Surgical correction of pyelonephritis caused by multidrug-resistant Escherichia coli in a dairy cow

A four-year-old red Holstein Friesian cow was admitted to the clinic with fever and milk drop. Blood analysis revealed the presence of a chronic infection, and the diagnosis of pyelonephritis of the right kidney was made after repeated ultrasound examinations. The animal was treated with procaine benzylpenicillin, sulfadoxine trimethoprim, oxytetracycline and enrofloxacine but this therapy was not successful. Nephrectomy was performed after the left kidney proved to have a normal function. The removed right kidney was greatly enlarged and filled with pus. Escherichia coli was isolated from the kidney. The strain was multidrug-resistant, including resistance to aminopenicillins, streptomycin, sulfonamides and trimethoprim. The cow was treated with amoxicillin and clavulanic acid after the operation. Postoperatively, an abscess developed and a tube drain was placed during a second surgery to enable daily rinsing with a chlorhexidine solution. After a postoperative care period of two months, the animal was sent back to the farm, where it returned to an acceptable level of milk production. This case demonstrates that with basic surgical skills, a good preparation and knowledge of anatomy, nephrectomy is attainable for a first-opinion veterinarian, with an acceptable economic prognosis for the farmer