EC25S-086: Individualized antibiotic treatment durations guided by SAA concentrations in cats with acute pyelonephritis

(Resubmit) This project investigates the use of serum amyloid A (SAA), a systemic inflammatory biomarker, to optimize antibiotic use in cats with pyelonephritis. Pyelonephritis, a bacterial infection of the kidneys, is an important cause of kidney injury in cats associated with good clinical outcomes with appropriate treatment. However, evidence is lacking to guide antibiotic treatment durations in cats with pyelonephritis despite expert consensus guidelines advocating for shorter treatment durations to avoid prolonged antibiotic exposures and to minimize the risk of bacteria developing antibiotic resistance. Compared to the short antibiotic treatment durations in people with pyelonephritis, antibiotic treatment durations remain prolonged in cats.
Systemic biomarkers are increased in people with pyelonephritis and offer a monitoring tool to assess antibiotic response. Recent studies have reported significantly increased SAA concentrations in cats with pyelonephritis compared to other causes of feline kidney injury, including our recent study that found SAA concentrations returned to normal in association with antibiotic treatment and concurrent clinical improvement. However, using SAA concentrations to tailor antibiotic treatment durations or the clinical performance of a point-of-care SAA assay has not been investigated in cats with pyelonephritis. A point-of-care SAA assay would provide more timely results and be more economical for serial monitoring.
This pilot study evaluates if SAA concentrations, in conjunction with clinical improvement, can be used to determine the duration of antibiotic therapy in cats with pyelonephritis. The results of this study may provide clinicians with additional tools to individualize antibiotic prescribing in cats with pyelonephritis and avoid unnecessary antibiotic exposures.
[Kidney Disease Fund in honor of Vicki Thayer, DVM, DABVP (Feline)]