Page 532 - ONLINE PROCEEDING BOOK WSAVA 2017
P. 532

532
An Urban Experience
If clinical signs of UTI or fever are present: perform a culture after replacement of the urinary catheter with a new catheter. Several mL of urine should be removed to clear the catheter before a specimen is obtained for culture. Alternatively, remove the catheter and perform a cystocentesis. Culture from the collection bag,
and culture of the catheter tip after removal are not recommended. Treatment should follow the guidelines for sporadic bacterial cystitis, and is more likely to be successful after catheter removal.
Pyelonephritis
C&S testing should always be performed. Treatment should be initiated while awaiting culture results,
using antimicrobials effective against Gram-negative Enterobacteriaceae. A  uoroquinolone is a reasonable  rst choice, after which treatment should be based
on C&S results. If combination treatment was used initially and C&S results indicate that both drugs are not required, the spectrum should be narrowed. Treatment for 4 weeks has been recommended, but it is likely
that shorter durations of treatment (10-14 days) may
be effective. Culture is recommended 1-2 weeks after treatment is discontinued, together with a physical examination and assessment of azotemia, but the possibility of subclinical bacteriuria should be considered when interpreting culture results.
Urological surgery, minimally invasive urological procedures and urologic implants
Bacterial culture of urine collected by cystocentesis
is indicated prior to cystoscopic procedures or laparoscopic or open urologic surgery. If bacteriuria is identi ed, treatment based on susceptibility result is indicated for 3-5 days immediately before the procedure to reduce bacterial counts. Peri-operative antimicrobial prophylaxis should be considered for procedures that involve stone manipulation or open surgical procedures that involve the urinary tract. When antimicrobial prophylaxis is indicated, the antimicrobial(s) should be administered intravenously within 60 minutes of the procedure and be re-dosed intra-operatively after 2 half- lives of the drug have passed (when applicable), in order to target the time that bacterial invasion is most likely to occur. Typically, this is until wound closure or completion of an endoscopic procedure. An appropriate choice for peri-operative prophylaxis is a  rst- or second-generation cephalosporin. In the absence of complicating factors or infection, peri-operative prophylaxis should not continue for greater than 24h.
Medical dissolution of struvite urolithiasis
Urine culture should be performed in all cases where urolithiasis is identi ed. Culture of surgically-removed uroliths can be considered, but the clinical relevance of results is unclear. If evidence of bacterial cystitis
is present, antimicrobial drug selection should be
approached as per sporadic cystitis. At least seven days of treatment is suggested for animals with urolithiasis and concurrent bacterial cystitis. The need for further treatment is unclear. Limited data are available regarding the need for antimicrobials during dietary dissolution of struvite uroliths. Low level data suggest that treatment may not be required; therefore, antimicrobial treatment during the dissolution period is not recommended in animals that do not have evidence of ongoing bacterial cystitis. Bacterial culture can be considered during dietary dissolution period in the absence of clinical
signs of cystitis. If a urease-producing bacterial species is identi ed, treatment can be justi ed. Urine culture after completion of medical urolith dissolution is not recommended in the absence of clinical signs of lower urinary tract disease. Con rmation of elimination of uroliths through diagnostic imaging and investigation of predisposing factors for cystitis is important.
Bacterial prostatitis
Empirical treatment for bacterial prostatitis should
target Enterobacteriaceae. Administration of a
veterinary  uoroquinolone such as enro oxacin
should be considered while awaiting culture and susceptibility testing results. Trimethoprim-sulfonamide can be considered but is not recommended where a  uoroquinolone can be used because of the greater risk of adverse effects with the typical duration of treatment. Limited data are available to guide duration of treatment. Four weeks is typically recommended for acute prostatitis, with 4-6 weeks for chronic disease. Shorter durations might be effective in dogs with acute prostatitis that are castrated and where there is rapid clinical response. A longer duration of treatment may be required in some chronic cases, particularly when abscessation is present or when castration is not performed. Castration should be recommended in dogs that are not intended for breeding. Poor initial response to therapy should lead to re-assessment of the diagnosis and if prostatitis is
still suspected, consideration of collection of ultrasound- guided  ne needle aspirate of prostatic cyst  uid or prostatic tissue core biopsy for culture and cytology or histopathology. Prostatic abscesses should be drained because of the low likelihood of resolution with medical treatment alone. If necessary, surgical drainage should be performed after culture results are available, whenever possible, to facilitate proper peri-operative antimicrobial therapy.
References
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; Epub Jun 27.
42ND WORLD SMALL ANIMAL VETERINARY ASSOCIATION CONGRESS AND FECAVA 23RD EUROCONGRESS


































































































   530   531   532   533   534