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Moet elke kat of hond met chronische nierziekte en een positieve urine cultuur behandeld worden met antibiotica?

Nee, behandeling is enkel aangeraden in geval van een positieve urinecultuur in combinatie met minstens 1 van de volgende:

  1. systemische klachten (koorts, leukocytose)
  2. pyurie (> 5 witte bloedcellen per veld in het sediment)
  3. aanwezigheid van lagere urinewegklachten (strangurie, dysurie, ..)
  4. een plotse en overklaarbare verslechtering van de nierfunctie.

Aangezien het soms moeilijk is om in te schatten of een dier met chronische nierziekte en subklinische bacteriurie behandeld moet worden of niet, vermelden we hier ook graag even een stukje advies dat gegeven wordt door de auteurs uit het artikel ‘URINARY TRACT INFECTION AND SUBCLINICAL BACTERIURIA IN CATS: a clinical update’ (Dorsch R et al, J Fel Med Surg, 2019): ‘If a cat with CKD shows lower urinary tract signs or if there is a suspicion of pyelonephritis, this would be a clear indication to culture the urine and, in cases of significant bacterial growth, to treat the cat based on culture/susceptibility test results.

In CKD cats without any clinical signs but with haematuria or pyuria ± bacteriuria in the stained urine sediment, the authors would typically perform urine culture. If the culture comes back positive, the decision to treat is a difficult one and depends on the totality of clinical signs, laboratory parameters, diagnostic imaging findings, the identified bacterial isolate, and whether this was the first positive culture or there had been previous unsuccessful attempts to eliminate bacteriuria. Subclinical bacteriuria always requires an individually tailored approach. For example, if subclinical bacteriuria with E coli is identified in a cat with CKD that has never been treated, the authors typically make one attempt to eliminate bacteriuria and treat the cat for 2 weeks with an antimicrobial determined to be effective based on culture/susceptibility testing.

If instead it is a cat with recurrent subclinical bacteriuria that has been treated previously and the cat has stable renal function, then the authors’ decision would be not to treat at this stage and make the owners aware of possible clinical signs of cystitis and pyelonephritis. If the same cat presents again with clinical signs of UTI, urine culture should be performed again as it cannot be concluded that the isolate causing clinical signs is the same as the one previously cultured. The treatment should then be based on the new culture/ susceptibility test results. If immediate treatment is warranted, an antimicrobial that was shown to be effective based on the last susceptibility testing can be selected. Treatment of subclinical bacteriuria is typically not warranted if the urine culture reveals growth of Enterococcus species.’