Resistant E Coli in Cat: Please Help

"Setchell" wrote in message
...
I have some answers to questions raised by J.dvm and Phil.

The leukocytes and erythrocytes in her urine are according to my vet "+3",
which she says is off the scale. Meaning, I assume, the strain is
virulent. However, that does not mean according to her it will become
systemic or dangerous. She simply said: No e coli should be in the
bladder and we should kill it. No ifs ands or buts.


I agree



After consultation with a vet. internist, the only drug they recommend of
the 4 that might kill this thing is called
Trimethoprim-sulfphamethoxazole. Apparently this drug was pulled from the
market for cats awhile ago but we can get some. Possible side-effect:
renal crystalization. Upside: it's oral, can be done at home.
Recommendation: bloodwork, 3 days on, more bloodwork, continue if possible
until we get several negative urine cultures. Likely length of treatment:
6 weeks, but may be more.


Sounds very reasonable

Once this is done, we can try to address the bladder stones; her pH is
acid, so the assumption is that it's an oxylate stone. How we address
them is up in the air, given her chronic renal failure. Switching her off
k/d to use diet to address the stones is problematic;

Staying on K/D would be appropriate because it maintains a less acidic urine
which may slow the development of oxalate stones.


so is, of course, surgery.


The only reasons not to have surgery would be if he has very advanced renal
disease and is not expected to live much longer or there is no way to afford
it. I wouldn't be too quick to recommend removing the kidney stone but the
bladder stones are a source of discomfort that ought to be removed.
Anesthesia can be very safe in cats with renal disease as long as IV fluids
are given and blood pressure is monitored.



J. dvm


Right now I'm very tempted to say: Leave my cat alone. We don't know if
her CRF will accelerate; we don't know if the e coli will become toxic.
And then...she threw up this morning and started straining again, and I
start to panic again. I have no idea what to do.

Any thoughts are very much appreciated.

Thank you J. dvm!! I appreciate your feedback more than you know. I'll
keep everybody posted. Thanks so much to this newsgroup for helping me ask
the right questions and take a reasonable course of action, as best I can.


"J. dvm" wrote in message
.. .

"Setchell" wrote in message
...
I have some answers to questions raised by J.dvm and Phil.

The leukocytes and erythrocytes in her urine are according to my vet
"+3", which she says is off the scale. Meaning, I assume, the strain is
virulent. However, that does not mean according to her it will become
systemic or dangerous. She simply said: No e coli should be in the
bladder and we should kill it. No ifs ands or buts.


I agree



After consultation with a vet. internist, the only drug they recommend of
the 4 that might kill this thing is called
Trimethoprim-sulfphamethoxazole. Apparently this drug was pulled from the
market for cats awhile ago but we can get some. Possible side-effect:
renal crystalization. Upside: it's oral, can be done at home.
Recommendation: bloodwork, 3 days on, more bloodwork, continue if
possible until we get several negative urine cultures. Likely length of
treatment: 6 weeks, but may be more.


Sounds very reasonable

Once this is done, we can try to address the bladder stones; her pH is
acid, so the assumption is that it's an oxylate stone. How we address
them is up in the air, given her chronic renal failure. Switching her
off k/d to use diet to address the stones is problematic;

Staying on K/D would be appropriate because it maintains a less acidic
urine which may slow the development of oxalate stones.


so is, of course, surgery.


The only reasons not to have surgery would be if he has very advanced
renal disease and is not expected to live much longer or there is no way
to afford it. I wouldn't be too quick to recommend removing the kidney
stone but the bladder stones are a source of discomfort that ought to be
removed. Anesthesia can be very safe in cats with renal disease as long as
IV fluids are given and blood pressure is monitored.



J. dvm


Right now I'm very tempted to say: Leave my cat alone. We don't know if
her CRF will accelerate; we don't know if the e coli will become toxic.
And then...she threw up this morning and started straining again, and I
start to panic again. I have no idea what to do.

Any thoughts are very much appreciated.

"Phil P." wrote in message
nk.net...

I don't know if you're aware of this, but many strains of E. coli and
Klebsiella are relatively avirulent. Has the specific strain of E. coli
been
positively identified? If there were only a few leukocytes and
erythrocytes
in the urine sediment, the strain is probably relatively avirulent.
Avirulent strains are opportunists, and capable only of invading and
surviving in a compromised urinary tract- the cat's defenses are probably
compromised due to CRF-, but they sure can be highly resistant to
antibiotics! E.coli is especially capable of adapting their resistance to
different antibiotics. Before trying potentially toxic antibiotics, you
might want to find out if your cat's particular strain of E. coli is
indeed
virulent.


It's important to treat this infection no matter what strain it is. Her
immune system is comprimised due to the kidney disease making her more
susceptible to damage from even a mildly toxogenic bacteria. An infection
in her kidneys will accelerate her renal disease so it must be dealt with.
One of my son's kidneys is scarred down to two thirds of its normal size due
to recurrent infections from a bacteria that was repeatedly dismissed as non
pathogenic.

J.

"Setchell" wrote in message
...
Phil:
Thanks again for your quick response. your questions, the urine was
collected by cystocentisis. We did the test twice (first was sent to the
regular lab, the second was sent to Cornell University's lab for the
extended panel).


I wasn't sure how the sample was collected. Since the bacteria was found in
her bladder, then it should be treated as a pathogen regardless of the
strain- feline bladder urine always should be sterile. Many UTIs are
misdiagnosed because many vets use voided urine that has been contaminated
with normal bacteria from the lower urinary tract- and even by bacteria from
outside the urinary tract- which results in the unnecessary use of
antibiotics. The overuse of antibiotics produces many antibiotic-resistant
bacteria.



I asked about the potential of the bug being avirulent and
I will again with an internist that I'm going to be getting a second
opinion
from. He told me so far that he thought the drug selected is the right
one
(apparently it's Batrim for humans) but we would need to test her
frequently
while dosing to make sure it's not having bad side effects.


I think you mean Bactrim. Kinda risky for a cat with acidic urine and
uro/nephroliths. Bactrim is known for increasing the risk of crystals. Has
your vet considered amoxicillin/clavulanate potassium?
Amoxicillin/clavulanate potassium is effective against most strains of E.
coli.




The drug is fairly affordable, and thank god it won't require
hospitalization such as was first thought. So...it seems that may be the
way to go as long as we're careful about her kidneys during dosing and I
can
confirm that it's a virulent strain.

Since the urine was collected directly from the bladder, don't waste time
typing the strain. Feline urine collected directly from the bladder should
be sterile.



Thanks for the info on the diet, I'm going to follow up on that as well.
I
think we're going to maintain her on k/d and cosequin during the
antibiotic
treatment, if that's what I go with. I have another cat, and my next set
of
questions is going to be about transmission of this e coli to him and to
us
(my wife and I) and if any precautions need to be taken. Surprisingly I
can
find little on the net that specifically addresses cat or dog transfer of
e
coli to humans. (plenty on farm animals and petting zoos...).

Thanks so much for your help so far Phil!

I'd keep a very close watch on her kidney stones (nephroliths)- they can be
a source of inflammation and infection and even kidney damage. If the stone
grows, it can displace normal kidney tissue and can even cause CRF if stones
are in both kidneys.

Since your vet is working with Cornell, ask him to find out if Cornell does
lithotripsy (sound waves to break up stones) in cats. Lithotripsy doesn't
require surgery. I think U of Tenn. does lithotripsy in cats, so, I'm sure
other vet universities are also performing it.

Best of luck.

Phil

"J. dvm" wrote in message
.. .



It's important to treat this infection no matter what strain it is. Her
immune system is comprimised due to the kidney disease making her more
susceptible to damage from even a mildly toxogenic bacteria. An infection
in her kidneys will accelerate her renal disease so it must be dealt with.

Now that I know the urine was collected via cystocentisis and the bacteria
was found in her bladder and not from her distal urinary tract, I agree.

Phil

Phil: Once again my great thanks. Amoxicillin was on the panels and the
strain is resistant to that; I'll check on that combination, although I'm
presuming if it was resistant to amoxicillin then it wouldn't work. There
was an incredibly long list of drugs this thing was resistant to, it amazed
the technician at Cornell as well (who, by the way, said she is seeing more
and more of this kind of resistant E coli and sighed loudly when she said
it).

This cat actually went through surgery last July for a polyp in her ear; she
needed a total oblation. They were going to do her bladder stones at the
time but decided to hold off (long story), which now that she's showing
signs of distress I'm a bit upset about. In any case, she recovered fine
but the hospital and my vet refused to consider any kidney stone surgery,
given her bloodwork (abit over 200 creatinine, etc. for about a year and a
half now, her kidneys are also quite small for some reason)---said they
couldn't risk it. I'll look into lithotripsy---I assume you mean for the
bladder stones, but also the kidney stones?

This little girl is a triple threat with CRF, all these stones and an
infection. All four drugs are risky. The Bactrim is the only one I can
give her at home orally and not hydrate her or hospitalize her. I assume I
can give it simultaneously with Cosequin; at least nobody has told me not
to. People had better watch out because I can only assume these bugs are
going to get nastier.

Any thoughts on my questions about transmission to my wife and I or my other
cat is appreciated. God only knows how she got this thing. We even have a
water purification system in our home. Maybe I should have it checked!

You've given me a lot of help and peace of mind---best wishes these
holidays---

JB



"Phil P." wrote in message
nk.net...

"Setchell" wrote in message
...
Phil:
Thanks again for your quick response. your questions, the urine was
collected by cystocentisis. We did the test twice (first was sent to the
regular lab, the second was sent to Cornell University's lab for the
extended panel).


I wasn't sure how the sample was collected. Since the bacteria was found
in
her bladder, then it should be treated as a pathogen regardless of the
strain- feline bladder urine always should be sterile. Many UTIs are
misdiagnosed because many vets use voided urine that has been contaminated
with normal bacteria from the lower urinary tract- and even by bacteria
from
outside the urinary tract- which results in the unnecessary use of
antibiotics. The overuse of antibiotics produces many antibiotic-resistant
bacteria.



I asked about the potential of the bug being avirulent and
I will again with an internist that I'm going to be getting a second
opinion
from. He told me so far that he thought the drug selected is the right
one
(apparently it's Batrim for humans) but we would need to test her
frequently
while dosing to make sure it's not having bad side effects.


I think you mean Bactrim. Kinda risky for a cat with acidic urine and
uro/nephroliths. Bactrim is known for increasing the risk of crystals.
Has
your vet considered amoxicillin/clavulanate potassium?
Amoxicillin/clavulanate potassium is effective against most strains of E.
coli.




The drug is fairly affordable, and thank god it won't require
hospitalization such as was first thought. So...it seems that may be the
way to go as long as we're careful about her kidneys during dosing and I
can
confirm that it's a virulent strain.

Since the urine was collected directly from the bladder, don't waste time
typing the strain. Feline urine collected directly from the bladder
should
be sterile.



Thanks for the info on the diet, I'm going to follow up on that as well.
I
think we're going to maintain her on k/d and cosequin during the
antibiotic
treatment, if that's what I go with. I have another cat, and my next set
of
questions is going to be about transmission of this e coli to him and to
us
(my wife and I) and if any precautions need to be taken. Surprisingly I
can
find little on the net that specifically addresses cat or dog transfer of
e
coli to humans. (plenty on farm animals and petting zoos...).

Thanks so much for your help so far Phil!

I'd keep a very close watch on her kidney stones (nephroliths)- they can
be
a source of inflammation and infection and even kidney damage. If the
stone
grows, it can displace normal kidney tissue and can even cause CRF if
stones
are in both kidneys.

Since your vet is working with Cornell, ask him to find out if Cornell
does
lithotripsy (sound waves to break up stones) in cats. Lithotripsy doesn't
require surgery. I think U of Tenn. does lithotripsy in cats, so, I'm sure
other vet universities are also performing it.

Best of luck.

Phil

"Setchell" wrote in message
...
Phil: Once again my great thanks. Amoxicillin was on the panels and the
strain is resistant to that; I'll check on that combination, although I'm
presuming if it was resistant to amoxicillin then it wouldn't work.


Amoxicillin by itself isn't very effective against some strains of E. coli,
but
when potassium clavulanate is mixed with amoxicillin, it extends the
spectrum of Amoxicillin and kills many strains of otherwise resistant E.
coli. Some strains of E.coli produce an enzyme (beta-lactamase) that
inactivates amoxicillin. Potassium clavulanate inactivates
beta-lactamase so the amoxicillin can kill the E.coli.

Some strains of E.coli are really unpredictable because they can swap pieces
of their DNA among themselves which can result in major changes in their
susceptibility in a single generation! Treacherous little buggers.


There
was an incredibly long list of drugs this thing was resistant to, it
amazed
the technician at Cornell as well (who, by the way, said she is seeing
more
and more of this kind of resistant E coli and sighed loudly when she said
it).


Susceptibility testing doesn't always accurately predict how well the
combination of amoxicillin and potassium clavulanate will actually work in
a cat. Many susceptibility lists were based on the human formulation,
Augmentin, in which the amoxicillin:clavulanic acid ratio is 2:1- the
veterinary formulation is *twice* as potent- 4:1. Also, most lists are
based on the minimal inhibitory concentration (MIC) of the antibiotic in
human plasma- but much higher concentrations of the antibiotic are reachable
in urine than in plasma- sometimes as much as 50x.

If she were my cat, I'd try the amoxi/clavulanate before a more toxic
antibiotic.



This cat actually went through surgery last July for a polyp in her ear;
she
needed a total oblation. They were going to do her bladder stones at the
time but decided to hold off (long story), which now that she's showing
signs of distress I'm a bit upset about. In any case, she recovered fine
but the hospital and my vet refused to consider any kidney stone surgery,
given her bloodwork (abit over 200 creatinine, etc. for about a year and a
half now, her kidneys are also quite small for some reason)---said they
couldn't risk it. I'll look into lithotripsy---I assume you mean for the
bladder stones, but also the kidney stones?

I think lithotripsy has been used on feline ureteral and bladder stones, but
I'm not sure if has been used yet on nephroliths- nephroliths aren't very
common in cats.

You'll have to keep a close watch on the nephrolith because it could migrate
and obstruct a ureter which could result in acute renal failure. The
nephroloith could even be the source of the infection.



This little girl is a triple threat with CRF, all these stones and an
infection. All four drugs are risky. The Bactrim is the only one I can
give her at home orally and not hydrate her or hospitalize her. I assume
I
can give it simultaneously with Cosequin; at least nobody has told me not
to. People had better watch out because I can only assume these bugs are
going to get nastier.

Any thoughts on my questions about transmission to my wife and I or my
other
cat is appreciated. God only knows how she got this thing. We even have
a
water purification system in our home. Maybe I should have it checked!


E. coli infection in cats is usually of fecal origin and occurs in the
litterbox- although it can also be acquired from food. Females are more
susceptible because of their shorter urethra-- the infection has a shorter
distance to travel. I would keep the litter level low so there's less
chance of her 'port of entry' coming in contact with contaminated litter,
and until this infection is resolved, change the litter and disinfect the
litterbox very frequently.

About the best disinfectant I know of is Trifectant- bleach is too noxious
to use frequently.

Here's the spec sheet for Trifectant
http://www.maxshouse.com/Equipment/T...Spec_Sheet.jpg

Here's where you can order tablets to mix in spray bottles, 1.3 oz packets
(makes 1 gal) or 10# tubs.

http://lambriarvetsupply.com/sitemap...+50+per+Bottle



You've given me a lot of help and peace of mind---best wishes these
holidays---


Thanks! The same to you. I wish you the best of luck with your cat.

Phil