gcv-border Posted February 28, 2012 Report Share Posted February 28, 2012 I am wondering if anyone has dealt with this situation - and how you handled it or if you have any advice: I have an ~14.5 year old Sheltie mix female rescue dog. She has been with me for 11 years. About 2 months ago, she had an episode of multiple urination spots in the house which had blood in them. I whisked her to the vet that same day. She was started on amoxicillin (300 mg bid). When the results of the sterile bladder tap came back a few days later, she definitely had an infection - E. coli that was sensitive to amoxicillin, but resistant to cephalexin. As a result, the recommended treatment was to keep her on the same dose of amoxicillin for 6 weeks - which I followed religiously. I also added a capsule of Pure Encapsulations cranberry extract/d-Mannose on the advice of my vet. (This is supposed to help prevent attachment of E. coli to the bladder walls - see this topic http://www.bordercollie.org/boards/index.php?showtopic=32652) During the six weeks, her runny eyes cleared up. (I thought that her eyes were runny because she was quite old.) She also had a fiber break and lost her entire undercoat, but that is growing back nicely now. She has also regained a lot of pep and is more playful. Oh, and any incontinence problems are long gone. All in all, she is doing great. A week after I finished the 6 week course of amoxi, I brought her back in for another sterile bladder culture. I thought it would just be a formality to show that all was good - i.e. her infection was cleared up. Imagine my surprise when the results came back that she still is harboring a bladder infection. It is still E. coli and is sensitive to all antibiotics tested (Amikacin, Clavamox, Amoxicillin, Cefovecin, Cefpodoxime, Cephalexin, Enrofloxacin, Marbofloxacin, Nitrofurantoin, Tetracycline and Trimethoprim/Sulfa) Note that this E. coli infection is no longer resistant to Cephalexin. The more troubling result is that the culture came back at 100,000 CFU/mL - after 6 weeks of amoxicillin! Right now, my vet is considering another long course of a stronger antibiotic - Marbofloxacin if I heard him correctly - but first, he is going to talk to the lab to make sure there were no mistakes and will also consult with a couple of the other vets at the practice to get their input. OK, so has anyone encountered this? Any advice? BTW, Ritz is doing great, but I don't want to let this infection fester and probably flare up at a later date. Jovi Link to comment Share on other sites More sharing options...
TEC Posted February 28, 2012 Report Share Posted February 28, 2012 I am wondering if anyone has dealt with this situation - and how you handled it or if you have any advice: OK, so has anyone encountered this? Any advice? BTW, Ritz is doing great, but I don't want to let this infection fester and probably flare up at a later date. Jovi I haven't had to deal specifically with persistent UTI in pets. As you know, resistance to antibiotics is a huge issue in infections of that type. You might ask your vet about Nitrofurantoin. Wikipedia says, "Resistance to other antibiotics has led to increased interest in this agent.[2]" Best wishes with that. It's got to be worrisome. IME, a matter of finding the right antibiotic. Like your vet, hope it's a mistake. -- Kind Regards, TEC Link to comment Share on other sites More sharing options...
gcv-border Posted February 28, 2012 Author Report Share Posted February 28, 2012 I haven't had to deal specifically with persistent UTI in pets. As you know, resistance to antibiotics is a huge issue in infections of that type. You might ask your vet about Nitrofurantoin. Wikipedia says, "Resistance to other antibiotics has led to increased interest in this agent.[2]" Best wishes with that. It's got to be worrisome. IME, a matter of finding the right antibiotic. Like your vet, hope it's a mistake. -- Kind Regards, TEC Actually, this bug, on the surface, seems to be fairly normal since it is not resistant to any of the usual antibiotics (see the list of 11 antibiotics that were used in susceptibility testing). The worrisome factor is why she still has a UTI after such an extended treatment. thank you for your thoughts, Jovi Link to comment Share on other sites More sharing options...
BCjetta Posted February 28, 2012 Report Share Posted February 28, 2012 If they haven't ruled out a bladder stone I'd rule that out. Also I'd make sure she has no bad teeth because bacteria in the mouth can cause recurrent bladder infections and other infections. If both those things are good, I'd just go with a stronger antibiotic. Amoxi is one of the weaker ones. Link to comment Share on other sites More sharing options...
gcv-border Posted February 28, 2012 Author Report Share Posted February 28, 2012 If they haven't ruled out a bladder stone I'd rule that out. Also I'd make sure she has no bad teeth because bacteria in the mouth can cause recurrent bladder infections and other infections. If both those things are good, I'd just go with a stronger antibiotic. Amoxi is one of the weaker ones. Yes, she does have dirty teeth. She tends to be one of those dogs that seem to be genetically predisposed to tartar - even within a couple of months of a vet cleaning. I have not had a vet clean her teeth for the last couple of years because of her age and the anaesthesia required. I have been occasionally brushing and occasionally giving her raw pork neck bones. I admit it has not been enough since her teeth are dirty, but not as bad as before. I guess I may have been fooling myself that it was OK. I will discuss this with the vet. They had done an ultrasound for stones when I brought her in for the first visit. She was clear. Thanks for the suggestion, Jovi Link to comment Share on other sites More sharing options...
gcv-border Posted February 28, 2012 Author Report Share Posted February 28, 2012 As I was doing my morning chores, I was thinking about this. Ritz has an E. coli infection in her bladder, and the bacteria most associated with tarter on the teeth are Staph and Strep. So not sure if the bad teeth and bladder infection are related, but I am certainly going to raise it with the vet. Jovi Link to comment Share on other sites More sharing options...
diane allen Posted February 28, 2012 Report Share Posted February 28, 2012 Wow - is your name Diane? Sounds just like me and my Lucy (who is now a 16 yr old border collie). She was diagnosed with kidney disease about a year ago, but has been doing amazingly well, given that. She had liver surgery at age 14, but on one med for that and liver enzymes are great. I thought she was "off" around the end of Dec. Did a free catch, yep, infection. Did 2 weeks of Clavamox. Took about 10 days off, tested again via cysto - still infection (in her case, it was Klepsiella, but a different species - though I don't know how accurate those cultures are). This time we got Simplicef, which is nice in that it is taken only once a day in the evening, when she is most likely to take anything. But why my vets are only doing two weeks, I dunno. In any case, we just did another test, still infected, more Simplicef. We see her internal medicine vet next week, and will likely get at least another two weeks worth of meds. Whether that will do it or not remains to be seen. My "local" vet said it might be that her immune system is just so weak that it can't fight off the bugs, and/or what he called "stagnant pool" syndrome - basically, she may not be emptying her bladder completely each time she urinates, so it sits there and grows nasties. Not much to do for either. The bugger for her is that antibx have always played havoc with her gut - inappetance, diarrhea, etc. She is obviously not feeling good. I too have started D-Mannose (instead of cranberry capsules, which she has gotten for years), as well as oil of oregano (which is another whole problem, as it tastes so bad...). I would recommend the K9KidneyDiet Yahoo group. They are MOST helpful, though be forewarned: they want a long questionnaire filled out before you actually "join." My girlie has had bad teeth for years. Once, when she was about 8 years old, she had some major dental work done, and voila! Her incontinence virtually stopped!! She's had a few accidents lately, but I figure that's pretty normal. Her dental vet is in the same place (400 miles away from home) as the internal medicine guy....we may stop in, but there's no way I'm doing a full anesthetized dental on her now. Sigh. Keep us posted - and I will, as well. diane Link to comment Share on other sites More sharing options...
gcv-border Posted February 28, 2012 Author Report Share Posted February 28, 2012 Diane, Tx for relating your experience with your older girl. I hope you get a handle on it. I will be interested to follow what happens. I did talk to my vet today, and here are his comments: He spoke to a vet at Antech (the testing laboratory) and a vet at the vet school at VA Tech. One brought up the issue of the possibility of a bladder tumor which may be incubating the bacteria and preventing the antibx from being effective. On the other hand, they are wondering if it is a reinfection (within 9 days of stopping the previous course of amoxicillin? That sure is fast.) since the E. coli from the second culture showed a different antibiotic-resistance pattern than from the first culture. The next step sounds somewhat similar to what you have done. We are going to try a 2 week course of a stronger antibx, Clavamox. The vet was originally going to use marbofloxacin, but since marbofloxacin is one of the 'big guns', we are going to hold off in case we have to use it as a last resort. So 2 weeks of Clavamox with retesting around 10 days to see if the infection is cleared, or at least, diminished. 1) continue with the cranberry/D-mannose capsules, 2) add probiotics, 3) add fiber (1 Tbsp of metamucil b.i.d. I asked about pumpkin, but he said that one would have to feed a much larger volume of pumpkin to get the same amount of fiber in metamucil) 4) wipe her butt with baby wipes to keep it as clean as possible i.e. prevent fecal matter from entering the urethra. That area is normally very clean for her so I wouldn't think that she should have much contamination via this route, but the E. coli (commonly found in fecal matter) is coming from somewhere and this is the most likely route. If this doesn't work, we may try an ultrasound of her bladder and kidney to see if we can get any more information (i.e. can a tumor or something else be seen?) That's the plan, Jovi Link to comment Share on other sites More sharing options...
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