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Rosales-Castillo A, Jiménez-Guerra G, Ruiz-Gómez L, Expósito-Ruíz M, Navarro-Marí JM, Gutiérrez-Fernández J. Emerging Presence of Culturable Microorganisms in Clinical Samples of the Genitourinary System: Systematic Review and Experience in Specialized Care of a Regional Hospital. J Clin Med 2022; 11:jcm11051348. [PMID: 35268439 PMCID: PMC8911399 DOI: 10.3390/jcm11051348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 11/16/2022] Open
Abstract
The detection of emerging pathogens responsible for genitourinary infections has increased with technological advances. We conducted a systematic review of publications on the involvement of these microorganisms in genitourinary samples, and we also investigated their presence and antibiotic susceptibility in samples from patients at our regional hospital (Granada, Spain). The MEDLINE database was searched up to 31 December 2020, and a cross-sectional descriptive study was performed of results obtained in urine samples and genital exudates from January 2016 through December 2019. The review highlighted the frequent involvement of Neisseria meningitidis in genital infections, while the data on other microorganisms were consistent with findings in our patient series. The emerging microorganisms most often responsible for urinary tract infections were Streptococcus bovis (58.5%) and Gardnerella vaginalis (23.6%) in females, and S. bovis (32.3%), Aerococcus urinae (18.6%), and Corynebacterium spp. (16.9%) in males; those most frequently reported in genital infections were S. viridans (36.4%) in females and C. glucuronolyticum (32.2%) and G. vaginalis (35.6%) in males. In general, emerging pathogens are resistant to conventional antibiotics such as penicillin. However, there has also been an increase in beta-lactam resistance by the S. bovis group and Corynebacterium spp. The systematic review showed that emerging microorganisms are responsible for only a small percentage of genitourinary infections but are of major clinical interest, with a predominance of the S. bovis group, G. vaginalis, Lactobacillus spp., Aerococcus spp., and Corynebacterium spp. in urine samples and of G. vaginalis and C. glucuronolyticum in genital samples. Given the increasing resistance to antibiotics empirically prescribed in patients with genitourinary infections, it is recommended to create an antibiogram in all cases.
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Affiliation(s)
- Antonio Rosales-Castillo
- Servicio de Medicina Interna, Virgen de las Nieves University Hospital & Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain;
- Program in Clinical Medicine and Public Health, University of Granada & Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18016 Granada, Spain
| | - Gemma Jiménez-Guerra
- Laboratory of Microbiology, Virgen de las Nieves University Hospital & Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain; (G.J.-G.); (J.M.N.-M.)
| | - Lara Ruiz-Gómez
- Department of Microbiology, School of Medicine, University of Granada & Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Avenida de la Investigación 11, 18016 Granada, Spain;
| | - Manuela Expósito-Ruíz
- Unit of Biostatistics, Department of Statistics, School of Medicine, University of Granada, 18016 Granada, Spain;
| | - José María Navarro-Marí
- Laboratory of Microbiology, Virgen de las Nieves University Hospital & Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain; (G.J.-G.); (J.M.N.-M.)
| | - José Gutiérrez-Fernández
- Program in Clinical Medicine and Public Health, University of Granada & Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18016 Granada, Spain
- Laboratory of Microbiology, Virgen de las Nieves University Hospital & Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain; (G.J.-G.); (J.M.N.-M.)
- Department of Microbiology, School of Medicine, University of Granada & Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Avenida de la Investigación 11, 18016 Granada, Spain;
- Correspondence:
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Greydanus DE, Cabral MD, Patel DR. Pelvic inflammatory disease in the adolescent and young adult: An update. Dis Mon 2021; 68:101287. [PMID: 34521505 DOI: 10.1016/j.disamonth.2021.101287] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is typically polymicrobial with classic core involvement of Neisseria gonorrhoeae and/or Chlamydia trachomatis, though other endogenous flora from the vagino-cervical areas can be involved as well. It is often a sexually transmitted disease but other etiologic routes are also noted. A variety of risk factors have been identified including adolescence, young adulthood, adolescent cervical ectropion, multiple sexual partners, immature immune system, history of previous PID, risky contraceptive practices and others. An early diagnosis and prompt treatment are necessary to reduce risks of PID complications such as chronic pelvic pain, ectopic pregnancy and infertility. Current management principles of PID are also reviewed. It is important for clinicians to screen sexually active females for common sexually transmitted infections such as Chlamydia trachomatis and provide safer sex education to their adolescent and young adult patients. Clinicians should provide comprehensive management to persons with PID and utilize established guidelines such as those from the US Centers for Disease Control and Prevention (CDC).
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Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| | - Maria Demma Cabral
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
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Emergent genital infection by Leptotrichia trevisanii. Infection 2018; 47:111-114. [PMID: 29980937 DOI: 10.1007/s15010-018-1175-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Abstract
We report the first case of an association between Leptotrichia trevisanii and an episode of pelvic inflammatory disease (PID) and the second case of the isolation of this infection in the cervical canal. A 45-yr-old woman was admitted to our emergency department with clinical and radiological signs and symptoms compatible with an episode of PID. She was hospitalized for intravenous antibiotic control and treatment and the subsequent surgical drainage of abscesses. Cultures were taken throughout the process, but only cultures from cervical canal exudate were positive, with the growth of L. trevisanii species. It appears important to carry out a complete microbiological screening, not limited to conventional agents, on adequate clinical samples to detect possible infectious agents that may be missed in these cases.
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Polena V, Huchon C, Varas Ramos C, Rouzier R, Dumont A, Fauconnier A. Non-invasive tools for the diagnosis of potentially life-threatening gynaecological emergencies: a systematic review. PLoS One 2015; 10:e0114189. [PMID: 25723401 PMCID: PMC4344336 DOI: 10.1371/journal.pone.0114189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/05/2014] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To identify non-invasive tools for diagnosis of the major potentially life-threatening gynaecological emergencies (G-PLEs) reported in previous studies, and to assess their diagnostic accuracy. METHODS MEDLINE; EMBASE; Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library) were searched to identify all eligible studies published in English or French between January 1990 and December 2012. Studies were considered eligible if they were primary diagnostic studies of any designs, with a gold standard and with sufficient information for construction of a 2 × 2 contingency table, concerning at least one of the following G-PLEs: complicated ectopic pregnancy, complicated pelvic inflammatory disease, adnexal torsion and haemoperitoneum of any gynaecological origin. Extraction of data and assessment of study quality were conducted by two independent reviewers. We set the thresholds for the diagnostic value of signs retrieved at Sensibility ≥ 95% and LR-≤ 0.25, or Specificity ≥ 90% and LR+ ≥ 4. RESULTS We identified 8288 reports of diagnostic studies for the selected G-PLEs, 45 of which met the inclusion criteria. The methodological quality of the included studies was generally low. The most common diagnostic tools evaluated were transvaginal ultrasound (20/45), followed by medical history (18/45), clinical examination (15/45) and laboratory tests (14/45). Standardised questioning about symptoms, systolic blood pressure<110 mmHg, shock index>0.85, identification of a mass by abdominal palpation or vaginal examination, haemoglobin concentration <10 g/dl and six ultrasound and Doppler signs presented high performances for the diagnosis of G-PLEs. Transvaginal ultrasound was the diagnostic tool with the best individual performance for the diagnosis of all G-PLEs. CONCLUSION This systematic review suggests that blood pressure measurement, haemoglobin tests and transvaginal ultrasound are cornerstone examinations for the diagnosis of G-PLEs that should be available in all gynaecological emergency care services. Standardised questioning about symptoms could be used for triage of patients.
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Affiliation(s)
- Viola Polena
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France
| | - Cyrille Huchon
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France; Department of Gynaecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, 78103, Poissy, France
| | - Catalina Varas Ramos
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France
| | - Roman Rouzier
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France; Department of Surgery, Institut Curie, 35 rue Dailly, 92210, Saint-Cloud, France
| | - Alexandre Dumont
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France; Institut de Recherche pour le Développement, UMR 216, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Arnaud Fauconnier
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France; Department of Gynaecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, 78103, Poissy, France
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Leichliter JS, Chandra A, Aral SO. Correlates of self-reported pelvic inflammatory disease treatment in sexually experienced reproductive-aged women in the United States, 1995 and 2006-2010. Sex Transm Dis 2013; 40:413-8. [PMID: 23588132 PMCID: PMC5245165 DOI: 10.1097/olq.0b013e318285ce46] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few studies have examined recent temporal trends in self-reported receipt of pelvic inflammatory disease (PID) treatment. We assessed trends in receipt of PID treatment and associated correlates using national survey data. METHODS We used data from the National Survey of Family Growth, a multistage national probability survey of 15- to 44-year-old women. We examined trends in self-reported receipt of PID treatment from 1995, 2002, to 2006-2010. In addition, we examined correlates of PID treatment in 1995 and 2006-2010 in bivariate and adjusted analyses. RESULTS From 1995 to 2002, receipt of PID treatment significantly declined from 8.6% to 5.7% (P < 0.0001); however, there was no difference from 2002 to 2006-2010 (5.0%, P = 0.16). In bivariate analyses, racial differences in PID treatment declined across time; in 2006-2010, there was no significant difference between racial/ethnic groups (P = 0.22). Also in bivariate analyses, similar to 1995, in 2006 to 2010, some of the highest reports of receipt of PID treatment were women who were 35 to 44 years old (5.6%), had an income less than 150% of poverty level (7.5%), had less than high school education (6.7%), douched (7.7%), had intercourse before age 15 years (10.3%), and had 10 or more lifetime partners (8.0%). In adjusted analyses, differing from 1995, women at less than 150% of the poverty level were more likely (adjusted odds ratio [AOR], 2.60; 95% confidence interval [CI], 1.79-3.76) than women at 300% or more of the poverty level to have received PID treatment in 2006-2010. CONCLUSIONS Receipt of PID treatment declined from 1995 to 2006-2010, with the burden affecting women of lower socioeconomic status.
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Affiliation(s)
- Jami S Leichliter
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Jung SI, Kim YJ, Park HS, Jeon HJ, Jeong KA. Acute pelvic inflammatory disease: Diagnostic performance of CT. J Obstet Gynaecol Res 2010; 37:228-35. [DOI: 10.1111/j.1447-0756.2010.01380.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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YENUSOVA YI. Efficacy of the therapy of non-complicated mixed infections of the urogenital tract with Safocid (a combined drug). VESTNIK DERMATOLOGII I VENEROLOGII 2010. [DOI: 10.25208/vdv931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The author presents data from the current scientific literature related to etiology of inflammatory diseases of the urogenital system.
The author also presents the results of a complex clinical, laboratory and instrumental study of 32 patients with non-complicated
mixed infections of the urogenital tract and assessment of the efficacy of their therapy with the use of Safocid (a combined drug).
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Abstract
PURPOSE Quality of life utilities for health states associated with pelvic inflammatory disease (PID) have been estimated but not directly measured. Utilities for PID could have important implications on the cost-effectiveness of interventions to prevent and manage this disease. METHODS We obtained, in women with versus without a history of PID, visual analogue scale (VAS) and time-tradeoff (TTO) valuations for 5 PID-associated health states: ambulatory PID treatment, hospital PID treatment, ectopic pregnancy, chronic pelvic pain, and infertility. Subjects read brief scenarios describing the medical, functional, and social activity effects typically associated with each state, then gave valuations in the order above. RESULTS Health state valuations were obtained from 56 women with and 150 women without a PID history. Subjects with a PID history had significantly lower mean valuations (P <0.05) on the VAS for ectopic pregnancy (0.55 vs. 0.63), pelvic pain (0.45 vs. 0.53), and infertility (0.53 vs. 0.66) but not on the TTO; VAS differences remained significant when controlling for demographic and childbearing characteristics. VAS and TTO valuations were similar in women with versus without a history of PID for the ambulatory and hospital PID treatment health states. CONCLUSION PID has substantial impact on utility. In addition, some PID-related health states are valued less by women who have experienced PID, which could affect cost-effectiveness analyses of PID treatments when examined from the societal versus patient perspective.
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Affiliation(s)
- Teresa Erb
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA
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Bonil Martínez V, Guindos Rua S, Coll Usandizaga F, Vila Escudé E, Marhuenda Irastorza C. Perihepatitis en adolescente sexualmente activa. An Pediatr (Barc) 2008; 68:534-6. [DOI: 10.1157/13120212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Endometrioma and oocyte retrieval–induced pelvic abscess: a clinical concern or an exceptional complication? Fertil Steril 2008; 89:1263-1266. [DOI: 10.1016/j.fertnstert.2007.05.038] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Revised: 05/29/2007] [Accepted: 05/29/2007] [Indexed: 11/21/2022]
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Gynecology. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cost-Effectiveness of Alternative Outpatient Pelvic Inflammatory Disease Treatment Strategies. Sex Transm Dis 2007. [DOI: 10.1097/olq.0b013e3181161d47] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Smith KJ, Cook RL, Roberts MS. Time from sexually transmitted infection acquisition to pelvic inflammatory disease development: influence on the cost-effectiveness of different screening intervals. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2007; 10:358-66. [PMID: 17888100 DOI: 10.1111/j.1524-4733.2007.00189.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To prevent pelvic inflammatory disease (PID), some experts recommend screening for sexually transmitted infection (STI) every 12 months, with more frequent screening suggested in higher-risk women. Nevertheless, the time from STI acquisition to PID development, possibly an important factor to consider in screening interval choice, is unknown and its influence on the effectiveness and cost-effectiveness of screening is unclear. METHODS Using a Markov model, we estimated PID cases averted and the incremental cost-effectiveness resulting from 6- or 12-month screening strategies for high-risk young women (6%/year infection risk, 2.8%/year PID risk with 12-month screening) while varying PID development time from 1 to 12 months after initial infection. Lower-risk women and alternative parameter values were examined in sensitivity analyses. RESULTS Relative to 12-month screening, 6-month screening decreases PID cases from 6.0% (1 month development time)to 19.4% (12 months); the incremental cost per quality-adjusted life-year (QALY) gained compared with the other strategies varies from $16,600 (12 months development time) to $31,800 (1 month) for high-risk women. In lower-risk women, every 6-month screening is more economically unfavorable, with greater costs per QALY gained at shorter PID development time. CONCLUSION From a cost-effectiveness standpoint, uncertainty about PID development time is not a significant factor in choosing a screening interval in high-risk women, but could be important in lower-risk groups. Significant increases in PID cases averted occur with more frequent screening when PID development time is lengthened, which may allow estimation of this interval through the use of more sophisticated modeling techniques.
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Affiliation(s)
- Kenneth J Smith
- School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Beigi RH, Switzer GE, Presley L, Soper DE. Awareness of infectious diseases in obstetrics and gynecology among residents and residency directors. Infect Dis Obstet Gynecol 2007; 2006:42967. [PMID: 17485801 PMCID: PMC1779608 DOI: 10.1155/idog/2006/42967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Awareness of the subspecialty of infectious diseases in obstetrics and gynecology is low among United States residents and residency directors.
Objective. Given the burden of infectious diseases on women's health, we sought to assess current awareness, interest, and perceived value of the subspecialty of infectious diseases in obstetrics and gynecology among current United States obstetrics and gynecology residents and residency directors. Methods. Two separate surveys addressing awareness, perceived value and interest in the subspecialty were sent to (1) a random 20% sample of obstetrics and gynecology residents and (2) all obstetrics and gynecology residency directors. Results. Seventy percent of the residency directors were familiar with the subspecialty and 67.0% placed value on infectious disease specialists in an academic department. Thirty percent of the residents reported awareness of the subspecialty. Thirty-six percent of residency directors reported that medical infectious disease specialists deliver formal education to the obstetrics and gynecology residents. Conclusion. United States obstetrics and gynecology residents and residency directors have a low awareness of the subspecialty. An open niche exists for formal education of residents in infectious diseases in obstetrics and gynecology by department specialists. These findings can be incorporated into ongoing recruitment efforts for the subspecialty of infectious diseases in obstetrics and gynecology.
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Affiliation(s)
- Richard H. Beigi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- *Richard H. Beigi:
| | - Galen E. Switzer
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Veteran's Affairs Medical Center, University Drive C, Pittsburgh, PA 15240, USA
| | - Larraine Presley
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109-1998, USA
| | - David E. Soper
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC 29425, USA
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Smith KJ, Ness RB, Roberts MS. Hospitalization for Pelvic Inflammatory Disease: A Cost-Effectiveness Analysis. Sex Transm Dis 2007; 34:108-12. [PMID: 16794559 DOI: 10.1097/01.olq.0000225321.61049.13] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Nulliparous women are frequently hospitalized for treatment of pelvic inflammatory disease (PID). GOAL The goal of this study was to determine the economic feasibility of hospitalizing adolescents and young women for PID. STUDY DESIGN The authors conducted a Markov decision model, estimating the cost-effectiveness of hospitalization compared with outpatient therapy for mild to moderate PID for adolescents and young women, calculating costs per quality-adjusted life-year (QALY) gained under various assumptions about hospitalization effects on complications. RESULTS If hospitalization decreases PID complications by 10%, 20%, or 30%, the cost/QALY gained is 145,000 dollars, 67,400 dollars, or 42,400 dollars, respectively, compared with outpatient therapy. Assumptions about hospitalization effects on the development of chronic pelvic pain heavily weight the analysis; costs/QALY gained by hospitalization increase considerably if chronic pain is unaffected. CONCLUSION Hospitalization for PID treatment to possibly preserve fertility in nulliparous young women and adolescents is unlikely to be economically reasonable even if substantial improvements in PID complication rates are assumed.
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Affiliation(s)
- Kenneth J Smith
- Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Walleser S, Salkeld G, Donovan B. The cost effectiveness of screening for genital Chlamydia trachomatis infection in Australia. Sex Health 2006; 3:225-34. [PMID: 17112432 DOI: 10.1071/sh06016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Accepted: 10/13/2006] [Indexed: 11/23/2022]
Abstract
Background: In Australia, there is no published study on the cost effectiveness of screening for chlamydia. The aim of this study was to examine the cost effectiveness of a hypothetical screening programme for chlamydia based on annual opportunistic testing of all women 25 years of age or younger consulting a general practitioner, compared with no screening. Methods: A decision–analytic modelling approach was used to determine the incremental cost effectiveness ratio (ICER) of screening compared with no screening over 25 years. The analysis measured Australian health-care costs and benefits were assessed in terms of quality-adjusted life years (QALYs). Results: The analysis resulted in a cost per QALY of $2968 for screening. One-way sensitivity analyses on all variables, and multi-way sensitivity analyses on some variables, showed a wide range for the cost effectiveness, from dominance (where screening is effective and saves money overall) to an ICER of $67 715 per QALY. Conclusions: The results indicate that annual opportunistic screening for chlamydia in women under 25 is a potentially worthwhile undertaking. However, the analysis also highlights uncertainties around the natural history of chlamydia and the effectiveness of chlamydia screening. Given these uncertainties, the need for further primary data collection in these areas becomes apparent.
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Affiliation(s)
- Silke Walleser
- NHMRC Clinical Trials Centre, University of Sydney, NSW 2050, Australia.
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Likis FE. Upper Genital Tract Infections in Women. Sex Transm Dis 2006. [DOI: 10.1007/978-1-59745-040-9_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Trent M, Ellen JM, Walker A. Pelvic inflammatory disease in adolescents: care delivery in pediatric ambulatory settings. Pediatr Emerg Care 2005; 21:431-6. [PMID: 16027575 DOI: 10.1097/01.pec.0000169432.14067.eb] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate care delivery patterns in patients treated for pelvic inflammatory disease in pediatric outpatient settings and to determine the effect of practice type on care delivery. DESIGN/SETTING Retrospective review of medical records for patients treated as outpatients in an urban academic pediatric facility. Care patterns were evaluated according to the Centers for Disease Control sexually transmitted disease guidelines. PARTICIPANTS Fifty-six adolescent patients who were diagnosed with pelvic inflammatory disease in pediatric ambulatory settings between January 1, 2002, and December 31, 2002. MAIN OUTCOME MEASURES Demographic information, documented patient history and examination, laboratory data, and discharge instructions. RESULTS Forty percent of patients were prescribed inadequate courses of medications. Patients who were seen in the pediatric emergency department were less likely to receive a standard medication regimen than those seen in the ambulatory setting. Most patients did not receive adequate instruction for self-care on review of written discharge instructions, and there were no differences based on location of care. CONCLUSIONS Many adolescents treated as outpatients for pelvic inflammatory disease may not receive adequate medications and instructions for self-care at discharge in pediatric ambulatory settings. This study suggests a need for aggressive quality improvement measures to enhance the care of adolescents with pelvic inflammatory disease in pediatric outpatient settings.
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Affiliation(s)
- Maria Trent
- Pediatrics Department, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
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Patel DR. Management of pelvic inflammatory disease in adolescents. Indian J Pediatr 2004; 71:845-7. [PMID: 15448393 DOI: 10.1007/bf02730726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pelvic inflammatory disease (PID) is highly prevalent among sexually active adolescent females. The major organisms are N gonorrhoeae and C trachomatis. Diagnosis is based on historical information and clinical findings. Early diagnosis and treatment effectively reduce the incidence of complications associated with PID. Highly effective treatment regimens are available and main antimicrobials used include quinolones, cephalosporins, metronidazole, doxycycline, and azithromycin. Delay or inadequate treatment is associated with long term sequelae including tubal infertility and chronic pelvic pain. Prevention efforts should be directed towards routine screening and treatment for sexually transmissible infections, public education and provision of resources for treatment and follow-up.
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Affiliation(s)
- Dilip R Patel
- Michigan State University, Kalamazoo Center for Medical Studies, Oakland Drive, Kalamazoo, Michigan State 49008, USA.
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Mena J, López-Hidalgo M, Gordillo R, Rodríguez A, Cóndor L. Embarazo ectópico tubárico tras programa FIV embarazo ectópico abdominal. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2004. [DOI: 10.1016/s0210-573x(04)77354-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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