Relationship between uterine biopsy score, endometrial infection and inflammation in the mare

Summary Objective: Endometrial biopsy score is an accepted marker of uterine health and predicted fertility, and it has been suggested that endometrial alternations are correlated with susceptibility to persistent infectious endometritis. The objective of this study was to investigate associations of endometrial biopsy score with: 1) presence of polymorphonuclear cells (PMNs) in the epithelium and stratum compactum in histopathology; 2) presence of PMNs in cytology and 3) presence of infection in microbiology. Materials and methods: The material for examination was collected from 69 mares suspected for subclinical endometritis (bred three or more times unsuccessfully in the same breeding season) and from 15 maiden mares. Samples were collected by endometrial biopsy and cytobrush technique. Results: Endometrial alterations (biopsy score IIA, IIB, III) were found in 64 of 82 mares (78%). There was an increase in PMN occurrence for grades IIA, IIB and III. When comparing grades and PMNs infiltration, we observed statistically significant differences between grades I and IIA (p = 0.222) and grades I and IIB (p = 0.042) in samples collected by endometrial biopsy. Statistically significant differences were found in microbiological examination (biopsy p = 0.036; cytobrush p = 0.189), cytological examination (biopsy p = 0.040; cytobrush p = 0.079) and PMN infiltration (p = 0.042) between mares with biopsy scores I and IIB. Furthermore, the highest percentage of infected mares was in grade IIA and IIB, and we found statistically significant differences between grades I and IIA (p = 0.043), and grades I and IIB (p = 0.036) in biopsy samples. We observed a tendency to higher prevalence of endometrial infection in mares with biopsy score IIA, IIB and III than with biopsy score I in samples collected using cytobrush technique. However, there were no statistical significant differences. Conclusion: Degenerative endometrial changes can predispose to uterine infection and inflammation. Our study shows that mares with endometrial score I are less predisposed to infection than mares with category IIA, IIB and III. Endometrial biopsy is a reliable diagnostic tool.

In VitroEfficacy of Nonantibiotic Treatments on Biofilm Disruption of Gram-Negative Pathogens and anIn VivoModel of Infectious Endometritis Utilizing Isolates from the Equine Uterus

In this study, we evaluated the ability of the equine clinical treatmentsN-acetylcysteine, EDTA, and hydrogen peroxide to disruptin vitrobiofilms and kill equine reproductive pathogens (Escherichia coli,Pseudomonas aeruginosa, orKlebsiella pneumoniae) isolated from clinical cases.N-acetylcysteine (3.3%) decreased biofilm biomass and killed bacteria within the biofilms ofE. coliisolates. The CFU of recoverableP. aeruginosaandK. pneumoniaeisolates were decreased, but the biofilm biomass was unchanged. Exposure to hydrogen peroxide (1%) decreased the biofilm biomass and reduced the CFU ofE. coliisolates,K. pneumoniaeisolates were observed to have a reduction in CFU, and minimal effects were observed forP. aeruginosaisolates. Chelating agents (EDTA formulations) reducedE. coliCFU but were ineffective at disrupting preformed biofilms or decreasing the CFU ofP. aeruginosaandK. pneumoniaewithin a biofilm. No single nonantibiotic treatment commonly used in equine veterinary practice was able to reduce the CFU and biofilm biomass of all three Gram-negative species of bacteria evaluated. Anin vivoequine model of infectious endometritis was also developed to monitor biofilm formation, utilizing bioluminescence imaging with equineP. aeruginosaisolates from this study. Following infection, the endometrial surface contained focal areas of bacterial growth encased in a strongly adherent “biofilm-like” matrix, suggesting that biofilms are present during clinical cases of infectious equine endometritis. Our results indicate that Gram-negative bacteria isolated from the equine uterus are capable of producing a biofilmin vitro, andP. aeruginosais capable of producing biofilm-like materialin vivo.