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Urinary tract infections in cats and multidrug-resistant E. coli

The term urinary tract infection (UTI) refers to the adherence, multiplication and persistence of an infectious agent within the urogenital system which provokes an associated inflammatory response and clinical signs.1

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Clinical signs of urinary tract infections in cats

Clinical signs of lower UTI in cats include polyuria, macroscopic haematuria, periuria, dysuria and stranguria. These are nonspecific and may be present in any feline lower urinary tract disease, with idiopathic cystitis the most common in cats. Pyelonephritis is an upper UTI that in its acute form courses with fever, kidney pain, anorexia, lethargy, polyuria, polydipsia, vomiting and diarrhoea.1

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Aetiology of urinary tract infections in cats

Most UTIs are due to bacteria; while under 1% of urinary tract infections are parasitic, fungal or viral infections.1 Alashraf AR et al. recently reported the isolation of pathogenic Leptospira spp. in the urine and kidneys of cats with naturally acquired infection, which suggests that infected cats may be involved in the transmission of Leptospira spp.2

In practice, Escherichia coli is the pathogen most frequently isolated from cat urine and is present in 39–59% of positive cultures.1

The incidence of multidrug-resistant (MDR) E. coli infection is increasing in both humans and pets.3 A risk factor analysis confirmed that the number of antibiotic families used correlates directly with an increased risk of an MDR E. coli urinary tract infection, but the association with the number of days of hospitalisation did not reach statistical significance.4

Urinary tract infections in cats: diagnosis

Urinary tract infections are diagnosed according to the clinical signs, urinalysis results andquantitative bacterial cultures. Urine cultures are essential for a reliable diagnosis, especially in cats, as several different aetiologies give rise to the same clinical signs in the lower urinary tract.1

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Urinary tract infections in cats: treatment

If a genuine bacterial urinary tract infection is identified, the treatment plan depends on the patient’s history of UTIs, the affected structures and any comorbidities. In addition, to prevent treatment failure and the development of antibiotic resistance, the antimicrobial therapy should preferably be selected on the basis of in vitro susceptibility testing.1

Urinary tract infections are one of the main reasons for the use of antimicrobial agents in veterinary medicine, and this use contributes to the development of antimicrobial resistance. Antimicrobials are often overprescribed in cats leading to the misuse of some drugs, such as third-generation cephalosporins and fluoroquinolones.1 The emergence of MDR bacteria is a growing public health concern, so the treatment of bacterial diseases is becoming a challenge due to emergent MDR strains resulting in longer and more costly infections.3,4

Urinary tract infections in cats: prevention

Monitoring for recurrences and the spread of resistance is a critical element of prevention in order to keep resistance at low levels.3

To maintain or even reduce these levels of resistance, all vets and pet parents must develop measures and tools to help control these infections and implement precise strategies for the administration of antimicrobial agents in cats and dogs.3

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References:
1. Dorsch R., Teichmann-Knorrn S., Sjetne Lund H. (2019). Urinary tract infection and subclinical bacteriuria in cats: A clinical update. Journal of Feline Medicine and Surgery; 21(11):1023-1038.
2. Alashraf A.R., Lau S.F., Khairani-Bejo S., et al. (2020). First report of pathogenic Leptospira spp. isolated from urine and kidneys of naturally infected cats. PLoS One;15(3):e0230048. Published 2020 Mar 10. doi:10.1371/journal.pone.0230048.
3. Saputra S, Jordan D, Mitchell T, Wong HS, Abraham RJ, Kidsley A, et al. (2017). Antimicrobial resistance in clinical Escherichia coli isolated from companion animals in Australia. Vet Microbiol;211:43-50.
4. Hernandez J., Bota D., Farbos M., Bernardin F., Ragetly G., Médaille C. (2014). Risk factors for urinary tract infection with multiple drug-resistant Escherichia coli in cats. Journal of Feline Medicine and Surgery;16(2):75-81.
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