Revista de la Facultad de Medicina (Jul 1996)
Diagnóstico de la enfermedad pélvica inflamatoria aguda y sus complicaciones en el Instituto Materno Infantil (IMI) de Santa Fe de Bogotá entre 1992-1993
Abstract
Objectives: To study the frequency of pelvic inflammatory disease (PID), and to evaluate its risk factors. Additionaly, to determine by laparoscopy the efficacy of the clinical diagnosis and to describe the bacterial etiology of PID and its complications. Design: Case control study. Place: Infectology Service at Instituto Materno Infantil, Santa Fe de Bogota, a third level hospital. Case subjects, inclusion and exclusion criteria: Outpatients with pelvic pain and clinical diagnosis of PID between 1992 and 1993 were included in the study. AUof them accepted and signed an informed consent. The exclusion criteria were pregnancy, another concomitant infectious disease and to have received any antimicrobial treatment in the days previous to consultation. Cases were the patients with PID confinned by laparoscopy and the control group was conformed by patients with another pathology. Methods, variables and statistical procedures: A medical history was done with special attention to the risk factors, and the clinical and laboratory findings. The gold standard was the laparoscopy. The clinical and laparoscopic classification was done and samples were taken for the microbiological studies. Case and controls were compared regarding to socio-demographic variables using the Student's t test. Associated univariate analisys was done between the risks factors and the entity as well as the diagnostic criteria and the occurrence of PID using the indirect relative risk (OR) with the confidence intervals. The frequency of bacterial isolates was also determined. Results: The prevalence of the PID was 9.2/1,000. A total of 63 patients were included in the study, 45 cases and 18 controls, 15% of the patients were less than 20 years old. The sensitivity of the clinical diagnosis was 71 %. The endocervical purulent exudate was the only criteria statistically significant associated with PID (OR=5.65). The polimicrobial etiology of PID was confirmed with the isolation of Neisseria gonorrhoeae, Chlamydia trachomatis and a group of aerobic and anaerobic bacteria. Conclusions: PID was diagnosed in young women, in childbearing age and it was related with sexually transmitted diseases. The diagnosis based only on clinical criteria would give false positives. The laparoscopy procedure is recommended in cases with no clear diagnosis and when a mass is detected at the gynecological examination. The treatment must cover all bacteria implicated with this pathology. A national collaborative study is required in order to determine the risk factors for PID in our population.
