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#1
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Resistant E Coli in Cat: Please Help
Please help us and our 7 year old female cat. She has an antibiotic
resistant strain of e coli in her urine (culture and resistance test done twice). Only about 4 extremely potent and potentially damaging antibiotics are all that the bug is susceptible to. She has chronic kidney disease (held at bay with K/D dry formula; her blood levels are not too bad right now so no other treatment is necessary), kidney stones, and bladder stones (both confirmed by ultrasound). The problem is this: most all of these potent antibiotics either create kidney stones, bladder stones, or aplastic anemia; all are dangerous to her health and most require a hospitalization we might not be able to afford. Clinically she is straining to urinate about every two days, bouts lasting an hour or so. Her bloodwork is otherwise fine, no elevation of white cell count, etc; a little blood in the urine, pH is okay. So---we don't know if it's the bladder stones or the e coli that's causing the straining; according to my vet, it's chicken and the egg. She said we can't operate on the bladder stones until the infection is cleared. My questions a Do we place her health in jeopardy by hitting her with one of these antibiotics? Is it possible that we should just treat the symptoms with diet (if its struvites, I need to find out) and ignore this infection for awhile? My vet is acting as if this bug has to be killed NOW, but the given her health---compromised kidney function especially---I'm really afraid to proceed. Any advice would be appreciated. JB |
#2
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Resistant E Coli in Cat: Please Help
"Setchell" wrote in message ... Please help us and our 7 year old female cat. She has an antibiotic resistant strain of e coli in her urine (culture and resistance test done twice). Only about 4 extremely potent and potentially damaging antibiotics are all that the bug is susceptible to. Do you know which antibiotics the bacteria is susceptible? |
#3
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Resistant E Coli in Cat: Please Help
I can find out from my vet on Tuesday when she's back from a trip---I'll
post what she tells me. They're unusual---they needed to run an "extended panel" at Cornell University's lab to find some meds that might kill the bacteria. "J. dvm" wrote in message ... Do you know which antibiotics the bacteria is susceptible? |
#4
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Resistant E Coli in Cat: Please Help
JB,
For this big of a decision -- if you feel uncomfortable with what your vet is suggesting, you might want to get another vet opinion. Also, if you haven't already, I would read everything you can on e.coli in cats. Maybe go to the library and see if they have reference books like Cornell's book on cat health. A google search will turn up lots of references, too. Good luck with your cat, Rhonda Setchell wrote: Please help us and our 7 year old female cat. She has an antibiotic resistant strain of e coli in her urine (culture and resistance test done twice). |
#5
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Resistant E Coli in Cat: Please Help
"Setchell" wrote in message ... I can find out from my vet on Tuesday when she's back from a trip---I'll post what she tells me. They're unusual---they needed to run an "extended panel" at Cornell University's lab to find some meds that might kill the bacteria. I'll check back then. In your research you may come across discussions of the use of cranberry juice for it's properties in reducing e coli adherence to the bladder wall. I would not recommend this because in people it increases oxalate levels in the urine and may acidify the urine thereby potentially encouraging the growth of oxalate stones. J. dvm "J. dvm" wrote in message ... Do you know which antibiotics the bacteria is susceptible? |
#6
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Resistant E Coli in Cat: Please Help
"Setchell" wrote in message ... Please help us and our 7 year old female cat. She has an antibiotic resistant strain of e coli in her urine (culture and resistance test done twice). Only about 4 extremely potent and potentially damaging antibiotics are all that the bug is susceptible to. She has chronic kidney disease (held at bay with K/D dry formula; her blood levels are not too bad right now so no other treatment is necessary), kidney stones, and bladder stones (both confirmed by ultrasound). The problem is this: most all of these potent antibiotics either create kidney stones, bladder stones, or aplastic anemia; all are dangerous to her health and most require a hospitalization we might not be able to afford. Clinically she is straining to urinate about every two days, bouts lasting an hour or so. Her bloodwork is otherwise fine, no elevation of white cell count, etc; a little blood in the urine, pH is okay. So---we don't know if it's the bladder stones or the e coli that's causing the straining; according to my vet, it's chicken and the egg. She said we can't operate on the bladder stones until the infection is cleared. My questions a Do we place her health in jeopardy by hitting her with one of these antibiotics? Is it possible that we should just treat the symptoms with diet (if its struvites, I need to find out) and ignore this infection for awhile? My vet is acting as if this bug has to be killed NOW, but the given her health---compromised kidney function especially---I'm really afraid to proceed. Any advice would be appreciated. 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. Generally, most cats don't show any symptoms when they have a UTI. Straining to urinate is almost always a symptom of feline interstitial cystitis (inflammation of the bladder wall)- which could be caused by crystals or a defect in layer that coats the bladder wall (GAG layer). Inflammation in the bladder wall causes a nervous sensation that mimics the feeling of a full bladder. So, she may be straining to urinate because she feels like her bladder is full even though its empty. You might want to speak to your vet about a GAG supplement such as Cosequin and Adequan to help repair the bladder wall. Amitriptyline has also been used to treat cats with interstitial cystitis and seems to help. Amitriptyline also has some analgesic and anti-inflammatory properties in addition to producing a calming effect. Best of luck, Phil |
#7
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Resistant E Coli in Cat: Please Help
Phil: Thanks so much!! Indeed my cat is on Cosequin, for about 16 days now.
It seems to help. I will request that information about the urine sample and the virulence of the e coli strain from my vet tomorrow morning. With any luck, it will be okay. She does have bladder stones and sediment according to the ultrasound and x-rays, so perhaps it's not the bug that's bothering her. Besides straining and a little less appetite, she has no other clinical symptoms. Her CRF is showing up only in her bloodwork---alittle extra water drinking perhaps---and her creatinine level is a bit above 200, which according to my vet is elevated but not very high. So...I'd like to think I could avoid highly potent drugs, and maybe even bladder stone removal surgery, but my vet is hesitant to switch her from the k/d to s/d or the like due to the CRF and kidney stones. Perhaps she might live okay if the cosequin kicks in without either surgery or dangerous meds, do you think that's a possibility? Ocassional straining may be the least of her worries given the CRF. On the other hand, surgery may increase her quality of life, if it can be done with little harm to her kidneys. These choices are so hard. But, you've given me hope about the e coli. I'll post the results of my discussion with my vet tomorrow. All the best! JB 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. Generally, most cats don't show any symptoms when they have a UTI. Straining to urinate is almost always a symptom of feline interstitial cystitis (inflammation of the bladder wall)- which could be caused by crystals or a defect in layer that coats the bladder wall (GAG layer). Inflammation in the bladder wall causes a nervous sensation that mimics the feeling of a full bladder. So, she may be straining to urinate because she feels like her bladder is full even though its empty. You might want to speak to your vet about a GAG supplement such as Cosequin and Adequan to help repair the bladder wall. Amitriptyline has also been used to treat cats with interstitial cystitis and seems to help. Amitriptyline also has some analgesic and anti-inflammatory properties in addition to producing a calming effect. Best of luck, Phil |
#8
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Resistant E Coli in Cat: Please Help
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. 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. 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; so is, of course, surgery. 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. |
#9
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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. Urine dipstick results for leukocytes in cats are *notoriously* inaccurate and should never be relied upon- or even used. False-positives are *very* common- 50%. 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. How was the urine sample collected? If the urine was collected by any means other than with a needle directly from the bladder (cystocentesis), the urine was likely contaminated with bacteria that normally inhabit the distal urinary tract. 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. Again, by which method is the urine collected. Voided urine or urine obtained via a catheter can't be used for culture due to bacterial contamination. 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. Not necessarily. A single urine pH determination does not give any indication of urine pH throughout the day. If your cat didn't eat for 12 hours prior to collecting the urine sample, the urine would probably be acidic. Also, your cat is eating k/d which is a neutral-to *alkaline* diet. 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; so is, of course, surgery. Calcium oxalate stones can't be dissolved. However, the diet used to treat CaOx is x/d has almost the identical acidity as k/d. k/d's pH = 6.6 - 6.9; x/d's pH = (6.6 - 6.8). In fact, I use x/d for cats in early stage CRF because of its striking similarity to k/d. Thus, there really no need to switch diets. In your previous post you said s/d was mentioned. S/d is used to dissolve *struvite* not calcium oxalate. Feeding s/d can actually promote calcium oxalate. 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. To be very honest with you, I think you should seek a second opinion. Your vet has already made some very basic and serious mistakes. Best of luck, Phil |
#10
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Resistant E Coli in Cat: Please Help
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 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. 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. 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! "Phil P." wrote in message k.net... "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. Urine dipstick results for leukocytes in cats are *notoriously* inaccurate and should never be relied upon- or even used. False-positives are *very* common- 50%. 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. How was the urine sample collected? If the urine was collected by any means other than with a needle directly from the bladder (cystocentesis), the urine was likely contaminated with bacteria that normally inhabit the distal urinary tract. 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. Again, by which method is the urine collected. Voided urine or urine obtained via a catheter can't be used for culture due to bacterial contamination. 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. Not necessarily. A single urine pH determination does not give any indication of urine pH throughout the day. If your cat didn't eat for 12 hours prior to collecting the urine sample, the urine would probably be acidic. Also, your cat is eating k/d which is a neutral-to *alkaline* diet. 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; so is, of course, surgery. Calcium oxalate stones can't be dissolved. However, the diet used to treat CaOx is x/d has almost the identical acidity as k/d. k/d's pH = 6.6 - 6.9; x/d's pH = (6.6 - 6.8). In fact, I use x/d for cats in early stage CRF because of its striking similarity to k/d. Thus, there really no need to switch diets. In your previous post you said s/d was mentioned. S/d is used to dissolve *struvite* not calcium oxalate. Feeding s/d can actually promote calcium oxalate. 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. To be very honest with you, I think you should seek a second opinion. Your vet has already made some very basic and serious mistakes. Best of luck, Phil |
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