Ipas, Chapel Hill, NC 27514, USA.
Contraception. 2011 Apr;83(4):330-5. doi: 10.1016/j.contraception.2010.08.022. Epub 2010 Oct 8.
In response to concerns about serious infections following medical abortion, in early 2006 the Planned Parenthood Federation of America changed the route of misoprostol administration from vaginal to buccal and required either routine antibiotic coverage or universal screening and treatment for chlamydia; in July 2007, the Planned Parenthood Federation of America began requiring routine antibiotic coverage for all medical abortions. We previously reported a pronounced drop in the rate of serious infections following the adoption of these new infection control measures. Our objective in this study was to assess whether the degree of severity of the serious infections differed in the three infection control groups (vaginal misoprostol and no antibiotics; buccal misoprostol and screen-and-treat method; buccal misoprostol and routine antibiotics) or, equivalently, to assess whether the declines in rates of serious infections after the adoption of new infection control measures differed across the degree of severity categories. Of particular importance is whether the new infection control measures selectively reduced the least severe serious infections but did not diminish the rate of the most severe infections.
We performed a retrospective analysis assessing the degree of severity of infections before infection controls were implemented and after each of the two new measures was adopted: buccal administration of antibiotics with either screen-and-treat method or routine antibiotic coverage. We ranked the severity of infection from 1 (when treatment occurred in an emergency department) to 4 (when death occurred). We compared the distributions of the severity of serious infections in the three infection control groups (none; buccal misoprostol and screen-and-treat method; buccal misoprostol and routine antibiotics) or, equivalently, assessed whether the declines in rates of serious infections after the adoption of new infection control measures differed across the degree of severity categories using the Jonckheere-Terpstra test for a doubly ordered 4 × 3 table.
The distribution of infection by severity was the same for all three infection control groups. Likewise, when the two new infection control groups--buccal misoprostol plus either screen-and-treat method or routine antibiotics--were combined, the distribution of infection by severity was the same before and after the new measures were implemented.
The pronounced decline in the rate of serious infections occurred in each category of severity.
鉴于人们对药物流产后发生严重感染的担忧，2006 年初，美国计划生育联合会改变了米索前列醇的给药途径，从阴道给药改为颊部给药，并要求常规使用抗生素覆盖或对衣原体进行普遍筛查和治疗；2007 年 7 月，美国计划生育联合会开始要求所有药物流产都常规使用抗生素。我们之前报告过，在采用这些新的感染控制措施后，严重感染的发生率明显下降。我们在这项研究中的目的是评估在这三种感染控制组（阴道给予米索前列醇且不使用抗生素；颊部给予米索前列醇并采用筛查和治疗方法；颊部给予米索前列醇并常规使用抗生素）中，严重感染的严重程度是否存在差异，或者，同样地，评估在采用新的感染控制措施后，严重感染率的下降是否在不同严重程度类别之间存在差异。特别重要的是，新的感染控制措施是否选择性地降低了最不严重的严重感染，但没有降低最严重感染的发生率。
我们进行了一项回顾性分析，评估了在实施感染控制措施之前以及在采用两种新措施（颊部使用抗生素，采用筛查和治疗方法或常规抗生素覆盖）之后，感染的严重程度。我们将感染的严重程度从 1（发生在急诊科的治疗）到 4（发生死亡）进行排序。我们比较了三种感染控制组（无感染控制；颊部给予米索前列醇和筛查和治疗方法；颊部给予米索前列醇和常规抗生素）的严重感染分布情况，或者，等效地，使用 Jonckheere-Terpstra 检验对双序 4×3 表评估在采用新的感染控制措施后，严重感染率的下降在不同严重程度类别之间是否存在差异。
在所有三种感染控制组中，感染的严重程度分布相同。同样，当将两种新的感染控制组（颊部给予米索前列醇加筛查和治疗方法或常规抗生素）合并时，在实施新措施前后，感染的严重程度分布相同。
在每个严重程度类别中，严重感染的发生率都明显下降。
