UTI

Name a few urine properties that defend against UTIs?

Acidic pH

High osmolarity

Mechanical flushing

What are mucosal defences of the Urinary tract against UTI's?

Mucopolysaccharide lining

Cytokine secretion

IgA secretion

What is the most common way a UTI developes?

Ascending bacteria from skin/GI

What can cause a UTI to be missed on culture?

Bacteria grow in low O2

Slow-growing bacteria

When should we treat a UTI?

Bacteria w/ UTI symptoms -> don't tx if subclinical b/c there are commensals in urine -> could cause resistance.

What is a recurrent UTI?

- More than 3 UTI in a year. Or 2 in 6 months.

If emperical therapy of UTI does not resolve clinical signs what should the next treatment plan be?

Urine Culture -> ABX based on culture.

NSAIDS

What ABX should not be used for UTI as empirical tx?

Floroquinolones

Why do we use amoxicillin as a first line therapy for UTI?

It concentrates in the urine

What is the biggest risk of increased multi-drug resistance?

Longer corsase of abx/ prior uses of drugs on non-target organs

What is the gold standard for urine collection?

Cysto in a white top or red top glass tuve

When should urine be analyzed?

30 Mins after collection or refrigerate (may cause crystal artifacts)

What can occur if a urine sample is not refigerated 30mins after collection?

Increased pH

Decreased cells

Increased bacteria

The kirby-bauer disc diffusion is best for ____ concentration of a drug and not ____?

Plasma

NOT URINE (NOT GOOD TEST FOR URINE suseptability test)

What test is most clinically relevant to test for sensitivity for a UTI?

MIC -> min inhibitory con

An antimicrobial is susceptible if it is less than ___ x the MIC?

4x

The ____ an antibiotic is from the break point the better the ABX will be against that agent?

Further away (Less than)

If the break point is 32ug/ml which of the following ABX would be the best choice?

A. MIC 16

B. MIC 32

C. MIC 8

D. MIC 64

C- lowest/ farthest away from the break point

What is the most common bacterium found in a UTI?

E. coli (Gram - bacteria)

Name a few causes of ascending re-infections of UTIs?

Anotomic deformities- Vulva confomation

Systemic illness -DM

Damaged mucosa

Uroliths

Immunosuppression

How can antibiotic use cause an increased risk of recurrent UTIs?

Increases proliferation of GI bacteria

Neg impact on natural urobiome

What are common reasons for chronic infections in the bladder?

Intracellular bacterial colonies

Biofilms

What is the most common cause of a recurrent UTI in a female?

Recessed vulva

What should be evaluated when collecting urine?

Stream quality

Urine retention

What conditions might we see glycosuria in that could potentially lead to recurring UTIs?

DM

Fanconi syndrome

Renal glucosuria

What are the conditions that cause dilute urine that could result in recurrent UTIs?

Hyperthyroidism

Kidney dz

What is better to dx bladder stones Rads or U/S?

U/S will catch small stones as well as stones like cystine/ urate that dont show up on rads

How should a recurrent UTI be tx if you cannot find the underlying condition?

Select ABX from culture,

Repeat culture 7 days after therapy; if still positive, consider other dx

If negative cont tx for 4w then reculture 7 days post abx completion

What are a few alternative tx of UTIs in dogs?

Probiotics - dont work well -> diff flora

Cranbery -> doesnt work well

Mannose

What does cranberry do to help tx UTI?

Type A Propanthocyanidines -> inhibit E. coli fimbiae

How does Mannose help prevent UTI?

blocks adhesion of E. coli to uroepithelium

How does Methenamine help prevent UTI?

Turns acidic urine to formaldehyde - pickles bacteria

What are indications for methenamine?

Recurrent UTI

Urine pH lower than 5.5 consistently

What are CI of methanamine?

Renal insufficency

Sulfonamide usage

In an intact male dog if UTI does not resolve after culture, nsaids and New ABX what should be investigated?

Prostatic involvment

What ABX is best for prostatic involvement in a UTI?

Floroquinolones

TMS

-tx for 4-6 weeks

How should a urinary catheter be handled in a UTI?

Insert aseptically

Closed drainage system

Check daily

Remove ASAP

UTIs are ____ in healthy cats?

Rare

What are comorbities that can lead to UTIs in cats?

CKD

DM

Hyperthyroidsim

Perineal urethrostomy

In an acidic urine sample, if you find rods, what are you suspecting the bacteria is, and what is the first line of therapy?

E. coli - tx w/amoxicillin and TMS for 3-5 days

If a urine sample is acidic w/ cocci bacteria in the u/a what would you suspect the bacteria is most likely, and what is the first line of therapy?

Strep/ enterococcus - tx w/ amoxicillin and TMS for 3-5 days

If a urine sample is Alkaline w/ rods bacteria in the u/a what would you suspect the bacteria is most likely, and what is the first line of therapy?

Proteus - x w/ amoxicillin and TMS for 3-5 days

If a urine sample is Alkaline w/ cocci bacteria in the u/a what would you suspect the bacteria is most likely, and what is the first line of therapy?

Staph - clavamox and TMS for 3-5 days

What is a relapsing uti?

Recurrence of a UTI a few days post ABX and clinical signs resolve but come back

What is a Reinfection UTI?

Recurrance of UTI after a few weeks after D/C ABX clinical signs are gone for a few weeks but return

What is a refractory UTI?

Clinical signs do not resolve while on ABX or after D/C ABX