Managing bacterial cystitis in the ER

Clinical signs due to lower urinary tract disease (LUTD) are a common reason for presentation to the ER. As part of his presentation “Infectious disease in the emergency room” during the 2013 Veterinary Emergency and Critical Care Society meeting, Steven Epstein, DVM, DACVECC, discussed the management of bacterial cystitis in this setting.

In cats with clinical signs of LUTD, bacterial cystitis is rare, noted Dr. Epstein. However, the risk of infection in these cats increases with increased urinary catheterization, increasing age (> 10 years), or urinary surgery. Based on changes in resistance rates and bacterial populations, Dr. Epstein recommends a urine culture for all dogs that are presented with LUTD and for cats in which there is a comorbid disease present (i.e. diabetes). The presence of pyuria or bacteriuria should always prompt culture, but culture is no longer recommended soley based on isosthenuria. Dr. Epstein discussed the use of in-practice urine culture kits to screen for urinary infections. Positive results can then prompt submission to a commercial laboratory for microorganism identification and susceptibility testing.

Antimicrobial use guidelines should be used to guide clinical treatment of patients with bacterial cystitis.1 In general, in patients with uncomplicated urinary tract infections (UTIs), amoxicillin or trimethoprim-sulfamethoxazole can be used as a first-line antibiotic choice while awaiting culture results, and treatment should last seven to 14 days. There is some research indicating that treatment for as little as three days may be sufficient, but this is still being investigated.

There is no evidence that intra- or post-treatment cultures are needed in these uncomplicated UTI cases. Patients with complicated UTIs will require the same length of treatment, but repeat culture is recommended five days into therapy and again seven days after treatment. For patients in which pyelonephritis is suspected, Dr. Epstein recommends starting with a fluoroquinolone while culture results are pending.

Reference

1. Weese JS, Blondeau JM, Boothe D, et al. Antimicrobial use guidelines for the treatment of urinary tract disease in dogs and cats: Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases. Vet Med Int 2011.