Predictive models for metritis cure using farm-collected data, metabolic and inflammation biomarkers, and hemogram variables measured at diagnosis

Differences in lactational performance associated with antimicrobial treatment and clinical cure failure of metritis in dairy cows

The objective of this study was to evaluate the differences in milk production, reproductive performance, and culling associated with antimicrobial therapy and clinical cure of metritis in dairy cows. In this study, data from 2 randomized controlled trials consisting of 900 Holstein cows from 5 dairy farms in California, Florida, and Texas were used. Cows were examined for metritis (fetid, watery, reddish-brownish vaginal discharge; VD) at 4, 7, and 10 DIM (study d 0). Cows diagnosed with metritis (n = 900) were randomly assigned (regardless of fever) to receive ceftiofur (CEF = 457) or to remain untreated (NT = 443). Clinical cure of metritis was assessed at study d 13 ± 1 based on the visual evaluation of the VD; cows that underwent clinical cure displayed clear, mucopurulent, or purulent discharge (cured = 710), whereas cows with clinical cure failure had persistent fetid, watery, reddish-brownish VD (not cured = 190). The data were analyzed considering antimicrobial treatment, cure status on d 13 ± 1, and their interaction. Risk of pregnancy and culling at 300 DIM were analyzed using logistic regression, time to pregnancy and culling by 300 DIM were analyzed using Cox's proportional hazard, and milk production within 300 DIM was analyzed using ANOVA with repeated measures. Antimicrobial treatment and cure status were included as fixed effects and farm as a random effect in all models. Both randomized trials that generated data used in this study reported a greater risk of clinical cure associated with CEF treatment. Differences in risk of pregnancy at 300 DIM were associated with cure status (cured = 70.9% vs. not cured = 61.7%), but not with antimicrobial treatment or antimicrobial treatment by cure interaction. The risk of culling at 300 DIM was not associated with cure status, antimicrobial treatment, or antimicrobial treatment by cure interaction. Reduced median time to pregnancy was associated with cure status (cured = 134 vs. not cured = 154 d) but not with antimicrobial treatment or antimicrobial treatment by cure interaction. No interaction of antimicrobial treatment by cure status was observed on milk production; however, interactions between antimicrobial treatment, parity, and month of lactation and cure, parity, and month of lactation were observed. Differences in milk production between multiparous CEF and NT cows were observed in the third month of lactation. Conversely, differences in milk production associated with cure status were observed for primiparous and multiparous cows in the first and second months of lactation, whereas only multiparous cows in the eighth, ninth, and tenth months of lactation presented differences in milk production. Clinical cure of metritis was positively associated with milk production and reproduction, regardless of antimicrobial therapy, warranting further investigation regarding selective therapy of metritis.

Differences in uterine and serum metabolome associated with clinical cure failure of metritis in dairy cows†

This study investigated differences in uterine and serum metabolome associated with clinical cure failure of metritis in dairy cows. Metritis was diagnosed in lactating Holstein cows from two Florida dairies and defined by the presence of fetid, watery, reddish-brown vaginal discharge from 4 to 12 days postpartum (dpp). Cows with metritis (n = 24) were paired with cows without metritis of similar parity and dpp (n = 24). On the day of metritis diagnosis (day 0), all cows with metritis received antimicrobial therapy. The continued presence of the fetid, watery, reddish-brown discharge on day 5 (n = 16) was defined as clinical cure failure, whereas clinical cure was defined by its absence (n = 8). Metabolome analyses of uterine lavage (days 0 and 5) and serum samples (day 0) were conducted using untargeted gas chromatography time-of-flight mass spectrometry. Normalized data were analyzed using partial least squares-discriminant analysis and ANOVA, adjusting P-values for multiple comparisons. Differences in the uterine metabolome on day 0 associated with clinical cure failure were linked to carbohydrate, amino acid, and lipid metabolism. Greater concentrations of arachidonic acid, ribose, and glutaric acid were associated with clinical cure failure, suggesting a greater degree of tissue lesion and inflammation. No differences in the serum metabolome were associated with cure failure. No differences in uterine metabolome were associated with clinical cure failure on day 5. The findings suggest that clinical cure failure is associated with a greater uterine inflammatory process that did not persist until cure assessment day.

A randomized controlled trial evaluating the efficacy of systemic ceftiofur administration for metritis therapy in dairy cows and the effect of metritis cure on economically important outcomes

The main objective of this study was to evaluate the effect of ceftiofur on metritis cure, milk yield, reproductive performance, and culling up to 300 DIM. The secondary objective was to evaluate the effect of metritis cure at 5 (early cure [ECURE]) and 14 (late cure [LCURE]) days after diagnosis on milk production, reproduction, and culling. A total of 422 Holstein cows diagnosed with metritis from 4 herds located in Texas, California, and Florida were enrolled in a randomized clinical trial. Cows diagnosed with metritis (fetid, watery, reddish or brownish uterine discharge) were blocked by herd and parity and were randomly allocated to receive systemic administration of ceftiofur (CEF) or to remain untreated (CON). In addition, 399 nonmetritic cows (NMET) were included for comparison purposes. Metritis cure was evaluated at 5 and 14 d after diagnosis and was defined as the absence of metritis clinical signs. Logistic regression models were fitted to the data to assess the effect of treatment on metritis cure. Milk yield was analyzed using a mixed linear model, while logistic regression, Cox proportional hazard, and Kaplan-Meier survival analysis models were fitted to culling and reproduction data. Cows treated with CEF had 1.86 (95% CI: 1.22-2.81) and 1.68 (95% CI: 1.02-2.75) greater odds of being cured than CON cows at 5 and 14 d after diagnosis, respectively. No effect of CEF was observed for milk yield; however, NMET cows had greater milk yield compared with metritic cows (CEF = 36.0, 95% CI = 33.8-38.1; CON = 36.1, 95% CI = 33.9-38.2; NMET = 36.9 kg/d, 95% CI = 34.8-39.4). Likewise, no effect of CEF was observed on reproductive performance and culling. Nonetheless, the likelihood of conceiving for NMET cows was 1.72 (95% CI = 1.41-2.12) and 1.64 (95% CI = 1.33-2.00) times greater than for CEF and CON cows, respectively. Ceftiofur-treated and CON cows had 2.93 (95% CI = 1.90-4.51) and 2.37 (95% CI = 1.51-3.71) greater hazard of culling compared with NMET, respectively. Regardless of treatment, no differences between ECURE and LCURE were observed on milk yield, reproduction, and culling throughout the entire lactation, but cows that cured at 5 or 14 d after diagnosis had greater milk production in the first 60 DIM compared with cows that did not cure (NCURE). Cows in ECURE and LCURE also had a 1.59 (95% CI = 1.16-2.16) and 1.49 (95% CI = 1.08-2.05) greater hazard of pregnancy and 0.43 (95% CI = 0.26-0.71) and 0.56 (95% CI = 0.34-0.92) hazard of culling compared with NCURE. Ceftiofur therapy increased metritis cure, but benefits to productivity and longevity were not observed. Also, cows that fail to cure have impaired lactation performance, but no differences regarding timing of cure were observed.