Case 1

Two days later, you receive Felicia’s final urine culture results: E. coli – 100,000 cfu, sensitive to all antibiotics tested.

Notice that, although she has a positive urine culture, she had no bacteriuria or pyuria. This is a common finding in diabetic patients due to their low urine specific gravity and decreased immune response. And for this reason, we cannot rely on sediment analysis alone to rule out the presence of infection.

Her owner reports that Felicia already seems less lethargic at home so you plan to leave her insulin dose the same for now and continue treating her pyelonephritis for six weeks. Ideally in these cases, we’d like to reculture her urine during antibiotic therapy as well as a week after discontinuing the antibiotics to make sure we’ve treated appropriately.

Conclusion

At her two-week follow-up appointment, the owner reports that Felicia is doing well; she’s no longer lingering at her water bowl and is very active. Her physical examination is normal and her weight is stable. Since her clinical signs seem so well controlled you decide to obtain a fructosamine concentration instead of a blood glucose curve. Your results are 264 mg/dl which is in the realm of good regulation. Good job, Doc!

REFERENCES

1.    Comparison of a low carbohydrate-low fiber diet and a moderate carbohydrate-high fiber diet in the management of feline diabetes mellitus. J Feline Med Surg. April 2006;8(2):73-84. Nicole Bennett, Deborah S Greco, Mark E Peterson, Claudia Kirk, Mark Mathes, Martin J Fettman.

2.    Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine 6th ed. Philadelphia, Pa: Saunders, 2005.

3.    Urinary tract infections in cats with hyperthyroidism, diabetes mellitus and chronic kidney disease. J Feline Med Surg. April 2007;9(2):124-32. Bettina Mayer-Roenne, Richard E Goldstein, Hollis N Erb.

4.    Frequency and risk factors for urinary tract infection in cats with diabetes mellitus. J Vet Intern Med. 2006 Jul-Aug;20(4):850-5. N L Bailiff, R W Nelson, E C Feldman, J L Westropp, G V Ling, S S Jang, P H Kass.

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