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Cat Forum / Health and Behavior / December 2005Resistant 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 are: 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 brancatoREMOVE@rcn.com > 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? 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. > Do you know which antibiotics the bacteria is susceptible? >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 >> Do you know which antibiotics the bacteria is susceptible? 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 > 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). > 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 [quoted text clipped - 17 lines] > 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 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 [quoted text clipped - 31 lines] > > Phil 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. > 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. [quoted text clipped - 3 lines] > 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 Phil: Thanks again for your quick response. Re: 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! >> I have some answers to questions raised by J.dvm and Phil. >> [quoted text clipped - 71 lines] > > Phil > Phil: > Thanks again for your quick response. Re: 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 [quoted text clipped - 5 lines] > > 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 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: >> Thanks again for your quick response. Re: your questions, the urine was [quoted text clipped - 73 lines] > > 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. 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 [quoted text clipped - 5 lines] > 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 [quoted text clipped - 6 lines] > 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/Trifectant_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.php?i=Trifectant+Tablets%2C+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 >I have some answers to questions raised by J.dvm and Phil. > [quoted text clipped - 3 lines] > 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 [quoted text clipped - 4 lines] > 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. >>I have some answers to questions raised by J.dvm and Phil. >> [quoted text clipped - 42 lines] >> >> Any thoughts are very much 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 [quoted text clipped - 10 lines] > 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. > 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
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