Abstract：
BACKGROUND: Pyometra is a disease characterized by the collection of pus in the uterus. The clinical characteristics and etiology of pyometra have not been sufficiently described. In this study, we investigated the clinical characteristics, epidemiology, outcomes, and risk factors of septic shock in patients with pyometra.
METHODS: Patients with pyometra admitted to one of four university-affiliated hospitals between January 2010 to August 2022 were enrolled. Pyometra cases associated with peripartum infection and surgical site infection were excluded. Clinical characteristics and outcomes of pyometra were described, and pyometra patients with or without septic shock were compared.
RESULTS: A total of 192 patients was included. Twenty-eight-day all-cause mortality was 5.0%, and the 1-year recurrence rate was 6.3%. Median patient age was 77.5 years. The two most common symptoms were abdominal pain (49.0%) and vaginal discharge (47.9%). Escherichia coli (40.1%), Klebsiella pneumoniae (16.7%), and Streptococcus spp.(16.0%) were the pathogens most frequently isolated by conventional culture; those isolated from polymerase chain reaction were Mycoplasma hominis (48.0%), and Ureaplasma spp. (32.0%). In multivariable analysis, fever, uterine perforation, and dementia were associated with increased incidence of septic shock, while vaginal discharge was associated with a lower incidence of septic shock.
CONCLUSIONS: Our findings suggest that pyometra is a unique gynecological infectious syndrome in post-menopausal individuals. The most common associated pathogens are similar to those involved in urinary tract infections rather than those of sexually transmitted diseases. Decreased cognitive function could delay early diagnosis of pyometra and lead to septic shock and higher mortality.
METHODS: Patients with pyometra admitted to one of four university-affiliated hospitals between January 2010 to August 2022 were enrolled. Pyometra cases associated with peripartum infection and surgical site infection were excluded. Clinical characteristics and outcomes of pyometra were described, and pyometra patients with or without septic shock were compared.
RESULTS: A total of 192 patients was included. Twenty-eight-day all-cause mortality was 5.0%, and the 1-year recurrence rate was 6.3%. Median patient age was 77.5 years. The two most common symptoms were abdominal pain (49.0%) and vaginal discharge (47.9%). Escherichia coli (40.1%), Klebsiella pneumoniae (16.7%), and Streptococcus spp.(16.0%) were the pathogens most frequently isolated by conventional culture; those isolated from polymerase chain reaction were Mycoplasma hominis (48.0%), and Ureaplasma spp. (32.0%). In multivariable analysis, fever, uterine perforation, and dementia were associated with increased incidence of septic shock, while vaginal discharge was associated with a lower incidence of septic shock.
CONCLUSIONS: Our findings suggest that pyometra is a unique gynecological infectious syndrome in post-menopausal individuals. The most common associated pathogens are similar to those involved in urinary tract infections rather than those of sexually transmitted diseases. Decreased cognitive function could delay early diagnosis of pyometra and lead to septic shock and higher mortality.
摘要：
背景：子宫积脓是一种以子宫积脓为特征的疾病。子宫积脓的临床特征和病因尚未得到充分描述。在这项研究中,我们调查了临床特征，流行病学,结果，和脓疱患者脓毒性休克的危险因素。
方法：纳入2010年1月至2022年8月在四家大学附属医院之一收治的子宫积脓患者。排除与围产期感染和手术部位感染相关的子宫积脓病例。描述了子宫积脓的临床特征和结果，并对有或无脓毒性休克的子宫积脓患者进行比较。
结果：共纳入192例患者。28天全因死亡率为5.0%,1年复发率为6.3%。患者年龄中位数为77.5岁。最常见的两种症状是腹痛（49.0％）和阴道分泌物（47.9％）。大肠杆菌（40.1%），肺炎克雷伯菌（16.7%），和链球菌。（16.0％）是通过常规培养最常见的病原体；通过聚合酶链反应分离的是人型支原体（48.0％），和脲原体属。（32.0%）。在多变量分析中，发烧,子宫穿孔,痴呆与感染性休克的发生率增加有关,而阴道分泌物与脓毒性休克的发生率较低相关。
结论：我们的研究结果表明，子宫积脓是绝经后个体的一种独特的妇科感染性综合征。最常见的相关病原体类似于涉及尿路感染的病原体，而不是性传播疾病的病原体。认知功能下降可能会延迟宫腔积脓的早期诊断，并导致感染性休克和更高的死亡率。
方法：纳入2010年1月至2022年8月在四家大学附属医院之一收治的子宫积脓患者。排除与围产期感染和手术部位感染相关的子宫积脓病例。描述了子宫积脓的临床特征和结果，并对有或无脓毒性休克的子宫积脓患者进行比较。
结果：共纳入192例患者。28天全因死亡率为5.0%,1年复发率为6.3%。患者年龄中位数为77.5岁。最常见的两种症状是腹痛（49.0％）和阴道分泌物（47.9％）。大肠杆菌（40.1%），肺炎克雷伯菌（16.7%），和链球菌。（16.0％）是通过常规培养最常见的病原体；通过聚合酶链反应分离的是人型支原体（48.0％），和脲原体属。（32.0%）。在多变量分析中，发烧,子宫穿孔,痴呆与感染性休克的发生率增加有关,而阴道分泌物与脓毒性休克的发生率较低相关。
结论：我们的研究结果表明，子宫积脓是绝经后个体的一种独特的妇科感染性综合征。最常见的相关病原体类似于涉及尿路感染的病原体，而不是性传播疾病的病原体。认知功能下降可能会延迟宫腔积脓的早期诊断，并导致感染性休克和更高的死亡率。
