Acute pyelonephritis in cats is frequently caused by Escherichia coli resistant to potentiated penicillins but has a better prognosis than other causes of acute kidney injury.

OBJECTIVE: To describe the clinical findings, microbiological data, treatment, and outcome of a population of cats with suspected acute pyelonephritis (APN). ANIMALS: 32 client-owned cats. CLINICAL PRESENTATION AND PROCEDURES: Retrospective case series from 2 veterinary teaching hospitals between January 1, 2014, and December 31, 2020. Cats were included if they had a positive bacterial urine culture and a clinical diagnosis of acute kidney injury. RESULTS: Older female cats with underlying chronic kidney disease have a higher probability to develop bacterial culture-positive acute kidney injury or APN. Escherichia coli was the most commonly cultured bacterial species, and E coli isolates with susceptibility testing were resistant to amoxicillin-clavulanate but susceptible to fluoroquinolones or third-generation cephalosporins. Of the 20 cats with available follow-up information in the medical record, 14 were alive at 3 months after hospital discharge. Markers of renal function including creatinine (P = .008), BUN (P = .005), and phosphorus (P < .001) at the time of presentation were all higher in nonsurvivors compared with survivors. CLINICAL RELEVANCE: The survival rate with feline APN is higher than previous reports of acute kidney injury when all etiologies are considered. Nonsurvivors had more pronounced azotemia upon initial presentation. Amoxicillin-clavulanate was a poor empirical antimicrobial in this cohort based on the microbiological data.

Prevalence of antibiotic use for dogs and cats in United States veterinary teaching hospitals, August 2020.

BACKGROUND: Awareness of prescribing practices helps identify opportunities to improve antibiotic use (AU). OBJECTIVES: To estimate AU prevalence in dogs and cats in U.S. veterinary teaching hospitals (VTHs) and identify antibiotic drugs commonly prescribed, indications for use, and evidence of bacterial infection. ANIMALS: Medical record data were collected from dogs and cats examined at 14 VTHs. METHODS: Data were collected from VTH medical records of dogs and cats examined by primary care, urgent care, emergency and critical care, internal medicine, and surgery services on a single day during August 13-September 3, 2020. Data included signalment; clinical service; inpatient or outpatient status; clinical conditions; diagnostic tests; evidence of bacterial infection; intended reason for AU; name and route of antibiotics prescribed. RESULTS: Of 883 dogs and cats, 322 (36.5%) were prescribed at least 1 antibiotic. Among 285 antibiotics administered systemically intended for treatment of infection, 10.9% were prescribed without evidence of infection. The most common class of antibiotics presribed for systemic administration was potentiated penicillin for dogs (115/346, 33.3%) and cats (27/80, 33.8%). For dogs and cats, first-generation cephalosporins (93/346, 26.9% and 11/80, 13.8%, respectively) and fluoroquinolones (51/346, 14.7% and 19/80, 23.8%, respectively) was second or third most-prescribed. Common AU indications included skin, respiratory, and urinary conditions, and perioperative use. CONCLUSIONS AND CLINICAL IMPORTANCE: Collaborative data collection provides a sustainable methodology to generate national AU prevalence estimates and bring attention to areas requiring additional research and detailed data collection. These efforts can also identify practice improvement opportunities in settings where future veterinarians are trained.

Change over time and agreement between clinical markers of disease resolution in dogs with aspiration-induced lung injury.

BACKGROUND: There is a lack of consensus regarding which markers of disease resolution to prioritise when assessing treatment response in client-owned dogs with aspiration-induced lung injury. This study describes the change over time and the agreement between the clinical markers used to determine disease resolution. METHODS: Physical examination (PE), owner-reported clinical signs (CS-O), thoracic radiographs (TXR) scores and C-reactive protein (CRP) concentrations were determined at enrolment, after 24, 48 and 72 hours, and after 7, 14 and 28 days. RESULTS: PE scores were significantly improved at 48 hours, while CRP initially increased (24 hours) and then decreased (48 hours). PE, CS-O and CRP significantly improved earlier (7 days) than TXR (14 days). The median number of days to marker normalisation was 7, 9 and 14 for PE, CRP and CS-O, respectively. Marker agreement was excellent/very good at enrolment and fair/poor during disease recovery. LIMITATIONS: Analysis did not control for differences aetiology of aspiration or the lack of standardisation in treatment approach. CONCLUSIONS: PE was the earliest and most consistent marker indicating disease resolution. Serial CRP monitoring (72 hours) may provide an objective marker of early treatment response. Alongside PE normalisation, improvement in CS-O, CRP and TRX may assist in determining disease resolution and guide treatments, including limiting antibiotic exposure in dogs with aspiration-induced lung injury.

No adverse consequences associated with targeting clinical signs to initiate antimicrobial treatment of postoperative subclinical bacteriuria in dogs following surgical decompression of Hansen type I thoracolumbar disk herniation.

OBJECTIVE: To describe the prevalence of postoperative bacteriuria, clinical course of subclinical bacteriuria in the absence of antimicrobial intervention, clinical signs of bacteriuria that trigger antimicrobial treatment, and outcomes for dogs with subclinical bacteriuria following surgical decompression of acute intervertebral disc herniation (IVDH) Hansen type I. ANIMALS: Twenty client-owned dogs undergoing hemilaminectomy for acute (≤ 6 days) IVDH Hansen type I affecting the thoracolumbar spinal cord segments between August 2018 and January 2019. PROCEDURES: In this prospective study, dogs were serially evaluated at presentation, hospital discharge, 2 weeks postoperatively, and between 4 and 6 weeks postoperatively. Dogs were monitored for clinical signs of bacteriuria, underwent laboratory monitoring (CBC, biochemical analyses, urinalysis, urine bacterial culture), and were scored for neurologic and urinary status. In the absence of clinical signs, bacteriuria was not treated with antimicrobials. RESULTS: Four of the 18 dogs developed bacteriuria without clinical signs 4 days to 4 to 6 weeks after surgery. In all 4 dogs, bacteriuria resulted in lower urinary tract signs 13 to 26 weeks postoperatively. No dogs had evidence of systemic illness despite delaying antimicrobial treatment until clinical signs developed. New-onset incontinence was the only clinical sign in 3 dogs. All bacterial isolates had wide antimicrobial susceptibility. Bacteriuria and clinical signs resolved with beta-lactam antimicrobial treatment. CLINICAL RELEVANCE: Postoperative bacteriuria occurs in some dogs with IVDH Hansen type I and, when present, may lead to clinical signs over time. Clinical signs of bacteriuria may be limited to new-onset urinary incontinence, inappropriate urination, or both. Delaying antimicrobial treatment until clinical signs of bacteriuria developed did not result in adverse consequences or systemic illness.

Glucocorticoids, Cyclosporine, Azathioprine, Chlorambucil, and Mycophenolate in Dogs and Cats: Clinical Uses, Pharmacology, and Side Effects.

The treatment of immune-mediated disease in dogs and cats continues to evolve as new therapies are adapted from human medicine. Glucocorticoids remain the first-line treatment followed by second-line therapies including cyclosporine, azathioprine (dogs), chlorambucil, or mycophenolate. Second-line therapies are introduced due to the patient's lack of response or intolerable effects to glucocorticoids or may be introduced early in the disease treatment due to the patient's severe life-threatening clinical presentation. The goals of immunosuppressive treatment are to achieve disease remission while minimizing drug side effects. Ultimately, gradual drug tapering to the lowest dose to maintain disease remission or successful drug withdrawal.

A retrospective review of canine benign prostatic hyperplasia with and without prostatitis.

Benign prostatic hyperplasia (BPH) is the most common prostatic disorder in older intact male dogs, but despite its prevalence, there are inconsistencies in clinical diagnosis and treatment. Although prostate size was historically considered the hallmark feature of BPH in men, currently, there is only a weak correlation between prostate size and clinical severity. We performed a retrospective cohort study with the primary objective of assessing clinical signs, ultrasonographic findings, treatments, and outcomes in dogs diagnosed with BPH, with and without concurrent prostatitis. We reviewed medical records and obtained data on presenting signs, prostatic imaging, and prevalence of concurrent bacteriuria. Prostate size was determined by ultrasonography and compared to the calculated expected size based on patient age and weight. Treatment and outcome were described for the cases with a minimum 2 months follow-up. Median age of dogs diagnosed with BPH was 8 years. Clinical signs were present in 16/25 dogs and scored as mild to moderate (median Zambelli's Symptom Index for BPH score 12). The median prostatic volume to body mass ratio was 1.60 mm3/kg. Prostate size did not correlate with the symptom severity. Concurrent bacteriuria was confirmed in 4/25 cases via bacterial culture and/or cytology. Treatments pursued and responses were only available in a subpopulation of dogs (n = 9) and were highly variable. Studies are needed to determine if current treatment options for BPH in dogs resolve associated clinical signs in addition to reducing prostate size.

Biomarkers of oxidative stress as an assessment of the redox status of the liver in dogs.

BACKGROUND: Oxidative stress is associated with a diverse group of liver disorders across species. OBJECTIVES: Determine whether glutathione (GSH) concentration in plasma and red blood cells correlates with liver GSH concentration in dogs and evaluate whether other markers of systemic oxidative stress, plasma vitamin E and urine 8-isoprostanes/creatinine (F2 -IsoPs/Cr) concentrations, correlate with liver GSH. ANIMALS: Thirty-four client-owned dogs undergoing clinically indicated liver biopsy and 15 healthy control dogs. METHODS: Prospective, observational cross-sectional study. Urine and blood were collected before liver biopsy. Plasma, erythrocyte, and liver GSH were measured using high performance liquid chromatography (HPLC); vitamin E was measured by HPLC, and F2 -IsoPs/Cr was measured by gas chromatography/mass spectrometry. RESULTS: All dogs were treated at the discretion of the attending clinician (24/34 received antioxidants; 4/34 fed therapeutic liver diet), which included dogs with primary or secondary liver disease (inflammatory (n = 21), metabolic (n = 9), vascular (n = 2), and neoplastic (n = 2)). Median GSH concentrations in plasma, erythrocyte, and liver were 0.18 mg/dL (range 0.14 to 0.56 mg/dL), 56.7 mg/dL (18.3 to 79.2 mg/dL), and 181 mg/dL (39.9 to 527 mg/dL), respectively. No significant correlations were found between liver GSH and erythrocyte GSH, plasma GSH, vitamin E, or F2 -IsoPs/Cr. Dogs undergoing clinically indicated liver biopsy had significantly higher urine F2 -IsoPs/Cr than did healthy controls (5.89 vs 2.98 ng/mg; P < .0001). CONCLUSIONS AND CLINICAL IMPORTANCE: Erythrocyte and plasma GSH are not indicative of liver GSH concentration in dogs. In addition, dogs undergoing clinically indicated liver biopsy have evidence of increased systemic oxidative stress compared to healthy controls.

Hypocholesterolemia and nonregenerative, suspected immune-mediated, anemia: Report of 3 canine cases.

This report describes hypocholesterolemia in 3 dogs with nonregenerative, suspected immune-mediated anemias. Common causes of hypocholesterolemia were ruled out, raising suspicion for a mechanistic link between anemia and hypocholesterolemia in dogs. As observed in humans with concurrent anemia and hypocholesterolemia, cholesterol concentrations increased to within the reference interval once the dogs' anemia resolved.

Hypocholestérolémie et anémie non régénérative suspectée d'origine immunitaire : rapport de 3 cas canins. Ce rapport décrit l'hypocholestérolémie chez trois chiens atteints d'une anémie non régénérative suspectée d'origine immunitaire. Les causes communes d'hypocholestérolémie ont été écartées, soulevant des doutes pour un lien mécanistique entre l'anémie et l'hypocholestérolémie chez les chiens. Tel qu'il a été observé chez les humains atteints d'anémie et d'hypocholestérolémie concomitante, les concentrations de cholestérol ont augmenté dans l'intervalle de référence une fois que l'anémie des chiens s'est résorbée.(Traduit par Isabelle Vallières).

Clinical performance of a commercial point-of-care urine culture system for identification of bacteriuria in dogs.

OBJECTIVE To evaluate the clinical performance of a commercially available compartmentalized urine culture and antimicrobial susceptibility test plate (CCSP) for identification of canine bacteriuria and assessment of isolate antimicrobial susceptibility. DESIGN Cross-sectional study. ANIMALS 71 dogs. PROCEDURES Urine samples (n = 84) were divided into 3 aliquots. One aliquot (reference culture) was plated on culture medium ≤ 1 hour after collection for quantitative culture and testing by standard laboratory methods, another was stored at 4°C for 24 hours (to mimic storage practices at primary care facilities) and then processed by standard methods, and the third was applied to a CCSP ≤ 1 hour after collection to be processed and interpreted according to manufacturer instructions. Results were compared with those for reference culture, which was used as the criterion reference standard. Sensitivity, specificity, positive and negative predictive values, and agreement between methods was evaluated. RESULTS 43 isolates (25 single and 9 multiple isolates) were identified in 34 reference cultures. All results for stored cultures were identical to those for reference cultures. Overall sensitivity of the CCSP method to detect bacteriuria was 93%, and specificity was 100%. Thirty-three of 43 (77%) and 19 of 33 (58%) CCSP bacterial isolates were correctly identified to the genus and species level, respectively. The CCSP antimicrobial susceptibility results matched those for reference cultures for 13 of 33 (39%) isolates evaluated. CONCLUSIONS AND CLINICAL RELEVANCE Limitations of the CCSP method included inaccuracy of some antimicrobial susceptibility test results and failure to correctly identify bacteriuria in some dogs.

Concurrent cranial mediastinal Blastomyces granuloma and carcinoma with cranial vena caval syndrome in a dog.

This report describes an unusual progression of blastomycosis in a dog with concurrent mediastinal carcinoma. The dog was evaluated for respiratory distress. Diagnostic results revealed chylothorax and a cranial vena caval thrombus. Histopathology of the cranial mediastinal mass diagnosed mediastinal carcinoma and fungal granuloma. Intercurrent disease may complicate the clinical presentation and clinical course of blastomycosis.

Granulome médiastinal àBlastomyceset carcinome concomitant avec le syndrome d'une veine cave crâniale chez un chien. Ce rapport décrit une progression inusitée d'une blastomycose chez un chien atteint d'un carcinome médiastinal concomitant. Le chien a été évalué pour une détresse respiratoire. Les résultats diagnostiques ont révélé le chylothorax et un thrombus de la veine cave crâniale. L'histopathologie de la masse médiastinale crâniale a révélé un diagnostic de carcinome médiastinal et de granulome fongique. La maladie intercurrente peut compliquer la présentation clinique et l'évolution clinique de la blastomycose.(Traduit par Isabelle Vallières).

Update in feline therapeutics: clinical use of 10 emerging therapies.

PRACTICAL RELEVANCE: The field of veterinary medicine is constantly evolving. New medications are being introduced into clinical practice, and novel uses for established medications are frequently being discovered as new information comes to light. CLINICAL CHALLENGES: Therapeutic options for our feline patients can be restricted based on inadequate clinical evidence, adverse effects and patient compliance concerns. Additionally, with the reduced availability of commonly used medications in some regions, clinicians are forced to utilize alternatives with which they may have limited experience. AUDIENCE: This review article is directed towards primary care veterinarians working with feline patients. The selection of medications discussed is based on many of the clinical challenges commonly encountered in practice. EVIDENCE BASE: The evidence for use of some of these medications is limited due to their novelty. Known mechanisms of action, pharmacokinetic and pharmacodynamics data, adverse effects and clinical uses are reviewed where possible, with clinical recommendations made based on the evidence of data available.

Prevalence and clinical outcome of subclinical bacteriuria in female dogs.

OBJECTIVE: To determine the prevalence of subclinical bacteriuria and its natural clinical course over a 3-month period in healthy female dogs. DESIGN: Observational, prospective, cross-sectional study. ANIMALS: 101 healthy client-owned female dogs. PROCEDURES: In all dogs, screening clinicopathologic tests and bacteriologic culture of urine were performed. In culture-positive dogs, subclinical bacteriuria was confirmed by 2 positive culture results within 2 weeks and dogs were reevaluated at 3 months. RESULTS: The prevalence of subclinical bacteriuria in healthy female dogs was 9 of 101 (8.9%). Three-month follow-up data were available for 8 of 9 dogs with subclinical bacteriuria. Four dogs had persistent bacteriuria, and 4 had transient bacteriuria. No dogs with subclinical bacteriuria developed clinical signs during the 3-month observation period. Subclinical bacteriuria was diagnosed in 6 of 51 (12%) young and middle-aged dogs and 3 of 50 (6.0%) senior and geriatric dogs. No significant difference was found in the prevalence of subclinical bacteriuria with age. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that subclinical bacteriuria is a nonprogressive condition in healthy female dogs and can be persistent or transient. No significant difference in the prevalence of subclinical bacteriuria in young and middle-aged dogs versus senior and geriatric dogs was detected. No dogs with subclinical bacteriuria developed clinical signs requiring antimicrobial treatment during the 3-month observation period. Healthy female dogs with subclinical bacteriuria may be a population of dogs in which antimicrobial treatment is unnecessary.

Update on immununosuppressive therapies for dogs and cats.

Treatment of immune-mediated disease in dogs and cats continues to evolve as new therapies are introduced or adapted from human medicine. Glucocorticoids remain the first-line therapy for many of the immune-mediated or inflammatory diseases of cats and dogs. The focus of this article is to provide an update on some of the common immunosuppressive therapies used in small animal veterinary medicine. The goals of therapy are to induce disease remission through the inhibition of inflammation and the modulation of lymphocyte function.

Clinical use of cyclosporine as an adjunctive therapy in the management of feline idiopathic pure red cell aplasia.

The clinical use of cyclosporine is described in a group of client-owned cats diagnosed with idiopathic pure red cell aplasia (PRCA). All 10 cats were treated with combinations of glucocorticoids and cyclosporine. Of the 10 cats, the eight for which follow-up data was available achieved and maintained remission for a median of 31 and 406 days, respectively. Therapy was reduced or discontinued in 7/8 cats; 2/7 maintained remission off therapy and 5/7 cats relapsed. Remission was reinduced in four cats, with 3/4 cats maintained long-term on low dose therapy. Adverse effects associated with cyclosporine therapy were responsive to dose reduction or drug withdrawal. Feline idiopathic PRCA was responsive to combination immunosuppressive therapy with glucocorticoids and cyclosporine. Relapse was common, particularly after drug discontinuation; therefore, most cats required maintenance long-term low dose therapy.

Multiple recurrent pancreatic cysts with associated pancreatic inflammation and atrophy in a cat.

Previous reports of true pancreatic cysts in cats have suggested that pancreatic cysts in cats are benign incidental findings. This case report describes the progressive clinical course and diagnostic findings in a cat with multiple recurrent pancreatic cysts. The presenting clinical signs included diarrhea, intermittent vomiting, polyphagia, and marked weight loss. Pancreatic cysts were identified via abdominal ultrasound and computed tomography (CT). An exploratory celiotomy and lesion histopathology confirmed multiple true pancreatic cysts of unknown etiology. One month after surgery the cat presented for lethargy and decreased appetite. Clinical re-evaluation was diagnostic for diabetes mellitus and an abdominal ultrasound confirmed recurrence of the pancreatic cysts. The recurrent nature of the pancreatic cysts and the concurrent development of diabetes mellitus were suggestive of progressive loss of pancreatic function or insulin resistance. This is the first described case of multiple recurring pancreatic cysts in a cat associated with pancreatic inflammation, atrophy and endocrine dysfunction.