Prevalence of bovine endometritis, virulence mechanisms of <i>Escherichia coli</i> , and current therapeutic strategies: A review

Dairy cow endometritis is a common postpartum disease influenced by geographic, management, environmental, diagnostic, and socio-economic factors. Escherichia coli (E. coli) was prioritized for its early colonization, frequent detection, and key inflammatory role in endometritis. Its pathogenicity depends on virulence factors, including adhesins, toxins, lipopolysaccharides (LPS), capsule antigens, siderophores, and biofilm formation. These factors jointly promote bacterial colonization, immune activation, tissue damage, and disease progression. This study combines a systematic review and meta-analysis to assess the prevalence and distribution of E. coli, and provides a descriptive synthesis of its key virulence factors, pathogenic mechanisms, and treatment strategies. Unlike descriptive reviews, this study links epidemiological patterns with pathogenic mechanisms and therapies. Main limitations include high epidemiological heterogeneity and limited clinical validation of therapeutic strategies. It further evaluates current treatment strategies to assess the feasibility of novel therapies, aiming to provide a reference for precise prevention and control in clinical practice.