Antimicrobial Resistance and Current Alternatives in Veterinary Practice: A Review.

Antibiotics are commonly used to treat bacterial infections. For many years, antibiotics have been used at sub-therapeutic doses to promote animal growth and misused as prophylactics and metaphylactic on farms. The widespread and improper use of antibiotics has resulted in a serious problem, defined as antibiotic resistance by the World Health Organisation, which is a major public health threat in the 21st century. Bacteria have evolved sophisticated mechanistic strategies to avoid being killed by antibiotics. These strategies can be classified as intrinsic resistance (referring to the inherent structural or functional characteristics of a bacterial species) or acquired resistance (referring to mutations in chromosomal genes or the acquisition of external genetic determinants of resistance). In farm animals, the use of antibiotics warrants serious consideration, as their residues leach into the environment through effluents and come into contact with humans through food. Several factors have contributed to the emergence of antibiotic-resistant bacteria. This review provides an update on antibiotic resistance mechanisms, while focusing on the effects of this threat on veterinary medicine, and highlighting causal factors in clinical practice. Finally, it makes an excursus on alternative therapies, such as the use of bacteriophages, bacteriocins, antimicrobial photodynamic therapy, phytochemicals, and ozone therapy, which should be used to combat antibiotic-resistant infections. Some of these therapies, such as ozone therapy, are aimed at preventing the persistence of antibiotics in animal tissues and their contact with the final consumer of food of animal origin.

Evaluation of antibacterial oxygen/ozone mixture in vitro activity on bacteria isolated from cervico-vaginal mucus of cows with acute metritis.

Ozone is an oxidating gas showing a strong microbicidal activity on bacteria, fungi, viruses and protozoa. The aim of this study was to test the in vitro bacteriocidal action of an Ozone/Oxygen gas mixture on bacteria isolated from the cervico-vaginal mucus of cows affected by acute metritis. A pilot study was initially carried out on reference strains (Escherichia coli ATCC 25922, Staphylococcus aureus ATCC 25923 and Mycoplasma bovigenitalium ATCC 19852) that were tested with three different treatments: a control positive baseline group (B-group) was incubated without gas treatment, a control positive oxygen group (O2-group) was treated with pure oxygen 100%, and the treated group (T-group) was exposed to a gaseous constant flow of an Ozone/Oxygen mixture, at 50, 35, 20 µg Ozone/ml and for 5, 3 and 1 min for every different Ozone concentration. In both positive control groups, the number of colony forming units (CFU) per ml was higher than 300 CFU/ml (E. coli and S. aureus) and higher than 30 CFU/ml for M. bovigenitalium, after incubation. The T-groups showed a minimal bacterial growth equal to or lower than 1 CFU/ml per plate. Based on the results of the pilot study, a second phase was performed on bacteria isolated from the cervico-vaginal mucus (Klebsiella pneumoniae, Enterobacter agglomerans, E. coli, Proteus mirabilis and M. bovigenitalium) using the lower concentration of 20 µg/ml of Ozone for the minimum exposure time of 1 min. The E. coli and S. aureus reference strains and the clinical isolates (K. pneumoniae, E. agglomerans, E. coli, P. mirabilis) were incubated at 37 °C for 48 h and the colonies were manually counted at 24 h and 48 h following inoculation. The cultures of M. bovigenitalium (both ATCC and clinical isolate) were incubated in a jar with modified atmosphere conditions with 5% CO2 at 37 °C for 4-7 days and colony counting was performed. The second phase showed a low number of CFUs (equal to or less than 7 CFU/ml) for the clinical isolates K. pneumoniae, E. agglomerans, E. coli and P. mirabilis, and, of note, for M. bovigenitalium, both ATCC and clinical isolate, the growth was completely inhibited. Ozone was demonstrated to have a bacteriocidal activity. This study encourages further research of in vivo application of low doses of gaseous Ozone for the treatment of metritis in cows by using minimal exposure times.

Scopolamine administration in repeat breeder cows on the day of heat.

Scopolamine is a parasympatholytic drug that can modulate uterine contractile activity. Based on the hypothesis that deficiency in uterine contractility is a cause of Repeat Breeder (RB) syndrome in cows, this study aimed to evaluate the efficacy of scopolamine administration in RB cows, on the day of heat, in increasing conception rates. Forty RB cows were randomly divided into treated group [T; 20 cows treated with scopolamine butylbromide 40 mg/100 kg of body weight (BW) by the intramuscular (IM) route after clinical confirmation of heat (T0)] and the control group [C; 20 cows treated with 2 mL/100 kg of BW of saline solution, IM, at T0]. Twelve hours later (T1), all of the cows were artificially inseminated (AI). Blood plasma-progesterone (P4), hydroxyproline, and prostaglandin F2α metabolite (PGFM), concentrations were assessed at T0 and T1. Additionally, the uterine tone was evaluated by transrectal palpation. Conception rates were recorded. Drug administration increased the conception rates in group T to 80% unlike group C (25%) (P < 0.0001). Higher PGFM concentration levels were registered in the treated group than in the control group. The higher PGF2α secretion in pregnant cows of the T group may have reduced the P4 levels, making conception possible. Scopolamine administration at the time of heat can improve uterine contractility. This makes it more suitable for promoting conception in RB cows, where hormonal alterations and contractile and biochemical deficits are responsible for the syndrome.

Kisspeptin-10 and gonadotropin inhibiting hormone during pregnancy in dairy cows.

Recently, two different molecules have been discovered to play an important role in reproduction: kisspeptin (Kp) and gonadotropin inhibiting hormone (GnIH). The aim of this study was to establish the trend of kisspeptin 10 (Kp­10) and GnIH concentrations, during all phases of pregnancy in cattle, in order to understand their possible role in the physiology of pregnancy. To examine the correlation between these hormones and steroid hormones, cortisol and oestradiol 17ß (E2) were also analyzed. Eighty pregnant cows were enrolled and the pregnancy was divided into 8 periods of 30 days each (from 30­60 days to 240­270 days). Blood samples were collected from all cows, once only for cow. Kp­10, GnIH, cortisol and E2 were measured in sera. After an initial plateau, Kp­10 concentrations increased at 90­120 days and then decreased until 180­210 days, undergoing a further increase until 240­270 days. GnIH concentrations decreased until 90­120 days, then increased until the end of gestation. These trends were opposing until 180­210 days, whereat concentrations of both increased until the end of gestation. Cortisol concentrations were homogenous at all times, except at the final period, in which they were higher. E2 showed two peaks, at 90­120 days and 240­270 days. The trends in Kp­10 and GnIH concentrations suggest that these two hormones might act to maintain the delicate endocrine equilibrium of pregnancy.

The Use of Abdominal Ultrasound to Improve the Cryptorchidectomy of Pigs.

This study aimed to describe a technique to locate retained testes in pigs by means of ultrasound examination and thereafter proceed with cryptorchidectomy. Fifty-two monolateral cryptorchid pigs were enrolled. After anaesthesia, 42 pigs (Group U) underwent ultrasound examination before cryptorchidectomy, and 10 pigs (Group C) were used as control group without ultrasonography. The total duration of anaesthesia, ultrasound examination, and surgery was evaluated. In 10 pigs of Group U and 10 pigs of Group C, the heart rate (HR), respiratory rate (RR), and body temperature (T) were monitored to assess intraoperative pain response. An operator used the Piglet Grimace Scale (PGS) to assess postoperative pain. In Group U, the total time required for anaesthesia and surgery was less than Group C. No intra- or postoperative complications were reported in both groups. For HR, RR, and T, no statistically significant differences were observed. During the postoperative pain assessment, the highest pain scores were recorded at T6 (6 h after surgery). Ultrasound examination was found to be a valid technique for locating the retained testis in the abdomen in cryptorchid pigs and to reduce the duration of the surgery.

Kisspeptin in the early post-partum of the dairy cow.

Recently, a new molecule, kisspeptin (Kp), and in particular Kisspeptin 10 (Kp10), was implicated in stimulating the hypothalamic-pituitary-gonadal axis. The aim of this study was to evaluate circulating Kp10 levels in the early post-partum period of the dairy cow. Blood samples were collected from 40 dairy cows, at 10 (T10), 12 (T12), 14 (T14) and 16 (T16) days after calving. Progesterone (P4) levels were evaluated using ELISA, and levels of oestrogens (E2) and Kp were evaluated using a radio-immunologic method. After an initial plateau, Kp10 significantly increased at T14 and decreased at T16. The P4 and E2 mean serum values remained in the physiological range. It is likely that Kp10 enhanced hypothalamic GnRH release as well as pituitary gonadotropin secretion, thus promoting follicular growth and the increase in E2 levels, which might have further enhanced Kp10 release through a positive feedback loop. To our best knowledge, this is the first report on the range of Kp10 blood concentration during the early post-partum period in the dairy cow. The results of our study will increase our current understanding of the complex neuro-endocrine crosstalk underlying the resumption of ovarian cyclicity in the dairy cow.

Kisspeptin and bovine follicular cysts.

The aim of this study was to investigate kisspeptin (Kp) and sexual hormone blood concentrations in healthy dairy cows (H) and in cows diagnosed with ovarian follicular cysts (FC). Forty dairy cows were enrolled in this study and divided in 2 groups of 20 subjects each. All cows underwent blood collection on the day of diagnosis and on that of heat detection, respectively. Kisspeptin 10, estradiol, and progesterone blood concentrations were assessed. All the parameters were higher in Group FC than in Group H. These results suggest that the higher steroid levels found may have determined the increase in Kp secretion in the cystic cows. This, in turn, may have directly or indirectly stimulated the sustained Luteinizing Hormone (LH) release, known to occur in dairy cystic disease.

In vivo model for mastocytosis: A comparative review.

Human mastocytosis are heterogeneous group of neoplastic diseases characterized by a different degree of uncontrolled mast cell (MC) proliferation and activation. Interestingly, human mastocytosis share several biological and clinical features with canine mast cell disorders, so called canine mast cell tumors (CMCTs). These CMCTs are the most common spontaneous cutaneous tumors found in dogs representing a valid model to study neoplastic mast cell disorders. It has been discovered that the pathological activation of c-Kit receptor (c-KitR), expressed by MCs, has been involved in the pathogenesis of neoplastic MC disorders. In this review we have focused on human mastocytosis in terms of: (i) epidemiology and classification; (ii) pathogenesis at molecular levels; (iii) clinical presentation. In addition, we have summarized animal models useful to study neoplastic MC disorders including CMCTs and murine transgenic models. Finally, we have revised therapeutic approaches mostly common in human and canine MCTs and novel tyrosine kinase inhibitors approved for CMCTs and recently translated in human clinical trials.

Fluoroquinolone and Ovariectomy in the Bitch: Physiology of the Immune System as to CD56 and CD16 Expression.

Natural killer (NK) cells are innate lymphoid cells which act against a variety of pathogens and tumours. Phenotypically they are characterized by surface markers named cluster designation (CD) antigens. CD56 and CD16 are recognized as specific NK markers in the dogs as well as in humans. Surgical interventions suppress NK cells both in rats and humans. In this direction, it has been shown that an antibiotic regimen (amoxicillin, benzylpenicillin/dihydrostreptomycin, sulfametazine/sulfamerazine/ sulfathiazole, enrofloxacin, lincomycin/spectinomycin) administered only twice is effective in preventing infections after laparatomic ovariectomy, in the bitch. On these grounds, this research will show that the administration of a fluoroquinolone (5 mg/kg of enrofloxacin, Baytril®, Bayer, Milan, Italy) one hour before and at the end of ovariectomy is able to increase CD56 and CD16 expression levels. Moreover, the antibiotic administration modifies the relative expression levels of the two CD; thus suggesting that the fluoroquinolone employed enhances the activation of a specific subset of NK cells mainly involved in body recovering during the post operative period as already observed in humans.

Influence of hCG on inducible nitric oxide synthase gene expression in ram testicular arteries.

UNLABELLED: Background. Experimental evidence suggests a relationship between the vasodilatory effect of hCG and the NOS system in the testis. The influence of hCG administration on testicular vascular NOS gene expression has not been fully investigated. OBJECTIVE: This study aimed to evaluate the presence of the nitric oxide syntheses gene in ram testicular arteries and the influence of hCG administration on its expression. MATERIALS AND METHODS: Both testicular arteries of sixteen rams were extracted before and after i.v. administration of 5000 IU of hCG or placebo. The expression of the iNOS gene was investigated by real time PCR. Data were analyzed by means of Wilcoxon and Mann-Whitney tests. A p value of < 0.05 was considered statistically significant. RESULTS: PCR revealed the presence of iNOS mRNA in all basal samples but the expression of the iNOS gene was significantly reduced in all arteries obtained 24 h after the administration of either hCG or placebo. A significant reduction in the expression of iNOS gene was observed in the testicular arteries extracted after 24 h in both treated and placebo groups. On the other hand hCG stimulation did not significantly influence iNOS expression following its administration compared to a placebo. CONCLUSION: Ram testicular arteries express the iNOS gene but hCG stimulation did not significantly influence iNOS expression. A significant reduction in the expression of this gene was observed in the testicular arteries extracted after 24 h in both treated and placebo groups, suggesting that iNOS expression on the testicular artery could be influenced by the spermatic vessel ligation of the controlateral testis.

Immunological aspects of metritis in dairy cows: a review.

This paper reviews puerperal metritis in the cow, particularly the complex and multi-factorial pathogenesis characterized by an altered cross-talk among infectious agents, endocrine and immune systems. Uterine infections impair fertility and is one of the main causes of economic losses in dairy production. The early postpartum is a period characterized by an increased exposition to infectious agents and the disruption of the metabolic homeostasis, leading to endocrine and immunologic disorders. Dysregulation of uterine defence mechanisms results in the development of metritis. Because there is a complex interaction between infectious, endocrine and immune factors during metritis, there is need to use safer and cheaper drugs which are able to strengthen the anti-infective actions of the routine therapies.

Tyrosine kinase inhibitors (TKIs) in human and pet tumours with special reference to breast cancer: a comparative review.

Tyrosine kinase receptors (TKRs) play a key role in tumour cell proliferation and survival since they are involved in endothelial cell activation leading to tumour neoangiogenesis. In particular, vascular endothelial growth factor receptors (VEGFRs), platelet-derived growth factor receptor (PDGFR), stem cell factor receptor (c-KitR), and colony-stimulating factor 1 (CSF-1) are overexpressed or constitutively activated in human and pet malignancies. A variety of small molecule inhibitors targeting specific tyrosine kinases (known as tyrosine kinase inhibitors or TKIs) have recently been approved, or are under investigation, for the treatment of human cancer. TKI application in animal cancer is however relatively recent. This review aims to illustrate the major aspects of tyrosine kinase dysfunctions, with special regard to human and animal cancer of the mammary gland, providing an update on the background of the anti-angiogenic and anti-neoplastic properties of TKIs in human and veterinary cancer.

In vitro effects of L-arginine on spontaneous and homocysteine-induced contractility of pregnant canine uteri.

The L-Arginine-Nitric Oxide Synthase-Nitric Oxide (L-Arg-NOS-NO) system exerts a pivotal role in the maintenance of uterine quiescence during pregnancy, whereas Homocysteine (Hcy) promotes uterine contractility. The aim of this study was to test the in vitro effects of L-Arg on spontaneous and Hcy-induced contractions of uteri excised from pregnant bitches. 104 strips cut from pregnant uteri were mounted in an organ bath. 40 out of 104 strips (16 from mid-gestation uteri and 24 from close to term uteri, respectively) were exposed to cumulative doses of L-Arg; 40 strips (16 from mid-gestation-uteri and 24 from close to term-uteri, respectively) were exposed to N-nitro-L-arginine methyl ester (L-NAME), a NOS antagonist; the remaining 24 strips (from close-to-term uteri) were first exposed to a single dose of Hcy and then to increasing doses of L-Arg. L-Arg showed no effects on spontaneous contractility both in mid-gestation- and close to term-uterine strips, whereas it promoted a relaxant effect on Hcy-induced contractility. On the contrary, L-NAME increased amplitude of contraction both in mid-gestation and close to term strips. These findings suggest that the L-Arg-NO system is present in the uterus of pregnant bitches and that Hcy is able to modulate its actions. Further investigation of this system may provide the basis of future obstetrical therapies in bitches.

Epidural vs intramuscular administration of lecirelin, a GnRH analogue, for the resolution of follicular cysts in dairy cows.

Bovine follicular cysts are an ovarian disorder of dairy cows associated with abnormal estrous behaviour and infertility. The treatment of choice is intramuscular administration of a GnRH analogue, which acts by triggering pituitary release of LH. However, the presence of GnRH and GnRH receptors on spinal cord and ovary in some species, and the kind of innervation of the ovary, let us hypothesize that GnRH and its analogues may also act when administered by epidural route, as happens for other drugs. Therefore the aim of this study was to compare the effects of epidural vs intramuscular administration of lecirelin (a GnRH analogue) on FC regression, estrus detection and pregnancy outcomes. The study was conducted on 220 Friesian cows affected by follicular cysts, divided among 4 groups: Group L(epid) and Group L(im) received, respectively 50 µg of lecirelin in the epidural space and intramuscular; Group C(epid) and Group C(im) were used as control groups. In Group L(epid), estrus induction and pregnancy rates were significantly higher than in Group L(im). The results of this study show that the epidural administration of lecirelin promoted the remission of follicular cysts and an improvement of reproductive parameters compared to intramuscular administration. Thus, an alternative therapeutical approach is available for FC treatment, in order to obtain an easier restoration of the ovarian activity, especially in those cases refractory to classical therapeutic approaches.

Functional expression of the extracellular calcium sensing receptor (CaSR) in equine umbilical cord matrix size-sieved stem cells.

BACKGROUND: The present study investigates the effects of high external calcium concentration ([Ca(2+)](o)) and the calcimimetic NPS R-467, a known calcium-sensing receptor (CaSR) agonist, on growth/proliferation of two equine size-sieved umbilical cord matrix mesenchymal stem cell (eUCM-MSC) lines. The involvement of CaSR on observed cell response was analyzed at both the mRNA and protein level. METHODOLOGY/PRINCIPAL FINDINGS: A large (>8 µm in diameter) and a small (<8 µm) cell line were cultured in medium containing: 1) low [Ca(2+)](o) (0.37 mM); 2) high [Ca(2+)](o) (2.87 mM); 3) NPS R-467 (3 µM) in presence of high [Ca(2+)](o) and 4) the CaSR antagonist NPS 2390 (10 µM for 30 min.) followed by incubation in presence of NPS R-467 in medium with high [Ca(2+)](o). Growth/proliferation rates were compared between groups. In large cells, the addition of NPS R-467 significantly increased cell growth whereas increasing [Ca(2+)](o) was not effective in this cell line. In small cells, both higher [Ca(2+)](o) and NPS R-467 increased cell growth. In both cell lines, preincubation with the CaSR antagonist NPS 2390 significantly inhibited the agonistic effect of NPS R-467. In both cell lines, increased [Ca(2+)](o) and/or NPS R-467 reduced doubling time values.Treatment with NPS R-467 down-regulated CaSR mRNA expression in both cell lines. In large cells, NPS R-467 reduced CaSR labeling in the cytosol and increased it at cortical level. CONCLUSIONS/SIGNIFICANCE: In conclusion, calcium and the calcimimetic NPS R-467 reduce CaSR mRNA expression and stimulate cell growth/proliferation in eUCM-MSC. Their use as components of media for eUCM-MSC culture could be beneficial to obtain enough cells for down-stream purposes.

Uterine contractility is strongly influenced by steroids and glucose metabolism: an in vitro study on bovine myometrium.

BACKGROUND: Energetic substrates and hormonal phase are important for uterine contractions. Etomoxir a muscle carnitine palmitoyltransferase-1 inhibitor, able to diverge uterine metabolic pathways towards glycolysis, facilitates glucose utilisation. The aim of this study was to evaluate its effect on uterine contractility in different hormonal situations. METHODS: Uterine samples were collected from 60 cows during follicular phase, luteal phase and pregnancy. The cows were slaughtered at a local abattoir. Longitudinal strips were mounted vertically in a 30-ml organ bath connected to an isometric force transducer. Contractions were recorded with an ink-writing polygraph. After the equilibration period, etomoxir was added to the organ bath at different concentrations. The amplitude and frequency of contractions were registered before and after addition of etomoxir. RESULTS: In 17 strips from pregnant cows, etomoxir increased the amplitude (p < 0.05) of contractions but not the frequency in comparison with basal conditions. In 15 strips from cows in the luteal phase, etomoxir increased the amplitude (p < 0.05) and frequency of contractions (p < 0.05 at 5 µM and p < 0.01 at 8 and 10 µM). In 18 strips from cows in the follicular phase, etomoxir increased the frequency of contractions but not the amplitude (p < 0.01 at 5 µM and p < 0.05 at 8 and 10 µM). CONCLUSIONS: This study confirms the importance of glucose for uterine contractility and, moreover, it underlines different patterns of contraction with regard to the hormonal status.

Bovine ovarian follicular cysts: in vitro effects of lecirelin, a GnRH analogue.

This study investigates the mechanisms of action by which a GnRH analogue may modulate the contractility of the bovine ovarian follicular wall. The in vitro evaluation of the spontaneous basal contractility of bovine preovulatory and cystic follicles was performed, followed by testing the effects of lecirelin, a GnRH analogue, on their basal contractility. Strips of tissue in isolated organ bath were employed. In addition, to better investigate the mechanism of action of lecirelin, the study of the effects of cumulative doses of nifedipine (a calcium channel blocker), phentolamine (an α-adrenoceptor antagonist) and reserpine (an inhibitor of the vesicular up-take of catecholamines) alone and, at the highest doses employed, associated to lecirelin, was set up. The results demonstrate that in basal conditions and after the addition of lecirelin, the strips from preovulatory follicles contract significantly more than strips from cysts. Furthermore, among the patterns of contractility evoked by the three drugs employed, the one induced by nifedipine was the only one unaffected by the addition of lecirelin. The data obtained provide the hypothesis that one of the main mechanisms of action of GnRH, could involve calcium channels.

Follicular development in pregnant cows after the administration of equine chorionic gonadotropin (eCG): a new insight.

The follicular development in the cow occurs in a wave-like pattern, and it takes place also during pregnancy. In the cow, Equine Chorionic Gonadotropin (eCG) is used for superovulation, but a decrease in total fertility has been reported, likely because of its immunogenic properties in species other than equine. In this regard, immune response has been implicated in follicular growth, ovulation, and placental development. So, aims of our study are to test the safety of eCG administered during pregnancy and characterize the ovarian activity, the quality of oocytes, the hormonal status, and interleukin levels in eCG-treated pregnant cows.

Reactive oxygen species (ROS): involvement in bovine follicular cysts etiopathogenesis.

Ovulation is compared to an acute inflammatory process during which vasoactive agents, prostanoids, leukotrienes and Reactive Oxygen Species (ROS) develop. The aim of this study was to evaluate the levels of ROS in cystic and follicular fluid, in order to establish their involvement in the etiopathogenesis of Cystic Ovarian Follicle (COF) in dairy cows. The study was conducted in 30 healthy cows (group C) and 30 cows affected by COF (group COF). The fluid of follicular cysts and of preovulatory follicles was drawn by means of ultrasound guided aspiration from the cows of both groups. The fluid obtained was analyzed by a photometric analytical system to detect ROS level. ROS concentration was statistically lower in the cystic fluid than in the follicular one (62.4 +/- 13.36 U.Carr vs. 84.89 +/- 26.99 U.Carr) (p<0.05), thus suggesting that an alteration of the cascade responsible for ROS production may be implicated in the complex etipathogenesis of COF.

Effects of antibiotics on biochemical parameters, leukocytes and reactive oxygen species (ROS) in bitches after ovariectomy.

It is well known that following surgical procedures, a variety of patho-physiological alterations occurs in the host, such as changes in haemodynamic, endocrine and immune functions, as well as increase in Reactive Oxygen Species (ROS). Antibiotic administration, a common practice used in surgery, affects immune functions and ROS generation. Our study was aimed to investigate the effect of five different antibiotic regimens: amoxicillin, benzylpenicillin/dihydrostreptomycin, sulfametazine/sulfamerazine/ sulfathiazole, enrofloxacin, lincomycin/spectinomycin, administered twice (2 hours before skin incision and 6 hours after the end of the surgical suture), on biochemical parameters, leukocytes and ROS concentrations, in bitches undergoing open laparotomic ovariectomy. All treated bitches recovered from surgery without developing either systemic dysfunctions, or infections at the surgical site. Mean healing time was 7 +/- 3 days. An increase in white blood cell count, in differential leukocyte count and in ROS concentrations occurred 24 hours after the end of surgery, followed by a gradual decrease to basal values within the fourth day after surgery. The biochemical parameters remained quite constant throughout the study. In conclusion, our results show that the above antibiotic regimens, administered only twice, are efficient in inducing an uneventful recovery after laparotomic ovariectomy and preventing the development of infections in the bitch.