Patients with indwelling urinary catheters do not require prophylactic antimicrobial therapy. Treatment of these patients
is only indicated if there are clinical signs or cytologic evidence supportive of infection. In that case, treatment should
be based on culture and sensitivity data.
Routine culture of the catheter tip or urine at the time of catheter removal is not recommended. In those patients in which
there is a high risk for or significant consequence to a UTI, culture of a sterilely collected urine sample is recommended.
UPPER UTIs (PYELONEPHRITIS)
Diagnosis of upper UTIs is similar to that of other UTIs described above. Treatment should be determined based on serum susceptibility
data rather than urine concentrations, and initial therapy should target gram-negative organisms since they are commonly involved
in these infections. Fluoroquinolones are a reasonable first choice while culture results are pending. Treatment for four
to six weeks is often required. As for complicated UTIs, cultures should be repeated one week after starting therapy and again
one week after termination of therapy to ensure elimination. If continued infection or multidrug-resistance is noted, consultation
with a specialist is indicated.
The incidence of multidrug-resistant organisms is growing and may be a reflection of inappropriate antimicrobial therapy leading
to the emergence and dissemination of these pathogens. Because of limited drug choices available to treat these infections,
drugs that are important in human medicine are sometimes required. The use of these drugs (i.e. vancomycin, carbapenems, and linezolid), however, is not justified unless these criteria are met:
1. Infection must be documented based on clinical signs, cytologic abnormalities, and culture results.
2. There are no other reasonable antimicrobial options to which the organism is sensitive, and susceptibility to the chosen
drug is documented.
3. These drugs should not be used in cases in which there is not a realistic chance of eliminating the infection.
4. Consultation with a specialist must be obtained to evaluate whether there are any other viable options and whether treatment
Weese JS, Blondeau JM, Boothe D, et al. Antimicrobial use guidelines for 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;2011;263768. Epub 2011 Jun 27.
This "Hot Literature" update was provided by Jennifer L. Garcia, DVM, DACVIM, a veterinary internal medicine consultant in