Treating UTIs With Bacteria?

Hello Summarians!

Wow! Sometimes it’s the outrageous clinical studies that can change whole treatment paradigms. Who could have imagined treating UTIs with a non-pathogenic strain?

It brings the discussion of antimicrobial stewardship into a whole new perspective, that we even have to be thinking along these lines.

Until next time, keep your mind open to all things…

Conservative Management Of Disk Disease In Dogs

This study examined the natural history and outcomes of thoracolumbar intervertebral disk extrusion (TL IVDE) in nonambulatory dogs managed conservatively rather than surgically. Conservative treatment typically involves analgesia, restricted movement, and bladder management, with recovery depending on inflammation resolution, neuroplasticity, and sometimes spontaneous decompression of the spinal cord. While surgery is widely recommended—especially for dogs unable to walk—direct comparisons between surgical and conservative management are limited, and some dogs recover without surgery. A systematic review suggested that 86% of deep pain–positive (DPP) dogs regain ambulation with conservative care, and this study confirmed that nearly all DPP dogs recovered. Importantly, about half of deep pain–negative (DPN) dogs also regained the ability to walk, a better outcome than many previous reports suggested. 

The recovery rates in this cohort were comparable to those seen with surgical decompression: approximately 96% versus 90% for DPP dogs, and 48% versus 50% for DPN dogs. Recovery times were variable but similar to surgical outcomes, although definitions of ambulation differed across studies. Many dogs took more than four weeks to recover, highlighting the importance of allowing adequate time before judging prognosis. The study also noted a higher-than-usual rate of progressive myelomalacia (PMM), possibly due to the inclusion of dogs already showing signs of PMM at presentation. 

MRI data showed that disk extrusions often regressed over 12 weeks, reducing spinal cord compression, but this was not consistently associated with functional recovery, indicating that decompression is not always essential for improvement. Limitations included lack of confirmation of the exact compressive material on MRI, variability in imaging technique, and exclusion of brachycephalic or large-breed dogs. 

Overall, the findings suggest that many small dogs with TL IVDE, including some DPN cases, can recover without surgical intervention, and that conservative management should be considered a valid option when surgery is not feasible. However, further research is needed to determine which dogs are most likely to benefit from surgery versus conservative treatment. 

Khan S, Jeffery ND, Freeman P. Recovery of ambulation in small, nonbrachycephalic dogs after conservative management of acute thoracolumbar disk extrusion. J Vet Intern Med. 2024; 38(5): 2603-2611. doi:10.1111/jvim.17149 

Bottom line — Interesting statistics.

Biotherapeutic Alternative For UTIs

This study investigated the use of asymptomatic bacteriuria (ASB) Escherichia coli strain 212 as a biotherapeutic alternative to antimicrobials for treating recurrent urinary tract infections (UTI) in dogs. Bacterial cystitis is common and typically managed with antibiotics, but resistance is an increasing concern. In humans and animal models, ASB E. coli strains have shown protective, antimicrobial, and even analgesic effects by colonizing the bladder and preventing infection by pathogenic uropathogenic E. coli (UPEC) strains. 

A previous pilot trial demonstrated that intravesicular administration of ASB E. coli 212 was safe in dogs and provided clinical benefit in some with recurrent UTI. Building on this, the present randomized, prospective non-inferiority study compared ASB E. coli 212 with a standard 7-day antimicrobial course. The primary endpoint was clinical cure within two weeks, with a non-inferiority margin of 12%. The results showed that ASB E. coli 212 was not inferior to antimicrobial therapy. Some dogs experienced durable benefits, with clinical cure lasting up to 13 months, and the treatment was well tolerated, with only mild, transient hyporexia noted in a few cases. 

The study protocol allowed up to two instillations of ASB E. coli 212. Dogs that did not improve after the first administration sometimes responded after the second, suggesting a potential dose-dependent effect. Interestingly, some dogs improved clinically without evidence of bladder colonization, consistent with experimental data suggesting ASB E. coli 212 provides analgesic effects in addition to antimicrobial interference. Owners were generally accepting of the treatment, as it eliminated the need for daily oral medication and avoided antibiotics. Importantly, no major adverse events occurred. 

Limitations included the relatively short 14-day primary evaluation period and incomplete long-term follow-up. Nonetheless, longer-term clinical observations supported the possibility that ASB E. coli 212 provides extended protection. The findings suggest that this biotherapeutic could be a safe, effective, and antibiotic-sparing option for dogs with recurrent UTI, though future work should define the optimal dosing, frequency, and concentration to maximize efficacy. 

Segev G, Chen H, Dear JD, et al. Evaluation of the efficacy of a live Escherichia coli biotherapeutic product (asymptomatic bacteriuria E. coli 212). J Vet Intern Med. 2024; 38(5): 2548-2555. doi:10.1111/jvim.17167 

Bottom line — Seems to be safe and effective.

Video Capsule Endoscopy

This prospective study evaluated the veterinary-specific video capsule endoscopy (VCE) system ALICAM in dogs with chronic enteropathy (CE) compared to healthy controls (HCs). VCE was found to be safe and feasible in dogs over 10 kg, with all capsules successfully passing through the gastrointestinal tract and no cases of retention. This contrasts with higher rates of incomplete studies reported in human medicine and in previous canine studies, where capsule retention was more common. 

Unexpectedly, there were no significant differences in the number, severity, or extent of gastrointestinal abnormalities between CE dogs and healthy controls. Findings such as erythema, erosions, villous changes, and dilated lacteals occurred at similar rates in both groups. The presence of dilated lacteals, typically associated with intestinal lymphangiectasia and disease, was equally observed in CE and HC dogs, suggesting that such abnormalities may sometimes represent normal variation rather than pathology. This parallels observations in human medicine, where VCE has revealed nonspecific lesions in healthy individuals. 

VCE offered advantages over traditional bidirectional gastrointestinal endoscopy, including full small intestine visualization and avoidance of general anesthesia. However, it cannot provide biopsies for histopathology—the current gold standard for diagnosing chronic enteropathy and inflammatory bowel disease. Image quality was sometimes poor, especially in the colon, and no bowel preparation beyond fasting was used. The study also noted potential interobserver variability, though initial agreement between blinded reviewers was high. 

In conclusion, VCE with ALICAM is a safe, noninvasive diagnostic tool for dogs with and without CE, capable of assessing the entire gastrointestinal tract. However, its diagnostic value for CE is limited by the nonspecific nature of macroscopic lesions and the lack of histological sampling. Future studies with larger populations, including dogs with more severe CE, are needed to clarify the clinical significance of VCE findings and to explore its role alongside conventional endoscopy. 

Holmberg J, Ljungvall I, Pelander L, et al. Video capsule endoscopy findings in dogs with chronic enteropathy and in healthy dogs. J Vet Intern Med. 2024; 38(5): 2454-2463. doi:10.1111/jvim.17168 

Bottom line — Potentially useful for screening dogs.

Just putting things in perspective …