C10008055 / invoice 10000

04/03/2026 R: broken nail on LF dew claw, recheck UTI

Ongoing meds: gets meloxicam every few days, last dose a few days ago

O reports no more urinary symptoms 
No longer has urinary incontinence, suspect UTI was the underlying cause 

Current concern: noticed last night, broken dew claw on LF

PE:
BAR
Lovely dog 
Chest ausc NAD, HR 120 bpm no murmurs 
Lung clear , panting
Abdo palp NAD 
T 38.5
Reduced muscle mass? weight appear to be stable 

Broken nail on LF dew claw just distal to quick, applied lignocaine topically waited a few mins then removed broken portion easily with haemostats

Cysto for urine 
In house UA 
Sent for C&S urine vetnostics 

Plan: 
Oral melox for 4 days in a row ( for broken nail) 
then resume normal frequency 

JY to report urine test results

After consult; in house UA showed bacteria ( rods definitively, suspect cocci) 
Discussed at rounds (CM also present) while awaiting C& S results recommend to start amoxycillin 
Consider cystopro ( perhaps wait until C&S results through first) 

10/03/2026 LAB 
Reported 6/3 

URINE EXAMINATION
 Specimen Cystocentesis
 CHEMISTRY MICROSCOPY

 CULTURE Heavy growth (>10^8 CFU/L)
 Org 1: Staphylococcus pseudintermedius
 Org 2: Enterococcus species

 SUSCEPTIBILITY -1--2-                                       -1--2-
 Ampi/Amoxycillin    R S                 Cefovecin         S R
 Cephalexin             S R                 Enrofloxacin     S R
 Doxycycline            S S                 Sulpha/Trimeth S R
 Marbofloxacin        S S                  Clavulan/Amox S S

 Final report

 Staphylococcus spp can secrete urease to generate ammonia allowing sur
 vival in the lower pH of the bladder and increasing its biofilm-formin g
 ability and adhesion to the bladder epithelium. Urease producing bac
 teria have been implicated in the development of crystals, urolithiasi s
 and rarely, encrusted cystitis. Biofilm production protects organism s
 from antimicrobial therapy allowing persistence. Many species of St
 aphylococcus have additional virulence factors such as the production of
 haemolysins which may be variably active depending on the pH and bl
 adder conditions. Consider these factors as well as any underlying iss
 ues (obesity, poor perineal conformation, endocrinopathy) which determ
 ining a treatment plan. Concurrent urolithiasis and/or crystalluria wo
 uld suggest that the isolate is a urease-producing strain.

 Enterococci are part of the normal urogenital flora in many species.
 Enterococcus as a uropathogen in complicated or recurrent infections c
 an produce several virulence factors necessary for initial adhesion an d
 colonization of bladder mucosal surfaces, for cellular invasion (mac
 rophages, bladder epithelium), and for suppressing the innate immune r
 esponse at the site of infection (ideal for co-habitation with other u
 ropathogens). In addition, Enterococci are known to produce biofilms w
 hich protect against antibiotic penetration, act as a refuge for other
 uropathogens (mixed organism infections) and allow the formation of p
 ersister cells which contributes to organism survival and persistence.
 Kristen Todhunter
 Veterinary Pathologist

10/03/2026 JY interpretation of latest urine C&S results 

Grew 2 types of bacteria 1) staph pseudointermedius and 2) enterococcus spp
Different from prev C&S ( proteus) 
Currently on amoxycilline which staph pseudointermedius is resistant to 
Adv change to amoxyclav ( doxy is bacteristatic; marbofloxacin will be expensive)