Is There a Benefit to Culturing Intra-Uterine Devices in Pelvic Inflammatory Disease?

Aims: The study aimed to compare the clinical course and disease severity between culture positive and culture negative patients with intra-uterine devices (IUD)-associated pelvic inflammatory disease (PID).

Methods: A retrospective study of all IUD-associated PID patients admitted to tertiary medical center between 2010 and 2015. All patients received standard empiric antibiotic therapy upon admission. The study cohort was divided into 2: patients with culture positive IUDs and patients with negative cultures. Electronic medical records and culture results were analyzed from the time of admission.

Results: During the study period, 480 hospitalized patients were diagnosed with PID. Of these, 94 patients had IUD-associated PID, 59 with positive cultures and 35 with negative cultures. While fever was more common in the latter (p = 0.01), no significant differences were found in disease severity in patient outcomes (i.e., length of stay, rates of invasive treatment, and total abdominal hysterectomies). In a sub-analysis of patients with IUD cultures of established PID pathogens only, there were no differences in disease severity and outcome in patients with antibiotic susceptible or resistant strains.

Conclusions: IUD removal for culture in PID patients is probably unnecessary. Alteration of treatment according to the culture results may have little impact on disease course and outcome.