ArticleCureus2026
Risk Factors for Severe Pyometra Uteri in Elderly Women: A Case-Control Study at a Tertiary Care Hospital in Japan.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background Pyometra uteri (PU) is an uncommon gynecologic condition characterized by purulent accumulation within the uterine cavity. Although it is typically managed conservatively with drainage and antibiotics, severe cases - particularly those complicated by uterine rupture (UR) - are associated with substantial morbidity and high mortality. Evidence regarding factors associated with severe PU remains limited, especially in aging populations. This study, therefore, explored clinical and microbiological factors potentially associated with severe PU in elderly women. Methods This retrospective case-control study included 120 patients diagnosed with PU at a tertiary-care hospital in Japan between January 2014 and September 2024. Severe cases were defined as those requiring intensive care unit (ICU) or high care unit (HCU) admission. Clinical characteristics, microbiological findings, and outcomes were compared between severe (n=10) and non-severe (n=110) cases. Because of the limited number of severe cases, multivariable logistic regression was not feasible; therefore, univariate logistic regression analyses were performed, with additional age- and BMI-adjusted stratified analyses using the Mantel-Haenszel method. Receiver operating characteristic (ROC) curve analysis was used to explore the predictive performance of abscess size. Results The median age of the study population was 84 years. Ten patients (8.3%) were classified as severe; and all had UR. The in-hospital mortality rate among severe cases was 50%. Several clinical and microbiological variables were statistically associated with severe disease in univariate analyses, including fever, abdominal pain, presence of coexisting adenomyosis, detection of extended-spectrum β-lactamase (ESBL)-producing
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