What pathogens are most uropathogens derived from?
-Fecal flora (most common)
-Skin flora (less common)
Which parts of the urinary tract are normally sterile?
**distal urethra and external genitalia have commensal bacterial flora
What is the most common bacterial isolate from canine UTIs?
What are the defense mechanisms in place that helps protect an animal from UTIs?
-Anatomical and physiological factors
-Mucosal defense barriers
-Antimicrobial effects of urine
-Renal defense mechanisms
Describe normal micturition.
Voiding should be frequent, complete, and have an adequate flow.
What are some clinical conditions related to normal micturition that can be associated with an increased risk of UTI?
What are some clinical conditions related to anatomical and physiological factors that can be associated with an increased risk of UTI?
-Urethral sphincter mechanism incompetence
-Anatomical abnormalities following surgery (perineal urethrostomy)
What are some clinical conditions related to failure of mucosal defense barriers that can be associated with an increased risk of UTI?
-Direct trauma (catheterization)
-Disease processes (neoplasia)
-Chemical irritants (cyclophosphamide)
What does the term 'recrudescent' mean with UTIs?
Same strain is causing the UTI as before, indicating treatment failure.
What does the term 'recurrence' mean with UTIs?
A new strain is causing the UTI, indicating susceptibility of the animal.
Presence of microbes in the urine.
Presence of bacteria in the urine (greater than 10e5 per ml indicates infection; less than 10e3 indicates contamination)
Presence of fungi in the urine.
Increased numbers of white blood cells in urine (greater than 5/hpf).
-->Significance of numbers depends on method of collection; cystocentesis=greater than 3-5/hpf, catheter/freecatch=greater than 5-10/hpf
What are some historical and physical findings consistent with upper urinary tract infection?
-Renal/lumbar pain (distinguish from intervertebral disc disease)
What are some historical and physical findings consistent with lower urinary tract infection?
How are UTIs diagnosed?
-Urinalysis and urine sediment examination
-Quantitative culture of urine (gold standard)
-Blood work and radiographs useful to establish underlying causes
What is the best method of obtaining urine samples?
Cystocentesis; note that animal should not have received antibiotics for 5-7 days prior to sampling.
How are UTIs generally treated?
Antibiotics; ideally choice based on culture and sensitivity.
What are the principles of choosing an Ab for a UTI?
-Based on C&S
-Excreted in urine (high concentrations where it's needed the most)
-No/low risk of toxicity
-Easy to administer
-Good penetration into other related tissues if required (prostate, for example)
-Prescribing should comply with cascade
-Avoid abuse of newer/broad spec products
When is empiric antibiotic use indicated?
Appropriate for first incidence where there is no obvious underlying cause.
What are two likely pathogens to cause UTIs?
What are some antimicrobial drugs that are most appropriate for empirical use?
Why should a urine culture be done after UTI treatment is finished?
Ensure treatment was successful!
When may treatment of UTIs fail?
-Infection is not the cause
-Inadequate delivery of antibiotic (client factors, side effects, ineffective drug/delivery of drug)
-Antibiotic resistance (intrinsic or acquired)
-Undiagnosed/untreated predisposing factors leading to superinfection