Data_Sheet_1_Diagnostic and Treatment Practices of Equine Endometritis—A Questionnaire.docx

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.

子宫内膜炎（Endometritis）是导致母马生育能力受损的主要诱因。本研究旨在收集兽医临床中针对子宫内膜炎的诊断与治疗实践信息，并探究从业者的专业从业年限、接诊病例量以及地理位置对其子宫内膜炎病例管理方案的潜在影响。为此，研究邀请了680名马科动物兽医参与一份包含34个问题的在线调查问卷，最终回收了来自德国全境的117份有效答卷。多数受访者来自下萨克森州，且每年接诊的子宫内膜炎患马不足20匹。针对慢性传染性子宫内膜炎的诊断，多数从业者采用棉拭子手工采集子宫样本进行微生物学检测，仅少数从业者使用窥器检查技术（speculum technique）。几乎所有受访者均报告称，抗生素耐药病原菌的检出率低于5%。多数从业者倾向于采用甲氧苄啶-磺胺嘧啶（trimethoprim-sulfadiazine）进行全身性抗生素治疗，仅少数兽医会采用子宫内抗生素给药方案。近半数受访者会在子宫微生物培养结果呈阳性时常规开展子宫冲洗术，冲洗液多采用0.9%生理盐水；刺激性冲洗液（如碘剂、氯己定、煤油）的使用频率则相对较低。完成治疗后采集子宫内膜样本进行培养是临床常见操作。尽管从业者所在地理位置与诊疗决策（如选择母马进行子宫内膜炎培养的标准，p < 0.05）之间仅存在极弱的相关性，但接诊母马数量对诊疗方案的选择影响显著（如刺激性宫腔内治疗的使用情况，p < 0.05）。持续性繁殖诱导性子宫内膜炎（Persistent Breeding Induced Endometritis, PBIE）的诊疗方案受接诊母马数量影响（如催产素（oxytocin）的使用情况，p < 0.05），且29.6%的受访者会在PBIE的诊疗流程中使用抗生素。综上，临床实际应用的治疗策略差异显著，甚至包含无循证依据的方案，但多数德国马科动物兽医仍会采用指南推荐的适宜治疗手段。遵循抗生素使用指南，多数兽医会依据子宫内膜培养结果制定给药方案，但不会常规开展细胞学检查、低容量子宫冲洗或子宫活检。据报告，子宫耐药病原菌的检出率较低，且马科动物兽医更倾向于采用全身性而非局部抗生素给药方案治疗子宫内膜炎。