Page 521 - Cote clinical veterinary advisor dogs and cats 4th

Cystitis, Bacterial 233

• Immunosuppressive drug therapy, including PHYSICAL EXAM FINDINGS • Lower urinary tract neoplasia (e.g., transi-
glucocorticoids • Usually unremarkable • Feline lower urinary tract signs/disease;
tional cell carcinoma)
VetBooks.ir retention (physical or functional causes), illness or condition (e.g., findings suggestive • Obstructive uropathy Diseases and Disorders
• Disorders of micturition, including urine
• Occasionally: findings related to associated
interstitial cystitis
urinary incontinence, and vulvar (or rarely,
of endocrine disorder, urolithiasis, prostatitis)
preputial) conformational abnormalities
• Bacteremia • Rarely Initial Database
○ Painful bladder
• Prostatitis, vaginitis, pyometra, pyelonephritis ○ Palpably thickened urethra on rectal exam • CBC and serum biochemistry profile:
• Urinary catheterization, especially indwelling (concurrent urethritis) unnecessary for uncomplicated cystitis; may
catheters reflect predisposing illness or condition in
• Perineal urethrostomy Etiology and Pathophysiology complicated infections
• Infecting bacteria usually ascend through the • Urinalysis: bacteriuria, pyuria, hematuria, and/
CONTAGION AND ZOONOSIS urethra to the bladder, but hematogenous or proteinuria. Sample should be obtained by
Occasionally, clonally identical strains of infection or infection from pyelonephritis midstream catch (clean perineum first), clean
uropathogenic Escherichia coli are transmitted is possible. catheterization, or cystocentesis (ideal unless
between human and animal members of a • Bacterial virulence factors influence likeli- bladder cancer or coagulopathy suspected).
household. hood of infection. Flora adapted for preputial ○ May reflect predisposing illness or condi-
and vaginal environments are protective from tion (e.g., crystals, glucosuria)
ASSOCIATED DISORDERS uropathogenic infection. ○ Sediment exam may be inactive despite
Struvite urolithiasis, pyelonephritis, emphyse- • Multiple physical (e.g., intact uroepithelium, infection, especially with diabetes mellitus,
matous cystitis, prostatitis voiding action of urination, urethral pressure hyperadrenocorticism, or other conditions
causing dilute urine.
Clinical Presentation and length), chemical (e.g., urine osmolality, ○ Leukocyte squares on urine dipstick are
urea content, pH), and immunologic host
DISEASE FORMS/SUBTYPES defenses protect from infection. Disruption or notoriously inaccurate.
• Uncomplicated: first infection in the absence defects in these defenses predispose to infection. • Gram stain of urine sediment
of structural or functional host defects • The most common pathogens are E. • Urine culture/susceptibility
• Complicated: infection in a dog with coli, Staphylococcus, Proteus, Enterococcus, ○ Samples should be collected by clean cath-
structural or functional defects (see Risk Klebsiella, Streptococcus, Enterobacter, and eterization or cystocentesis (ideal unless
Factors above), in any cat, or any recurrent Pseudomonas. Only ≈20% of infections bladder neoplasia or bleeding disorder
or refractory UTI involve more than one species. suspected). Bacterial number should be
• Recurrent: repeated infections with the same • Bacterial resistance to antibiotics can be prob- quantified to distinguish contamination
3
(relapse) or different (reinfection) species of lematic. Resistance may be inherent or may (<10 bacteria/mL) from infection.
bacteria result from genetic transfer of resistance factors ○ Although preferred, culture is not neces-
• Refractory: persistent infection with the same or from mutation and selection pressures. sary for first occurrence of uncomplicated
bacteria despite antibiotic treatment cystitis.
• Subclinical bacteriuria: positive bacterial DIAGNOSIS ○ Culture/sensitivity should always be
urine culture for an animal with no clinical obtained from complicated UTI.
evidence of infection Diagnostic Overview ○ An inactive sediment does not eliminate
the need for culture and sensitivity when
HISTORY, CHIEF COMPLAINT In animals with signs of dysuria, cystitis is often UTI is suspected because many concur-
• Signs encountered most commonly include recognized on urinalysis (obtained by cystocen- rent disorders produce dilute urine, limit
○ Pollakiuria tesis, catheter, or midstream catch) as bacteriuria leukocyte responses in the urine, or both,
○ Stranguria/dysuria and pyuria. Urine culture and susceptibility are producing a negative microscopic sediment
○ Hematuria indicated for all complicated UTIs. Absence exam despite active cystitis.
○ Inappropriate elimination of bacteriuria cannot rule out UTI, especially
○ Malodorous urine when urine is poorly concentrated. Advanced or Confirmatory Testing
○ Perivulvar dermatitis Reserved for complicated UTI, primarily with
• If clinical signs absent, subclinical bacteriuria Differential Diagnosis the intention of identifying risk factors:
is a more appropriate diagnosis than cystitis/ • Urolithiasis • Abdominal radiographs: radiopaque uroliths,
UTI; treatment generally not required. • Prostatitis prostatomegaly, rarely emphysematous cystitis

A B C

CYSTITIS, BACTERIAL Urinalysis for dogs with bacterial cystitis often demonstrates white blood cells (A) and
bacteria: rods (B) and/or cocci (C). Gram stain can inform the initial antimicrobial choice while awaiting results of
culture and susceptibility.

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