Pre-test probability of urinary tract infection in dogs with clinical signs of lower urinary tract disease

Sørensen, Thomas Lund; Holmslykke, M.; Nordlund, Mia; Siersma, Volkert; Jessen, Lisbeth Rem

doi:10.1016/j.tvjl.2019.03.003

Cited by 12 publications

(20 citation statements)

References 27 publications

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“…Empirical drug selection is almost always used when treating suspected bacterial upper or lower urinary tract disease, either because urine cultures are not performed or because treatment is initiated while awaiting culture results. The predominant causes of bacterial cystitis in dogs are members of the Enterobacteriaceae family, particularly Escherichia coli , with staphylococci tending to be the next most prevalent group 11,12 . Therefore, empirical antimicrobial choices should reach therapeutic levels in urine and be active against those bacterial groups.…”

Section: Discussionmentioning

confidence: 99%

“…The predominant causes of bacterial cystitis in dogs are members of the Enterobacteriaceae family, particularly Escherichia coli , with staphylococci tending to be the next most prevalent group. 11 , 12 Therefore, empirical antimicrobial choices should reach therapeutic levels in urine and be active against those bacterial groups. From pharmacological and microbiological standpoints, beta‐lactams and fluoroquinolones are excellent options.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of antimicrobial prescriptions in dogs with suspected bacterial urinary tract disease

Weese

Webb

Ballance

et al. 2021

Veterinary Internal Medicne

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Background Antimicrobials are commonly used to treat urinary tract disease in dogs. Understanding antimicrobial use is a critical component of antimicrobial stewardship efforts. Hypothesis/Objectives To evaluate antimicrobial prescriptions for dogs diagnosed with acute cystitis, recurrent cystitis, and pyelonephritis. Animals Dogs prescribed antimicrobials for urinary tract disease at veterinary practices in the United States and Canada. Materials and Methods A retrospective review of antimicrobial prescriptions was performed. Results The main clinical concerns were sporadic bacterial cystitis (n = 6582), recurrent cystitis (n = 428), and pyelonephritis (n = 326). Amoxicillin/clavulanic acid (2702, 41%), cefpodoxime (1024, 16%), and amoxicillin (874, 13%) were most commonly prescribed for sporadic bacterial cystitis. The median prescribed duration was 12 days (range, 3‐60 days; interquartile range [IQR], 4 days). Shorter durations were used in 2018 (median, 10 days; IQR, 4 days) compared to both 2016 and 2017 (both median, 14 days; IQR, 4 days; P ≤ .0002). Amoxicillin/clavulanic acid (146, 33%), marbofloxacin (95, 21%), and cefpodoxime (65, 14%) were most commonly used for recurrent cystitis; median duration of 14 days (range, 3‐77 days; IQR, 10.5 days). Amoxicillin/clavulanic acid (86, 26%), marbofloxacin (56, 17%), and enrofloxacin (36, 11%) were most commonly prescribed for pyelonephritis; however, 93 (29%) dogs received drug combinations. The median duration of treatment was 14 days (range, 3‐77 days; IQR, 11 days). Conclusions and Clinical Importance Decreases in duration and increased use of recommended first‐line antimicrobials were encouraging. Common drug choices and durations should still be targets for antimicrobial stewardship programs that aim to optimize antimicrobial use, concurrently maximizing patient benefits while minimizing antimicrobial use and use of higher tier antimicrobials.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of antimicrobial prescriptions in dogs with suspected bacterial urinary tract disease

Weese

Webb

Ballance

et al. 2021

Veterinary Internal Medicne

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“…Accurate patient selection in this context is therefore crucial to minimise inappropriate treatment. The pre-test probability of UTI has been previously investigated in dogs [15] and people [43,44]. Although confirmed bacterial infection was only found in 46 to 65 % of dogs presenting with one or more lower urinary tract signs [13][14][15]45], by focusing on a narrow, increased-risk population (exclusively female dogs), the positive predictive value of each lower urinary tract sign should be greater than the values described for all dogs.…”

Section: Discussionmentioning

confidence: 99%

“…The pre-test probability of UTI has been previously investigated in dogs [15] and people [43,44]. Although confirmed bacterial infection was only found in 46 to 65 % of dogs presenting with one or more lower urinary tract signs [13][14][15]45], by focusing on a narrow, increased-risk population (exclusively female dogs), the positive predictive value of each lower urinary tract sign should be greater than the values described for all dogs. The ultimate decision to enrol any dog requires an intention of the participating veterinarian to prescribe antimicrobial therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical suspicion of a UTI is based on the presentation of compatible lower urinary tract signs (pollakiuria, dysuria/ stranguria and haematuria). However, these signs are not pathognomonic for the presence of infection, with only 46 to 65 % of dogs with one or more clinical signs of lower urinary tract disease having infection confirmed at culture [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Prospective trial of different antimicrobial treatment durations for presumptive canine urinary tract infections

et al. 2021

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Background Avoidance of unnecessary antimicrobial administration is a key tenet of antimicrobial stewardship; knowing the optimal duration of therapy obviates over-treatment. However, little research has been performed to establish course lengths for common canine infections. In clinical practice, antimicrobial therapy is frequently prescribed in dogs presenting lower urinary tract signs (haematuria, pollakiuria and dysuria/stranguria). The proposed length of treatment in International Consensus guidelines has decreased with each iteration, but these recommendations remain arbitrary and largely extrapolated from experience in people. Methods The objective of this prospective, multi-centre study is to find the shortest course duration that is non-inferior to the standard duration of 7 days of amoxicillin/clavulanate in terms of clinical outcomes for female dogs with lower urinary tract signs consistent with a urinary tract infection. An electronic data capture platform will be used by participating veterinarians working in clinical practice in the United Kingdom. Eligible dogs must be female, aged between 6 months and 10 years and have lower urinary tract signs of up to seven days’ duration. Enrolment will be offered in cases where the case clinician intends to prescribe antimicrobial therapy. Automatic pseudo-randomisation to treatment group will be based on the day of presentation (Monday-Friday); all antimicrobial courses will be completed on the Sunday after presentation generating different treatment durations. Follow-up data will be collected 1, 8 and 22–26 days after completion of the antimicrobial course to ensure effective safety netting, and to monitor short-term outcome and recurrence rates. Informed owner consent will be obtained in all cases. The study is approved by the Ethical Review Board of the University of Nottingham and has an Animal Test Certificate from the Veterinary Medicine’s Directorate. Discussion This study has been designed to mirror current standards of clinical management; conclusions should therefore, be widely applicable and guide practising veterinarians in their antimicrobial decision-making process. A duration-response curve will be created allowing determination of the optimal treatment duration for the management of female dogs with lower urinary tract signs. It is hoped that these results will contribute valuable information to improve future antimicrobial stewardship as part of a wider one-health perspective.

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Urine sample collection and handling

Struck-Lewicka,

Waszczuk-Jankowska,

Markuszewski

2024

Reference Module in Chemistry, Molecular Sciences and Chemical Engineering

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Pre-test probability of urinary tract infection in dogs with clinical signs of lower urinary tract disease

Cited by 12 publications

References 27 publications

Evaluation of antimicrobial prescriptions in dogs with suspected bacterial urinary tract disease

Evaluation of antimicrobial prescriptions in dogs with suspected bacterial urinary tract disease

Prospective trial of different antimicrobial treatment durations for presumptive canine urinary tract infections

Urine sample collection and handling

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