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

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).

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.

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.

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.