Acute Puerperal Metritis Research Articles

Discrepancies of bovine haptoglobin concentrations between serum and plasma using two different anticoagulants and a colorimetric assay based on peroxidase activity.

Haptoglobin (Hp) is an emerging diagnostic marker in cattle, and knowledge of suitable sample types and measurement methods is important. The aims of this study were to compare the results of a colorimetric assay (CA) and an ELISA for bovine Hp using serum, EDTA plasma, and lithium-heparinized (LH) plasma, respectively, and to assess the diagnostic potential for puerperal metritis. In experiment 1, Hp was measured in pooled aliquots of serum (n = 10), EDTA plasma (n = 10), and LH plasma (n = 10) of 100 healthy fresh lactating dairy cows from 10 farms using both the CA and the ELISA. In experiment 2, five healthy and five cows with acute puerperal metritis were sampled, and Hp was determined using both assays for all three sample types. In experiment 3, aliquots of serum and LH plasma from cows in different lactation stages were transferred into plain, EDTA-coated, and LH-coated tubes and mixed before colorimetric analyses. Distilled water was also placed into each tube type and treated similarly. Plasma samples measured with the CA showed on average 2.3 (EDTA) and 2.5 (LH) times higher Hp concentrations compared with serum, whereas no differences were seen with the ELISA results between sample types. Based on a clinical cut-off value, both methods differentiated sick from healthy cows. Haptoglobin measurements with the ELISA were less precise compared with CA measurements due to high dilutions. No influence of the anticoagulants on the CA was observed. Due to measurement discrepancies between serum and plasma, CAs for bovine Hp based on peroxidase activity should be performed with serum, or specific reference ranges for plasma samples should be established. In this study, CA results obtained with LH plasma were more precise than results obtained with EDTA plasma. Both the CA and the ELISA are suitable diagnostic tools for the diagnosis of puerperal metritis, but CA measurements were more precise in this study.

Associations between days in the close-up group and milk production, transition cow diseases, reproductive performance, culling, and behavior around calving of Holstein dairy cows

The objective of experiment I was to evaluate the association between days in the close-up group (DINCU) and milk production, early lactation diseases, reproductive performance, and culling. In experiment II behavioral changes associated with DINCU were evaluated using a neck-mounted sensor (Smarttag neck, Nedap Livestock Management, Groenlo, the Netherlands). Cow-lactations of 28,813 animals from 14,155 individual cows of 2 farms in northern Germany and western Slovakia, calving between January 2015 and December 2020, were included in the study. After exclusion of cows with a gestation length <262 and >292 d and cows with >42 DINCU data from 8,794 and 19,598 nulliparous and parous cows, respectively, were available for final statistical analyses. To analyze the association between DINCU and second test-d 305-d mature-equivalent milk projection, linear mixed models were calculated. Binary data (i.e., clinical hypocalcemia, hyperketonemia, retained placenta [RP], acute puerperal metritis [APM], mastitis, left displaced abomasum [LDA], first service pregnancy risk) were analyzed using logistic regression models. To analyze the association between DINCU and culling or death during the first 300 DIM Cox proportional hazards were used. To analyze the association between DINCU and behavior 7 d before to 7 d after calving (i.e., activity, inactivity, eating, ruminating time), linear mixed models were calculated. Nulliparous cows with a short (<10 DINCU) and a long stay (>30 DINCU) in the close-up group had a lower milk production an increased risk for hyperketonemia, RP, and APM compared with nulliparous cows with DINCU between 21 to 28 d. Parous cows with a short (<10 DINCU) and a long stay (>30 DINCU) in the close-up group had a lower milk production, an increased risk for RP and mastitis, a reduced first service pregnancy risk, and an increased culling risk, compared with parous cows with DINCU between 21 to 28 d. Furthermore, the risk for clinical hypocalcemia and LDA was increased in parous cows with >30 DINCU compared with parous cows with <30 DINCU. The risk for APM was increased in parous cows with <10 DINCU compared with parous cows with >10 DINCU. In nulliparous cows no association was found between DINCU and the risk for left displaced abomasum and mastitis. In experiment II, cows with 7 and 35 DINCU had an impaired behavior around calving compared with cows with 14, 21, and 28 DINCU. During the last 7 d before parturition, these cows were more inactive and had a reduced eating and ruminating time. After calving, cows with 7 DINCU spent less time eating. In conclusion, cows with <10 DINCU and cows with >30 DINCU had a lower milk production, a higher risk to incur diseases and an impaired behavior, especially before calving.

Mortality and culling of adult dairy cows in Jordan: A 3-year study (2016-2018) based on a single intensively managed dairy farm.

Dairy cow mortality and culling are important parameters reflecting on cow health, productivity, and welfare as well as important determinants of herd sustainability, growth, and profitability. There are no published reports on the causes and rates of mortality and culling of dairy cows in Jordan. Therefore, the objectives of this study were to determine the most common causes and rates of mortality and culling of adult dairy cows in Jordan using a single well-managed dairy farm as a model over 3 years. Data extracted from the farm management record software over 3 years (January 2016-December 2018) were used in this study. Cow-specific data included the date and month of sale, death or euthanasia, age, parity, reproductive status, and daily milk yield. Cow health-specific data included physical examination findings, presumptive diagnosis, medical or surgical treatments, postmortem findings, and any available laboratory findings. Descriptive analysis was performed to determine means (± standard deviation) and frequencies of various variables using Excel Spreadsheets of Microsoft Word 10. The 3-year rolling cow population in the farm used in the study was 500 ± 35. The overall mortality and culling rates were 5.9% and 28.5%, respectively. The mean age of died and culled cows was 3 ± 1.2 and 4 ± 1.5 years, respectively. The mortality rates were highest in the colder months (January through April). The most frequent causes of mortality were infectious diseases (28%), followed by non-infectious gastrointestinal diseases (25%), udder and teat diseases (mastitis 22%), and other diseases/accidents (25%). Of the infectious diseases, the most frequently diagnosed were enterotoxemia (12%), tuberculosis (TB) (8%), enteric salmonellosis (7%), and paratuberculosis (1%). The most frequently diagnosed non-infectious gastrointestinal diseases were traumatic reticulitis (11%), vagal indigestion (9%), and abomasal ulcer (5%). The most frequently diagnosed diseases causing mortality involving other body systems were reproductive diseases (acute puerperal metritis 6%), respiratory diseases (pneumonia 5% and pulmonary embolism 1%), metabolic diseases (fatty liver 3%), musculoskeletal diseases (septic arthritis 3% and downer cow syndrome 4%), neurologic diseases (unspecified causes 2%), and finally accidents (electrocution 1%). The most frequent causes of culling were old age/low milk production (39%), followed by the poor reproductive performance (31%), diseases/accidents (24%), and unidentified causes (6%). The most frequent diseases/accidents causing culling were udder diseases (mastitis 32%), followed by non-infectious gastrointestinal diseases (28%) (vagal indigestion [15%], rumen tympany [7%], and abomasal ulcer [6%]), musculoskeletal diseases (23%) (foot and claw diseases [7%], downer cow syndrome [7%], hip luxation [5%], septic arthritis [2%], and gastrocnemius rupture [2%]), respiratory diseases (pneumonia 10%), and finally infectious diseases (9%) (paratuberculosis [3%], hemorrhagic bowel syndrome [2%], and TB [2%]). Results of this study showed that the majority of deaths and culling of dairy cows in Jordan are due to infectious diseases followed by non-infectious gastrointestinal diseases and mastitis. More efforts aiming at improving biosecurity standards, nutritional management, and mastitis prevention measures are required to limit the impact of disease on farm economy, animal health and productivity, and animal welfare in Jordan.

Complementary and Alternative Treatments for Postpartum Uterine Diseases in Dairy Cows

The goal of treating postpartum uterine diseases in dairy cows is to reach clinical cure in a reasonable amount of time and to improve reproductive performance while minimizing milk and meat residue issues. The ultimate goal is to reduce the economic losses caused by uterine diseases. This article focuses on postpartum uterine diseasess in dairy cows, in particular acute puerperal metritis, pyometra and endometritis. The usual treatment approach for these conditions is systemic or local antibiotic therapy to control bacterial growth. Based on clinical signs and bacteria identification using dependent- and independent-based methods, antibiotic use appears to be the most logical and effective therapeutic approach. However, despite considerable research, the treatment of uterine diseasess remains a subject of considerable controversy in the literature. Although some local and systemic antibiotic therapies are effective at mitigating the consequences of postpartum uterine diseases, antibiotic use in the current global context is a serious concern because it is associated with selective pressures on bacteria and the emergence of resistant bacteria in humans and animals. Research on mucosal immunology and the genital microbiota of cows has improved our understanding of uterine involution and how pathological agents behave during uterine diseases in dairy cows. And while antibiotic therapy remains the most common therapeutic option chosen by veterinarian practitioners to treat PUDs, complementary and alternative veterinary medicine is increasingly being considered in response to a demand from animal owners. However, because of the small number of randomized clinical trials and a lack of evidence-based medicine, there is widespread concern regarding the adequacy of evidence for the efficacy and safety of complementary and alternative veterinary medicine. The objectives of this article are to describe uterine involution and the main postpartum uterine diseases that occur during the postpartum period in dairy cows, briefly review the current approaches to treating postpartum uterine diseases, and critically review the evidence pertaining to complementary and alternative veterinary medicine in postpartum reproductive veterinary medicine.

Potential Benefits to Dairy Cow Welfare of Using a Ceftiofur-Ketoprofen Combination Drug for the Treatment of Inflammatory Disease Associated with Pyrexia: A Field Clinical Trial on Acute Puerperal Metritis.

Simple SummarySome diseases of dairy cows require the use of an antimicrobial and an anti-inflammatory drug in association to be fully cured and relieve pain. However, pharmacological treatments in cattle are subject to strict regulations and restrictions, and cow handling is not always easy and safe. For these reasons, only the antimicrobial is often administered, thus not fully applying the appropriate therapeutic protocol. This study investigated whether the use of a drug combining ceftiofur and ketoprofen in a single injection instead of ceftiofur alone can improve the healing and welfare of dairy cows affected by a pyretic inflammatory disease, such as acute puerperal metritis. The results show that the variation in the physiological parameters was similar between the two treatment groups, and daily activity and milk yield did not differ from healthy cows. However, affected cows that were treated with the combined drug seemed to be more likely to become pregnant within 120 days in milk than those that received the antimicrobial alone, having an estimated number of days open more similar to that of the healthy cows.This study aimed at investigating the benefits of using a drug combining ceftiofur and ketoprofen in a single injection on dairy cow welfare in the case of inflammatory disease with pyrexia, such as acute puerperal metritis (APM). Cows of an Italian dairy farm were examined between 5 and 14 days of calving: those with APM were randomly treated either with combined ceftiofur–ketoprofen (CD) or ceftiofur alone (C), starting from Day 0, and an equal number of healthy cows served as a control (CTR). Clinical examination and blood sampling were performed until Day 7 in each group according to specific schedules. Daily cow activity was recorded until Day 14 and daily milk production until Day 30. Additional data on fertility were collected until 120 days in milk (DIM). Data of 20 cows per group were analyzed. Body temperature and haptoglobin concentration dropped between Day 0 and 4 in both CD and C, approaching the level of CTR. The cure rate at Day 7 (body temperature < 39.0 °C) was 65 (CD) and 55% (C), without statistical difference. Neither cow activity nor milk production differed among the three groups. Reproductive performances in both CD and C were similar to CTR, but CD cows were 2.8 times more likely to be pregnant within 120 DIM than C, becoming pregnant about 14 days sooner. Both treatments (CD and C) have been effective in bringing the cows back to health conditions (CTR), and further studies would be needed to confirm the positive effect observed for CD on days open of the affected cows.

Association between serum calcium dynamics around parturition and common postpartum diseases in dairy cows

The objective of this study was to compare periparturient serum Ca dynamics (CaDyn) in cows with and without diseases in early lactation. The study enrolled 1,949 cows from a commercial dairy farm in northern Germany. Blood samples were drawn 7 d before expected calving date and on d 0, 1, 3, and 7 after calving and analyzed for serum Ca concentration. Cows were monitored for clinical hypocalcemia (CH), ketosis, left displaced abomasum (LDA), retained placenta, acute puerperal metritis (APM), mastitis, and pneumonia. To evaluate the association between CaDyn and diseases during the transition period, repeated measures ANOVA with first-order autoregressive covariance were performed. Serum CaDyn of healthy cows (i.e., without any of the aforementioned diseases) was compared with CaDyn of cows with one of the aforementioned diseases (CH, ketosis, APM, mastitis, LDA, and pneumonia), and cows with multiple diseases (CH+, ketosis+, APM+, mastitis+, LDA+, and pneumonia+). Separate models were built for primiparous and multiparous cows. For primiparous cows, we evaluated the association between CaDyn and ketosis (healthy cows vs. cows with ketosis vs. cows with ketosis+) and CaDyn and APM (healthy cows vs. cows with APM vs. cows with APM+). The same models were built for multiparous cows. Three additional models were built for multiparous cows to evaluate the association between CaDyn and CH (healthy cows vs. cows with CH vs. cows with CH+), mastitis (healthy cows vs. cows with mastitis vs. cows with mastitis+), or LDA (healthy cows vs. cows with LDA vs. cows with LDA+). In primiparous cows, serum Ca concentrations of cows with ketosis, APM, and APM+ were significantly reduced on d 3 and 7 after calving, compared with healthy cows. Serum Ca concentrations of primiparous cows with ketosis+ were reduced on d 3, but not on d 7 after calving. Multiparous cows with CH had significantly reduced serum Ca concentrations on d 0, 1, and 3 compared with healthy cows. On d 3 and 7, serum Ca concentration of CH+ cows was significantly reduced compared with healthy multiparous cows. Multiparous cows with ketosis and ketosis+ had significantly reduced serum Ca concentrations on d 1 and 3 compared with healthy cows. Cows with APM+ had significantly increased serum Ca concentrations on d 0 and reduced serum Ca concentrations on d 3, compared with healthy cows. Whereas multiparous cows with mastitis had a reduced serum Ca concentration on d 1, mastitis+ cows had a reduced serum Ca concentration on d 1 and 3, compared with healthy multiparous cows. Overall, multiparous cows with LDA+ had reduced serum Ca concentrations. Especially a delayed onset of hypocalcemia (d 3 and 7) was indicative for the development of disease in primiparous cows. In multiparous cows, reduced serum Ca concentrations on d 1 and 3 were associated with occurrence of diseases. Future studies should evaluate whether reduced serum Ca concentrations are a cause or concomitant circumstance of diseases in early lactation.

A Novel and Sensitive LC-MS/MS Method for the Quantitation of Ceftiofur in Pharmaceutical Preparations and Milk Samples.

In the present study, a sensitive and selective liquid chromatographytandem mass spectrometry (LC-MS/MS) method was described for the determination of ceftiofur (CEF) in cow milk and pharmaceutical preparations. CEF is an antibiotic compound, which is commonly used in the treatment of animal diseases such as respiratory system, soft tissue, and foot infections, as well as postpartum acute puerperal metritis. One of the critical features of CEF is its prescription while breastfeeding cows; in accordance, its quantitative estimation is essential to assess its residual amounts. In the method reported herein, after simple protein precipitation using acetonitrile, the pre-treated samples were introduced into an LC-MS/MS instrument equipped with a Chromolith® High-Resolution RP-18 series HPLC column (100 mm × 4.6 mm from Merck KGaA, Germany). Electrospray ionization was employed as the ionization source in the triple-quadrupole tandem mass spectrometer. For the calibration method using solvent-based standards, LOQ was 3.038 ng/mL, 12.15 ng/mL, and LOD was 1.215 ng/mL and 6.076 ng/mL for ESI+ and ESI- modes, respectively. On the other hand, for the method of matrix-matched standards, LOQ was 1.701 ng/mL, 10.13 ng/mL, and LOD was 0.486 ng/mL and 5.929 ng/mL for ESI+ and ESI- modes, respectively as obtained from signal to noise ratio. Applicability of both positive and negative ion modes was tested, and the analyte was detected via multiple reaction monitoring. The distorting effects of the milk matrix on the MS ionization and quantitation of CEF were overcome by using matrix-matched calibration for the first time.

Serum calcium dynamics within the first 3 days in milk and the associated risk of acute puerperal metritis

The objectives of this study were to evaluate postpartum serum calcium dynamics for different parity groups of dairy cows and to assess whether serum calcium concentration on d 0, 1, and 3 postpartum was associated with the risk of developing acute puerperal metritis (APM). The study took place on a commercial dairy farm in northern Germany and included 4,043 Holstein dairy cows. Calving difficulties, such as dystocia, twins, or stillbirth, were recorded. Blood samples were obtained on d 0, 1, and 3 after calving for analysis of serum calcium concentration. Animals were examined daily for clinical symptoms of retained placenta, APM, mastitis, and displaced abomasum until 10 d in milk. To determine serum calcium dynamics postpartum, we performed repeated-measures ANOVA with first-order autoregressive covariance. A logistic regression model was used to evaluate the association of serum calcium concentration with the risk of developing metritis. Serum calcium concentration was affected by time relative to calving, parity, and APM. Increasing parity negatively affected serum calcium concentration on d 0 and 1. Serum calcium concentration reached its lowest level on d 1 and 3 in multiparous and primiparous cows, respectively. The concentration increased from d 1 to 3 in multiparous cows and decreased from d 0 to 3 in primiparous cows. The association of APM and serum calcium dynamics varied by parity. On d 3, serum calcium concentration was significantly lower in animals with subsequent APM than in those without APM. The overall incidence of APM was 12.0% (primiparous cows, 20.4%; multiparous cows, 8.6%). An association existed between serum calcium concentration on d 3 after calving and APM. Primiparous cows had an odds ratio of 0.12 for serum calcium concentration on d 3, indicating that a primiparous cow with serum calcium concentration of 2.5 mmol/L had a 88% lower chance of developing APM compared with a cow with a concentration of 1.5 mmol/L. Multiparous cows had an odds ratio of 0.34 for serum calcium concentration on d 3, indicating that a multiparous cow with serum calcium concentration of 2.5 mmol/L had a 66% lower chance of developing APM compared with a cow with a concentration of 1.5 mmol/L. Primiparous cows with low serum calcium concentration had the highest predicted probability of developing APM. Our results reveal a dynamic in serum calcium concentration in the first 3 d in milk. Consequently, the day of sampling and the observed risk period for hypocalcemia are important when conducting epidemiological studies to evaluate associations between hypocalcemia and clinical diseases.

Effects of Ketoprofen Administration on Relation between Acute Phase Proteins and Metabolic Parameters in Cows during Early Lactation

Background: Acute phase proteins (APPs) are clinically useful parameters for measuring the occurrence and severity of inflammatory responses in cattle. As large group of proteins, APPs are mainly secreted by hepatocytes whose concentration increase or decrease as response to tissue injury, inflammation or infection. The transition from late pregnancy to early lactation is associated with a compromised immune status coupled with increased acute phase response. Non-steroidal anti-inflammatory drugs (NSAIDs) are used in treatment of inflammatory conditions. The main objective of the present study was to analyze the effects of a preventive administration of the NSAID (ketoprofen) in post-calving dairy cows on concentration of APPs (haptoglobin and fibrinogen) and their relationship with indicators of liver function.Materials, Methods &amp; Results: The treatment group (n = 15) was given an intramuscular injection of ketoprofen in the concentration of 3 mg/kg during three consecutive days after calving. The control group (n = 15) was not treated with ketoprofen. Blood samples were taken from coccygeal vein, on the first day of treatment and in the first and second week postpartum and they were analyzed for metabolic parameters (albumin and aspartat aminotransferaze) and APPs such as haptoglobin and fibrinogen. Compared with control, ketoprofen administration decrease the levels of haptoglobin and fibrinogen and AST activity. Increase in albumin concentration was recorded in experimental group of cows compared with control. Negative correlations (P &lt; 0.01) were found between the haptoglobin concentration and albumin concentration and aspartate aminotransferaze activity. Discussion: As inflammatory indicator in dairy cows, it is recorded that serum concentrations of haptoglobin is increased during mastitis. Beside haptoglobin, fibrinogen represents one of the APPs whose serum concentration increases during response in the acute phase. During the first and second week after partus, in cows with acute puerperal metritis, an increase in fibrinogen concentration was observed in relation to clinically healthy animals. Based on our results, it can be concluded that an intramuscular injection of ketoprofen (3 mg × kg. bw.-1) administered in cows in the first days following parturition reduces the concentration of some APPs (haptoglobin and fibrinogen). In regard to Hp concentration, the treatment success agreed with previous results using i.m. acetyl-lysine salicylate during the first 5 days of lactation. Reduction in APPs concentration in our research results could be attributed to the anti-inflammatory effect of ketoprofen. In addition, use of ketoprofen reduces the intensity of relationship between inflammatory markers and indicators of liver funcition. Impaired functional capacity of the liver may be associated with reduced albumin concentration in the peripartal period, and during inflammatory or infectious diseases. Increase in albumin concentration in experimental group of cows compared to the control in our research could be attributed to the anti-inflammatory effect of ketoprofen. Hence it can be concluded that the use of ketoprofen immediately after calving reduces the intensity of relationship between inflammatory marker liver function and that NSAID treatment could be used in in improving animal well-being and controlling of the occurence and intesity of postpartum diseases.

Randomized clinical trial of ceftiofur hydrochloride treatment to prevent acute puerperal metritis in dairy cows having Escherichia coli in their uterus at day 1 postpartum

Ceftiofur is a class 1 antibiotic (World Health Organization classification) and there is an increasing pressure from the veterinary and medical bodies to revisit its use for treating and preventing diseases in dairy cows such as acute puerperal metritis (APM). The presence of Escherichia coli (E. coli) in the uterus of dairy cows at day 1 postpartum was shown to increase by 3 the risk of subsequently developing APM. Unfortunately, there are no data describing the efficacy of ceftiofur treatment to prevent APM in the subset of cows with E. coli in their uterus at day 1 postpartum. Therefore, the objective of the study was to quantify the efficacy of ceftiofur treatment in dairy cows with E. coli in their uterus at day 1 postpartum to prevent APM.

Reducing the incidence of acute puerperal metritis in primiparous cows by application of pegbovigrastim in a Holstein dairy herd

In dairy cows, immunosuppression occurs frequently during the periparturient period and is characterised by transient neutropenia and impaired polymorphonuclear neutrophil function. As a consequence, postpartum cows are more susceptible to production-related diseases such as mastitis, retained foetal membranes and metritis. Recently, it has been shown that a double injection with recombinant bovine granulocyte colony-stimulating factor covalently bound to polyethylene glycol (PEG rbG-CSF) increased polymorphonuclear neutrophil number and the exocytosis of myeloperoxidase by stimulating polymorphonuclear neutrophil, which also played a role in innate uterine immune defence. The aim of this randomised clinical study was to investigate the effects of two periparturient PEG rbG-CSF injections (IMR; Imrestor&lt;sup&gt;TM&lt;/sup&gt;, Elanco Animal Health, Bad Homburg/Germany) on the incidence of acute puerperal metritis, number of antibiotic doses required for treatment of acute puerperal metritis as well as parameters of milking performance (i.e., milk yield, milk fat, milk protein, and somatic cell count on the first dairy herd improvement test day) in primiparous cows within a dairy herd with an elevated incidence of acute puerperal metritis. In total, 169 heavily pregnant heifers were randomly assigned to the treatment group (IMR: n = 82) who received 15 mg PEG rbG-CSF subcutaneously 10 ± 3 days before the anticipated calving date and within 24 hours after calving, or to the untreated control group (Co: n = 87). In total, data from 157 animals (IMR: n = 75, Co: n = 82) were analysed. Administration of PEG rbG-CSF reduced the incidence of acute puerperal metritis in primiparous cows significantly (IMR: 22.7%, Co: 43.9%, P = 0.003; relative reduction: 48.3%). Moreover, the number of antibiotic doses per calving required for treatment of acute puerperal metritis was significantly lower in the pegbovigastrim group (IMR: 0.32 ± 0.66, Co: 0.59 ± 0.75, P = 0.005). No significant differences regarding incidence of clinical mastitis, milk production or milk composition were observed. These results suggest that further research should be performed to identify herd- and animal-specific factors that can be predictors of the beneficial effects of pegbovigrastim in preventing uterine diseases.

Minimum inhibitory concentrations of frequently used antibiotics against Escherichia coli and Trueperella pyogenes isolated from uteri of postpartum dairy cows

The objective of this study was to determine minimum inhibitory concentrations (MIC) of frequently used antimicrobials for Escherichia coli and Trueperella pyogenes isolated from postpartum bovine uteri of cows with acute puerperal metritis (APM, n = 67), cows suspected to have APM (n = 37), and healthy cows (n = 37) and to evaluate possible differences in MIC according to clinical signs. Cows with APM had reddish-brown, fetid vaginal discharge and rectal temperature (RT) ≥39.5°C within 21 d in milk; cows suspected to have APM had either reddish-brown, fetid vaginal discharge or RT ≥39.5°C within 21 d in milk; and healthy cows had neither fetid discharge nor RT ≥39.5°C. Samples were collected from cows on commercial dairy herds (n = 7) using the cytobrush technique. A total of 37 T. pyogenes isolates and 85 E. coli isolates were tested. Ceftiofur, a third-generation cephalosporin that is often used to treat APM, was the focus of analysis. Trueperella pyogenes and E. coli were isolated more often from samples of cows with APM (46 and 90%, respectively) compared with samples from healthy cows (19 and 54%, respectively). Regarding cows suspected to have APM, T. pyogenes and E. coli were numerically more often isolated (30 and 70%, respectively) than in healthy cows (19 and 54%, respectively). Minimum inhibitory concentrations of ceftiofur were low. For T. pyogenes and E. coli, MIC50 (concentration that inhibited growth of 50% of isolates) were 0.25 and 0.5 µg/mL and MIC90 (concentration that inhibited growth of 90% of isolates) were 0.5 and 1 µg/mL, respectively. Although ceftiofur inhibited all T. pyogenes at the highest concentration tested (64 µg/mL), the growth of 5.9% of E. coli was not impaired. Recently, ampicillin has been suggested as an alternative treatment for APM. Although the T. pyogenes isolates exhibited low MIC in general (MIC50 ≤0.015 µg/mL and MIC90 = 0.06 µg/mL) and 81.1% of all T. pyogenes could be inhibited at the lowest ampicillin concentration tested, 11.8% of the E. coli isolates were not impaired at the highest concentration (64 µg/mL) tested in this study. The MIC50 and MIC90 of E. coli were 4 and ≥128 µg/mL, respectively. We detected no difference in the MIC distributions of ceftiofur or ampicillin among isolates from the 3 APM groups. In summary, E. coli with high MIC against ceftiofur as well as against ampicillin were found in this study.

Efficacy of Non-steroidal Anti-inflammatory Drugs for the Treatment of Acute Puerperal Metritis in Dairy Cows

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Acute puerperal metritis (APM) is a potentially life threatening, painful disease and is often treated with third-generation cephalosporins (Machado et al., 2014; Stojkov et al., 2015). An increasing antibiotic resistance is well documented and associated with decreasing clinical efficacy, animal welfare and economic consequences (Thomson et al., 2004). Hence, there is the need to evaluate alternative therapies to antibiotics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; The objective of this study was to assess the efficacy of ketoprofen for the treatment of APM compared with ceftiofur hydrochloride.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and Methods:&lt;/strong&gt; A total of 610 dairy cows from 6 farms in Germany were enrolled. Inclusion criteria was a rectal temperature (RT) ≥ 39.5 °C and a reddish-brown fetid vaginal discharge within the first 10 DIM. Cows meeting the inclusion criteria were randomly allocated to treatment with ketoprofen (3 mg/kg of body weight, n = 300) or treatment with ceftiofur (1 mg/kg of body weight, n = 310), both administered on 3 consecutive days. Rectal temperature was recorded daily for a period of 7 days after enrollment. Cows that showed RT ≥ 39.5 °C on day 4 to 7 after inclusion received an extended treatment (extT) with ceftiofur for 3 (ketoprofen group) or 2 (ceftiofur group) more days. Between 21 and 40 DIM cows were examined with the metricheck device and vaginal discharge was categorized on a 5-point scale according to the presence of pus.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 52 cows (35 from ketoprofen group, 17 from ceftiofur group) were excluded from analysis due to missing protocol compliance (n = 37) or concurrent disease (n = 15). Cows initially treated with ketoprofen had higher odds of extT than cows treated with ceftiofur (61% vs 31%, OR 3.47, P &amp;lt; 0.01, n = 558). Occurrence of purulent vaginal discharge (PVD) was similar for both treatment groups. However, cows with extT had 2.12 (P &amp;lt; 0.01, n = 438) times the odds of PVD than cows without extended treatment. Treatment group did not affect milk yield, first artificial insemination pregnancy risk, time to first AI and time to pregnancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The results indicate that although cows initially treated with ketoprofen were more likely to receive extT, fewer doses of ceftiofur (1.83) were required compared with cows initially treated with ceftiofur (3.63). Consequently, there is considerable potential of reducing antimicrobial treatment by implementing a treatment protocol starting with ketoprofen.&lt;/p&gt;&lt;br /&gt; &lt;img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /&gt;

500 Appraisal of therapeutic efficacy of antibiotics and prostaglandin based protocol in Holstein cattle suffering from acute puerperal metritis (APM)

500 Appraisal of therapeutic efficacy of antibiotics and prostaglandin based protocol in Holstein cattle suffering from acute puerperal metritis (APM)

Metritis vaccination in Holstein dairy heifers using a herd-specific multivalent vaccine – Effects on uterine health and fertility in first lactation

In cattle, acute puerperal metritis (APM) compromises animal welfare and has an economic impact to the farmer because of the detrimental effects on reproductive performance, milk production, and survivability. The aim of this randomized clinical study was to investigate the effects of a prepartum immunization using a herd-specific multivalent vaccine on incidence of APM, prevalence of clinical endometritis (CE), and selected measures of reproductive performance in primiparous Holstein cows. Pregnant nulliparous cows (230±4days of gestation) assigned to the vaccinated group (VG; n=142) received subcutaneously 5.0mL of a multivalent herd-specific vaccine containing inactivated whole bacterial cells of Trueperella pyogenes, Escherichia coli, Streptococcus uberis, Bacteroides species, and Peptostreptococcus species obtained from uterine swabs of primiparous cows suffering from APM at the time of enrolment and three weeks later. Heifers allocated to the control group (Co; n=144) remained unvaccinated. Rectal temperature in the first 10days in milk (DIM) did not differ between treatments, and no interaction between treatment and day was observed (interaction treatment*day: p=0.623). Incidence of APM (VG, 46.0%, Co, 48.9%, p=0.588), number of antibiotic doses per cow to treat APM (VG, 0.63±0.81, Co, 0.64±0.75, p=0.496), prevalence of CE at 35 DIM (VG, 24.6%, Co, 19.3%, p=0.350), first service pregnancy per artificial insemination (VG, 40.3%, Co, 45.5%, p=0.541), number of inseminations until 150 DIM (VG, 2.0±1.4, Co, 1.9±1.3, p=0.749), interval from calving to first service (median days, VG, 52, Co, 52, p=0.915), and interval from calving to pregnancy (median days, VG, 90, Co, 83, p=0.419) did not differ between VG and Co. Treatment did not affect activity of aspartate aminotransferase (AST) and creatine kinase (CK) or concentrations of beta-hydroxybutyrate (BHB) and haptoglobin in serum samples collected at 5 DIM. Furthermore, treatment did not influence yields of milk, fat or protein in the first 100 DIM. Moreover, no signs that vaccination provided an attenuation of severity of the APM cases were detected as the course of rectal body temperature and values of AST, CK, BHB, and haptoglobin were not influenced by treatment within the group of cows with diagnosed APM. Use of this herd-specific multivalent vaccine designed to reduce metritis was not efficacious at reducing the risk of uterine disease or influencing production and reproduction in dairy cows.

Antibiotic treatment of metritis in dairy cows—A meta-analysis

The objective of this meta-analysis was to assess the efficacy of the treatment of bovine metritis with common antibiotic and nonantibiotic treatment options. Acute puerperal metritis, a systemic and potentially painful illness with rectal temperature >39.5°C and signs of toxemia due to an infection of the uterus, occurs within 21 d after parturition. Because of the infectious nature, antibiotics are considered beneficial for the treatment of acute puerperal metritis. Each use of an antimicrobial drug, however, is associated with selective pressure for eventual emergence of resistant bacteria. The 23 trials evaluated in the course of a previously conducted systematic review were the basis for meta-analytic investigations. Selected trials were screened regarding their eligibility for the following investigations: (1) comparison of different antibiotic treatments with respect to metritis prevalence at time of re-examination, (2) efficacy of ceftiofur treatment with respect to metritis prevalence at time of re-examination, (3) comparison of efficacy of antibiotic versus nonantibiotic drugs with respect to metritis prevalence at time of re-examination, and (4) equivalence assessment of treatment effects on reproductive performance measures. Where at least 3 trials had investigated the same outcome variable and met the inclusion criteria (inclusion of a control or reference group diagnosed with metritis; reporting means and standard deviation in case of continuous data), meta-analytic investigations were carried out. Due to a shortage of comparable studies, we could not conduct investigations (1) and (3). Ceftiofur treatment of 828 metritic cows was associated with a decrease in the prevalence of metritis following treatment in comparison to 804 untreated cows. In conclusion, meta-analytic investigations uncovered a need for more high-quality studies. Furthermore, a positive effect of the most commonly used antibiotic drug, ceftiofur, for the treatment of bovine metritis could be shown. A comparison with other antibiotic or nonantibiotic treatment options could not be made.

A longitudinal cohort study of acute puerperal metritis cases in Swedish dairy cows.

BackgroundAcute puerperal metritis affects cows during the early postpartum period and causes fever, fetid vaginal discharge and general depression. The disease is severe and treatment with antimicrobials is often required. This study followed 79 Swedish dairy cows with acute puerperal metritis with registered treatment and outcome in terms of recovery. Bacteria isolated from the uterus and their susceptibility to penicillin were studied. Clinical cases were assigned by participating practitioners who examined the cows, performed uterine swab sampling, decided treatment and provided information about cow health and calving conditions. Fertility and culling data were collected from the official Swedish milk and health recording scheme. Recovery from disease was defined in four levels; as a cow that survived 1 or 4 months, was inseminated and subsequently became pregnant. Intervals from dates of first and latest calving to insemination date were studied.ResultsThe most common bacterial findings were a mixed culture of Escherichia coli and bacteria such as Gram positive cocci, Fusobacterium necrophorum, Clostridium spp. or Trueperella pyogenes. The Gram positive cocci, Pasteurella spp. and F. necrophorum were generally susceptible to penicillin. The majority of cows (70%) were treated with penicillin in accordance with the Swedish policy on treatment of metritis while 19% were treated with tetracycline and 8% were not treated with antimicrobials. Recovery rates were similar between treatments. Besides “calving to last insemination” interval (CLI) that was 5 days shorter than the national mean, fertility was slightly reduced compared to national means. “Calving to first insemination” interval (CFI) was 4 days longer than national mean and number of inseminations/cow increased from 1.9 to 2.1. Escherichia coli culture positive cows did not become pregnant to the same extent as cows without E. coli in the uterus (P = 0.046). Twin births resulted in a longer CFI (P = 0.034). The culling rate was generally high (42% within 300 days after occurrence of metritis), though death associated with acute disease was low (6%).Conclusions Escherichia coli was the most common bacterial pathogen isolated from cases of acute puerperal metritis in the present study. This bacterium is inherently resistant to penicillin, but although most cows were treated with penicillin, death due to acute disease was low and recovery and final fertility results were acceptable. In times of emerging antimicrobial resistance and demand for prudent antimicrobial use, we suggest that penicillin is a “good enough” choice if antimicrobial treatment of acute puerperal metritis is needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13028-016-0257-9) contains supplementary material, which is available to authorized users.

Post-partum serum albumin as a predictor of metritis

The transition cow is in a negative nutrient balance, recognized largely as a negative energy and calcium balance. In response to the negative energy state, the body begins to mobilize body fat. In response to the negative calcium balance, the body begins to mobilize calcium stores from bone. A negative protein balance has also been documented, and results in mobilization of protein reserves from skeletal muscles. Total serum protein has been associated with cow health, but serum albumin is more specific and plays an important role in transporting triglycerides and calcium. Albumin has been proposed as a potential biomarker for health in the transition cow. The objective of this study was to determine whether low serum albumin concentrations 2 days after calving would result in an increased risk of developing acute puerperal metritis (APM). A secondary objective was to establish whether total or ionized calcium levels 48 hours post calving were associated with serum albumin levels early postpartum.

Randomized, controlled clinical trial on the efficacy of nonsteroidal antiinflammatory drugs for the treatment of acute puerperal metritis in dairy cows

The objective of this study was to assess the efficacy of ketoprofen compared with ceftiofur hydrochloride for the treatment of acute puerperal metritis (APM). Specifically, we set out to compare the incidence of extended treatment (extT) between treatment groups, to determine the prevalence of purulent vaginal discharge (PVD) and milk yield on the first 3 milk tests postpartum, and to analyze reproductive performance of cows treated with ketoprofen or ceftiofur. Cows with rectal temperature ≥39.5°C and reddish-brown fetid vaginal discharge within the first 10 d in milk (DIM) were diagnosed with APM. Day of enrollment and first day of treatment was considered study day 1. Rectal temperature was recorded daily until study day 7. A total of 610 dairy cows with APM were enrolled in this randomized clinical trial. Cows meeting the inclusion criteria were allocated to treatment with ketoprofen (3mg/kg of body weight, n=300) or treatment with ceftiofur (1mg/kg of body weight, n=310) on study days 1, 2, and 3. Cows that showed rectal temperature ≥39.5°C between study days 4 and 7 received an extT with ceftiofur for 3 (ketoprofen group) or 2 (ceftiofur group) more days. Cows were examined with the Metricheck device (Simcro, Hamilton, New Zealand) between DIM 21 and 40, and vaginal discharge was categorized on a 5-point scale according to the presence of pus. Cows with a score ≥2 were classified as having PVD. Fifty-two cows (35 from ketoprofen group, 17 from ceftiofur group) were excluded from analysis due to missing protocol compliance (n=37) or concurrent disease (n=15). Cows treated with ketoprofen were more likely to have an extT than cows treated with ceftiofur (61 vs. 31%). Prevalence of PVD did not differ between the 2 treatment groups (ketoprofen, 56%; ceftiofur, 53%). Cows, however, that needed an extT after the initial 3-d treatment were more likely to develop PVD than cows without extT (64 vs. 46%). Treatment group did not affect milk yield (ketoprofen group, 35.5±0.4kg; ceftiofur group, 35.2±0.3kg), first artificial insemination pregnancy risk (ketoprofen group, 20% vs. ceftiofur group, 25%), median days to first artificial insemination [ketoprofen group, 73 d, 95% confidence interval (CI): 70-75 d vs. ceftiofur group, 75 d, 95% CI: 72-76 d] and median days to pregnancy (ketoprofen group, 144 d, 95% CI: 132-158 d vs. ceftiofur group, 133 d, 95% CI: 119-153 d). These results indicate that although cows initially treated with ketoprofen were more likely to receive extT, fewer doses of ceftiofur (1.83) were required compared with cows initially treated with ceftiofur (3.63). Moreover, the prevalence of PVD was not increased and milk yield and reproductive performance were not negatively affected by the initial treatment with ketoprofen.

Technical note: Intraobserver, interobserver, and test-retest reliabilities of an assessment of vaginal discharge from cows with and without acute puerperal metritis

Acute puerperal metritis (APM) in dairy cows is a common disease occurring in the first 10 d after calving. According to a widely accepted definition, the diagnosis is primarily based on body temperature and sensorial assessment of vaginal discharge. The scope of this study was to evaluate the reliability for color, smell, and viscosity of vaginal discharge from healthy cows and cows with APM. Fifteen investigators evaluated 6 vaginal discharge samples 10 times. Subsequently, the investigators rated the health status of the cows and the diagnostic value of color, smell, and viscosity. In a final questionnaire, the investigators estimated their ability to diagnose APM correctly and the influence of experience. Reliability was tested using Cohen’s kappa (κ). Our study revealed slight to moderate reliabilities concerning the assessment of vaginal discharge. Overall interobserver reliability for color, smell, and viscosity was κ=0.15, 0.27, and 0.44, respectively. Overall intraobserver reliability for color, smell, and viscosity was κ=0.35, 0.39, and 0.6, respectively. By means of a questionnaire, overall personal expertise to detect cows suffering from APM correctly as such was estimated to be 59%, whereas the diagnostic value of a combination of color, smell, and viscosity to detect cows with APM correctly was estimated to be 91.1% perfect. We found a discrepancy between reliability and the personal perception of diagnostic value. Our study shows that the sensorial assessment of color, smell, and viscosity of vaginal discharge in cows postpartum is subjective.