Received: 13 February 2020 Revised: 2 November 2020 Accepted: 11 December 2020

DOI: 10.1002/vetr.60

ORIGINAL RESEARCH

Antimicrobial susceptibility of bacterial isolates from

urinary tract infections in companion animals in Spain

Laila Darwich1,2 Chiara Seminati1 Ares Burballa3 Alba Nieto1

Inma Durán4 Núria Tarradas4 Rafael A. Molina-López5

1
Departament de Sanitat i Anatomia Animal,
Universitat Autònoma de Barcelona (UAB),
Cerdanyola del Vallès, Spain
2
UAB, Centre de Recerca en Sanitat Animal
(CReSA, IRTA-UAB), Campus de la
Universitat Autònoma de Barcelona,
Cerdanyola del Vallès, Spain
3
Hospital Veterinari Garbi, Cabrera de Mar,
Spain
4
Departamento Veterinaria de Laboratorio
Echevarne, S.A., Barcelona, Spain
5
Catalan Wildlife Service, Centre de Fauna
Salvatge de Torreferrussa, Barcelona, Spain
Correspondence
Laila Darwich, Departament de Sanitat i
Anatomia Animal, Universitat Autònoma
de Barcelona (UAB), Cerdanyola del Vallès,
08193, Spain.
Email: laila.darwich@uab.cat
Abstract
Background: The increasing emergence of multidrug-resistant bacteria,
causing urinary tract infections (UTI) in dogs and cats, represents a great ther-
apeutic challenge and a public health concern.
Methods: Laboratory records of 4943 urinary microbiological diagnosis
results and antimicrobial resistance profiles of suspected UTI cases in dogs
and cats were analysed from 2016 to 2018 in Spain.
Results: This study showed a higher percentage of positive microbiological
diagnoses in dogs (42%, 1368/3270) than in cats (27%, 457/1673). Although
Escherichia coli was the most frequently isolated bacterium, the frequency
of antimicrobial susceptibility of E. coli isolates was lower compared to
other bacterial species like Enterococcus spp., Staphylococcus spp., Kleb-
siella pneumoniae, Pseudomonas aeruginosa, Enterobacter (E. cloacae), and
Proteus mirabilis. The antimicrobial susceptibility testing of Gram-positive
cocci showed higher levels of resistance in cats to common beta-lactams
used for the treatment of complicated UTIs, as well as to fluoroquinolones,
aminoglycosides, and carbapenems. Moreover, enterobacteria (E. coli, K.
pneumoniae, and P. mirabilis) from cats presented high resistance frequen-
cies to beta-lactams, including third- and fourth-generation cephalosporins
and fluoroquinolones.
Conclusion: This study updates data on the current antimicrobial resistance
in UTI bacteria from companion animals in Spain, which may help to guide
clinicians for the appropriate use of antimicrobials.

KEYWORDS
antimicrobial resistance, companion animals, urinary tract infections

INTRODUCTION public health because a significant proportion of the

In the last decades, the overuse of antibiotics in human
and veterinary medicine has led to the spread of
antimicrobial-resistant (AMR) pathogens, such as the
extended-spectrum beta-lactamase (ESBL)-producing
Enterobacteriaceae, which has become a global health
problem.1 Bacterial urinary tract infections (UTI) are
commonly diagnosed in veterinary medicine, espe-
cially in small companion animals2 that are habitually
treated with antimicrobial therapy.3,4 The increasing
emergence of multidrug-resistant (MDR) bacteria
causing UTI in dogs and cats is of great veterinary
public health concern5 . On the one hand, this situa-
tion represents a therapeutic challenge for veterinary
medicine where the use of antimicrobials is highly
demanded;6 on the other hand, it is a challenge to
pathogens are potentially zoonotic, which may trans-
mit to humans through direct contact with companion
animals.7,8
Antimicrobial treatment of sporadic UTI is usually
administered empirically based on previous clinical
diagnosis data, although it is supposed to start after
knowing the susceptibility testing result of the iso-
lated bacteria and should be monitored in the case of
recurrent cystitis post-treatment.3,4 Thus, monitoring
antimicrobial resistance is crucial in medicine to pro-
vide clinicians with evidence to guide antimicrobial
choice as well as to develop and refine antimicrobial
policies at both the national and clinic levels. More-
over, according to the World Organization for Animal
Health, veterinary professionals should make a ratio-
nal use of antimicrobial agents in order to reduce

Vet Rec. 2021;e60. wileyonlinelibrary.com/journal/vetr © 2021 British Veterinary Association 1 of 8

https://doi.org/10.1002/vetr.60
2 of 8
the emergence of AMR.9 Recently, different initiatives
and networks have been created in Europe to help
address this issue with providing general AMR data on
UTI in companion animals.10,11 However, antimicro-
bial resistance may change geographically and over
time; thus, updated data on the UTI aetiology and its
regional susceptibility patterns is of crucial impor-
tance for rational drug selection and evidence-based
antimicrobial policies.12
The goal of this study was to determine the fre-
quency of bacterial urinary pathogens and their
antimicrobial resistance patterns in dogs and cats with
suspected UTI in Spain.
MATERIALS AND METHODS
Data source and management
Retrospective data of microbiological results obtained
between January 2016 and January 2018 from the Vet-
erinary Medicine Department of a large private Labo-
ratory of Diagnosis located in Barcelona were used for
this study. The analysed data comprised all the micro-
biological results of urine specimens of dogs and cats
with lower urinary tract dysfunction (suspected bac-
terial UTI) from different provinces of Spain. Clini-
cal signs referable to lower urinary diseases include
straining, hematuria, pollakiuria (frequent passage of
small amounts of urine), and in cats, periuria (urina-
tions outside the litter box).13 The data were assessed
for duplicates and missing information, finally only
including complete records for the analysis. The fol-
lowing variables were extracted from the records: ani-
mal species and gender, county of specimen, bacterial
identification, and antimicrobial susceptibility testing.
Microbiological analysis and antimicrobial
susceptibility testing
Microbiological identification was performed using
the MALDI-TOF mass spectrometer. All Gram-positive
bacterial isolates were subjected to antimicrobial
susceptibility testing against a panel of antimicro-
bial agents using the standard disc diffusion method
according to the Performance Standards for Antimi-
crobial Susceptibility Testing for bacteria isolated
from animals (M31-A3, CLSI VET01, 2008)14 and
from humans (M100-S24, CLSI, 2016) for drugs not
licensed for veterinary use.15 The antimicrobial panel
for Gram-positive bacteria included the following
classes: beta-lactams (amoxicillin-clavulanic acid,
ampicillin, cephalexin, cefazolin, cefuroxime, cefo-
taxime, and cefovecin) and carbapenems (imipenem
and meropenem); fluoroquinolones (ciprofloxacin,
enrofloxacin, marbofloxacin, and pradofloxacin);
aminoglycosides (amikacin, gentamicin, and
tobramycin); macrolides (erythromycin); tetracyclines
(doxycycline); trimethoprim/sulphamethoxazole;
fosfomycin; nitrofurantoin; and glycopetides (van-
Veterinary Record
comycin). For Gram-negative bacteria, NM44
MicroScan (Beckman Coulter, Villepinte, France)
system was performed for all the antimicrobials
except for those antibiotics authorised for veterinary
uses that are not included in the automatic scan panels
(enrofloxacin, pradofloxacin, marbofloxacin, doxycy-
cline, cephalexin, and cefovecin). The MicroScan is an
automated bacterial identification and susceptibility
testing system based on the microbiology principles
of true minimum inhibitory concentration testing.
The laboratory has the quality management system
certificate ISO-9001 since 1998 and the accreditation
from ENAC (National Accreditation Entity) according
to criteria included in the ISO/IEC 17025 Standard
defined in the Technical Annexes 511/LE1947 for Phar-
maceutical Toxicology and Microbiology Testing.
Based on the lab testing readings, isolates were clas-
sified as susceptible, intermediate, or resistant. For
statistical assessments, all isolates that exhibited inter-
mediate resistance were re-classified as resistant. In
addition, multidrug resistance (MDR) was defined as
resistance to at least one agent in ≥3 antimicrobial cat-
egories; extensive drug resistance (XDR) as resistance
to all but two of the tested antimicrobial categories;
and finally pan-drug (PDR) as resistance to all the cat-
egories tested.16
Statistical analysis
Descriptive and statistical analysis was performed
using the SPSS Advanced Models TM 15.0 (SPSS Inc.
233 South Wacker Drive, Chicago, IL). The chi-square
(χ2 ) or Fisher’s exact tests were used to compare
pathogen and AMR frequencies by animal groups.
Statistically significant results were considered when
p < 0.05.
RESULTS
The total number of records analysed in this study
comprised 4943 microbiological results of suspected
UTI: 3270 dogs (1546 males/1724 females) and 1673
cats (992 males/681 females). Samples came from vet-
erinary clinics of 17 different Autonomous Commu-
nity of Spain, principally from Catalonia (68%) and
Madrid (18%) (Figure 1). A microbiological identi-
fication was obtained from 37% (1825/4943) of the
records, with a single pathogen identified as the
causative agent of the confirmed UTI. The propor-
tion of positive diagnosis in dogs was 42% (1368/3270),
whereas in cats it decreased to 27% (457/1673).
According to the bacteriological identification,
Escherichia coli (44.6%), Enterococcus spp. (15%), Pro-
teus mirabilis (10.6%), Staphylococcus spp. (9.5%), and
Klebsiella pneumoniae (5.3%) were the most frequent
bacterial species diagnosed in both animal groups
(Table 1). Proteus mirabilis was found more prevalent
in dogs (13% vs. 3%, χ2 = 36.38, p < 0.05), and Entero-
coccus spp. was highly prevalent in cats (24.3% vs. 12%,
Veterinary Record 3 of 8

Asturias
Cantabria
Galicia
Basque Country

Navarre

The Rioja

Castilla y León
Catalonia
Aragon

Madrid

Balearics
Estremadura
Castilla-La Mancha Valencian Community

Murcia
Andalusia

Legend
Number of cases (range)
1 - 100
100 - 500
Canary Islands 500 - 1.000
> 1.000

0 125 250
Km

FIGURE 1 Distribution of samples analysed from the different Autonomous Community of Spain

F I G U R E 2 Comparison of urinary tract

infectious agent (UTI) frequencies between cats and
dogs. *Significant differences (p < 0.05)

χ2 = 41.1, p < 0.05) (Figure 2). Other relevant bacteria,
such as Streptococcus spp. (2.2%), Serratia marcescens
(1.2%), Acinetobacter spp. (0.7%), and Citrobacter spp.
(0.6%), were also diagnosed but in lower frequencies
and mostly in dogs (Table 1).
The study of the antimicrobial susceptibility pattern
showed that 93% of the bacteria were resistant to at
least one agent of the total antimicrobial categories,
and 42% of them presented an MDR pattern (4.2%
were XDR and 0.4% PDR strains). The percentage of
MDR (50% in cat vs. 40% in dogs) and XDR (9.4% vs.
2.4%) strains were higher in cats than in dogs (Table 2).
Enterococcus spp. (13%), E. coli (8.3%), P. mirabilis
(7.7%), Pseudomonas aeruginosa (4%), and K. pneu-
moniae (3%) were the bacterial species with higher
MDR levels. In addition, Enterococcus spp. (n = 3), K.
4 of 8 Veterinary Record

TA B L E 1 Number and frequencies of the bacterial isolates identified in the microbiological cultures of UTI cases

Number of isolates (n) Percentage of isolates (%)a

Microbiological results Dogs Cats Total Dogs Cats Total p-value*

Acinetobacter spp. 13 0 13 1 0 0.7 Ns

A. baumannii 4 0 4
A. lwoffii 4 0 4
Citrobacter spp. 12 0 12 0.9 0 0.6 Ns
C. koseri 9 0 9
C. freundii 2 0 2
Enterobacter spp. 25 18 43 1.8 3.9 2.3 Ns
E. cloacae 17 16 33
E. aerogenes 4 2 6
Enteroccoccus spp. 163 111 274 11.9 24.3 15 <0.05
E. faecalis 8 9 17
E. faecium 2 1 3
Escherichia spp. 632 182 814 46.2 39.8 44.6 Ns
Escherichia coli 632 182 814
Klebsiella spp. 75 22 97 5.5 4.8 5.3 Ns
K. pneumoniae 70 20 90
K. oxytoca 4 2 6
Proteus spp. 179 14 193 13 3 10.6 <0.05
P. mirabilis 176 14 190
P. vulgaris 2 0 2
Pseudomonas spp. 52 24 76 3.8 5.2 4.2 Ns
P. aeruginosa 45 19 64
P. fluorescens 3 1 4
P. luteola 3 1 4
Serratia spp. 22 0 22 1.6 0 1.2 Ns
S. marcescens 20 0 20
Staphylococcus spp. 117 56 173 8.5 12.3 9.5 Ns
S. pseudintermedius 5 1 6
S. felis 0 4 4
Streptococcus spp. 40 0 40 2.9 0 2.2 Ns
S. canis 1 0 1
a
Total number of positive samples N = 1825 (dog samples = 1368; cat samples = 457).
*Chi-square (χ2 ) test. Ns, no significant differences. Other bacterial species not showed in the table represented the remaining 3.8% of the total isolates.

pneumoniae (n = 1), and P. mirabilis (n = 1) isolates
from dogs and P. aeruginosa (n = 1), K. pneumoniae
(n = 1), and Enterobacter (n = 1) isolates from cats
showed a PDR profile (Table 2).
In general, the susceptibility profile of E. coli strains
showed a lower MDR level compared to other bacteria
such as K. pneumoniae, P. aeruginosa, or P. mirabilis
(Figure 3). The susceptibility levels below 60% were
mainly observed for ampicillin and first-generation
cephalosporines in both animal groups. The statisti-
cal analysis showed differences between the sensitiv-
ity levels of E. coli isolates from dogs to cephalotin
(31.5% susceptibility in dogs vs. 46.3% in cats,
χ2 = 11.75) and from cats to cefepime (91.1% vs. 62.5%,
χ2 = 7.85).
The MDR profile of K. pneumoniae was principally
observed for Beta-lactams, fluoroquinolones, doxycy-
cline, and nitrofurantoin (Figure 3). Those isolates
from cat specimens showed higher levels of resistance
for chepalosporins and fluoroquinolones in compari-
son to dog isolates.
On the other hand, Pseudomonas spp., mainly
P. aeruginosa, that are intrinsically resistant to
cephalosporines (with the exception of ceftazidime)
and trimethoprim/sulphamethoxazole, showed
antimicrobial resistance to fluoroquinolones and
nitrofurantoin in both dog and cat isolates (Figure 3).
In this line, Proteus spp., which are intrinsically resis-
tant to ampicilin, cefazolin, tetracyclines, and nitrofu-
rantoine, presented the lowest levels of susceptibility
to these drugs. Cat isolates presented significant resis-
tance to enrofloxacin and cefovecin compared to dogs
(Figure 3).
With regard to the susceptibility patterns of the
Gram-positive cocci, Enterococcus spp., as expected,
presented high levels of AMR to cephalosporines
and macrolides, and meanwhile to fluoroquinolones,
aminoglycosides, and carbapenems (Figure 4). Again,
Veterinary Record 5 of 8

TA B L E 2 Number and proportion of bacterial isolates presenting a multidrug resistance pattern from the total population, dogs, and
cats

Total positive records (N = 1825) Diagnosed cases inDogs (n = 1368) Diagnosed cases inCats (n = 457)
MDR (%) XDR (%) PDR (%) MDR (%) XDR (%) PDR (%) MDR (%) XDR (%) PDR (%)
All bacteria 774 (42) 76 (4.2) 8 (0.4) 543 (40) 33 (2.4) 5 (0.4) 231 (50) 43 (9.4) 3 (0.6)

Acinetobacter 7 (0.4) 0 0 7 (0.5) 0 0 0 0 0

E. coli 152 (8.3) 0 0 116 (8.5) 0 0 36 (7.9) 0 0
Enterobacter 23 (1.3) 0 1 13 (0.9) 0 0 10 (2.2) 0 1 (0.2)
Enterococcus 232 (13) 70 (3.8) 3 (0.2) 128 (9.4) 32 (2.3) 3 (0.2) 104 (22.7) 38 (8.3) 0
K. pneumoniae 51 (2.8) 0 2 (0.1) 35 (2.5) 0 1 16 (3.5) 0 1 (0.2)
P. mirabilis 141 (7.7) 0 1 130 (9.5) 0 1 11 (2.4) 0 0
P. aeruginosa 68 (3.7) 0 1 47 (3.4) 0 0 21 (4.6) 0 1 (0.2)
S. marcescens 8 (0.4) 0 0 8 (0.6) 0 0 0 0 0
Staphylococcus 53 (3) 5 (0.3) 0 33 (2.4) 0 0 20 (4.4) 5 (1) 0
Streptococcus 14 (0.8) 1 0 14 (1) 1 0 0 0 0
MDR, multidrug-resistant (≥3 antimicrobial classes); XDR, extensive drug resistance (resistance to all but two of the tested antimicrobial categories); PDR, pan-
drug (resistance to all the categories tested).

F I G U R E 3 Comparison of antimicrobial resistance frequencies (% of sensitivity) in Gram-negative bacteria isolated from dogs and cats
with urinary tract infections. *Significant differences (p < 0.05). Amoxicillin-clavulanic (AMC), ampicillin (AMP), cefoxitin (FOX), cephalexin
(LEX), cefazolin (CFZ), cephalotin (CEF), cefuroxime (CXM), ceftazidime (CAZ), cefotaxim (CTX), cefovecin (CVN), cefepime (FEP), imipenem
(IPM), meropenem (MEM), ciprofloxacin (CIP), enrofloxacin (ENR), marbofloxacin (MFX), pradofloxacin (PRA), amikacin (AMK), gentamicin
(GEN), tobramycin (TOB), doxycycline (DOX), fosfomycin (FOF), nitrofurantoin (NIT), and trimethoprim/sulphamethoxazole (SXT)

F I G U R E 4 Comparison of antimicrobial resistance frequencies (% of sensitivity) in Gram-positive bacteria isolated from dogs and cats
with urinary tract infections. *Significant differences (p < 0.05). Amoxicillin-clavulanic (AMC), ampicillin (AMP), cephalexin (LEX), cefazolin
(CFZ), cefuroxime (CXM), cefotaxim (CTX), cefovecin (CVN), imipenem (IPM), meropenem (MEM), ciprofloxacin (CIP), enrofloxacin (ENR),
marbofloxacin (MFX), pradofloxacin (PRA), amikacin (AMK), gentamicin (GEN), tobramycin (TOB), doxycycline (DOX), erythromycin (ERY),
fosfomycin (FOF), nitrofurantoin (NIT), trimethoprim/sulphamethoxazole (SXT), and vancomycin (VAN)
6 of 8
cat isolates presented lower susceptibility levels
than dogs for the following compounds: cephalexin,
cefovecin, imipenem, amikacin, doxycycline, fos-
fomycin, and trimethoprim/sulphamethoxazole. A
similar picture of the AMR pattern was observed for
the Staphylococcus isolates but with a lower level of
resistance than the Enterococcus (Figure 4).
DISCUSSION
Limited data on antimicrobial resistance in bacteria
isolated from companion animals with UTI is pub-
lished in Spain. In this study, we investigated the
microbiological results and the antimicrobial resis-
tance patterns of UTI in dogs and cats in different
regions of Spain. The results of this study confirm that
urine samples from dogs with suspicion of UTI have
a higher percentage of positive microbiological diag-
noses than the cat specimens (42% vs. 27%). Similar
to other works published in Europe, E. coli was the
most frequently isolated bacterium in both cats and
dogs, followed by Enterococcus spp. in cats17 and P.
mirabilis in dogs.2,10,18 Although E. coli was the most
common pathogen found in this study, the overall
resistance frequencies of MDR isolates were low (8%)
in comparison to other studies.10,18 By contrast, other
bacterial pathogens such as Enterococcus spp., K.
pneumoniae, P. aeruginosa, E. cloacae, and P. mirabilis
displayed higher frequencies of MDR, XDR, and PDR
profiles with great concern to both public and animal
health.19–21
Antimicrobial agents such as amoxicillin-clavulanic
acid, trimethoprim/sulphamethoxazole, tetracycline,
and cephalexin are reported to be effective against
E. coli UTI.22 In this study, the E. coli isolates from
dogs and cats with UTI presented high levels of resis-
tance to ampicillin, first-generation cephalosporins
(cephalothin and cephalexin) and doxycycline as pre-
viously described.18 Moreover, 70% of E. coli strains
in dogs showed resistance to cephalotin and around
40% in cats resist to cefepime (fourth-generation
cephalosporin). Cephalothin is the most widely used
intravenously antibiotic in admitted ICU animals as
a pre- and post-surgical coverage. Besides, cephalexin
is the preferred antibiotic for dermal bacterial infec-
tions in dogs. Therefore, the overuse of first-generation
cephalosporins in veterinary medicine may contribute
to the passive selection of the E. coli resistant strains.
Although cefepime is not commonly used in the treat-
ment of infectious diseases of small animals, a high
resistance to this antibiotic has been observed in cat
urinary infections. This poses a threat to public health
due to the potential transmission between cats and
their owners, compromising the effectiveness of the
last resort antibiotic for human medicine.
Conversely, the high frequencies of antimicrobial
susceptibility testing for amoxicillin acid–clavulanic
acid and trimethoprim/sulphamethoxazole can repre-
sent good alternatives in the treatment of E. coli UTIs.
In addition, the overall results of the present study,
except for those antibiotics to which particular bac-
Veterinary Record
terial species, such as Proteus and Pseudomonas spp.,
are intrinsically resistant, indicate that antimicrobial
sensitivity is low for fluoroquinolones in Klebsiella,
Proteus and Pseudomonas spp., and for carbapenems
in Enterococcus spp. Moreover, this lower suscepti-
bility was observed more frequent in bacterial spp.
isolated from cats. The use of fluoroquinolones is
widespread given its effectiveness and simplicity of
dosing. Therefore, the resistance to conventional
antibiotics might force the clinician to use other ones
such as carbapenems that are used as drug of last
resort for human medicine.23 Scant data on prescrib-
ing patterns and little guidance regarding appropriate
use of carbapenems are reported in small animal
veterinary medicine, but treatment durations longer
than typically recommended in human medicine have
been reported recently.24 On the other hand, differ-
ences found in the level of resistance to members of
the same antimicrobial class (such as enrofloxacin vs.
ciprofloxacin, or imipenem versus meropenem) might
be explained by overuse of some of these compounds
in the clinical veterinary practice.
According to our study, Staphylococcus spp. isolated
from cats were less sensitive to common beta-lactams,
which are used to treat complicated UTIs such as
amoxicillin-clavulanic acid or cefovecin. Moreover,
Klebsiella and Pseudomonas spp. presented high
resistance frequencies to beta-lactams, including
third-generation cephalosporins (3GC), and fluoro-
quinolones, with an evident predominance of K. pneu-
moniae isolates from cats. Recently, high-risk K. pneu-
moniae strains with a pattern of 3GC MDR has been
reported in companion animal with UTI in Portugal.25
Interestingly, these 3CG-resistant K. pneumoniae
clonal linages isolated from companion animals over-
lapped with the most common high-risk clonal linages
previously detected from human infections.21 Since
most of the UTI bacterial species found in companion
animals of this study have a zoonotic potential risk, it
would be recommended to conduct extreme hygiene
practices and preventive protocols under the One
Health approach to control the dissemination of MDR
bacteria between pets and humans.
The overall analysis of antimicrobial sensitivity test-
ing of this work reveals that strains isolated from cats
with UTI presented higher susceptibility profiles than
the dog isolates. A possible explanation of this finding
could be that cats are less sensitive to undergoing
bacterial-related UTIs, and most of the cases show-
ing lower urinary tract signs principally in young to
middle-aged cats.26 are caused by non-infectious
agent as feline idiopathic cystitis, urolithiasis,
nephrolitiasis,4 urethral plugs or strictures, trauma,
and neoplasia.26–28 On the other hand, older cats are
more commonly affected by bacterial UTI because of
concurrent diseases such as chronic kidney disease,
diabetes mellitus, and hyperthyroidism that cause
dilute urine and/or impair immune competence.29
Therefore, to the author knowledge, urine samples
submitted to the laboratory are likely from cats highly
treated with different antimicrobial agents commonly
used for the treatment of complicated UTIs. That
Veterinary Record
could explain the high levels of AMR found in cat iso-
lates from the present study. Therefore, antimicrobial
treatments should not be applied without having a
confirmed microbiological diagnosis beforehand, and
especially in cats, since this praxis can contribute to
increase the selection of MDR strains.
In conclusion, following the international guide-
lines of antimicrobial treatment of UTI,4 the
results of this study support the use of first-line
agents like amoxicillin-clavulanic acid or trimetho-
prim/sulphamethoxazole for the treatment of UTI
without complications (i.e. sporadic bacterial cys-
titis), principally those caused by E. coli. On the
other hand, the use of fluoroquinolones, long acting
cephalosporins (cefovecin), or carbapenems are not
recommended for routine use of most UTIs without
complications. These drugs should be reserved for
treatment of resistant infections or for sporadic cys-
titis where first-line agents are not appropriate based
on culture and susceptibility testing results or patient
factors. Particularly, fluoroquinolones could be used
as first-line agents for treatment of pyelonephritis and
prostatitis, and carbapenems should be only reserved
for ESBL-producing Enterobacteriaceae or MDR P.
aeruginosa infections.4,30
In this study, data on clinical history such as severity
of the type of UTI and antimicrobial usage were not
available. Also, some cases might have been treated
empirically prior to diagnosis and susceptibility test-
ing. Furthermore, the use of laboratory data may rep-
resent a bias towards resistance since urine cultures
from complicated cases tend to be requested more
often than simple, uncomplicated UTI.2,10,31 On the
other hand, since isolates that exhibited intermediate
resistance were classified as resistant, the resistance
levels of the tested strains might be overvalued.
Despite of these limitations, the results of this study
provide relevant and updated data on the current
antimicrobial resistance in UTI bacteria from com-
panion animals in Spain. These data together with
sound clinical judgment can be used as a guide for
the empirical treatment of companion animals while
waiting for susceptibility testing or when it is not
feasible.
ACKNOWLEDGEMENTS
The authors would like to thank to the Echevarne Lab
informatics for the data extraction and J.P. Garrido
(Forestal Catalana) for the map design.
CONFLICT OF INTEREST
The authors declare that there is no conflict of interest.
ORCID
Laila Darwich https://orcid.org/0000-0001-9027-
9452
Chiara Seminati https://orcid.org/0000-0002-9177-
4874
Rafael A. Molina-López https://orcid.org/0000-
0002-9043-2346
7 of 8
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How to cite this article: Darwich L, Seminati C,
Burballa A, et al. Antimicrobial susceptibility of
bacterial isolates from urinary tract infections in
companion animals in Spain. 2021;e60.
https://doi.org/10.1002/vetr.60