Characteristics Of Acute Pelvic Inflammatory Disease In Surgically Treated Females Over Ten years - A Single-Center Study

Abstract

Pelvic inflammatory disease (PID) is a public health problem that demands rapid diagnosis and treatment and may severely impair female reproductive health. To analyze anamnestic information, laboratory findings, and clinical and microbiological features of patients with severe acute PID that underwent a surgical procedure. This retrospective study enrolled 97 cases that were surgically treated in the Department of Obstetrics and Gynecology, Clinical Hospital „Sveti Duh“ between 2009 and 2019. Most women were within the age group 35-44 (38.14%). Lower abdominal pain was the most common symptom (92.78%). Compared to intraoperatively confirmed PID, C-reactive protein (CRP) yielded the highest sensitivity (88.10%) while cervical motion tenderness possessed the highest specificity (53.85%). The tubo-ovarian abscess was detected in 35.05% of intraoperative specimens, mainly occurring in women between 45-54 years (P=0.017) and absent between 15-24 (P=0.012) and 25-34 years (P=0.049). The length of hospital stay was influenced by the number of symptoms (ρ=0.316, P=0.002), admission CRP levels (ρ=0.620, P<0.001), and admission body temperature (ρ=0.386, P<0.001). Out of 59.30% of positive cultures, one pathogen was isolated in 70.59%, mainly Escherichia coli (41.18%). Admission CRP levels impacted the efficacy of microbiologic isolation (P=0.001). The empirical treatment was mostly based on the clindamycin/gentamicin combination (51.72%). Severe clinical picture that requires surgical treatment can be expected in women >35 years. Longer hospital stay was associated with more symptoms, higher CRP, and temperature values on admission. It is important to have a low threshold for diagnosis and to consider both aerobic and anaerobic pathogens when selecting antibiotic treatment.