RECURRENT UTIS: CAN ANYTHING REALLY BE DONE TO STOP THEM

摘要

It is estimated that 14% of female dogs will develop a urinary tract infection (UTI) within their lifetime. Although fewer male dogs are diagnosed with UTI than are female dogs, the percentage of male dogs with UTI increases with advancing age. Bacterial UTI is less common in cats, accounting for only 1-3% of all cases of feline lower urinary tract disease in North America. As cats age they are more commonly diagnosed with a UTI; the percentage of older cats (i.e., > 10 years of age) with UTI may beas high as 50%. Thankfully, recurrent UTI, defined as >2 UTI in a 6 month period or >3 UTI in a year, is encountered less frequently than simple, uncomplicated UTI. While the management of dogs with acute, uncomplicated UTI is fairly straightforward, themanagement of dogs with chronic UTI, due to either recurrence or persistence, can be anything but straightforward.In recent decades resistant pathogens are more commonly encountered, further complicating the management of animals with UTI. Of particular concern are the uropathogenic Escherichia coli (UPEC) and Enterococcus sp. UPEC is the most common etiologic agentfor UTI in most mammalian species. The ability of UPEC to establish intracellular residence and form biofilms allows the UPEC to avoid normal host defense mechanisms and makes them more difficult to eradicate with traditional antibiotic regimens.Antibiotic therapy is standard treatment for UTI but overuse leads to changes in the normal host microbiota and selection for resistant bacterial strains. Although severe adverse effects of antibiotic therapy for UTI may be infrequent, mild adverse effects are probably not and chronic antimicrobial administration is expensive for the client. There has been a shift of focus to the prevention of UTI in at risk people. This discussion will focus on different ways that recurrent UTI might be prevented, including strengthening of the host defense mechanisms, prophylactic antibiotics, and novel therapeutic approaches.