Comparison of two monitoring and treatment strategies for cows with acute puerperal metritis

Effect of automated health monitoring based on rumination, activity, and milk yield alerts versus visual observation on herd health monitoring and performance outcomes

A primary objective of this randomized trial was to compare the percentage of cows that underwent clinical examination and were diagnosed with clinical health disorders (CHD) with a health monitoring program that relied only on automated monitoring system alerts vs a program that relied only on visual observation of clinical signs of disease to select cows for clinical examination. Another objective was to compare the effects of these health monitoring programs on milk yield, the herd exit dynamics (i.e., cows sold and dead), and first service reproductive outcomes. Lactating Holstein cows (n = 1,204) enrolled in the experiment were fitted with a neck-attached sensor of an automated monitoring system (HR Tags; Merck & Co., Inc.) that generated health alerts based on rumination time and activity. Milk yield was monitored 3 times per day by automated milk meters (MM27BC, DeLaval). Cows were blocked by parity, close-up period diet, and stratified by previous lactation milk yield, and then were randomly assigned within block to different programs for monitoring health from 3 to 21 d in milk (DIM). Cows in the visual observation group (VO; n = 597) were selected for clinical examination exclusively based on visual observation of clinical signs of disease, whereas cows in the automated health monitoring group (AHM; n = 607) were selected for clinical examination based on health alerts consisting of the following: a Health Index Score < 86 arbitrary units, daily rumination < 250 min, or a reduction of > 20% in daily milk yield. Once selected for examination, the clinical exam was the same for both treatment groups. Binary data such as the occurrence of CHD, herd exit, and pregnancies per AI were analyzed with logistic regression. Daily and weekly milk yield were analyzed using ANOVA with repeated measurements. More cows underwent a clinical examination, more cows were diagnosed with at least one CHD, and more cows received treatment in the AHM than the VO treatment group. Cows in the AHM treatment had more accumulated milk than cows in the VO treatment from 2 to 21 DIM. Cows in the AHM treatment diagnosed with at least one CHD produced more milk from 3 to 18 and 20 to 21 DIM than cows diagnosed with a CHD in the VO treatment. Fewer cows left the herd up to 21 DIM for the AHM than the VO treatment. Pregnancies per AI at first service were greater for the VO than the AHM treatment at 30 d but not at 50 d after AI and no difference in pregnancy loss was detected. In conclusion, a health monitoring strategy that used automated health alerts increased the risk of undergoing clinical examination and having CHD diagnosed compared with a program that selected cows for clinical examination based exclusively on visual observation. Cows monitored with the program that relied on automated alerts also had greater milk yield in the first 21 DIM. Thus, monitoring cow health based on automated behavior and milk yield alerts might be a more effective alternative for health monitoring than exclusive use of visual observation of clinical signs of disease.

Association of uterine health in the first lactation with transition cow health and reproductive performance in the second lactation of Holstein dairy cows

The objective of this study was to evaluate the effects of puerperal metritis (PM) diagnosed and treated during the early postpartum period of the first lactation on transition cow health, milk production, reproduction, and culling of dairy cows in their second lactation. Diagnosis of PM was based on fetid watery red-brown uterine discharge and rectal temperature above 39.5°C. Two farms were enrolled in this retrospective observational cohort study (Farm A and B). In both farms, the following diseases were recorded during the first 30 DIM in lactation 1 and 2: clinical hypocalcemia (CH), retained fetal membrane (RFM), PM, hyperketonemia (KET), left displaced abomasum (LDA) and clinical mastitis (MAST). Statistical analyses were performed using SPSS for Windows separately for each farm. Linear and logistic regression models were used for continuous (e.g., milk yield) and binary (e.g., disease, pregnancy per AI, pregnancy loss) outcomes, respectively. Cox proportional hazard regression models were calculated to model the time to event outcomes for culling or death during the first 60 DIM and for pregnancy within 250 d of the second lactation. The initial models contained the following variables: year of calving, month of calving, calving ease, stillbirth, twins, days open in lactation 1, 305 d milk yield in lactation 1, PM in lactation 1, and PM in lactation 2 as explanatory variables. A total of 4,834 cows (Farm A) and 4,238 cows (Farm B) in the second lactation were considered for statistical analyses. On farm A, the incidence of PM in lactation 1 and 2 was 20.1% and 11.2%, respectively. On farm B, the incidence of PM in lactation 1 and 2 was 14.4% and 8.5%, respectively. On both farms, cows with PM in their first lactation had greater odds for RFM and PM in their second lactation, while there was no association of PM in the first lactation with any other non-uterine diseases (i.e., CH, KET, LDA, and MAST) in the second lactation. Cows with PM in lactation 2 had reduced milk yield. The reduction in milk yield in second lactation was greater for cows that already experienced PM in lactation 1. On Farm A, cows with PM in their first lactation had a greater hazard for culling within 60 DIM of the second lactation; however, the same association was not present on Farm B. Cows with PM in lactation 1 had reduced pregnancy per AI at first service in the second lactation only on farm B. Cows with PM in lactation 2 had reduced pregnancy per AI at first service in the second lactation on both farms. Pregnancy loss in lactation 2 was only associated with PM in lactation 2 but not with PM in lactation 1. On both farms, cows had a reduced hazard for pregnancy in their second lactation within 250 DIM when they experienced PM in either lactation. In conclusion, PM in the first lactation had long-lasting negative consequences (i.e., risk of uterine disease and lower reproductive performance) for cows in their next lactation.

In Vivo Efficacy of Echinops spinosus Decoction as a Therapeutic for Cows at Risk of Clinical Endometritis

Clinical endometritis (CE) is a multifactorial disease of dairy animals. Retained fetal membranes (RFM) and metritis are the major risk factors of CE in dairy cows. Because uterine inflammation affects the profitability of the dairy industry, antibiotics and hormonal therapies are commonly used to mitigate against the disease. However, the One-Health concept aims to reduce antibiotic use in food animals to avoid the emergence of drug resistance or residues in milk or meat. Thus, phytotherapy may represent a good alternative to antibiotics in food animals. Echinops spinosus (E. spinosus) is a natural plant known to have therapeutic, anti-inflammatory, antimicrobial, and wound-healing properties in vitro. The aim of the present study was to investigate the efficacy of E. spinosus as a preventive strategy for CE in dairy cows with other postpartum complications. Holstein−Friesian cows (n = 36) diagnosed with RFM or metritis enrolled in the study were allocated into three groups. One group received antibiotic treatment. Another group received prostaglandin injection (PG). The experimental group received E. spinosus decoction orally. As a control group, eutocic cows (n = 36), without RFM and metritis were included in the study. The efficiency of the treatment was based on the occurrence of CE and improved reproductive outcomes. At 30 ± 2 DPP, CE was diagnosed in 25%, 58.34%, and 75% in antibiotic, PG, and E. spinosus groups, respectively (p < 0.05). There were no differences between the groups at 55 ± 5 DPP (16.67%, 33.44%, and 41.67% in antibiotic, PG and E. spinosus groups, respectively, p > 0.05). The E. spinosus group had the longest open days, lowest conception rate at 150 DPP, and highest number of services per conception. Oral E. spinosus extract is ineffective as a therapeutic for cows at risk of CE. These findings may pave the way for future innovative strategies employing E. spinosus to protect cattle against endometritis.

Integration of statistical inferences and machine learning algorithms for prediction of metritis cure in dairy cows

The study's objectives were to identify cow-level and environmental factors associated with metritis cure to predict metritis cure using traditional statistics and machine learning algorithms. The data set used was from a previous study comparing the efficacy of different therapies and self-cure for metritis. Metritis was defined as fetid, watery, reddish-brownish discharge, with or without fever. Cure was defined as an absence of metritis signs 12 d after diagnosis. Cows were randomly allocated to receive a subcutaneous injection of 6.6 mg/kg of ceftiofur crystalline-free acid (Excede, Zoetis) at the day of diagnosis and 3 d later (n = 275); and no treatment at the time of metritis diagnosis (n = 275). The variables days in milk (DIM) at metritis diagnosis, treatment, season of the metritis diagnosis, month of metritis diagnostic, number of lactation, parity, calving score, dystocia, retained fetal membranes, body condition score at d 5 postpartum, vulvovaginal laceration score, the rectal temperature at the metritis diagnosis, fever at diagnosis, milk production from the day before to metritis diagnosis, and milk production slope up to 5, 7, and 9 DIM were offered to univariate logistic regression. Variables included in the multivariable logistic regression model were selected from the univariate analysis according to P-value. Variables were offered to the model to assess the association between these factors and metritis cure. Additionally, the univariate logistic regression variables were offered to a recursive feature elimination to find the optimal subset of features for a machine learning algorithms analysis. Cows without vulvovaginal laceration had 1.91 higher odds of curing of metritis than cows with vulvovaginal laceration. Cows that developed metritis at >7 DIM had 2.09 higher odds of being cured than cows that developed metritis at ≤7 DIM. For rectal temperature, each degree Celsius above 39.4°C led to lower odds to be cured than cows with rectal temperature ≤39.4°C. Furthermore, milk production slope and milk production difference from the day before to the metritis diagnosis were essential variables to predict metritis cure. Cows that had reduced milk production from the day before to the metritis diagnosis had lower odds to be cured than cows with moderate milk production increase. The results from the multivariable logistic regression and receiver operating characteristic analysis indicated that cows developing metritis at >7 DIM, with increase in milk production, and with a rectal temperature ≤39.40°C had increased likelihood of cure of metritis with an accuracy of 75%. The machine learning analysis showed that in addition to these variables, calving-related disorders, season, and month of metritis event were needed to predict whether the cow will cure or not from metritis with an accuracy ≥70% and F1 score (harmonic mean between precision and recall) ≥0.78. Although machine learning algorithms are acknowledged as powerful tools for predictive classification, the current study was unable to replicate its potential benefits. More research is needed to optimize predictive models of metritis cure.

The association of cow-related factors assessed at metritis diagnosis with metritis cure risk, reproductive performance, milk yield, and culling for untreated and ceftiofur-treated dairy cows

Our objective was to assess the association of cow-related factors with metritis cure risk and economically important outcomes. In this prospective cohort study nested inside a randomized clinical trial, cows enrolled in a clinical trial that aimed to evaluate an alternative metritis therapy that had available plasma samples collected at metritis diagnosis were included. Metritis was defined as fetid, watery, reddish-brownish discharge with or without fever, and cure was defined as the absence of metritis signs 12 d after diagnosis. Cows were randomly allocated to remain untreated (CON; n = 147) or receive subcutaneous injections of 6.6 mg/kg of ceftiofur crystalline-free acid at enrollment and 72 h later (CEF, n = 168). Additionally, a random subset of 150 nonmetritic cows (NMET) was also included to compare milk production, reproductive performance, and culling responses. Cow-related factors evaluated include plasma concentrations of nonesterified fatty acids, β-hydroxybutyrate, and haptoglobin (Hp), parity, rectal temperature, and days in milk (DIM) at metritis diagnosis, vulvovaginal laceration (VL), BCS, dystocia, twins, and retained placenta. Among CON cows, DIM at metritis diagnosis was positively associated with metritis cure [threshold = 8, area under the curve (AUC) = 0.67], whereas plasma Hp concentration tended to be negatively associated with cure of metritis (threshold = 0.54 mg/mL, AUC = 0.64). Among CEF cows, DIM at metritis diagnosis (threshold = 5, AUC = 0.67) and dystocia were positively associated with metritis cure, whereas VL and Hp (threshold = 0.78 mg/mL, AUC = 0.76) were negatively associated with cure. For CON cows that were diagnosed with metritis after 8 DIM or had plasma Hp concentration ≤0.54 mg/mL, milk production, pregnancy, and culling risk were comparable to NMET cows. However, performance was impaired when cows that developed metritis at ≤8 DIM or had Hp >0.54 mg/mL were left untreated. Among CEF cows, Hp, DIM at metritis diagnosis, dystocia, and VL were associated with metritis cure. Milk yield, reproductive performance, and culling losses are more pronounced among CEF cows when metritis was diagnosed at ≤5 DIM, Hp >0.78 mg/mL, or if they had VL or dystocia. In conclusion, these data indicate that timing of the onset of metritis and inflammatory biomarkers could be used for the development of a selective therapy strategy for metritis, but more research is needed to identify more accurate predictors of metritis spontaneous cure and treatment failure.

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.

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.

Effect of oral calcium administration on the cure and reproductive performance of Holstein cows diagnosed with puerperal metritis

Our objective was to evaluate the effect of oral calcium administration on clinical cure, survival, subsequent presentation of peripartal health disorders, and reproductive performance of Holstein cows diagnosed with puerperal metritis (PM) under certified organic management. A second objective was to evaluate the metabolic status at calving and at the time of PM diagnosis (d 0) in affected and matched healthy cows. Cows diagnosed with PM (n = 200) were assigned randomly to receive 1 of 2 treatments: (1) control received 3.75 mL of Optimum UterFlush [Van Beek Natural Science, Orange City, IA, containing yucca extract, cinnamaldehyde, thymol, and a proprietary blend of carvacrol (4-isopropyl-2-methylphenol, at 0.47 g/mL)] diluted in 117 mL of distilled water by intrauterine infusion, administered every other day for a total of 3 treatments (n = 100); (2) calcium-supplemented (CA) received the same intrauterine treatment plus 6 oral capsules providing calcium ('O' Cal-D Cap, Bio-Vet Inc., Barneveld, WI; 7.5-9.0 g of Ca/capsule) once per day, for 3 consecutive days after diagnosis of PM. All cows received hypertonic saline solution (500 mL of 7.2% solution i.v. once), dextrose (500 mL of 50% solution i.v. once), and oral aspirin (5 boluses/d for 3 d). Outcome variables included fever, presence of fetid vaginal discharge, and uterine score at d 6 and 14 after diagnosis, survival at 30 and 100 d in milk, reproductive performance, and incidence of other health disorders after PM. A group of 200 control healthy cows (CH) was matched with PM cows at d 0, and calcium and fatty acid serum concentrations were determined at calving and at the day of diagnosis of PM (d 0). Calcium status was also assessed in PM cows at d 1, 2, 3, and 6 after diagnosis. Treatment effects were tested by logistic regression, repeated measures analysis, and ANOVA. Average calcium serum concentrations at d 0 were lower in PM cows (1.57 mmol/L) compared with CH cows (2.10 mmol/L). In PM cows, calcium concentrations at d 1, 2, 3, and 6 after diagnosis were significantly higher in the CA group. Fatty acid serum concentrations at calving and at d 0 were higher in PM cows compared with CH cows (0.48 vs. 0.37 mmol/L and 0.49 vs. 0.35 mmol/L, for calving and d 0). No effect was observed for calcium administration on health and survival outcomes. However, the proportion of cows inseminated by 150 d in milk was greater for CA compared with control cows (66 vs. 55%). In conclusion, supplementing oral calcium at the time of diagnosing PM had no effect on health. High fatty acid concentrations at calving were significant risk factors for occurrence of PM. Furthermore, cows affected with PM had lower calcium and higher fatty acid concentrations than CH cows at d 0.

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

Background

Acute 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.

Results

The 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 material

The online version of this article (doi:10.1186/s13028-016-0257-9) contains supplementary material, which is available to authorized users.

Fresh-cow handling practices and methods for identification of health disorders on 45 dairy farms in California

The aim of the present study was to describe fresh-cow handling practices and techniques used during fresh cow evaluations to identify postpartum health disorders on 45 dairy farms in California ranging from 450 to 9,500 cows. Fresh cow practices were surveyed regarding (a) grouping and housing, (b) scheduling and work organization, (c) screening for health disorders, and (d) physical examination methods. Information was collected based on cow-side observations and responses from fresh cow evaluators. Cows were housed in the fresh cow pen for 3 to 14 (20%), 15 to 30 (49%), or >31 (31%) d in milk. Fresh cow evaluations were performed daily (78%), 6 times a week (11%), 2 to 5 times a week (9%), or were not routinely performed (2%). There was significant correlation between the duration of fresh cow evaluations and the number of cows housed in the fresh pen. Across all farms, the duration of evaluations ranged from 5 to 240 min, with an average of 16 s spent per cow. During fresh cow checks, evaluators always looked for abnormal vaginal discharge, retained fetal membranes, and down cows. Dairies evaluated appetite based on rumen fill (11%), reduction of feed in the feed bunk (20%), rumination sensors (2%), or a combination of these (29%). Milk yield was evaluated based on udder fill at fresh cow checks (40%), milk flow during milking (11%), milk yield records collected by milk meters (2%), or a combination of udder fill and milk meters (5%). Depressed attitude was evaluated on 64% of the dairies. Health-monitoring exams for early detection of metritis were implemented on 42% of the dairies based on rectal examination (13%), rectal temperature (22%), or both (7%). Dairies implementing health-monitoring exams took longer to perform fresh cow evaluations. Physical examination methods such as rectal examination, auscultation, rectal temperature evaluation, and cow-side ketosis tests were used on 76, 67, 38, and 9% of dairies, respectively. Across dairies, we found large variation in signs of health disorders screened and how those signs were evaluated. Fresh cows were primarily evaluated based on nonspecific and subjective observations during screening. Future research efforts should focus on developing and validating scoring systems to more objectively identify health disorders in postpartum cows.

The associations between postpartum serum haptoglobin concentration and metabolic status, calving difficulties, retained fetal membranes, and metritis

Measurement of serum haptoglobin (Hapto) concentrations results in only moderate reported specificity and sensitivity for the detection of metritic cows. The objective of this study was to evaluate associations between different variables and haptoglobin concentrations after calving. Parity, periparturient metabolic stress indicated by β-hydroxybutyric acid (BHBA) and nonesterified fatty acids (NEFA), calving difficulties, retained fetal membranes (RFM), and acute puerperal metritis (APM) were evaluated. A total of 443 Holstein Friesian cows were enrolled in this retrospective observational study. Acute puerperal metritis was diagnosed when a cow had fetid, reddish-brown, watery vaginal discharge in combination with rectal temperature ≥39.5°C. The retention of the fetal membranes has been defined as the failure to expel the fetal membranes within 12h after calving. Results of blood samples from 2 and 5 d in milk (DIM) were analyzed for Hapto, BHBA, and NEFA. Primiparous cows had a greater median Hapto concentration than multiparous cows at 5 DIM [primiparous: 2.25g/L, interquartile range (IQR) 1.45-2.50, n=146; multiparous: 1.13g/L, IQR 0.52-2.22, n=302; P<0.05]. Therefore, different Hapto thresholds based on references from literature for all cows (1.4g/L), primiparous cows (2.49g/L), and multiparous cows (1.4g/L) were used for further analysis. Periparturient metabolic stress indicated by elevated BHBA (≥1.2mmol/L) at 5 DIM was associated with elevated Hapto (odds ratio 2.39-2.87) regardless of parity. In contrast, elevated NEFA (≥0.6mmol/L) at 2 DIM was not a risk factor for elevated Hapto. Multiparous cows with assisted calving had a 2.46 times higher risk for elevated Hapto, whereas primiparous cows with assisted calving had no elevated risk for elevated Hapto at 5 DIM. Moreover, multiparous cows with RFM were 5.51 times more likely to have elevated Hapto at 5 DIM than cows without RFM. Acute puerperal metritis within the first 5 DIM was associated with elevated Hapto (odds ratio 2.74-5.01), regardless of parity. We speculate that the association of calving ease, RFM, and periparturient metabolic stress could explain the moderate sensitivity and specificity reported for the detection of metritic cows by measuring Hapto.

Invited review: Antibiotic treatment of metritis in dairy cows: a systematic approach

Acute puerperal metritis (APM) is an acute systemic illness with fever ≥ 39.5 °C and signs of toxemia due to an infection of the uterus occurring within 21 d after parturition. Because of the infectious nature of APM, antibiotics are considered beneficial for its treatment. Each use of an antimicrobial drug, however, is associated with selective pressure for the emergence of resistant bacteria. Hence, there is a significant need to encourage prudent use of antibiotics and alternative therapies to antibiotics. Therefore, the objective of this study was to systematically review the current literature on treatment of APM. A comprehensive and systematic literature search was conducted utilizing the PubMed and CAB Abstracts databases to identify literature focusing on the antibiotic therapy of puerperal metritis in the cow. After application of specific exclusion criteria, 21 publications comprising 23 trials remained for final evaluation. Data extraction revealed that the majority of the studies (n = 19) were attributable to the highest evidence level. Of 21 studies controlled, 11 had an untreated group and 3 a positive control group. The majority of the studies (n = 17) applied ceftiofur for the treatment of APM. Concerning the efficacy of ceftiofur, 7 studies observed clinical improvement, whereas none found improved reproductive performance. Fewer than half of the studies (n = 10) performed a bacteriological examination and only 4 implemented an antibiotic susceptibility test. Also, 3 studies (13.0%) described a self-cure rate per se. Little attention was given to the issue of bacterial resistance (n = 3), the need for reducing the application of antibiotics (n = 2), or guidelines for prudent use of antibiotics (n = 1). Our findings demonstrate that implementation of bacteriological examinations, sensitivity testing, and determination of minimum inhibitory concentrations, as well as reporting and discussion of critical issues (e.g., self-cure rates, resistance, prudent drug use), were suboptimal. On the other hand, the quality of studies on the treatment of APM was good, as indicated by evidence level 1. Nevertheless, more high-quality research considering self-cure rates is necessary to address critical issues related to APM and crucial to the dairy industry, such as resistance, prudent use of antibiotics, animal welfare, and cost-benefit ratios.

Receiver operating characteristic curve analysis to determine the diagnostic performance of serum haptoglobin concentration for the diagnosis of acute puerperal metritis in dairy cows

Acute puerperal metritis (APM) in dairy cows is characterized by fever and fetid vaginal discharge within 21 days in milk (DIM). Increased serum haptoglobin concentration (Hp) can support the diagnosis of APM. However, there is a dearth of information of the test performance of Hp as a measure for APM with a consistent definition and considering parity. The objective of this trial was to study the test performance of Hp to distinguish healthy cows from cows with APM. A total of 33 of 60 (55.0%) primiparous cows and 43 of 133 (32.3%) multiparous cows developed APM. Primiparous cows with APM had the greatest Hp. However, in primiparous cows Hp did not significantly differ between healthy cows (DIM 2: 1.49 ± 0.64 mg/mL; DIM 5: 2.13 ± 0.66 mg/mL; DIM 10: 1.46 ± 0.85 mg/mL) and cows with APM (DIM 2: 1.78 ± 0.62 mg/mL; DIM 5: 2.48 ± 0.64 mg/mL; DIM 10: 1.60 ± 0.81 mg/mL). In multiparous cows, Hp was greater in cows with APM (DIM 2: 1.27 ± 0.68 mg/mL; DIM 5: 1.89 ± 0.94 mg/mL; DIM 10: 1.23 ± 0.78 mg/mL) than in healthy cows (DIM 2: 0.99 ± 0.68 mg/mL; DIM 5: 1.10 ± 0.80 mg/mL; DIM 10: 0.83 ± 0.68 mg/mL). Sensitivity and specificity of Hp to diagnose APM in multiparous cows ranged from 72% to 79% and 54% to 71% on DIM 2, 5 and 10, respectively.

Diagnosis of acute puerperal metritis by electronic nose device analysis of vaginal discharge in dairy cows

The objective of this study was to estimate the diagnostic accuracy of an electronic nose device using vaginal discharge samples to diagnose acute puerperal metritis (APM) in dairy cows. Uterine fluid was sampled manually with a gloved hand and under sterile conditions for electronic nose device analysis (day in milk (DIM) 2, 5, and 10) and bacteriologic examination (DIM 5), respectively, and on additional days, if APM was diagnosed during the daily clinical examinations. A dataset containing samples from 70 cows was used to create a model and to validate the APM status predicted by this model, respectively. Half of the dataset (n = 35; 14 healthy and 21 metritic cows) was provided with information regarding the APM diagnosis and contained all three measurements (DIM 2, 5, and 10) for each cow and was used as a training set whereas the second half was blinded (n = 35; 14 healthy and 21 metritic cows) and contained only the samples collected on DIM 5 of each cow and was used to validate the created prediction model. A receiver operating characteristic curve was calculated using the prediction results of the validation test. The best observed sensitivity was 100% with specificity of 91.6% when using a threshold value of 0.3. The calculated P-value for the receiver operating characteristic curve was less than 0.01. Overall, Escherichia coli was isolated in eight of 28 (28.6%) and 22 of 42 (52.4%) samples collected from healthy and metritic cows, respectively. Trueperella pyogenes and Fusobacterium necrophorum were isolated in 14 and six of 28 (50.0% and 21.4%) and 17 and 16 of 42 (40.5% and 38.1%) samples collected from healthy and metritic cows, respectively. The prevalence of Escherichia coli and Trueperella pyogenes was similar in the samples obtained from metritic cows used for the training set and the validation test. The results are promising especially because of the objective nature of the measurements obtained by the electronic nose device.