Page 531 - ONLINE PROCEEDING BOOK WSAVA 2017
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WSVA7-0536
DSAVA: UROLOGY
UPDATE ON THE INTERNATIONAL GUIDELINES ON UTI (ISCAID)
J. Sykes1
1University of California- Davis, Department of Medicine & Epidemiology, Davis, USA
UPDATE ON THE INTERNATIONAL GUIDELINES FOR URINARY TRACT INFECTIONS (ISCAID)
The International Society for Companion Animal Infectious Diseases (ISCAID) Antimicrobial Guidelines Working Group was formed to develop guidelines
for antimicrobial drug use in dogs and cats, because
of concerns that antimicrobial drug resistance has dramatically increased in prevalence among isolates from dogs and cats in the last decade. The founding members of the ISCAID Working Group are Scott Weese, Joseph Blondeau, Dawn Boothe, Edward Breitschwerdt, Luca Guardabassi, Andrew Hillier, Michael Lappin, David Lloyd, Mark Papich, Shelley Rankin, Jane Sykes, and John Turnidge. Input has also been obtained from panels of Diplomates of relevant specialty groups. It should
be noted that members of the working group receive support from a variety of industry groups that provide funding for honoraria and research.
Guidelines for treatment of urinary tract disease in dogs and cats were published in 2011 and are available as open access documents for any individual to download (www.iscaid.org). During the course of guideline development, it became clear that there is a signi cant lack of objective, published information. Accordingly, recommendations are based on available data, whenever present, along with expert opinion, considering principles of infectious diseases, antimicrobial treatment, antimicrobial resistance, pharmacology, and internal medicine. Clinical trials that evaluate antimicrobial drug regimes for bacterial infections in dogs and cats are encouraged. In 2016 and 2017, the Working group began the process of revising guidelines for urinary tract infections based on additional evidence and peer expert input. As with the Respiratory Guidelines development process, Working Group members will be voting on recommendations and a Level of Agreement presented for each statement. Selected recommendations from previously published guidelines and the update are presented below.
Sporadic Cystitis
De nition: Sporadic bacterial infection of the bladder in an otherwise healthy individual with normal urinary tract anatomy and function.
A clinically signi cant infection implies the presence of dysuria, pollakiuria, and/or stranguria. Diagnosis of UTI cannot be made on the basis of clinical signs alone.
Complete urinalysis should be performed for all
cases and quantitative aerobic C&S testing is encouraged. Free-catch samples should not be used. For cystocentesis specimens, counts ≥ 103 CFU/mL indicate UTI. For catheterized specimens, counts ≥ 104 in males and ≥ 105 CFU/mL in females are signi cant. Recommendations for initial treatment are amoxicillin
(11 – 15 mg/kg PO q12h) or trimethoprim-sulfonamide (15 mg/kg PO q12h). If C&S testing reveals a resistant isolate and there is a lack of clinical response, treatment should be changed to an appropriate antimicrobial drug. Although treatment has been recommended in the past for 7 to 14 days, recent research suggests 3-5 days may be more appropriate. There is no evidence that intra- or post-treatment urinalysis or urine culture is indicated in the absence of ongoing clinical signs of UTI.
Recurrent Bacterial UTI
De nition: Recurrent UTIs are de ned by the presence of 3 or more episodes of UTI during a 12-month period or 2 or more infections within a 6 month period. Efforts should be made to identify the underlying cause; consider referral. Treatment should be based on the results
of C&S testing, with initial empiric therapy following
the recommendations for Sporadic Bacterial Cystitis. Although 4 weeks has been recommended for treatment, shorter durations are likely to be recommended in
the future, with a focus on clinical cure rather than microbiological cure. There is insuf cient evidence to recommend “pulse” or chronic low-dose treatment, urinary antiseptics, and nutritional supplements such as cranberry juice extract for prevention of UTIs.
Subclinical Bacteriuria
De nition: presence of bacteria in the urine as determined by positive bacterial culture, in the
absence of clinical signs of UTI. Treatment may not be necessary, but could be considered if there is a high risk of ascending or systemic infection (eg. patients with underlying renal disease)
Urinary Catheters
Proper aseptic placement and maintenance is critical. Open collection systems should not be used. Clinical signs of lower UTI or pyelonephritis absent: no culture or treatment indicated. The duration of catheterization should be as short as possible. Catheter removal is not necessary in the presence of subclinical bacteriuria. There is no indication for routine use of prophylactic antimicrobials after the catheter is removed.
An Urban Experience
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