Characteristics of Acute Pelvic Inflammatory Disease in Surgically Treated Females Over Ten Years - A Single-Center Study

Abstract

Background: Pelvic inflammatory disease (PID) is a public health problem that demands rapid diagnosis and treatment and may severely impair female reproductive health. Objective: To analyze anamnestic information, laboratory findings, and clinical and microbiological features of patients with severe acute PID that underwent a surgical procedure. Methods: This retrospective study enrolled 97 cases that were surgically treated in the Department of Obstetrics and Gynecology, University Hospital „ Sveti Duh“ between 2009 and 2019. Results: 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%). Conclusion: 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.