Repeat negative urine culture in cat on high dose COP

Re: Repeat negative urine culture in cat on high dose COP

Kate Richardson — Fri, 23 Jan 2015 14:25:42 GMT

I would try Marbofloxacin- I seem to have a few UTIs recently that were either resistant to amoxyclav (based on C&S) or unresponsive (particularly to Convenia. marbocyl was effective. It is also once daily and small tablets which helps. Or you could get the owners to inject the cat daily?

Re: Repeat negative urine culture in cat on high dose COP

Thomas Johnson — Fri, 23 Jan 2015 12:52:45 GMT

[quote user="Anthony Todd"]

[quote user="Kara Gibson"]COP - cyclophosphamide, vincristine and prednisolone, I apologise for the acronym![/quote]

Crikey, you can see why I asked what it stood for and used an appropriate query.....

CVP would have given me a clue!

[/quote]

Vincristine was initially marketed under the trade-name Oncovin.

Re: Repeat negative urine culture in cat on high dose COP

Anthony Todd — Fri, 23 Jan 2015 12:20:35 GMT

[quote user="Kara Gibson"]and there is blood and protein in his urine[/quote]

Sorry, didn't realise that, withdraw chastened....

Don't suppose there's any crystals??

Re: Repeat negative urine culture in cat on high dose COP

Anthony Todd — Fri, 23 Jan 2015 12:17:47 GMT

THREE LETTER ABBREVIATION.

More obvious than "COP", IMHO.!

Re: Repeat negative urine culture in cat on high dose COP

Hannah Wynne Richards — Fri, 23 Jan 2015 11:35:53 GMT

What does TLA mean?

Wynne

Re: Repeat negative urine culture in cat on high dose COP

Anthony Todd — Fri, 23 Jan 2015 09:35:46 GMT

[quote user="Kara Gibson"]COP - cyclophosphamide, vincristine and prednisolone, I apologise for the acronym![/quote]

Crikey, you can see why I asked what it stood for and used an appropriate query.....

CVP would have given me a clue!

Re: Repeat negative urine culture in cat on high dose COP

Kara Gibson — Fri, 23 Jan 2015 01:56:47 GMT

Thanks for all your helpful replies. So to address a few of the questions:

COP - cyclophosphamide, vincristine and prednisolone, I apologise for the acronym!

All samples I have taken have been via cystocentesis, 2 were placed in plain sterile pots (no boric acid!) and one I tried Andy's tip of spinning it down and placing the supernatant on a swab. Unfortunately I don not have access to in house culture. I have treated him with a 2 week course of amoxyclav and a 2 week course of cephalexin (but to make matters worse he is quite difficult to medicate, the preds are hard enough!).

His most recent biochemistry was all normal, his urine is concentrated (often around 1.050) and there is blood and protein in his urine. On ultrasound this time I can see a presumed blood clot but no stones.

Although the cat is not showing clinical signs we know cats e.g. with renal disease can suffer with 'silent' UTIs and we treat them so firstly I feel if there is infection here I want to treat it and hopefully prevent e.g. pyelonephritis and secondly if there is no infection that would imply the cyclophosphamide is causing hemorrhagic cystitis and I should address this.

Next time if I still can see bacteria I will definitely ask the lab for a Gram stain - thanks for this tip!

Re: Repeat negative urine culture in cat on high dose COP

Michael Woodhouse — Fri, 23 Jan 2015 01:46:07 GMT

WTF is what the ***. Stop mincing words.

Re: Repeat negative urine culture in cat on high dose COP

tess — Thu, 22 Jan 2015 23:10:36 GMT

[quote user="John Flynn"]

[quote user="Anthony Todd"]

[quote user="Hannah Wynne Richards"]WTF[/quote]

It's a TLA. and

WTF means What's This For ?, as far as I've always understood, but I'm happy to be corrected.

[/quote]

Why the face? I thought

[/quote]

Oh, the meaning I know for WTF isn't quite so polite!

Re: Repeat negative urine culture in cat on high dose COP

John Flynn — Thu, 22 Jan 2015 21:04:54 GMT

[quote user="Anthony Todd"]

[quote user="Hannah Wynne Richards"]WTF[/quote]

It's a TLA. and

WTF means What's This For ?, as far as I've always understood, but I'm happy to be corrected.

[/quote]

Why the face? I thought

Re: Repeat negative urine culture in cat on high dose COP

Chris Milligan — Thu, 22 Jan 2015 18:51:19 GMT

Hi Kara - interesting case and finding thanks for sharing. Remember that not all bacteria can be cultured, and still more culturable ones don't make it to the lab despite best intentions. Failing this one has to ask if we're sure they're bacteria - lymphomas can produce unusual proteins some of much can aggregate in urine, and of course cyclophosphamide is noted for its ability to cause cystitis which may become complicated by bacteria or other substances masquerading as bacteria. As you suggest as well these drugs may well be toxic to bacteria, but if so we might expect the infection to be cleared in the bladder.

It may be worth performing a UPCR to rule out a proteinaceous cause in addition to other recommendations here. Also do you have the patient's most recent haem and renal parameters?

Chris

Re: Repeat negative urine culture in cat on high dose COP

Anthony Todd — Thu, 22 Jan 2015 18:44:35 GMT

[quote user="Hannah Wynne Richards"]WTF[/quote]

It's a TLA. and

WTF means What's This For ?, as far as I've always understood, but I'm happy to be corrected.

Re: Repeat negative urine culture in cat on high dose COP

Hannah Wynne Richards — Thu, 22 Jan 2015 18:19:48 GMT

Chemotherapy protocol. I'm glad I'm not the only one annoyed by strings of initials.

BTW, what's WTF supposed to mean.

Wynne

Re: Repeat negative urine culture in cat on high dose COP

Anthony Todd — Thu, 22 Jan 2015 18:08:04 GMT

Are there any indications of disease relating to the bladder at all?

Why chase these bacteria if they're just living there and causing no harm?

WTF is "COP"? The closest I can get to is "Cost Only Payment"?

Re: Repeat negative urine culture in cat on high dose COP

Kate Richardson — Thu, 22 Jan 2015 12:02:07 GMT

[quote user="John Flynn"]If you like doing urine cultures, it's probably cheaper to get a bench-top incubator (37degrees, eg ebay or whatever) and some split culture plates (half blood-agar, half MacConkey's) and plate up the urine, sending any positives to lab (you'll need to check your regular lab, and the post service..., accepts plated cultures, most I've used do) for identification and antibiotic senstivity testing. Benefits= much less false negatives and unit cost being just a £2 plate for each negative culture (which lets face it is most of the urine cultures we send...).[/quote]

The benefit of the Speed bio however is the speed of results- you usually know if there are bacteria growing in 24 hours, and it also identifies them (e g. e.coli, staph, strep, pseudomonas) and you also get a sensitivity as well- all within 48 hours from starting.

Re: Repeat negative urine culture in cat on high dose COP

John Flynn — Wed, 21 Jan 2015 22:08:37 GMT

Just in case you're using it, avoid a urine culture pot with boric acid in it to reduce false negative result.

If you like doing urine cultures, it's probably cheaper to get a bench-top incubator (37degrees, eg ebay or whatever) and some split culture plates (half blood-agar, half MacConkey's) and plate up the urine, sending any positives to lab (you'll need to check your regular lab, and the post service..., accepts plated cultures, most I've used do) for identification and antibiotic senstivity testing. Benefits= much less false negatives and unit cost being just a £2 plate for each negative culture (which lets face it is most of the urine cultures we send...).

If you must post away to lab and really want a positive culture and have struggled thus far, then I'd try injecting some urine into a blood culture pot and sending that, making sure not on antibiotics for couple of days prior to sampling to avoid traces in the urine... a charcoal swab sounds a reasonable suggestion, but you'll be kicking yourself if its negative again...

Incidentally, is it necessary/sensible to treat asymptomatic bacteriuria in an immunocompromised patient? As much as I love a good urine culture I'm just not sure on this one, the intracellular bacteria might swing me, but I'd certainly not be using any fancy antibiotics on this one as "cure" sounds unlikely...

Re: Repeat negative urine culture in cat on high dose COP

Gareth C. — Wed, 21 Jan 2015 18:06:49 GMT

good to hear about the speed bio we use it too. very useful bit of kit, results seem believable too. re the OP if she is seeing intracellular bacteria then its not contamination.

Re: Repeat negative urine culture in cat on high dose COP

Kate Richardson — Wed, 21 Jan 2015 11:52:45 GMT

I don't suppose you have access to do an in house culture? We have the Speed Bio from Virbac? I think, small incubator, works very well and I find culturing immediately much more sensitive for the reasons Andrew stated. Or of you have a neighbouring practice who has in house culture facilities- maybe a large animal practice? Worth speaking to Virbac about their speed bio, I think it is great!

What antibiotics have you used so far?

Re: Repeat negative urine culture in cat on high dose COP

Andrew Kent — Wed, 21 Jan 2015 11:11:42 GMT

Hi Kara,

The frustrating this about urine cultures is that they are often negative when submitted to an external lab by post.

One question - are these cysto samples or free catch? If free catch then contamination should be considered.

In order to try to increase the chance of a culture and reliable result I would do the following:

Cysto urine sample

Submit urine to external lab for sediment exam and gram stain.

Spin down a sample of urine in a tube, get rid of the supernatant and then dip a culture swab into the sediment - in this way the bacteria are not sitting in the urine during transit and so you may increase the chance of a culture. You can culture both the urine and the swab.

With a gram stain it means that even if the culture is negative you get more information about the bacteria in which to direct therapy.

Hope this helps,

Andy

Re: Repeat negative urine culture in cat on high dose COP

Andrew Kent — Wed, 21 Jan 2015 11:11:42 GMT

Hi Kara,

The frustrating this about urine cultures is that they are often negative when submitted to an external lab by post.

One question - are these cysto samples or free catch? If free catch then contamination should be considered.

In order to try to increase the chance of a culture and reliable result I would do the following:

Cysto urine sample

Submit urine to external lab for sediment exam and gram stain.

With a gram stain it means that even if the culture is negative you get more information about the bacteria in which to direct therapy.

Hope this helps,

Andy

Re: Repeat negative urine culture in cat on high dose COP

Kara Gibson — Wed, 21 Jan 2015 10:46:34 GMT

Also, have seen some intracellular bacteria!

Re: Repeat negative urine culture in cat on high dose COP

Kara Gibson — Wed, 21 Jan 2015 10:45:40 GMT

I've checked for this multiple times! But all clear, and some other samples in between have had no bacteria.

Re: Repeat negative urine culture in cat on high dose COP

Holly Norman — Wed, 21 Jan 2015 10:07:06 GMT

Contaminants from your staining solution?