Diagnostic and Treatment Practices of Equine Endometritis—A Questionnaire

Abstract

Endometritis is a major cause for impaired fertility in mares. The objectives of this study were to collect information on diagnostic and treatment practices performed by veterinarians and to investigate possible effects of professional experience, caseload, and geographical location on the practitioners' management of endometritis cases. For this purpose, equine practitioners ( n = 680) were asked to fill out an online survey (34 questions). The online survey yielded 117 responses by veterinarians practicing in all parts of Germany. Most respondents came from Lower Saxony and managed <20 mares per year. For the diagnosis of chronic infectious endometritis, uterine sampling for microbiological examination was performed manually with a swab by the majority of practitioners whereas only few used the speculum technique. The incidence of antibiotic resistant pathogens was reported to be <5% by almost all respondents. Most practitioners relied on systemic antibiotic treatment with trimethoprim-sulfadiazine. Only occasionally veterinarians used intrauterine antibiotic therapy. Uterine lavages were performed routinely by almost half of the respondents in case of positive uterine cultures, mostly with 0.9% saline solution. Irritant solutions (e.g., iodine, chlorhexidine, kerosene) were used less often. Collection of an endometrial culture after completion of the treatment was common practice. While only a very limited association of the geographical location of practitioner (e.g., on selection of mares for endometrial culture, p < 0.05) was observed, the number of managed mares affected the answers notably (e.g., for use of irritating intrauterine treatment, p < 0.05). The management of persistent breeding induced endometritis (PBIE) was influenced by the number of managed mares (e.g., for use of oxytocin, p < 0.05) and 29.6% of respondents administered antibiotics as part of their PBIE management. In summary, treatment strategies in the field vary considerably and include also non-evidence-based methods, but most German practitioners apply the recommended suitable treatments. Following the guidelines for antibiotic usage, most veterinarians administer antibiotics dependent on endometrial culture results but do not use cytology, low-volume lavage, or biopsy routinely. Antibiotic resistant uterine pathogens are reported to be isolated infrequently and equine practitioners prefer systemic to local antibiotic treatment of endometritis.

Extracellular vesicles in low volume uterine lavage and serum: novel and promising biomarker for endometritis in Arabian mares

“…However, mares that fail to properly evoke such systemic inflammatory reaction are more likely to be susceptible for endometritis [ 21 , 24 ]. Endometritis provides the uterine environment with unsuitable conditions for sperm cells and implantation of the embryo [ 25 ]. In the last decades, there were several attempts to properly trace and control the pathophysiological pattern of equine endometritis.…”

“…In addition, researchers conducted very promising prognostic and diagnostic techniques for endometritis in mares, which precisely help in the management of such crucial conditions. These techniques were mainly explored through checking various cytological, microbiological, ultrasonographical and serological biomarkers in mares suffering from endometritis [ 25 – 27 ]. However, these different methodologies did not achieve better understanding of molecular regulation of equine endometritis.…”

A Novel Approach to Minimising Acute Equine Endometritis That May Help to Prevent the Development of the Chronic State

“…Despite the existence of a variety of treatment options ( Table 1 ), evidence-based reports on their effectiveness are lacking ( 66 ). A recent survey of equine practitioners in Germany concluded that most still mainly use systemic antibiotic therapy for equine endometritis ( 67 ). Slightly less than one half of respondents used uterine lavage in addition to the systemic antibiotics.…”

“…For uterine lavages, practitioners had mostly changed to 0.9% saline instead of potentially more irritant substances such as povidone iodine, N-acetylcysteine, hydrogen peroxide, dimethyl sulfoxide, or kerosene. Köhne et al ( 67 ) called for more research and better dissemination of results to clinicians in an effort to provide effective treatment.…”

IIB or not IIB, part 1: retrospective evaluation of Kenney–Doig categorization of equine endometrial biopsies at a veterinary diagnostic laboratory and comparison with published reports

“…[38][39][40] The use of endometrial biopsy as part of the breeding soundness exam is no longer considered routine by many equine clinicians and theriogenologists, and is now reserved as an additional test when other, less-invasive tests, such as transrectal palpation, ultrasonography, uterine cytology, and uterine bacterial culture, have already been done. 20,21,36 Given the continuous evolution of minimally contaminated breeding techniques and new uterine therapies, foaling rates are continuing to improve, specifically for biopsies within the 2 middle categories. Therefore, less emphasis is being placed on the foaling rates originally proposed by Kenney and Doig, and overall categorization of biopsies has become less important in the theriogenology world, in which theriogenologists are now trained to read their own biopsies.…”