# An Observational Study on the Diagnosis and Antibiotics Prescription in Cats with Lower Urinary Tract Disease by Veterinarians in Italy

## TL;DR

This study explores how Italian veterinarians diagnose and treat cat urinary tract diseases, highlighting differences in practices and overuse of antibiotics.

## Contribution

The study reveals widespread antibiotic use and inconsistent adherence to guidelines in diagnosing feline urinary tract disease among Italian veterinarians.

## Key findings

- Most veterinarians rely on clinical signs and urinalysis rather than urine culture for diagnosis.
- Antimicrobials are frequently prescribed despite low bacterial infection rates in cats.
- Larger veterinary facilities show better alignment with evidence-based practices.

## Abstract

This study investigated the diagnostic and therapeutic approaches to feline lower urinary tract disease among Italian veterinarians, emphasizing variations across small clinics, large clinics, and veterinary hospitals. Data were collected through an anonymous questionnaire completed by 317 veterinarians. The primary diagnostic criteria chosen by responders included clinical signs and urinalysis, while urine culture and sensitivity were infrequently performed. Despite the low reported percentage of bacterial cystitis in cats with lower urinary tract signs, antimicrobials were widely prescribed. Deviations from established guidelines were identified, underscoring the necessity for enhanced education on diagnostic procedures, antimicrobial selection, and treatment duration to promote effective antimicrobial stewardship.

Feline lower urinary tract disease (FLUTD) is a frequent diagnosis in cats, with bacterial causes constituting a minor percentage of cases. This observational study aimed to assess the diagnostic and therapeutic approaches to FLUTD among Italian veterinarians and explore variations in different workplaces. Data were collected via an anonymous survey completed by 317 veterinarians from small clinics (SC), large clinics (LC), and veterinary hospitals (VH). Results revealed that approximately half of respondents relied on clinical signs and urinalysis for diagnosis, while fewer incorporated abdominal ultrasound. Urine culture and sensitivity (UCS) testing was infrequently performed, primarily due to financial and logistical constraints, with higher compliance in VH practitioners. Antimicrobials were widely employed, with enhanced penicillins being the most prescribed class. The frequent empirical use of quinolones raises concern regarding gaps in antimicrobial stewardship. Despite some adherence to the ISCAID guidelines, discrepancies in diagnostic rigor, antimicrobial selection, and treatment duration were observed. Larger facilities demonstrated greater alignment with evidence-based practices, emphasizing the need for widespread education on appropriate antimicrobial use. This study underscores the importance of integrating guideline-based diagnostics and stewardship in managing feline urinary tract diseases.