尽管产褥期子宫炎(PM)是奶牛常见的传染病,目前,已有同行评审文献的临床病例定义与农场实践之间存在差异.在研究和农场实践中使用PM标准的不一致可能导致与处理奶牛的建议有关的差异,影响抗菌药物的合理使用。这项研究的目的是系统地回顾同行评审的文献,以了解用于PM病例定义的临床体征。使用的标准包括本地(例如,阴道分泌物)和全身感染的临床体征(例如,发烧,滴牛奶)。用于范围审查方案的系统审查和荟萃分析扩展的首选报告项目用于筛选常用数据库。按照这个协议,一名审稿人筛选了资格标题和摘要(n=2096),然后由2名审稿人对选定的文章进行全文筛选(n=396),以确认符合条件的文章(n=174).关于PM定义的引用次数最多的参考文章(37.5%)发表于2006年,其次是1998年至2009年之间的文章(13%)。在40.2%的文章中,没有提供PM定义的参考;阴道分泌物以颜色描述,气味,与PM定义相关时的粘度。用于描述阴道分泌物颜色的术语为红棕色(61.4%),红色(5.1%),棕色(8.6%),巧克力(4%)白色(1.7%),黄色(0.5%),粉红色(5.7%),或灰色(0.5%);24.1%的文章中未报告阴道分泌物颜色。阴道分泌物气味被描述为恶臭(75.8%),腐烂(5.1%),犯规(10.3%),或其他(5.7%;例如,异常,恶臭,有气味);7.4%的文章中没有提到气味。阴道分泌物粘度描述为水样(74.1%),脓性(27%),粘液脓性(8.6%),瘦(4%),浆液性(2.8%),或异常(2.3%),11.5%的文章中没有提到。59.7%的文章将发热作为PM诊断的标准。使用最多的直肠温度阈值为≥39.5°C(56.8%),其次是≥39.2°C(2.8%)。用于阴道分泌物评估的方法包括直肠触诊(37.3%),带手套的阴道内探查术(18.4%),Metricheck(9.8%),或窥器(5.7%);在28.7%的文章中,没有提到使用的诊断工具。文献中观察到的许多颜色和气味的阴道分泌物描述,用同义词来描述相同的阴道分泌物样本,强调缺乏术语共识可能导致分歧,特别是由于这些临床评估阴道分泌物颜色和气味的主观特征。尽管有精选的共识文章,在定义PM案例时,研究通常会忽略参考。此外,我们的研究结果强调,我们需要就用于诊断PM的标准和术语达成强有力和明确的共识.
Although puerperal metritis (PM) is a common infectious disease in dairy cattle, there are currently discrepancies between clinical case definitions within and between available peer-reviewed literature and on-farms practices. The inconsistent use of PM criteria across studies and on-farms practices can result in disparities related to recommendations for treating cows, affecting judicious use of antimicrobials. The objective of this study was to systematically
review the peer-reviewed literature for clinical signs used for case definition of PM. The criteria used included local (e.g., vaginal discharge) and systemic clinical signs of infection (e.g., fever, drop in milk). The Preferred Reporting Items for Systematic
Review and Meta-Analysis extension for scoping reviews protocols were used to screen commonly used databases. Following this protocol, one reviewer screened title and abstract for eligibility (n = 2,096), followed by full-text screening of selected articles (n = 396) by 2 reviewers to confirm eligible articles (n = 174). The most frequently cited reference article (37.5%) for the definition of PM was published in 2006, followed by articles published between 1998 and 2009 (13%). In 40.2% of articles, no reference was provided for definition of PM; vaginal discharge was described in terms of color, odor, and viscosity when related to the PM definition. Terms used for description of vaginal discharge color were red-brown (61.4%), red (5.1%), brown (8.6%), chocolate (4%), white (1.7%), yellow (0.5%), pink (5.7%), or gray (0.5%); vaginal discharge color was not reported in 24.1% articles. The vaginal discharge odor was described as fetid (75.8%), putrid (5.1%), foul (10.3%), or other (5.7%; e.g., abnormal, malodorous, odoriferous); odor was not mentioned in 7.4% of articles. The vaginal discharge viscosity was described as watery (74.1%), purulent (27%), mucopurulent (8.6%), thin (4%), serous (2.8%), or abnormal (2.3%) and was not mentioned in 11.5% of articles. Fever was included in 59.7% of articles as a criterion for PM diagnosis. The most used rectal temperature threshold was ≥39.5°C (56.8%), followed by ≥39.2°C (2.8%). Approaches used for vaginal discharge evaluation included rectal palpation (37.3%), intravaginal exploration with a gloved hand (18.4%), Metricheck (9.8%), or speculum (5.7%); and in 28.7% of articles, diagnostic tools used were not mentioned. Many of the color and odor vaginal discharge descriptions observed in the literature, used synonymous words to describe the same vaginal discharge sample, highlighting a lack of terminology consensus that could result in disagreements, especially due to the subjective character of these clinical evaluations of vaginal discharge color and odor. Although select consensus articles are available, it is common for studies to disregard a reference when defining PM cases. Furthermore, our findings highlight the need for a robust and clear consensus on criteria and terminology used to diagnose PM.