, the agreement between uroendoscopic and ultrasonographic diagnoses were compared. Dogs with recurrent urinary tract infections (rUTI) will have the highest diagnostic agreement between uroendoscopy and ultrasonography (US) compared to dogs presenting for other LUTD.
Animals
Two hundred thirty‐seven dogs presenting between 2014 and 2019 with lower urinary tract signs (LUTS) that had US within 60 days preceding uroendoscopy.
Methods
Retrospective study. Dogs were categorized by primary indication for ultrasound. Pertinent uroendoscopic findings were recorded and agreements (κ analysis) between the final uroendoscopic diagnosis were compared with the final ultrasonographic diagnosis.
Results
Pertinent uroendoscopic findings were recorded for 69/237 (29%) cases. For dogs presenting primarily for urinary incontinence (UI), agreement between uroendoscopy and US was 71% (46/65; κ = 0.47, 95% CI 0.28‐0.66), for dogs with stranguria, 58% (29/50; κ = 0.47, 95% CI 0.31‐0.62) and for dogs with rUTI the agreement was substantial at 87% (26/30; κ = 0.70, 95% CI 0.43‐0.98). Urethral strictures were the majority (14/21; 67%) of pertinent uroendoscopic findings for dogs with stranguria, of which 12 were male dogs.
Conclusions and Clinical Importance
Agreement between uroendoscopy and US was moderate for all dogs. Based on these data, recommendation for uroendoscopy should be tailored to individual clinical presentation and signalment; transabdominal US is not the preferred modality for urethral lesions.
Urinary incontinence (UI) is a disorder of micturition that can occur in dogs of any age, sex, and breed depending on the underlying cause and time of onset. Diagnosis and treatment for various ...causes of UI in dogs have been described by multiple comprehensive single author review articles, but large prospective clinical trials comparing treatment outcomes in veterinary medicine are lacking. The objectives of this consensus statement therefore are to provide guidelines on both recommended diagnostic testing and treatment for various causes of UI in dogs. Specifically, pathophysiology directly related to the canine urinary system will be reviewed and diagnostic and therapeutic challenges will be addressed. A panel of 12 experts in the field (8 small animal internists L. Adams, J. Bartges, A. Berent, J. Byron, J. Foster, A. Kendall, S. Vaden, J. Westropp, 2 neurologists J. Coates, N. Olby, 1 radiologist G. Oetelaar, and 1 surgeon C. Adin) was formed to assess and summarize evidence in the peer‐reviewed literature and to complement it with consensus recommendations using the Delphi method. Some statements were not voted on by all panelists. This consensus statement aims to provide guidance for management of both male and female dogs with underlying storage or voiding disorders resulting in UI.
Background
The ability to detect bacteriuria in dogs with a point‐of‐care test might improve medical care and antimicrobial stewardship.
Hypothesis and Objective
A rapid immunoassay (RIA; RapidBac) ...will provide acceptable sensitivity and specificity for diagnosis of bacteriuria.
Animals
Forty‐four client‐owned dogs with a clinical indication for urinalysis and aerobic bacterial urine culture.
Methods
Prospective study. Urine, collected by cystocentesis, was submitted for urinalysis and culture at a diagnostic laboratory. Owners completed an enrollment questionnaire regarding their dogs' clinical signs. The RIA was performed according to the manufacturer's guidelines. Results were compared to culture.
Results
Forty‐four urine specimens were evaluated from 44 dogs. The sensitivity and specificity of the RIA test to detect bacteriuria compared to urine culture were 81.8% (95% CI, 65.7%‐97.9%) and 95.5% (95% CI, 86.8%‐99.9%), respectively. For cultures yielding ≥103 CFU/mL, sensitivity increased to 90.0% (95% CI, 76.9%‐100%) and specificity was similar at 95.2% (95% CI, 86.1%‐99.9%). Malodorous urine, bacteriuria, and pyuria were more likely to be present in dogs with positive RIA or urine culture results compared to dogs with negative results.
Conclusions and Clinical Importance
The RIA was easy to perform and had good sensitivity and excellent specificity in this group of dogs. The RIA might be a useful screening test for decision‐making regarding antimicrobial therapy in dogs with a clinical indication for urine culture. Consideration could be given to amending the International Society for Companion Animal Infectious Disease definition of bacterial cystitis as the presence of signs of lower urinary tract disease together with positive culture or a positive RIA.
Interstitial cystitis (IC) presents as a chronic pain condition with variable combinations of symptoms depending on the species and individual patient. It is diagnosed by the presence of lower ...urinary tract signs and symptoms in combination with a variety of comorbid health problems, a history of life adversities, and the absence of other conditions that could cause the lower urinary tract signs. IC occurs naturally in humans and cats as a dimensional condition, with patients presenting with mild, moderate, and severe symptoms. Most patients appear to recover without specific treatment. A number of rodent models of IC have been used to study its causes and treatments. Unfortunately, current therapies generally fail to ameliorate IC symptoms long-term. The recent classification of IC as a chronic
pain disorder calls for a rethinking of current clinical and research approaches to it. Beginning when a patient encounters a clinician, precipitating, perpetuating, and palliating risk factors can be addressed until a cause or reliably effective therapy is identified, and identifying predisposing and preventive factors can inform epidemiological studies and health promotion interventions. Predisposing, precipitating, and perpetuating risk factors, including environmental, psychological, and biological, increase the activity of the central threat response system (CTRS), which plays a clinically important role in IC symptoms. Studies in cats and rodent models have revealed that environmental enrichment (EE), in the absence of bladder-directed therapies, leads to amelioration of IC symptoms, implying a central role for the CTRS in symptom precipitation and perpetuation. Conceptually moving the source of IC pain to the brain as a motivational state rather than one resulting from peripheral nociceptive input offers both clinicians and researchers novel opportunities to improve care for patients with IC and for researchers to use more ecologically valid rodent models. It may even be that IC results from an excess of risk to protective factors, making this imbalance a targetable cause rather than a consequence of IC.
Guidelines rationale:
A cat’s level of comfort with its environment is intrinsically linked to its physical health, emotional wellbeing and behavior. Having a basic understanding of the cat’s ...species-specific environmental needs and how cats interact with their environment will provide a foundation for addressing these fundamental requirements.
Environmental needs:
Addressing environmental needs is essential (not optional) for optimum wellbeing of the cat. Environmental needs include those relating not only to the cat’s physical surroundings (indoors or outdoors; in the home environment or at the veterinary practice) but also those affecting social interaction, including responses to human contact.
Five ‘pillars’ framework:
The authorship panel has organized the Guidelines around five primary concepts (‘pillars’) that provide the framework for a healthy feline environment. Understanding these principles and the unique environmental needs of the cat will help veterinarians, cat owners and care-givers to reduce stress, the incidence of stress-related disorders, and unwanted behavior in their feline patients and pets. The recommendations in the Guidelines apply to all pet cats, regardless of lifestyle.
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