Multiresistant UTI

RE: Multiresistant UTI

Silvia Maldonado — Fri, 24 Jul 2015 01:07:23 GMT

It might be a silly question, but when you said that it was a routine blood/urine screen, do you mean that there is no polyuria or any signs of cystitis in the cat? Or do you suspect that due to the renal disease the owner might not have noticed it?

RE: Multiresistant UTI

Richard Carter — Mon, 20 Jul 2015 16:18:19 GMT

combinations for synergistic effect?

RE: Multiresistant UTI

Andrew Kent — Sun, 19 Jul 2015 20:58:25 GMT

I think this is a difficult call in an asymptomatic cat - certainly in people they often leave asymptomatic infections alone but they would watch you fairly closely to make sure it doesn't progress and I share Kate's concern that these cats have little natural defence to infection and so pyelonephritis is a real possibility. For that reason I am usually not brave enough to leave these alone.

The issue with urine culture is that, as others have said, the concentration of antibiotic that can be achieved in urine is often much higher than in a culture plate and so we can overcome resistance in the animal. If I had to choose what to use, it would probably be either double dose marbofloxacin or high dose amox/clav.

You could also look at nutraceuticals

But I think you can argue this either way.....

Andy

RE: Multiresistant UTI

Kate Richardson — Fri, 17 Jul 2015 22:41:07 GMT

Bacterial infections aren't always symptomatic, particularly in renal disease, but really do need treating or you will end up with pyelonephritis or acute on chronic renal failure, so ignore it at your peril!

I am not sure that resistance to enrofloxacin and marb means automatic resistance to pradofloxacin- the opposite was the implication I had from the discussion we had with the prado rep, obviously some bias there, but I would be considering it in this case.

RE: Multiresistant UTI

John Flynn — Fri, 17 Jul 2015 22:11:22 GMT

[quote user="emma_j"]no symptoms of cystitis[/quote]

I wouldn't give any antibiotics here personally.

Chances of clearing the bacteriuria poor. Chances of producing an even more resistant bug high.

RE: Multiresistant UTI

emma_j — Fri, 17 Jul 2015 19:16:16 GMT

Thanks for the calm suggestion Luca! The lab is re-culturing and re-testing and should have some further results waiting for me on Monday morning.

C&P the MICs here:

Antibiotic	Result	MIC	Sensitivity Range
Ampicillin	RESISTANT	>=32	2 sssiR 32
Amoxycillin-Clavulanic acid	RESISTANT
Cephalexin	RESISTANT	>=64	4 ssssR 64
Cefovecin	RESISTANT	>=8	0.5 sssiR 8
Enrofloxacin	RESISTANT	>=4	0.12 sssiiR 4
Marbofloxacin	RESISTANT	>=4	0.5 ssiR 4
Potentiated sulphonamides	RESISTANT	>=320	20 ssrrR 320
Amoxicillin	RESISTANT

It does say that pradoflox sensitivity can be predicted by enro/marb so seems unlikely to be useful unfortunately. Good point about owner health also, the owner is elderly although always spritely! I will broach this when I talk to her.

I'll update with what happens next! I was thinking about possibly also adding in a GAG supplement, although may need to keep an eye on costs for this owner and no insurance.

RE: Multiresistant UTI

Kate Richardson — Fri, 17 Jul 2015 17:25:52 GMT

Pradofloxacin? can the lab test against this? Also liquid and once daily which may help you with this cat. But would also speak to the lab for further advice

RE: Multiresistant UTI

Michael Woodhouse — Fri, 17 Jul 2015 16:20:33 GMT

Do you have MIC values or just 'sensitive/resistant'?

Remembering that some antibiotics concentrate in urine unchanged and can achieve concentrations many times higher than plasma.

RE: Multiresistant UTI

Hannah Wynne Richards — Fri, 17 Jul 2015 15:30:17 GMT

Has the owner any long-term health issues. I'm thinking the owner may be infected with a multiple resistant E coli, which has caused 1st an enteric, then a urinary infection in the cat.

Wynne

RE: Multiresistant UTI

Luca Poddighe — Fri, 17 Jul 2015 15:29:28 GMT

Have you tried to ask the lab is they can extend the antibiogram to some less common antibiotic to try to find a medication that could help you?