Case 5

Based on Coco's follow-up urinalysis results and the fact that she is doing well at home, you recommend continuing treatment for another two weeks and performing a recheck urinalysis and culture five to seven days after antibiotic therapy.

At Coco's next visit, her owners report that she is doing well but still has intermittent episodes of urinating in the house. Her desire to go out all of the time has decreased.

Here are her follow-up test results:

Patient values

Reference range

Urine specific gravity

1.020

1.015-1.050

pH

6.9

5.5-7

Protein

1+

Negative

WBC

5-7

0-3/hpf

Bacteria

None seen

Negative

Given that Coco is still showing some clinical signs and that she has pyuria and proteinuria, you are still suspicious of an infection so you recommend a repeat urine bacterial culture. Fortunately, the clients agree. Note: Don't be misled by the absence of bacteriuria as this is not a sensitive indicator of infection, especially in a dilute urine sample.

Here are the urine bacterial culture and sensitivity testing results:

Organism: Pseudomonas species 10,000–50,000 cfu/ml

Antibiotic (µg/ml)

MIC

Interpretation

Reference range

Amikacin

≤ 8

S

8-64

Amoxicillin/clavulanate

NA

R

4-32

Ampicillin/amoxicillin

NA

R

0.25-32

Cefpodoxime

≥ 8

R

2-8

Cephalexin

NA

R

4-32

Enrofloxacin

2

I

0.5-4

Marbofloxacin

1

S

0.5-4

Nitrofurantoin

> 128

R

16-128

Trimethoprim/sulfonamide

NA

R

0.5-4

Ticarcillin

≤16

S

16-128

NA = not applicable

S = susceptible, R= resistant, I = intermediate

QUESTION 5

What could be the reason that Coco's urine bacterial culture is still positive? (There is more than one correct response.)

a) Owner noncompliance

b) Duration of treatment is insufficient

c) Poor absorption

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