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Journal of Dairy Science Nov 2014Acute 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... (Review)
Review
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.
Topics: Animals; Anti-Bacterial Agents; Cattle; Cattle Diseases; Cephalosporins; Drug Resistance, Bacterial; Endometritis; Female; Fever; Microbial Sensitivity Tests; Postpartum Period; Puerperal Disorders; Reproduction
PubMed: 25218751
DOI: 10.3168/jds.2014-8462 -
Journal of Dairy Science May 2017The objective of this meta-analysis was to assess the efficacy of the treatment of bovine metritis with common antibiotic and nonantibiotic treatment options. Acute... (Meta-Analysis)
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.
Topics: Animals; Anti-Bacterial Agents; Cattle; Cattle Diseases; Endometritis; Female; Postpartum Period; Reproduction
PubMed: 28365115
DOI: 10.3168/jds.2016-11834 -
Beijing Da Xue Xue Bao. Yi Xue Ban =... Jun 2010To get an overview of the fatality and secular trend of bloodstream infection (BSI) during hospitalization in China. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To get an overview of the fatality and secular trend of bloodstream infection (BSI) during hospitalization in China.
METHODS
Papers published between 1990 and Aug. 2008 on the core journals included by Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI) and VIP Chinese Periodical Database were systematically searched. Studies providing data of BSI fatality during hospitalization with a non-comparative, observational design were included. Meta-analysis was done using the generic inverse variance model.
RESULTS
Overall, 72 studies were included for this analysis. The weighted BSI fatality in-hospital based on them was 28.7% (95%CI: 27.2%-30.3%), with substantial differences between study and heterogeneity. For BSI cases from across all departments of hospitals, the weighed fatality was 20.7% (95%CI: 17.8%-24.0%). In the departments of burn, hematology and/or malignant tumors, and ICU, BSI fatalities were even higher, but were relatively low among BSI cases from neonatal wards, and patients with liver diseases, or diabetes mellitus. Fatality of hospital acquired BSI (HA-BSIs, 26.8%, 95%CI: 22.4%-32.0%) was significantly higher than that of community acquired BSI (CA-BSIs). For the past decades, BSI fatality has declined in various kinds of inpatients.
CONCLUSION
BSI fatality during hospitalization was at a high level in China, but with a downward trend over the past decades.
Topics: Bacteremia; Bacterial Infections; China; Cross Infection; Female; Hospitalization; Humans; Intensive Care Units; Male; Toxemia
PubMed: 20559406
DOI: No ID Found