Outcomes after treatment of nonsevere gram-negative clinical mastitis with ceftiofur hydrochloride for 2 or 5 days compared with negative control

A study was conducted at 3 commercial dairies in California to compare outcomes of treating nonsevere (mild and moderate) gram-negative (GN) clinical mastitis (CM) with intramammary (IMM) ceftiofur HCl (125 mg of ceftiofur HCl per tube) in either 2-d (SP2) or 5-d (SP5) treatment programs compared with nontreatment (CON). In addition, we contrasted results from cases classified as mild and moderate. Four hundred fifteen cases were included in the final dataset, including 135 CON, 133 SP2, and 147 SP5. Milk from quarters with CM was sampled for on-farm culture (OFC) to differentiate gram-positive (GP) and GN bacteria, with results known within 24 h. Those with GN infections were randomly assigned to experimental groups, while those with GP, mixed infections, and contaminated samples did not continue in the study and received standard farm therapy. For cows with GN infections, a sample was submitted for MALDI-TOF assay. Only nonsevere cases were enrolled, and all quarters yielded monocultures of GN species. Clinical scores were obtained 0, 1, 2, 3, 4, 5, 14, 21, and 28 ± 3 d relative to enrollment. Milk samples were collected from quarters 14, 21, and 28 ± 3 d after enrollment, and submitted for routine culture and, when appropriate, submitted to MALDI-TOF evaluation. For many response criteria, there were significant interactions between treatments and CM severity scores at the time of enrollment, with effectiveness of ceftiofur HCl treatment being more beneficial compared with CON as mastitis clinical severity increased. While most treatment responses were significant for animals with mild or moderate GN mastitis, the largest responses were noted among cows with moderate CM cases.

Selective treatment of nonsevere clinical mastitis does not adversely affect cure, somatic cell count, milk yield, recurrence, or culling: A systematic review and meta-analysis

Treatment of clinical mastitis (CM) contributes to antimicrobial use on dairy farms. Selective treatment of CM based on bacterial diagnosis can reduce antimicrobial use, as not all cases of CM will benefit from antimicrobial treatment, e.g., mild and moderate gram-negative infections. However, impacts of selective CM treatment on udder health and culling are not fully understood. A systematic search identified 13 studies that compared selective versus blanket CM treatment protocols. Reported outcomes were synthesized with random-effects models and presented as risk ratios or mean differences. Selective CM treatment protocol was not inferior to blanket CM treatment protocol for the outcome bacteriological cure. Noninferiority margins could not be established for the outcomes clinical cure, new intramammary infection, somatic cell count, milk yield, recurrence, or culling. However, no differences were detected between selective and blanket CM treatment protocols using traditional analyses, apart from a not clinically relevant increase in interval from treatment to clinical cure (0.4 d) in the selective group and higher proportion of clinical cure at 14 d in the selective group. The latter occurred in studies co-administering nonsteroidal anti-inflammatories only in the selective group. Bias could not be ruled out in most studies due to suboptimal randomization, although this would likely only affect subjective outcomes such as clinical cure. Hence, findings were supported by a high or moderate certainty of evidence for all outcome measures except clinical cure. In conclusion, this review supported the assertion that a selective CM treatment protocol can be adopted without adversely influencing bacteriological and clinical cure, somatic cell count, milk yield, and incidence of recurrence or culling.

What Is Success? A Narrative Review of Research Evaluating Outcomes of Antibiotics Used for Treatment of Clinical Mastitis

Treatment of clinical mastitis is the most common reason that antimicrobials are given to adult dairy cows and careful consideration of treatment protocols is necessary to ensure responsible antimicrobial stewardship. Clinical mastitis is caused by a variety of bacteria which stimulate an immune response that often results in spontaneous bacteriological clearance but can develop into long-term subclinical infections. Use of antimicrobial therapy is most beneficial for cases that are caused by pathogens that have a low rate of spontaneous cure but high rate of therapeutic cure. The purpose of this paper is to review studies that evaluated outcomes of antimicrobial therapy of clinical mastitis. Few studies reported differences in bacteriological cure among treatments and this outcome was rarely associated with clinical outcomes. Return to normal milk appearance was evaluated in most studies but demonstrated little variation and is not a reliable indicator of therapeutic success. Somatic cell count should be measured at quarter-level and will decline gradually after bacteriological clearance. Few researchers have evaluated important clinical outcomes such as post-treatment milk yield or culling. Few differences among approved antimicrobial therapies have been demonstrated and selection of antimicrobial therapy should consider the spectrum of activity relative to etiology.

Critically important antimicrobials are generally not needed to treat nonsevere clinical mastitis in lactating dairy cows: Results from a network meta-analysis

There is ongoing debate regarding whether critically important antimicrobials (CIA) should be used to treat infections in food-producing animals. In this systematic review, we determined whether CIA and non-CIA have comparable efficacy to treat nonsevere bovine clinical mastitis caused by the most commonly reported bacteria that cause mastitis worldwide. We screened CAB Abstracts, Web of Science, MEDLINE, Scopus, and PubMed for original epidemiological studies that assessed pathogen-specific bacteriological cure rates of antimicrobials used to treat nonsevere clinical mastitis in lactating dairy cows. Network models were fit using risk ratios of bacteriological cure as outcome. A total of 30 studies met inclusion criteria. Comparisons of cure rates demonstrated that CIA and non-CIA had comparable efficacy for treatment of nonsevere clinical mastitis in dairy cattle. Additionally, for cows with nonsevere clinical mastitis caused by Escherichia coli and Klebsiella spp., bacteriological cure rates were comparable for treated versus untreated cows; therefore, there was no evidence to justify treatment of these cases with CIA. Our findings supported that CIA in general are not necessary for treating nonsevere clinical mastitis in dairy cattle, the disease that accounts for the majority of antimicrobial usage in dairy herds worldwide. Furthermore, our findings support initiatives to reduce or eliminate use of CIA in dairy herds.

Internal Teat Sealant Administered at Drying off Reduces Intramammary Infections during the Dry and Early Lactation Periods of Dairy Cows

Simple Summary

Internal teat sealant (ITS) at drying off is a strategy used for the prevention of intramammary infections (IMI) during the dry period (DP), as it simulates the keratin plug’s purpose, which is to prevent the access of pathogens into the mammary gland. The results from randomized clinical trials provide valuable information about the efficacy of commercially available products to be used in dairy cattle, assisting farmers to choose the best protocols for mastitis control. This study evaluated a new ITS infused at drying off as an alternative to prevent IMI during DP in a tropical country. Our results showed no effect of treatments on risk of bacteriological cure, subclinical mastitis (SCM) cure, and new cases of SCM postpartum. On the other hand, the use of ITS combined with an intramammary antibiotic (SDCT) reduced the risk of clinical mastitis up to 60 days postpartum, the overall risk of new intramammary infections (NIMI), and the NIMI caused by major pathogens compared to the use of antimicrobial alone (ADCT). Thus, the use of ITS combined with an antimicrobial at drying off was effective to prevent NIMI and clinical mastitis up to 60 days postpartum.

Abstract

The effect of an internal teat sealant (ITS) on subsequent infection of the mammary gland was evaluated on the following mammary gland health indicators: (a) bacteriological cure of preexisting intramammary infections at drying off, (b) risk of postpartum new intramammary infections (NIMI), (c) cure and risk of new cases of subclinical mastitis (SCM), and (d) risk of postpartum clinical mastitis (CM). A total of 553 cows during late gestation were randomly assigned into two treatment protocols at drying off: (a) Dry cow therapy with 0.25 g of intramammary anhydrous cefalonium (ADCT; Cepravin^®, MSD Animal Health); or (b) ADCT combined with ITS (SDCT; 4 g bismuth subnitrate; Masti-Seal^®, MSD Animal Health, São Paulo, Brazil). Mammary quarter (MQ) milk samples were collected for microbiological culture and somatic cell count (SCC) at drying off and early lactation, and data from 1756 MQ were used in the multivariate logistic regression. There was no effect on the risk of bacteriological cure, SCM cure, and new cases of postpartum SCM. Still, SDCT reduced the risk of CM up to 60 days postpartum (DPP), overall NIMI risk, and the NIMI caused by major pathogens compared to ADCT. Thus, the DCT combined with ITS at drying off is effective for preventing NIMI during the dry period and CM up to 60 DPP.

Assessment of the Usefulness of Cefapirin and Cefalonium Disks for Susceptibility Testing of Staphylococcus aureus Isolates from Bovine Mastitis

Cefapirin (CEP) and cefalonium (CNM) are first-generation cephalosporins widely used to treat bovine mastitis caused by Gram-positive bacteria including staphylococci. However, disks for susceptibility testing of those drugs in causative bacteria are not available. This study evaluated the efficacy of 10 µg and 30 µg pilot disks of CEP (CEP10 and CEP30) and CNM (CNM10 and CNM30) against 130 Staphylococcusaureus isolates from bovine mastitis. Scattergrams of minimum inhibitory concentrations (MICs) and zone diameters (ZDs) illustrated significant correlations between the MICs and ZDs of CEP10 (r = −0.912), CEP30 (r = −0.933), CNM10 (r = −0.847), and CNM30 (r = −0.807). The analysis by Normalized Resistance Interpretation indicated that the epidemiolocal cut-off value (ECV) of MIC for both cefapirin and cefalonium is ≤ 0.5 µg/mL, and the ECV of ZD for CEP10, CEP30, CNM10, and CNM30 were ≥ 22 mm, ≥ 25 mm, ≥ 22 mm, and ≥ 29 mm, respectively. We believe that both 10 μg and 30 μg CEP and CNM susceptibility disks will be helpful for guiding the appropriate use of these antibiotics for bovine mastitis. Further studies toward the establishment of clinical breakpoint of CEP and CNM would be needed for their routine use.