Diagnosis of pelvic inflammatory disease (PID): intra-operative findings and comparison of vaginal and intra-abdominal cultures.
BACKGROUND
Pelvic inflammatory disease (PID) is frequent in adolescents and younger women. Diagnosis is usually based on the clinical findings, and the threshold for empiric antibiotic therapy should be low. However, at least in cases of resistance toward therapy or deterioration of symptoms, laparoscopic evaluation can be helpful.


METHODS
We searched the hospital charts for in-house patients who were treated for PID or tubo-ovarian abscess between 2007 and 2010. In cases with both vaginal and intra-abdominal bacterial cultures, results of those were compared.


RESULTS
73 patients with suspected PID or tubo-ovarian abscess were included. Median patients' age was 40 years (18-88), 18 of 73 (24.7 %) patients had an IUD at the time of consultation. 58 patients underwent laparoscopy or laparotomy. In 41 patients (70.7 %) tubo-ovarian abscess could be confirmed, four patients had differential gynecologic diagnoses, and two patients appendicitis. In vaginal swabs, most frequent bacteria were Streptococcus sp. (28.5 %), Escherichia coli (22.2 %), Enterococcus faecalis (15.9 %), and Staphylococcus sp. (9.5 %). In eight patients (11 %) Chlamydia trachomatis could be found, there was no case of Neisseria gonorrhea. In 33 patients both vaginal and abdominal cultures were available. In nine cases (27.3 %), identical bacteria could be found, however, 11 cases (33.3 %) showed different results.


CONCLUSIONS
In severe cases of PID, laparoscopic evaluation and taking an intra-abdominal bacterial culture are helpful for the confirmation of diagnosis, accurate microbiologic testing and specific therapy.
Department of Obstetrics and Gynecology, Klinikum Traunstein, Cuno-Niggl-Strasse 3, 83278, Traunstein, Germany, Christian.Schindlbeck@klinikum-traunstein.de.
Christian
C
Schindlbeck
Dominik
D
Dziura
Ioannis
I
Mylonas
D000005:Abdomen / Q000382:microbiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D007434:Intrauterine Devices / Q000382:microbiology; D010535:Laparoscopy; D007813:Laparotomy; D007902:Length of Stay / Q000706:statistics & numerical data; D007964:Leukocytosis / Q000209:etiology; D008875:Middle Aged; D000292:Pelvic Inflammatory Disease / Q000175:diagnosis* / Q000382:microbiology* / Q000628:therapy; D012189:Retrospective Studies; D014621:Vagina / Q000382:microbiology*; D055815:Young Adult
D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein