Infectious Disease Compendium

Endometritis

Diagnosis

Infection of the uterus, usually after a surgical intervention. Patients have fever, leukocytosis, and painful uterus.

Epidemiologic Risks

Usually after surgical procedures including C section.

Microbiology

Variable. Group A and B streptococci, enterococci, other streptococci, G. vaginalis, E. coli, and anaerobes. In the old days (and perhaps in the not too distant future) backstreet abortions were associated is C. perfringens uterine myonecrosis. Actinomycosis of the uterus can occur with prolonged IUD use, the one I saw left the IUD in for 20 years. But at least she didn't get pregnant.

Empiric Therapy

Clindamycin AND gentamicin have been the mainstay for decades, as the infections are usually simple and young people are not prone to aminoglycoside toxicity. Me? Based on local resistance patterns I suggest a third generation cephalosporin AND metronidazole. Other options include a quinolone AND metronidazole OR a carbapenem alone. I, of course, never use the penicillin/beta-lactamase inhibitors, but they are also recommended.

Pearls

Patients usually respond rapidly, if not look of an abscess or consider a resistant organisms.

Rants

ICD9 Codes (Soon to be supplanted by ICD10)

Endometriosis 617.9.