Endometrioma ups risk of failing antibiotic treatment for pelvic inflammatory disease

Among women with pelvic inflammatory disease, the presence of endometrioma is associated with a lower likelihood of responding to antibiotic treatment and a higher risk of surgical intervention, according to a study.

The study included 116 patients with endometriosis hospitalized due to pelvic inflammatory disease. Researchers compared disease outcomes between 59 patients with ovarian endometrioma component and 57 endometriosis patients without endometrioma.

The primary endpoint was severe pelvic inflammatory disease, defined as the need for surgical intervention or drainage. Secondary endpoints included tubo-ovarian abscess, number of hospitalization days, a positive cervical bacterial culture or urine sexually transmitted disease PCR test, and readmission due to partially treated or relapsing pelvic inflammatory disease.

Pelvic inflammatory disease in patients with endometrioma was found less likely to respond to antibiotic treatment with increased risk for surgical intervention or drainage as compared with their counterparts without endometrioma (adjusted odds ratio [OR], 3.5, 95 percent confidence interval [CI], 1.25–9.87).

Of the patients who were admitted to the hospital, patients with vs without endometrioma were older (26.5 vs 31.0 years; p=0.02) and less likely to have an intra uterine device (19.3 percent vs 5.1 percent; p=0.02). Furthermore, the presence of endometrioma was associated with a significantly higher rate of tubo-ovarian abscess (52.5 percent vs 19.3 percent; p<0.01).

Readmission rate, positive bacterial culture, and hospitalization duration were higher in the endometrioma group, although the differences did not reach statistical significance. Recent oocyte retrieval and patient age were not associated with an increased risk of severe pelvic inflammatory disease.