Diagnostic and stewardship considerations in fungal lower urinary tract infections of dogs and cats
Cameron Prior, Jane E Sykes, Vanessa R Barrs, Riina Rautemaa-Richardson, Lena Klingspor, Oliver A Cornely, Tamara Gull, Fergus Allerton, Nelesh P Govender, J Scott WeeseAbstract
Fungal cystitis in dogs and cats presents a diagnostic and therapeutic challenge, with implications for antifungal stewardship in veterinary medicine. Unlike bacterial cystitis, diagnostic pathways for fungal infection are less well-defined, and antifungal therapy is often empirical. This article discusses key considerations for the diagnosis and management of fungal urinary tract infections, including the interpretation of urine cytology, the potential role and limitations of fungal culture, and the value of species-level identification and antifungal susceptibility testing. Clinical, laboratory, and pharmacokinetic factors that influence treatment decisions are highlighted, alongside the effect of confounding host and iatrogenic risk factors. The article also explores current gaps in evidence, variability in laboratory capabilities, and opportunities for strengthening antifungal stewardship in veterinary practice. Rather than providing prescriptive recommendations, this work aims to raise awareness, facilitate informed decision-making, and guide future research and consensus-building efforts to improve outcomes for animals while contributing to broader antifungal stewardship initiatives.