Effects of Diagnostic Work-Up on Medical Decision-Making for Canine Urinary Tract Infection: An Observational Study in Danish Small Animal Practices

Diabetes mellitus is a common endocrinopathy diagnosed in small animal patients, and once stable can be managed and well controlled in the home environment. Complications can occur, however, when unexpected factors arise which can cause destabilisation of the patient. This article will provide a brief review of diabetes mellitus in canine and feline patients before describing some of the common complications that may be observed including hypoglycaemia, diabetic ketoacidosis, urinary tract infection, diabetic neuropathy and cataracts. The aim is to ensure the veterinary nurse has a good understanding of these complications, for them to be aware of the clinical symptoms that may be displayed, and for them to appreciate the different treatment options available allowing them to be efficient advocates for their patients should the need arise.

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Incidence of catheter-associated urinary tract infection among dogs in a small animal intensive care unit

Journal of the American Veterinary Medical Association ◽

10.2460/javma.2004.224.1936 ◽

2004 ◽

Vol 224 (12) ◽

pp. 1936-1940 ◽

Cited By ~ 77

Author(s):

Sean D. Smarick ◽

Steve C. Haskins ◽

Janet Aldrich ◽

Janet E. Foley ◽

Philip H. Kass ◽

...

Keyword(s):

Intensive Care Unit ◽

Urinary Tract Infection ◽

Intensive Care ◽

Urinary Tract ◽

Tract Infection ◽

Small Animal

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Optimizing the diagnostic work-up of acute uncomplicated urinary tract infections

BMC Family Practice ◽

10.1186/1471-2296-9-64 ◽

2008 ◽

Vol 9 (1) ◽

Cited By ~ 5

Author(s):

Bart J Knottnerus ◽

Patrick JE Bindels ◽

Suzanne E Geerlings ◽

Eric P Moll van Charante ◽

Gerben ter Riet

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Diagnostic Work ◽

Tract Infections ◽

Work Up ◽

Diagnostic Work Up

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Causes of lower urinary tract disease in Czech cat population

Acta Veterinaria Brno ◽

10.2754/avb201988040433 ◽

2019 ◽

Vol 88 (4) ◽

pp. 433-441

Author(s):

Barbora Hřibová ◽

Václav Ceplecha ◽

Kristína Řeháková ◽

Pavel Proks ◽

Vojtěch Gabriel ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Lower Urinary Tract ◽

Small Animal ◽

Epidemiological Data ◽

Urine Specific Gravity ◽

Urine Sediment ◽

Tract Disease ◽

Lower Urinary

This study was done to investigate epidemiological data and to report causes of lower urinary tract disease in a population of cats presented at the Small Animal Clinic of the University of Veterinary and Pharmaceutical Sciences Brno. Cats presented with lower urinary tract disease signs that had undergone a thorough physical examination and urinalysis (dipstick, urine specific gravity, urine sediment and dipslide urine culture) were included in the study. Urine samples were collected only by cystocentesis or sterile catheterization. Bloodwork, abdominal ultrasound, and abdominal radiographs were performed in 118 (66%), 170 (96%) and 9 (5%) patients, respectively. Cats that were treated with antibiotics or glucocorticoids during an episode of feline lower urinary tract disease (FLUTD) or during the foregoing month and which had undergone perineal urethrostomy or catheterization in private practice, were excluded. The study population consisted of 177 cats. Forty-one (23%) cats were diagnosed with a urethral plug, 26 cats (14%) with a urinary tract infection (UTI), 9 cats (5%) with urolithiasis and 101 cats (57%) with feline idiopathic cystitis (FIC). The cats diagnosed with UTI were significantly older than the cats with FIC, urethral plugs and urolithiasis. Urinary tract infection was diagnosed significantly more often in patients older than 10 years, and in female cats. The diagnosis of urethral plug was made significantly more often in males. Feline idiopathic cystitis and urethral plugs are the most common causes of FLUTD, and the causes are significantly age and sex-related.

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Construction of a patient decision aid for the treatment of uncomplicated urinary tract infection in primary care

10.21203/rs.3.rs-35154/v2 ◽

2020 ◽

Author(s):

Yves-Marie VINCENT ◽

Adèle FRACHON ◽

Clotilde BUFFETEAU ◽

Guillaume CONORT

Keyword(s):

Primary Care ◽

Decision Making ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Decision Aid ◽

Uncomplicated Urinary Tract Infection ◽

Shared Decision ◽

Patient Decision Aid ◽

Patient Decision

Abstract Background: Uncomplicated urinary tract infection (uUTI) is a frequent disorder in general practice. The risk of developing pyelonephritis remains low after uUTI, nonetheless, empiric antibiotic therapy is frequently prescribed for symptomatic purposes. This can lead to adverse effects and antibiotic resistance. Furthermore, patients sometimes wish to avoid taking antibiotics. Some European countries recommend discussing a delayed prescription with the patient and developing a shared decision. The aim of our study is to develop a patient decision aid (PtDA) that can be used in primary care to make a shared decision about whether to treat uUTI with antibiotics or not.Methods: We followed the steps recommended by the International Patient Decision Aids Standards, with a scoping phase, a design phase (including focus groups and literature review),and an alpha-testing phase. A steering group, made up of patients and physicians, met throughout the study to develop a draft and then a final version of a prototype PtDA.Results: The information included in the PtDA is the definition of uUTI, information on the options, their benefits, risks, and consequences, based on a review of the literature. The results of the focus group made it possible to determine the patient's values and preferences to be considered in decision-making, namely: the discomfort felt, the impact on daily life, the representations of antibiotics, and the position relative to the risk of adverse effect. The choices of presentation, organisation and design are the result of the work of the steering group, improved by feedback from alpha testing.Conclusions: Our results confirm a need for shared decision-making and the equipoise in this situation. More advice from outside physicians is still lacking. This PtDA needs to be validated in a beta-testing phase, and then tested in a clinical study comparing its use with the systematic prescription approach.

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Work-Up of Urinary Tract Infection in Infants and Children

Ultrasound Quarterly ◽

10.1097/00013644-200203000-00009 ◽

2002 ◽

Vol 18 (1) ◽

pp. 75

Author(s):

&NA;

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Infants And Children ◽

Work Up ◽

In Infants And Children

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Workload, diagnostic work-up and treatment of urinary tract infections in adults during out-of-hours primary care: a retrospective cohort study

BMC Family Practice ◽

10.1186/s12875-020-01305-8 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Michelle Spek ◽

Jochen W. L. Cals ◽

Guy J. Oudhuis ◽

Paul H. M. Savelkoul ◽

Eefje G. P. M. de Bont

Keyword(s):

Primary Care ◽

Cohort Study ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Electronic Patient Records ◽

Out Of Hours ◽

Diagnostic Work ◽

Tract Infections ◽

Work Up ◽

Diagnostic Work Up

Abstract Background Urinary tract infections (UTIs) are one of the most common infections in primary care. Previous research showed that GPs find it challenging to diagnose UTIs and frequently divert from guidelines leading to unwarranted antibiotic prescriptions and inefficient use of diagnostics such as urinary cultures. We hypothesise that management of UTIs during out-of-hours care may be extra challenging due to a higher workload and logistical issues regarding diagnostic work-up and obtaining results. We therefore aimed to study the workload, diagnostic work-up and treatment of UTIs during out-of-hours primary care. Methods We performed a retrospective observational cohort study in which we analysed a full year (2018) of electronic patient records of two large Dutch GP out-of-hours centres. All adult patients with UTI symptoms were included in this study. Descriptive statistics and multivariate regression were used to analyse diagnostics and subsequent management. Results A total of 5657 patients were included (78.9% female, mean age of 54 years), with an average of eight patients per day that contact a GP out-of-hours centre because of UTI symptoms. Urinary dipsticks were used in 87.5% of all patients visiting the out-of-hours centres with UTI symptoms. Strikingly, urinary cultures were only requested in 10.3% of patients in which urinary culture was indicated. Seventy-four percent of the patients received antibiotics. Seventy-nine percent of the patients with a negative nitrite test still received antibiotics. Remarkably, patients at risk of complications because of a UTI, such as men, received fewer antibiotic prescriptions. Conclusions In total, 74% of the patients received antibiotics. 8 out of 10 patients still received an antibiotic prescription in case of a negative nitrite test, and 9 out of 10 patients with an indication did not receive a urine culture. In conclusion, we found that correctly diagnosing UTIs and prescribing antibiotics for UTIs is a challenge that needs major improvement, especially during out-of-hours GP care.

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Cost-Benefit of Urinary Tract Infection Work-up Debated

Pediatrics in Review ◽

10.1542/pir.1.10.340 ◽

1980 ◽

Vol 1 (10) ◽

pp. 340-340

Author(s):

RICHARD H. RAPKIN ◽

R. J. H.

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Cost Benefit ◽

University Of New Mexico ◽

School Of Medicine ◽

The Cost ◽

The University ◽

Work Up ◽

Rule Out

Several letters have been received questioning whether Dr Rapkin's proposal for work-up of children with one urinary tract infection (UTI) was realistic (Pediatrics in Review 1:133, 1979). Dr Weagly of the Quincy Clinic, Quincy, Illinois, pointed out that the cost in their clinic was as follows: [See table in the PDF file] He feels that it is unrealistic to expect a family to attempt to finance this expense. He ends his thoughtful letter with "I feel that there must be a middle ground that will help the patient and still keep expenses under control." Dr Berger of the University of New Mexico School of Medicine, comments similarly that Dr Rapkin's recommendations that patients with even one documented UTI should have radiographs to rule out associated anomalies of the urinary tract, would be very costly.

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