Clinical Characteristics of Pyometra: Eleven Years of Experience from a Single Institution

Abstract

Background: Pyometra is defined as an accumulation of purulent material in the uterine cavity. It is caused by natural drainage impairment within the cervix and occurs predominantly in elderly women. In this study, we aimed to investigate the clinical characteristics and recurrent risk of pyometra. Methods: Data for patients diagnosed with pyometra between 2010 and 2021 were retrospectively reviewed. Basic patient characteristics, including age, underlying disease, management, chief complaint, antibiotics, and isolated organisms, were investigated. The risk of recurrence of pyometra was assessed using multivariate logistic regression analyses. In total, 65 patients with pyometra were included in this study. Results: The mean age of the patients was 75.8 ± 16.4 years. About half of the patients had been admitted to a nursing hospital due to poor mobility, and 61.5% of the patients had an Eastern Cooperative Oncology Group performance score of 2 or higher. The most prevalent presenting symptoms were vaginal discharge (73.9%) and fever (16.9%). Forty-eight (75.0%) patients underwent drainage, and seven (10.9%) underwent hysterectomy. Escherichia coli accounted for the most cases (36.9%), followed by Klebsiella pneumoniae (20.0%). Overall, 17 patients were extended-spectrum β-lactamase positive. Recurrence after drainage occurred in 16 (24.6%) of the 65 patients, and two patients died from septic shock. The isolation of Klebsiella pneumoniae was identified as a significant risk factor for recurrence (odds ratio (OR): 4.71; 95% confidence interval (CI): 1.09-20.47; p < 0.05). Conclusions: Because pyometra often occurs in elderly patients with chronic diseases, it is important to pursue appropriate treatment and prevention of recurrence to decrease the morbidity and mortality associated with this condition. The isolated organisms should be considered as a predisposing factor for recurrent pyometra.