1 Introduction: Bacterial urinary tract disease is a common disease in cats and one of the main reasons for the use of antibacterial drugs. Inappropriate treatment can lead to various health problems in cats (such as failure to fight infection, deve...
1
Introduction:
Bacterial urinary tract disease is a common disease in cats and one of the main reasons for the use of antibacterial drugs. Inappropriate treatment can lead to various health problems in cats (such as failure to fight infection, development of antimicrobial resistance), economic problems (such as the need for repeated or extended treatment), public health problems (such as antimicrobial resistance). In human medicine, guidelines for the use of antibiotics [such as those developed by the American Society of Infectious Diseases (IDSA)] guide doctors on how to manage a variety of infectious diseases, including urinary tract infections (UTIs), can be used directly or as the basis for guidelines for the use of antibiotics at the hospital level.
Etiology and Epidemiology of Urinary Tract Infection:
Urgent tract infection (UTI) occurs when the host defense mechanism is compromised and pathogenic microorganisms adhere, proliferate, and persist in the urinary tract. UTI is usually caused by bacteria, but fungi and viruses can also infect the urinary tract. UTI may involve multiple anatomical sites, which can be divided into upper urinary tract (such as kidney and ureter) infection and lower urinary tract (such as bladder, urethra and vagina).
Bacterial UTIs are not common in young cats with lower urinary tract diseases, but they are a major problem in older cats. As older cats have weakened urinary tract defense capabilities, their risk of developing bacterial UTI is increased. It is not clear whether defense dysfunction in elderly cats is due to aging itself or secondary to common geriatric diseases. But comorbidities in elderly cats (such as chronic kidney disease, diabetes and hyperthyroidism) may impair the body's normal defense mechanism, and this assumption may be reasonable.
3
Clinical symptoms:
Bacterial UTI may or may not be asymptomatic. Clinical symptoms associated with bacterial infection in the lower urinary tract are usually similar to those of other lower urinary tract diseases. These symptoms include, but are not limited to, frequent urination, difficulty urination, painful drip, hematuria, and improper urination. Bacterial infections in the kidneys may cause hematuria; if sepsis develops, the cat may experience systemic symptoms. In addition, upper urinary tract infection may lead to recurrent lower urinary tract infection UTI.
4
Diagnosis:
1. Urine analysis:
Urine analysis should be part of the minimum database for routine examinations of elderly or affected cats. When evaluating whether a diseased animal has UTI, bladder puncture is preferred to collect urine. A complete urine analysis should include a urine sediment examination. If the sampling method is appropriate, if the large white blood cells (5 per high-power field of view) appear, accompanied by hematuria and proteinuria, it will indicate inflammation. Significant bacteriuria was found in pyuria samples, suggesting active inflammation associated with infection. If the number of bacilli in the urine exceeds 10,000/mL, it may be seen in unstained urine sediments; but if the number of bacteria is small, it may not be observed every time. If the number of cocci is less than 100,000/mL, it is difficult to be observed in urine sediment. It is harder to detect bacteria in diluted urine, so it is harder to diagnose UTI when drinking and urinating. Bacteria were not detected in urine sediments, nor could the presence of bacteria or the UTI be ruled out. On the other hand, if the host's defense mechanism is impaired (such as feline leukemia virus infection), bacterial UTI may not appear concurrently in the presence of. Urine sediments can be stained with Reich, Gram, or Neomeramide stain to help check for bacteria. Although bacterial discovery in urine sediments can indicate bacterial UTI, infection should still be confirmed by urine culture.
2. Urine culture:
The positive results of urine culture from bladder puncture urine samples are the gold standard for diagnosing bacterial UTIs. The urine obtained from freely collected mid-level urine or artificial squeezing and urination should be read carefully after the urine culture is analyzed; urination samples may be contaminated by the urethra, vagina or the environment. Urine collected from non-absorbent cat litter is the least ideal sample. The best results can be obtained by treating urine immediately after collection. If the sample cannot be processed immediately (within 30 minutes), the urine can be stored in a sterile, dry, transparent container (such as a serum red-headed tube) and stored in refrigerated. Refrigerated urine cultured within 24 h results in the most accurate results.
3. Other tests:
Most cats with bacterial UTI have complex infections, and therefore, other laboratory and imaging tests are often required. In addition to urine analysis and urine culture, the minimum database also includes a complete blood count and a biochemical examination containing the electrolyte program. Other reasonable tests include thyroid hormone and retroviral testing, as well as abdominal X-rays and ultrasound examinations.
5
Treatment of urinary tract infection:
Antibiotics are the basis for the treatment of UTI. The selection of antibacterial drugs should consider: 1. Easy to administer; 2. Almost no or few adverse reactions; 3. Inexpensive; 4. It can achieve urine drug concentration (and the tissue drug concentration required for cases of kidney or prostate infection), at least 4 times the minimum inhibitory concentration of urinary tract pathogens. In most cases, antibacterial drugs should be selected based on the results of drug sensitivity tests for urinary tract pathogens.
Overuse and abuse of antimicrobial drugs may lead to the emergence of drug-resistant microorganisms, which have an impact on the successful treatment of diseased animals and on human health. Empirical treatment of bacterial UTIs with fluoroquinolones is not recommended because many Gram-positive bacteria are naturally resistant to these drugs, and many Gram-negative bacteria, including E.coli, are prone to these drugs. The study found that except for pdofloxacin, other generations of fluoroquinolones have cross-drug resistance. Once resistant to fluoroquinolones, the next generation of these drugs may become ineffective..
3. Upper Urinary Tract Infection (Pyelonephritis):
Pyelonephritis is a renal parenchymal infection caused by retrograde infection or bacteremia, most of which are caused by Enterobacteriaceae. In human medicine, acute pyelonephritis is classified as "non-complexity" or "complexity". Non-complexity refers to no potential comorbidity; complexity suggests systemic diseases such as diabetes, tumors, or structural/obstructive diseases such as urolithiasis or ureteral ectopicity.
Retrograde infection may be caused by clinically obvious lower urinary tract disease, but it may also occur in undiagnosed lower urinary tract infection, or bacteremia with no obvious cause found. In addition, leptospirosis must be considered in endemic areas, because nephritis caused by leptophytes can be co-induced pyelonephritis with other bacteria.
The incidence of pyelonephritis in cats is less recorded, partly because it is difficult to diagnose the disease explicitly. The symptoms of pyelonephritis are not obvious, making it difficult to diagnose clearly. In contrast to bacterial cystitis (the relatively low incidence of kidney damage in diseased animals), pyelonephritis can lead to severe and rapid kidney damage. Therefore, rapid diagnosis and treatment are important, and the consequences of failure of initial treatment are more severe than bacterial cystitis.
As an infection of kidney tissue, the key factor that determines the potential efficacy is the drug concentration of antibacterial drugs in serum/soft tissue, not in urine.
Treatment should be started immediately while waiting for the culture and drug sensitivity results. Initial treatment should include antibacterial drugs effective for the local/regional Enterobacteriaceae. If regional data also support it, fluoroquinolones or cefopoxime are preferred. Cefotaxime and ceftazidime can be used for intravenous administration.
If systemic symptoms, hematological or serum biochemical indicators (e.g. azotemia, acute phase protein) are not improved within 72 hours of treatment with antibacterial drugs, culture and sensitivity results indicate sensitivity to the antibacterial drugs used and confidence in customer compliance, a diagnosis other than bacterial pyelonephritis should be considered. At this time, the diagnosis of subclinical bacterial urine (termination of antibacterial therapy) or the presence of uncontrolled potential factors (such as ureteral stones, tumors) should be considered, and these problems need to be addressed to resolve potential infections.
has been recommended for 4-6 weeks of treatment for sick animals. However, the recommended treatment time for acute bacterial pyelonephritis in humans is 7-14 days, and there is no reason to think that cats need longer treatment cycles. In the absence of veterinary-specific data, the Working Group recommends treatment for 10-14 days.
4. Asymptomatic bacteriuria:
In human medicine, healthy women often experience asymptomatic bacteriuria, mostly benign. Risk factors include pregnancy, diabetes, spinal cord injury, indwelling catheters, and living in nursing homes. Women with asymptomatic bacteriuria will have more frequent symptom attacks, but antibacterial treatment does not reduce the number of attacks. No treatment benefits have been found in human medical clinical trials, and potential complications of treatment include adverse drug reactions and drug resistance. In a veterinary study, 10% to 15% of cats with hyperthyroidism, diabetes, or chronic kidney disease had asymptomatic bacteriuria. There are currently no prospective studies to compare the clinical effects of antibacterial drugs on asymptomatic bacteriuria in cats. Treatment of asymptomatic bacteriuria is not recommended unless the risk of upward infection or systemic infection is high (such as diseased animals with immunodeficiency, chronic kidney disease, etc.). How to prevent infection during indwelling catheter:
catheter placement is a common procedure in veterinary medicine and is an important part of the treatment of some sick animals. However, since the catheter directly connects the external environment to the bladder, placing the catheter can cause bacterial urine or bacterial cystitis.
In a clinical study, 52% of cats were infected by indwelling catheters, and the risk of infection increased with the prolonged catheter indwelling time. Indwelling catheters is especially dangerous during administration of diuretics or corticosteroids. If the diseased animal already has urinary tract disease, the risk of infection will be further increased and more complicated. Isogenic bacterial UTis may be prevented by the following points:
a. Avoid abuse of catheters, and routine replacement of catheters is not recommended to prevent bacterial urine or cystitis;
b. When a catheter is indwelled, the catheter should be regularly checked for any possible infection problems (such as rupture, extensive fecal contamination);
c. When a diseased animal is receiving diuretic treatment, catheter should be left with catheters with catheters with catheters;
d. Avoid indwelling catheters with catheters (such as glucocorticoids);
e. Reasonable use of antibacterial drugs for animals with catheters;
f. The diagnostic and therapeutic techniques used should minimize trauma and microbial contamination to the urinary tract. Antibacterial treatment for animals with indwelling catheters may seem to reduce the risk of iatrogenic infection, but this approach is highly recommended. Although concurrent oral or parenteral administration of antibacterial drugs during indwelling catheters can reduce the frequency of bacterial UTIs; however, this also increases the risk of UTIs caused by multidrug-resistant bacteria;
g. Indwelling time should be shortened as much as possible. In human medicine, timely removal of catheters is considered one of the most important routes to prevent infection;
h. There is currently no evidence that using cranberry extract or probiotics can effectively prevent catheter-related bacterial cystitis, but there are no contraindications for known safe treatments and supplements;
i. Intravesical perfusion of biocides or antibacterial drugs through catheters is not recommended;
}
