Urinary tract infections in dogs with spontaneous hypercortisolism – frequency, symptoms and involved pathogens

Abstract

Dogs with hypercortisolism are predisposed to developing bacteriuria associated either with clinical signs of cystitis or without clinical signs (subclinical bacteriuria). Based on current guidelines, dogs with subclinical bacteriuria should not be treated with antibiotics because there is no evidence that treatment improves outcome and because unnecessary treatments should be avoided. Before these guidelines were published in 2019, dogs with hypercortisolism and bacteriuria were commonly treated with antibiotics irrespective of clinical signs. Comprehensive data on the frequency of bacterial cystitis, subclinical bacteriuria and the outcome of antimicrobial treatment in dogs with hypercortisolism is sparse. The aims of this study were to investigate dogs with hypercortisolism for the presence of bacterial cystitis and subclinical bacteriuria, to address the pathogens involved, and to assess the outcome of antibiotic treatment. Dogs newly diagnosed with hypercortisolism between 2005 and 2015 from which a urine bacterial culture was available were included. Statistical analysis was performed with non-parametric tests. Of the 161 client-owned dogs included, 29 (18%) showed bacteriuria, which was subclinical in 24 (83%) cases. Escherichia coli was the most commonly isolated pathogen (58%). Bacteriuria was not associated with sex or neutering status. In 14 dogs, follow-up data was available, of which 13 (93%) were treated with antimicrobials for 14 to 28 days. Follow-up bacterial culture (1 to 118 days after cessation of therapy) was negative in 10 (77%) treated dogs; a negative follow-up culture was not associated with gender, age or duration of treatment. Bacteriuria persisted in three treated dogs and the one untreated dog. The prevalence of positive bacterial urinary culture in dogs with hypercortisolism was lower than previously reported. In the majority of dogs, bacteriuria was subclinical. Most dogs had a negative bacterial culture result after antimicrobial treatment; however, more resistant bacteria were detected in persistently positive urine. Hund mit Hyperkortisolismus neigen dazu eine Bakteriurie zu entwickeln, die entweder mit oder ohne klinische Anzeichen einer Blasenentzündung verbunden sein kann. Nach den aktuellen Behandlungsempfehlungen sollten Hunde mit subklinischer Bakteriurie nicht mit Antibiotika therapiert werden, da es keine Hinweise auf eine Verbesserung des Therapieerfolges gibt und unnötige Behandlungen vermieden werden sollten. Bevor diese Richtlinien im Jahr 2019 veröffentlicht wurden, wurden Hunde mit Hyperkortisolismus und Bakteriurie unabhängig von den klinischen Symptomen standardmässig mit Antibiotika behandelt. Daten zur Häufigkeit von bakteriellen Blasenentzündungen, subklinischer Bakteriurie und zum Ergebnis einer antimikrobiellen Behandlung bei Hunden mit Hyperkortisolismus liegen nur spärlich vor. Ziel dieser Studie war es, Hunde mit Hyperkortisolismus auf das Vorhandensein einer bakteriellen Blasenentzündung und subklinischen Bakteriurie zu untersuchen, die beteiligten Krankh...

Antimicrobial use practices in canine and feline patients with co-morbidities undergoing dental procedures in primary care practices in the US

“…Routine antimicrobial prophylaxis is not recommended in humans with endocrinopathies [ 16 ]. When evaluating the prevalence of bacteriuria in dogs with hypercortisolism, this is lower than expected with only 18% tested positive and of those 83% were subclinical [ 23 ]. A single case report detailing local and systemic complications following dental extractions in a cat with diabetes exists; however, this patient was not well controlled and risk cannot be ascertained from a single case [ 24 ].…”

Diagnostic value of different urine tests for urinary tract infection: a systematic review and meta-analysis

“…Urine culture can be tested separately, but this operation is complicated and easily contaminated by miscellaneous bacteria. In addition, urine culture testing has a high FP rate and it needs to be used for a long time (29)(30)(31). Urine dipstick tests and quantitative urine culture often have different results.…”

The relationships between sediment findings and culture results and the presence of proteinuria in canine urine samples

“…This could lead to significant renal proteinuria being missed and the introduction of bias into retrospective studies. This may be a particular problem in conditions such as diabetes mellitus and hyperadrenocorticism which are associated with both renal proteinuria and lower urinary tract disease (Ortega et al 1996, Hurley & Vaden 1998, Forrester et al 1999, Hess et al 2000, Smets et al 2012a,b, Herring et al 2014, Marynissen et al 2016, Hoffman et al 2018, Dupont et al 2020, Yoon et al 2020. In addition, some conditions such as Borrelia burgdorferi infections are associated with both inflammatory changes in urine and glomerulopathy (Grauer et al 1988, Borys et al 2019.…”