Antibiotic therapy for pelvic inflammatory disease

Research progress on the interaction between intestinal flora and microRNA in pelvic inflammatory diseases

Pelvic inflammatory disease (PID) is a common infectious disease of the female upper reproductive tract, and its pathological basis is immune inflammatory response. The imbalance of gut microflora (GM) may lead to the development of inflammatory process. A large number of studies have shown that fecal microbiota transplantation, probiotics, bacteria, prebiotics, and dietary intervention may play a potential role in remodeling GM and treating diseases. MicroRNAs (miRNAs) are involved in cell development, proliferation, apoptosis and other physiological processes. In addition, they play an important role in the inflammatory process, participating in the regulation of proinflammatory and anti-inflammatory pathways. Differences in miRNA profiles may be PID diagnostic tools and serve as prognostic markers of the disease. The relationship between miRNA and GM has not been fully elucidated. Recent studies have shown the role of miRNA in the regulation and induction of GM dysbiosis. In turn, microbiota can regulate the expression of miRNA and improve the immune status of the body. Therefore, this review aims to describe the interaction between GM and miRNA in PID, and to find potential precise targeted therapy for PID.

Periappendiceal Abscess Masquerading as Pyosalpinx: A Case Report and Mini Literature Review of Acute Appendicitis Misdiagnosis

A 17-year-old patient presented to the emergency department of the General Hospital of Trikala, Greece, reporting hypogastric pain accompanied by a fever of up to 38°C. The pain, progressively increasing in intensity, had been present for about a week, with the fever onset occurring 24 hours prior. Based on clinical examination, transvaginal ultrasound, and computed tomography findings, an incorrect diagnosis of pyosalpinx was made, and intravenous treatment with broad-spectrum antibiotics was initiated. However, the lack of improvement in the patient's clinical and laboratory findings after two days led to the decision to perform a laparotomy. Intraoperatively, a periappendiceal abscess was found, with a bilateral secondary extension of inflammation to the uterus, fallopian tubes, ovaries, and pelvic peritoneum. The inflamed appendix was resected from its retrocecal position, and the pelvic abscess was drained. The postoperative course was uneventful. This case report highlights an atypical presentation of acute appendicitis with abscess, which was preoperatively misdiagnosed as pyosalpinx. The main factors contributing to the misdiagnosis of acute appendicitis and the subsequent delay in medical care are discussed, emphasizing that early and accurate diagnosis is crucial in preventing adverse outcomes and ensuring effective treatment.

Declining global fertility rates and the implications for family planning and family building: an IFFS consensus document based on a narrative review of the literature

BACKGROUND

Family-planning policies have focused on contraceptive approaches to avoid unintended pregnancies, postpone, or terminate pregnancies and mitigate population growth. These policies have contributed to significantly slowing world population growth. Presently, half the countries worldwide exhibit a fertility rate below replacement level. Not including the effects of migration, many countries are predicted to have a population decline of >50% from 2017 to 2100, causing demographic changes with profound societal implications. Policies that optimize chances to have a child when desired increase fertility rates and are gaining interest as a family-building method. Increasingly, countries have implemented child-friendly policies (mainly financial incentives in addition to public funding of fertility treatment in a limited number of countries) to mitigate decreasing national populations. However, the extent of public spending on child benefits varies greatly from country to country. To our knowledge, this International Federation of Fertility Societies (IFFS) consensus document represents the first attempt to describe major disparities in access to fertility care in the context of the global trend of decreasing growth in the world population, based on a narrative review of the existing literature.

OBJECTIVE AND RATIONALE

The concept of family building, the process by which individuals or couples create or expand their families, has been largely ignored in family-planning paradigms. Family building encompasses various methods and options for individuals or couples who wish to have children. It can involve biological means, such as natural conception, as well as ART, surrogacy, adoption, and foster care. Family-building acknowledges the diverse ways in which individuals or couples can create their desired family and reflects the understanding that there is no one-size-fits-all approach to building a family. Developing education programs for young adults to increase family-building awareness and prevent infertility is urgently needed. Recommendations are provided and important knowledge gaps identified to provide professionals, the public, and policymakers with a comprehensive understanding of the role of child-friendly policies.

SEARCH METHODS

A narrative review of the existing literature was performed by invited global leaders who themselves significantly contributed to this research field. Each section of the review was prepared by two to three experts, each of whom searched the published literature (PubMed) for peer reviewed full papers and reviews. Sections were discussed monthly by all authors and quarterly by the review board. The final document was prepared following discussions among all team members during a hybrid invitational meeting where full consensus was reached.

OUTCOMES

Major advances in fertility care have dramatically improved family-building opportunities since the 1990s. Although up to 10% of all children are born as a result of fertility care in some wealthy countries, there is great variation in access to care. The high cost to patients of infertility treatment renders it unaffordable for most. Preliminary studies point to the increasing contribution of fertility care to the global population and the associated economic benefits for society.

WIDER IMPLICATIONS

Fertility care has rarely been discussed in the context of a rapid decrease in world population growth. Soon, most countries will have an average number of children per woman far below the replacement level. While this may have a beneficial impact on the environment, underpopulation is of great concern in many countries. Although governments have implemented child-friendly policies, distinct discrepancies in access to fertility care remain.

Comparison of risk prediction models for the progression of pelvic inflammatory disease patients to sepsis: Cox regression model and machine learning model

Introduction

The present study presents the development and validation of a clinical prediction model using random survival forest (RSF) and stepwise Cox regression, aiming to predict the probability of pelvic inflammatory disease (PID) progressing to sepsis.

Methods

A retrospective cohort study was conducted, gathering clinical data of patients diagnosed with PID between 2008 and 2019 from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Patients who met the Sepsis 3.0 diagnostic criteria were selected, with sepsis as the outcome. Univariate Cox regression and stepwise Cox regression were used to screen variables for constructing a nomogram. Moreover, an RSF model was created using machine learning algorithms. To verify the model's performance, a calibration curve, decision curve analysis (DCA), and receiver operating characteristic (ROC) curve were utilized. Furthermore, the capabilities of the two models for estimating the incidence of sepsis in PID patients within 3 and 7 days were compared.

Results

A total of 1064 PID patients were included, of whom 54 had progressed to sepsis. The established nomogram highlighted dialysis, reduced platelet (PLT) counts, history of pneumonia, medication of glucocorticoids, and increased leukocyte counts as significant predictive factors. The areas under the curve (AUCs) of the nomogram for prediction of PID progression to sepsis at 3-day and 7-day (3-/7-day) in the training set and the validation set were 0.886/0.863 and 0.824/0.726, respectively, and the C-index of the model was 0.8905. The RSF displayed excellent performance, with AUCs of 0.939/0.919 and 0.712/0.571 for 3-/7-day risk prediction in the training set and validation set, respectively.

Conclusion

The nomogram accurately predicted the incidence of sepsis in PID patients, and relevant risk factors were identified. While the RSF model outperformed the Cox regression models in predicting sepsis incidence, its performance exhibited some instability. On the other hand, the Cox regression-based nomogram displayed stable performance and improved interpretability, thereby supporting clinical decision-making in PID treatment.

Association between dietary trace minerals and pelvic inflammatory disease: data from the 2015-2018 National Health and Nutrition Examination Surveys

OBJECTIVE

Pelvic inflammatory disease (PID) is a prevalent gynecological disorder. Dietary trace minerals play an important role in combating many chronic diseases including PID. However, it is unknown whether dietary trace minerals and PID are related. This study aimed to examine the relationship between dietary trace minerals (copper, iron, selenium, and zinc) and PID.

METHODS

Data of women participants from the National Health and Nutrition Examination Survey (NHANES) 2015-2018 were enrolled in this cross-sectional investigation. Univariate and multivariate linear regression analyses of the relationship between dietary trace minerals and PID were performed, and restricted cubic spline (RCS) analyses were applied to visualize those relationships.

RESULTS

In total, 2,694 women between the ages of 20 and 59 years participated in the two NHANES cycles. In the univariate analyses, a significant negative relationship was identified between PID and dietary copper intake [odds ratio (OR) = 0.40, 95% confidence interval (CI): 0.24-0.67, p < 0.01] but not with iron (OR = 0.96, 95% CI: 0.90-1.03, p = 0.25), selenium (OR = 1.0, 95% CI: 0.99-1.0, p = 0.23), and zinc (OR = 0.94, 95% CI: 0.86-1.03, p = 0.17) intake. Following the adjustment for age and race (model 1), a robust correlation was found between dietary copper intake and PID (OR = 0.23, 95% CI = 0.09-0.61, p < 0.01), as indicated by the fully adjusted model 2 (OR = 0.29, 95% CI = 0.09-0.90, p = 0.03). Simultaneously, a significant trend was found between copper intake and PID across the quintile subgroups (p for trends <0.05), suggesting a robust relationship. Furthermore, the RCS analysis demonstrated a linear correlation between PID and dietary copper intake (overall p < 0.01, non-linear p = 0.09).

CONCLUSION

Decreased dietary copper intakes are linked to PID. However, additional research is needed to fully investigate this relationship due to the constraints of the study design.

POSTOPERATIVE INFECTIONS AFTER GYNECOLOGICAL SURGERIES IN UKRAINE

OBJECTIVE

Aim: To determine the current prevalence of surgical site infections (SSIs) after gynecological surgeries and antimicrobial resistance of causing pathogens in Ukraine.

PATIENTS AND METHODS

Materials and Methods: Multicenter prospective observational cohort study was conducted from January 2020 to December 2022 in nine hospitals from eight regions of Ukraine. Definitions of HAIs were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network. Antibiotic susceptibility was done by the disc diffusion test as recommended by EUCAST.

RESULTS

Results: A total 12.2% (420/3450) patients who undergoing gynecological surgeries were found to have SSIs. The difference in SSI rates between the three subgroups by route of surgery was not statistically significant, being 12.0% for the abdominal group,11.1% for the vaginal group, and 12.5% for the combined group. The most common causing pathogens of SSIs was Escherichia coli, Pseudomonas aeruginosa, Enterobacter spp., Streptococcus spp., and Klebsiella pneumoniae. Many Gram-negative pathogens isolated from SSI cases were found to be multidrug resistant.

CONCLUSION

Conclusions: This study showed that SSIs remains the common complication after gynecological procedures in Ukraine. Best practices should be established and followed to reduce the risk of SSIs associated with gynecologic surgery. Optimizing the antibiotic prophylaxis and empirical antimicrobial therapy may reduce the burden of SSIs in gynecological surgeries, but prevention is the key element.

The severity of depression is associated with pelvic inflammatory diseases: A cross-sectional study of the United States National Health and Nutrition Examinations from 2013 to 2018

Purpose

As depression in patients with pelvic inflammatory diseases (PID) has received increasing attention in recent years, this study aims to investigate the relationship between depression severity and risk factors for pelvic inflammatory disease, and to provide new perspectives in the treatment of PID.

Patients and methods

Multivariate regression was used to evaluate the association between pelvic inflammatory disease and the severity of depression. Females who participated in the United States National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018 were included. In addition, risk factors for PID and depression were also included in the analysis as adjustment factors.

Results

The risk of developing PID was associated with depressive status (odds ratio, OR 1.10, 95% confidence interval, CI 1.08–1.12), especially in people with severe depression (odds ratio, OR 6.34, 95% confidence interval, CI 3.72–10.79). Subgroup analysis showed differences in the risk of PID among people with different characteristics.

Conclusion

This study showed that there may be a potential positive association between depressive status and the prevalence of PID in the United States adult female population. Depression should be actively looked for in all patients with PID and treated appropriately

Effectiveness and safety of morinidazole in the treatment of pelvic inflammatory disease: A multicenter, prospective, open-label phase IV trial

Background

Antimicrobial resistance to metronidazole has emerged after several decades of worldwide use of the drug. The purpose of this study was to evaluate the effectiveness, safety and population pharmacokinetics of morinidazole plus levofloxacin in adult women with pelvic inflammatory disease (PID).

Methods

Patients in 30 hospitals received a 14-day course of 500 mg intravenous morinidazole twice daily plus 500 mg of levofloxacin daily. A total of 474 patients were included in the safety analysis set (SS); 398 patients were included in the full analysis set (FAS); 377 patients were included in the per protocol set (PPS); 16 patients were included in the microbiologically valid (MBV) population.

Results

The clinical resolution rates in the FAS and PPS populations at the test of cure (TOC, primary effectiveness end point, 7–30 days post-therapy) visit were 81.91 and 82.49% (311/377), respectively. There were 332 patients who did not receive antibiotics before treatment, and the clinical cure rate was 82.83%. Among 66 patients who received antibiotics before treatment, 51 patients were clinically cured 7–30 days after treatment, with a clinical cure rate of 77.27%. The bacteriological success rate in the MBV population at the TOC visit was 87.5%. The minimum inhibitory concentration (MIC) values of morinidazole for use against these anaerobes ranged from 1 to 8 μg/mL. The rate of drug-related adverse events (AEs) was 27.43%, and no serious AEs or deaths occurred during the study.

Conclusions

The study showed that treatment with a 14-day course of intravenous morinidazole, 500 mg twice daily, plus levofloxacin 500 mg daily, was effective and safe. The results of this study were consistent with the results of a phase III clinical trial, which verified the effectiveness and safety of morinidazole.

Evidence for the Use of Complementary and Alternative Medicine for Pelvic Inflammatory Disease: A Literature Review

Pelvic inflammatory disease (PID), a common infectious disease of the female reproductive tract, is mainly characterized by abdominal/pelvic pain and tenderness of the uterus, cervix, or adnexa on physical exam. In recent years, its incidence has gradually increased yearly due to numerous factors, including sexually transmitted diseases and intrauterine operations. Based on self-report of PID in the National Health and Nutrition Examination Survey (NHANES) 2013-2014 survey, PID impacts approximately 2.5 million women in the US during their reproductive age. Although empiric treatments such as antibiotics or surgery could alleviate the related symptoms of PID, its unsatisfactory obstetric outcome and high relapse bring heavy physical and psychological burden to women. Complementary and alternative medicine (CAM), a complementary therapy other than Western medicine with a complete theoretical and practical system, has been attached to importance in the world due to its remarkable efficacy. More people are accepting and trying to use CAM to treat gynecological diseases, including infertility, polycystic ovary syndrome, and PID, but its efficacy and mechanism are still controversial. This article reviews the previous literature systematically focusing on the effectiveness, safety, and mechanism of CAM in the treatment of PID to provide an evidence-based basis for the clinical application of CAM in patients with PID.

HEALTHCARE-ASSOCIATED TUBO-OVARIAN INFECTIONS IN UKRAINE: RESULTS OF A MULTICENTER STUDY (2020-2022)

OBJECTIVE

The aim: To determine the current prevalence of healthcare-associated tubo-ovarian infections in female and antimicrobial resistance of the responsible pathogens in Ukraine.

PATIENTS AND METHODS

Materials and methods: We performed a retrospective multicenter cohort study was based on healthcare-associated infections surveillance data. Definitions of health¬care-associated tubo-ovarian infections were used from the CDC/ NHSN. The susceptibility to antibiotics was determined by disk diffusion method according to the EUCAST.

RESULTS

Results: Among all the 1,528 of women in this study, the prevalence of healthcare-associated tubo-ovarian infections was 31.2%. Of these cases, Salpingitis, Oophoritis, and tubo-ovarian abscess were 47.5%, 34% and 18.5%, respectively. Of all cases tubo-ovarian infections in female, 74.7% were detected after hospital discharge. The predominant pathogens were: Escherichia coli (27.7%), Enterobacter spp. (12.2%), Klebsiella pneumoniae (9.6%), Staphylococcus aureus (8.2%), Pseudomonas aeruginosa (8.1%), and Enterococcus faecalis (7.5%), followed by Proteus mirabilis (5.1%), Streptococcus spp. (4.5%), Staphylococcus epidermidis (4.4%), and Acinetibacter spp. (4%). Methicillin-resistance was ob¬served in 16.8% of S. aureus (MRSA). No strains S.aureus and E. faecalis resistant to vancomycin. The overall proportion of extended spectrum beta-lactamases (ESBL) production among Enterobacteriaceae was 24.7%. The prevalence of ESBL production among E. coli isolates was 28.6% and among K. pneumoniae 12.8%. Resistance to third-generation cephalosporins was observed in 14.9% E.coli and 11.3% K. pneumoniae isolates. Carbapenem resistance was identified in 11.3% of P.aeruginosa isolates.

CONCLUSION

Conclusions: A healthcare-associated tubo-ovarian infections of the female in Ukraine is a common occurrence and many cases are caused by pathogens that are resistant to antibiotics.

A Rare Case of Small Bowel Obstruction Secondary to Pelvic Inflammatory Disease

Small bowel obstruction (SBO) secondary to pelvic inflammatory disease (PID) is a rare complication only reported on a few occasions. We presented a 38-year-old female with an acute abdomen secondary to PID diagnosed via CT and MRI abdomen. The patient was treated in a conservative manner and recovered with no further complications. In our case, the learning point is the consideration of such an etiology in women with no previous surgical history presenting with an acute abdomen.