Endometritis and Pyometra

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Endometritis and pyometra are seen more commonly in older females who suffer from cervical canal obstruction or carcinoma or following delivery. However, they can also be seen occasionally in adolescent females. Endometritis occurs when bacteria invade the uterine cavity, and pyometra develops when pus is collected within the uterus. Regardless of the etiology, anaerobes are predominant in endometritis and pyometra.

Hillier et al. (26) obtained endometrial biopsies for histologic and microbiologic study from 178 consecutive women with suspected PID, and 85 of them underwent laparoscopy to diagnose salpingitis. Histologic endometritis was confirmed in 117 (65%) women. Among women who underwent laparoscopy, salpingitis was present in 68% of those with and 23% of those without endometritis. Some but not all bacterial vaginosis-associated microorganisms were linked with

TABLE 1 Microbiology of 40 Vulvovaginal Pyogenic Infections

Bartholin's cyst

Labial cyst

Vaginal

Vulvar

Labial

abscess

abscess

abscess

abscess

wound

Total

No. of cases

(26)

(2)

(4)

(4)

(4)

(40)

Aerobes

Staphylococcus aureus

2

1

1

4

S. epidermidis

1

1

2

Enterococcus spp.

1

1

Neisseria gonorrhoeae

4

1

5

Diphtheroids

1

1

Lactobacillus spp.

3

3

Escherichia coli

6

1

7

Klebsiella pneumoniae

2

2

Proteus spp.

3

3

Acinetobacter spp.

1

1

Citrobacter spp.

2

2

Enterobacter spp.

1

1

Subtotal

24

1

3

1

3

32

Anaerobes

Peptostreptococci spp.

12

2

1

1

1

17

Veillonella spp.

2

2

Eubacteria spp.

2

2

Propionibacterium acnes

3

3

Lactobacillus spp.

1

1

Clostridium spp.

1

1

1

1

4

Fusobacterium spp.

2

2

Bacteroides spp.

8

2

3

12

B. fragilis group

5

4

1

1

11

Prevotella and

6

1

2

1

10

Porphyromonas spp.

Prevotella bivia

4

1

1

1

7

Subtotal

43

4

10

10

4

71

Total

67

5

13

11

7

103

Source: From Ref. 21.

Source: From Ref. 21.

endometritis. By logistic regression analysis, after adjustment for bacterial vaginosis, endometritis was associated with endometrial N. gonorrhoeae, C. trachomatis and AGNB. Mycoplasma genitalium is also associated with cervicitis and endometritis.

Carter and colleagues (27), who studied 133 patients with endometritis and pyometra, isolated obligate anaerobes from 75% of the patients. The most frequent anaerobic isolates were anaerobic streptoccocci and Bacteroides spp. Swenson and coworkers (19), studied 14 females with this diagnosis and recovered anaerobes from 13, often associated with facultative bacteria, but in pure culture in six. Muram et al. (28) recovered anaerobes only from five of 15 of their patients with pyometra, and mixed aerobic and anaerobic flora from seven.

Pyometra should be considered an abscess and treated promptly and vigorously with drainage of the uterine cavity followed by curettage to debride the necrotic tissue (29). The most serious fatal complication of these conditions is spread of the organisms from the uterus into the blood (6).

Antibiotics effective against aerobic and anaerobic bacteria should be given. This is especially important for patients with signs of systemic infection, such as fever, peritonitis, tachycardia, or leukocytosis. Appropriate specimens for cultures should be obtained prior to initiation of therapy. Combined therapy with an aminoglycoside or a third-generation cephalosporin and an agent against anaerobes (clindamycin, metronidazole, chloramphenicol, cefoxitin) or single-agent therapy with carbapenem (i.e., imipenem, meropenem) will be adequate in most patients. Evacuation of the uterus remains the mainstay of management, however.

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Bacterial Vaginosis Facts

Bacterial Vaginosis Facts

This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.

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