Initial Treatment for Chlamydia Improves Pelvic Inflammatory Disease Outcomes
Results of this study indicated that approximately 200 surgical interventions may have been preventable annually in Japan through the use of initial antibiotic therapy in all hospitalized patients wit
Initial treatment for Chlamydia trachomatis among hospitalized women with pelvic inflammatory disease provided significant improvements in rates of surgical intervention and mortality, according to a study published in Clinical Infectious Diseases.
Researchers analyzed data on Japanese patients with pelvic inflammatory disease admitted to the hospital between July 2010 and March 2016 (N=27,841) using the Diagnosis Procedure Combination database. Patients with cancer, who were pregnant, or who had missing data were excluded from the study.
Patients who were administered antibiotics for C trachomatis (most commonly: azithromycin, clarithromycin, doxycycline, levofloxacin, minocycline, and roxithromycin) within 2 days of being admitted (treatment group) were compared with those who were not administered antibiotics (control group). The primary study outcome was the rate of surgical intervention during hospitalization (laparoscopic surgery, laparotomy, and/or drainage procedure), excluding interventions within 2 days of admission. Secondary study outcomes included admission to intensive care, sepsis after admission, and death during hospitalization.
At admission, 8.8% (n=2463) of patients had turbo-ovarian abscess—a common complication of pelvic inflammatory disease. Mortality during hospitalization was 0.28% for women with turbo-ovarian abscess vs 0.56% for those without. Between the control group (n=21,591) and the treatment group (n=6250), 6149 propensity score matching pairs were found, with a C-statistic of 0.67. A similar rate of C trachomatis diagnosis was observed between the groups (control group: 3.7%, n=228; treatment group 3.8%, n=232).
A significant difference in rates of surgical intervention during hospitalization was seen both before and after propensity score matching (before matching: 11.3% for treatment group vs 17.2% for control; risk difference: -5.9%; 95% CI, -6.8% to -5.0% and after matching: 11.5% for treatment group vs 13.4% for control; risk difference: -1.9%; 95% CI, -3.1% to -0.7%). The treatment group also showed a significantly lower mortality rate compared with the control group (0.03% vs 0.16%, P =.02).
Limitations of the study included the retrospective and observational nature, confounders such as not having data for laboratory tests. In addition there were 2 factors that could bias the results: antibiotics for C trachomatis can be used to treat other pathogens associated with turbo-ovarian abscess, and the study excluded women who underwent surgery within 2 days of admission.
Study investigators concluded that “[t]he present retrospective study using a national inpatient database indicated that initial treatment for [C trachomatis] among hospitalized patients diagnosed with [pelvic inflammatory disease] had clinical benefits in terms of improved short-term outcomes.”
Shigemi D, Matsui H, Fushimi K, Yasunaga H. Therapeutic impact of initial treatment for Chlamydia trachomatis among patients with pelvic inflammatory disease: a retrospective cohort study using a national inpatient database in Japan [published online October 12, 2018]. Clin Infect Dis. doi: 10.1093/cid/ciy862