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Abstract Background Bacterial urinary tract infections have been associated with comorbidities and increased antimicrobial resistance over time. Objective To identify bacterial species, antimicrobial susceptibility patterns and risk factors associated with antimicrobial resistance. Animals Three hundred sixty-three positive urine cultures from 308 cats. Methods Bacterial species and antimicrobial susceptibility data from positive aerobic bacterial urine cultures from cats with growth of ≥103 colony forming units per milliliter (cfu/ml) were included. Medical records were reviewed, and bacteriuria was classified as sporadic bacterial cystitis, recurrent bacterial cystitis or subclinical bacteriuria (SBU). Multivariable logistic regression analysis was used to evaluate antimicrobial resistance risk factors. Results A total of 444 bacterial isolates from 363 bacteriuric episodes were identified. Escherichia coli (52%) and SBU (59%) were the most common organism and classification, respectively. When compared to other classifications of bacteriuria, Enterococcus spp. were more likely to be isolated from SBU episodes (P < .001), whereas E. coli was more likely to be isolated from sporadic bacterial cystitis episodes (P < .001). Recurrent bacterial cystitis was associated with an increased risk of antimicrobial resistance to amoxicillin/clavulanic acid (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.3-11.3). The percent susceptibilities of all bacterial isolates to commonly prescribed antimicrobials were amoxicillin/clavulanic acid (72%), cefazolin (49%), enrofloxacin (61%), and trimethoprim/sulfamethoxazole (75%). Multidrug resistance was highest for Enterococcus faecium isolates (65%). Conclusions and Clinical Importance No antimicrobial achieved >90% susceptible designation to all bacteria isolated highlighting the importance of performing urine culture and susceptibility testing, particularly for cats with recurrent bacterial cystitis.

Abstract Background Bacteremia has been associated with many diseases in dogs, but contemporary data from a large and diverse population are lacking. Hypothesis/Objectives Report reasons for blood culture, protocols used, and diseases associated with a positive result in a tertiary referral institution. We hypothesized that larger volumes of blood, lack of previous antimicrobial administration, and changes in hematologic variables would be associated with increased rates of microbiological growth. Animals A total of 279 dogs from which 323 blood culture results were available. Methods For 180 submissions, patient and blood culture protocol data at the time of specimen collection were collected prospectively using a survey form. For 143 submissions, data were retrospectively collected. Results Microbial growth was noted in 55/323 (17%) submissions, with 35/55 (63.6%) interpreted as clinically relevant growth and 20 (36.4%) interpreted as contamination, resulting in an overall positive rate of 10.8%. Specimen volume (p = 0.01), white blood cell count (p < 0.001), and neutrophil count (p = 0.001) were positively associated with relevant growth. Diseases associated with relevant growth were suspected discospondylitis (30%, p = 0.05) and illness while on immunosuppressive drugs (44%, p = 0.004). Submissions performed to assess for bacteremia as a secondary cause of immune-mediated disease were less likely to yield relevant growth (0%, p = 0.004) than those performed for other reasons. Conclusions and Clinical Importance In this population, blood cultures were most likely to provide diagnostically useful information in dogs with suspected discospondylitis and those receiving immunosuppressive drugs. Specimen volume should be maximized to increase the likelihood of clinically relevant growth.

Abstract Background Pyothorax, an accumulation of inflammatory fluid in the pleural space, is often caused by foreign body inhalation in dogs, whereas the etiology in cats can be more difficult to discern. Objective Compare clinical, microbiologic findings, and etiology in cats and dogs with pyothorax. Animals Twenty-nine cats and 60 dogs. Methods Medical records of cats and dogs diagnosed with pyothorax from 2010 to 2020 were reviewed. Clinical findings, fluid analysis, and microbiologic results were retrieved. Results Antimicrobials had been administered to equal proportions of cats and dogs before fluid sampling (45% and 47%). Groups did not differ in age or total protein concentration or percentage neutrophils in pleural fluid, but effusion cell count was significantly higher in cats than in dogs (P = .01). Neutrophils containing intracellular bacteria were identified in more cats (27/29, 93%) than dogs (44/60, 73%; P = .05). Penetrating damage to the thorax was implicated as the cause of pyothorax in equal percentages of cats (76%) and dogs (75%). Etiology could not be determined in 2 cats and 1 dog. Cats had higher numbers of bacterial isolates per patient (median, 3) than dogs (median, 1; P = .01) and anaerobes were isolated more often in cats (23/29, 73%) than in dogs (27/60, 45%; P = .003). Conclusions and Clinical Importance Pyothorax had similar etiologies in cats and dogs. Cats had higher fluid cell counts, higher numbers of bacterial isolates identified per patient, and intracellular bacteria detected more commonly than did dogs.

Abstract Background Factors associated with outcome in dogs diagnosed with infective endocarditis (IE) are not well characterized. Objectives Evaluate outcome and prognostic factors in dogs with IE. Animals One hundred and thirteen dogs with IE. Methods Medical records for dogs that fulfilled the modified Duke criteria between 2005 and 2020 were retrospectively reviewed. Signalment, preexisting conditions, clinicopathologic findings, treatment regimen, and outcomes were recorded. Univariate logistic regression was performed to identify categorical factors associated with mortality, and then multivariate analysis was performed. Results Dogs were categorized as survivors (n = 47), non-survivors (n = 57), or lost to follow-up (n = 9). Survival to discharge and at 1 month was documented in 79 (70%) of 113 and 56 (54%) of 104 dogs, respectively, with median survival time (MST) of 72 days. Risk factors associated with mortality included development of congestive heart failure (odds ratio [OR], 11.8; 95% confidence interval [CI], 1.4-97.8), thromboembolic events (OR, 5.7; 95% CI, 2.3-14.4), and acute kidney injury (OR, 6.2; 95% CI, 2.0-18.8). Administration of antithrombotic medications was associated with survival (OR, 0.35; 95% CI, 0.13-0.97). Dogs that were not treated with antithrombotics had MST of 92 days, whereas dogs treated with antithrombotics did not reach MST during the study period. The heart valves involved and etiologic agent identified did not correlate with outcome. Conclusion and Clinical Importance Dogs with IE that had thromboembolic events, acute kidney injury, or congestive heart failure had higher risk of mortality. Administration of antithrombotics was associated with prolonged survival time.

To describe and compare the traditional and semiquantitative acid-base status of dogs with immune-mediated hemolytic anemia (IMHA) and hypokalemia to those with normokalemia. Medical records of dogs with IMHA from a single institution over a 10-year period from January 1st, 2012 to December 31st, 2021 were retrospectively reviewed. Dogs were included if they met diagnostic criteria for IMHA based on the 2019 ACVIM consensus guidelines and had at least 1 blood potassium concentration measurement performed within 24 h of initial presentation. The dogs were divided into normokalemic and hypokalemic groups. Hypokalemia was categorized as mild (3-3.5 mEq/L [3-3.5 mmmol/L]), moderate (2-2.9 mEq/L [2-2.9 mmol/L]), or severe (<2 mEq/L [<2 mmol/L]). Population data, clinicopathologic data, and outcome were collected and recorded. Traditional and semiquantitative acid-base diagnoses were attributed to patients with sufficient data. 305 client-owned dogs with IMHA met the inclusion criteria. 186 dogs (61.0%) were normokalemic and 119 (39.0%) were hypokalemic (blood potassium concentration ≤ 3.5 mEq/L [≤ 3.5 mmol/L]) on presentation. The median blood potassium concentration in the hypokalemic group was 3.2 mEq/L (3.2 mmol/L) (interquartile range: 2.8-3.4 mEq/L [2.8-3.4 mmol/L]). Hypokalemia was mild in 78/119 (65.5%) dogs, moderate in 40/119 (33.6%) and severe in 1/119 (0.84%) cases. Metabolic acidosis was the most common traditional acid-base disorder identified in both normokalemic (26/82, 31.7%) and hypokalemic (44/92, 47.8%) dogs but the proportion was significantly higher in the hypokalemic group (  = 0.03). The semiquantitative approach identified acid-base abnormalities in 82/83 (98.8%) hypokalemic dogs. The most common abnormalities among the hypokalemic group were an unmeasured ion effect (74/83, 89.2%) and an alkalotic albumin effect (69/83, 83.1%). In the normokalemic group, the semiquantitative approach identified acid-base abnormalities in 62/63 (98.4%) dogs with unmeasured ions (55/63, 87.3%) and an alkalotic albumin effect (42/63, 66.7%) being the most common. Survival to discharge was significantly lower in the hypokalemic dogs (85/119, 71.4%) compared to the normokalemic population (163/186, 87.6%) (  = 0.02). Hypokalemia is common in dogs with IMHA within the first 24 h of presentation and is associated with a variety of acid-base abnormalities. Hypokalemic dogs with IMHA appear more likely to develop metabolic acidosis and less likely to survive to hospital discharge.

Cardiopulmonary resuscitation (CPR) outcomes have not been prospectively described since implementation of the Reassessment Campaign on Veterinary Resuscitation (RECOVER) guidelines. This study aimed to prospectively describe CPR outcomes and document arrest variables in dogs and cats at a U.S. veterinary teaching hospital since implementation of the RECOVER guidelines using the 2016 veterinary Utstein-style CPR reporting guidelines. One-hundred and seventy-two dogs and 47 cats that experienced cardiopulmonary arrest (CPA) underwent CPR following implementation of the RECOVER guidelines and were prospectively included. Supervising clinicians completed a data form for CPR events immediately following completion of CPR from December 2013 to June 2018. Seventy-five (44%) dogs and 26 (55%) cats attained return of spontaneous circulation (ROSC), 45 dogs (26%) and 16 cats (34%) had ROSC ≥ 20 min, 13 dogs (8%) and 10 cats (21%) were alive 24 h after CPR, and 12 dogs (7%) and 9 cats (19%) survived to hospital discharge. The most common cause of death in animals with ROSC ≥ 20 min was euthanasia. Patient outcomes were not significantly different since publication of the RECOVER guidelines except for a higher feline survival to hospital discharge rate. Dogs ( = 0.02) but not cats with initial shockable rhythms had increased rates of ROSC while the development of a shockable rhythm during CPR efforts was not associated with ROSC ( = 0.30). In closed chest CPR an end-tidal carbon dioxide (EtCO ) value of >16.5 mmHg was associated with a 75% sensitivity and 64% specificity for achieving ROSC. Since publication of the RECOVER guidelines, CPR practice did not clinically significantly change at our institution and no improvement of already high ROSC rates was noted. The percentage of cats surviving to hospital discharge was higher than previously reported and the reason for this improvement is not evident with these results. Euthanasia remains a major confounding factor in assessing intermediate and long-term CPR outcomes in dogs and cats.

Factors associated with positive cardiopulmonary resuscitation (CPR) outcomes defined according to the veterinary Utstein-style CPR reporting guidelines have not been described since implementation of the Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR clinical guidelines in 2012. The aims of this study were to assess factors associated with positive CPR outcomes at a U.S. veterinary teaching hospital, to re-evaluate these factors since implementation of the RECOVER guidelines compared to reported factors prior to their publication, and to identify potential additional factors since guideline publication. One-hundred and seventy-two dogs and 47 cats that experienced cardiopulmonary arrest (CPA) and had CPR performed were prospectively included in this observational study. Supervising clinicians were asked to complete a data form on CPR events immediately following completion of CPR efforts. Multivariable logistic regression was used to evaluate the effect of twenty hospital, animal, and arrest variables on the three patient outcomes “any return of spontaneous circulation (ROSC),” “sustained ROSC,” and survival to hospital discharge. Cats had significantly higher odds to achieve any ROSC [OR (95%CI) 2.72 (1.12–6.61), p = 0.028] and survive to hospital discharge than dogs [OR (95%CI) 4.87 (1.52–15.58), p = 0.008]. Patients had significantly lower odds of achieving any ROSC if CPA occurred during nighttime hours [OR (95%CI) nighttime = 0.52 (0.27–0.98), p = 0.043], and higher odds if CPA was witnessed [OR (95%CI) 3.45 (1.57–7.55), p = 0.002], if less people were involved in CPR efforts [OR (95%CI) 0.8 (0.66–0.96), p = 0.016], if pulses were palpable during CPR [OR (95%CI) 9.27 (4.16–20.63), p < 0.0005], and if an IV catheter was already in place at the time of CPA [OR (95%CI) 5.07 (2.12–12.07), p = 0.0003]. Odds for survival to hospital discharge were significantly higher if less people were involved in CPR efforts [OR (95%CI) 0.65 (0.46–0.91), p = 0.013] and for patients of the anesthesia service [OR (95%CI) 14.82 (3.91–56.17), p = 0.00007]. Overall, factors associated with improved CPR outcomes have remained similar since incorporation of RECOVER guidelines into daily practice. Witnessed CPA events and high-quality CPR interventions were associated with positive patient outcomes, emphasizing the importance of timely recognition and initiation of CPR efforts. An optimal CPR team size has yet to be determined.

Case summary A 9-month-old intact female domestic mediumhair cat presented with a 5-month history of obtundation, lethargy, hypernatremia (181 mmol/l; reference interval [RI] 151–158 mmol/l), hyperchloremia (142 mmol/l; RI 117–126 mmol/l), azotemia (blood urea nitrogen 51 mg/dl; RI 18–33 mg/dl), creatinine 3.0 mg/dl (RI 1.1–2.2 mg/dl), hyperphosphatemia (8.3 mg/dl; RI 3.2–6.3 mg/dl) and total hypercalcemia (11.4 mg/dl; RI 9–10.9 mg/dl), with concurrent polyuria with adipsia. Neurologic evaluation revealed proprioceptive deficits, and this finding paired with a history of focal seizure-like activity despite improving sodium concentrations suggested a cerebrothalamic lesion. For this reason, and historical and biochemical findings consistent with adipsic diabetes insipidus (DI), MRI of the brain was performed, which revealed a lesion of the hypophyseal fossa consistent with a pituitary cyst. Given the patient’s age and the timeline of clinical signs, a congenital pituitary cyst was strongly suspected. The patient was managed initially with intravenous fluids to correct the hypernatremia, then managed for more than 4 years with topical ocular desmopressin acetate administration and free water administered through a feeding tube. This cat’s clinical diagnosis included a congenital pituitary cyst with subsequent central DI and primary adipsia. Relevance and novel information The clinical presentations of primary adipsia or central DI are both rare in cats. This is the first report to describe these conditions occurring in a cat owing to a congenital pituitary cyst and describes successful long-term management of this condition.

The rising prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales is a significant threat to animal and human health. This study aims to describe the clinical features, antimicrobial susceptibility patterns, and genotypic features of infections associated with ESBL-producing Enterobacterales in dogs and cats seen at a tertiary referral veterinary teaching hospital. Enterobacterales isolated from dogs and cats that underwent ESBL testing during the study period were identified using a search of the hospital antimicrobial susceptibility test software database. Medical records of confirmed ESBL isolates were reviewed, and the source of infection, clinical findings, and antimicrobial susceptibility were recorded. Genomic DNA from bacterial isolates was evaluated for antimicrobial resistance genes with whole genome sequencing. Thirty ESBL-producing isolates were identified based on phenotypic testing (twenty-nine from dogs, one from a cat); twenty-six were Escherichia coli and the remainder were Klebsiella spp. Bacterial cystitis was the most commonly identified (8/30, 27%) clinical problem associated with infection. Resistance to three or more antimicrobial classes was identified in 90% (27/30) of isolates, and all isolates were susceptible to imipenem. Over 70% of isolates were susceptible to piperacillin-tazobactam, amikacin, and cefoxitin. BlaCTX-M-15 was the most common ESBL gene identified, present in 13/22 (59%) isolate genomes. A wide range of clinical infections were identified. Piperacillin-tazobactam and amikacin may be alternatives to carbapenem therapy. Further, larger-scale studies are needed.

Infective endocarditis (IE) is a potentially fatal disease in dogs. Limited information exists regarding the characterization of bacterial isolates from dogs with IE. The objective of this study was to describe bacterial isolates associated with IE and their antimicrobial susceptibility patterns. A retrospective analysis of dogs with IE and bacterial isolates was performed, and antimicrobial susceptibility was interpreted using current veterinary cut points where available. The susceptibility rate was assessed for association with survival and previous antimicrobial administration. Fifty-one bacterial isolates were identified from 45 dogs, and 33 had antimicrobial susceptibility performed. Staphylococcus spp. (14/51; 27.5%) was the most common organism. Antimicrobials with the lowest susceptibility rate were ampicillin (19/26; 73%), doxycycline (16/22; 73%), and enrofloxacin (22/29; 76%) with 12/33 (36%) of isolates exhibiting multidrug resistance (MDR). Individual antimicrobial resistances and the MDR rate were not associated with a difference in survival rate. Bacterial isolates from dogs that had received fluoroquinolone antimicrobials in the month before diagnosis had a higher rate of non-intrinsic fluoroquinolones resistance (5/8;62.5%) compared to those that did not receive fluoroquinolones (2/21; 9.5%) (p = 0.03). Antimicrobial resistance and MDR phenotype were common in this study. Culture and antimicrobial susceptibility testing should be pursued in dogs with IE to help guide antimicrobial therapy.