Brun J-L, Castan B, de Barbeyrac B, Cazanave C, Charvériat A, Faure K, Mignot S, Verdon R, Fritel X, Graesslin O
Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France.
Unité fonctionnelle d'infectiologie régionale, centre hospitalier d'Ajaccio, 27, avenue Impératrice-Eugénie, 20303 Ajaccio, France.
Gynecol Obstet Fertil Senol. 2019 May;47(5):398-403. doi: 10.1016/j.gofs.2019.03.012. Epub 2019 Mar 14.
To provide up-to-date guidelines on management of pelvic inflammatory disease (PID).
An initial search of the Cochrane database, PubMed, and Embase was performed using keywords related to PID to identify reports in any language published between January 1990 and January 2012, with an update in 2018. All identified reports published in French and English relevant to the areas of focus were included. A level of evidence based on the quality of the data available was applied for each area of focus and used for the guidelines.
PID must be suspected when spontaneous pelvic pain is associated with induced adnexal or uterine pain (grade B). Pelvic ultrasonography is necessary to exclude tubo-ovarian abscess (TOA) (grade C). Microbiological diagnosis requires endocervical and TOA sampling for molecular and bacteriological analysis (grade B). First-line treatment for uncomplicated PID combines ceftriaxone 1g, once, by intra-muscular (IM) or intra-venous (IV) route, doxycycline 100mg×2/d, and metronidazole 500mg×2/d oral (PO) for 10 days (grade A). First-line treatment for complicated PID combines IV ceftriaxone 1 to 2g/d until clinical improvement, doxycycline 100mg×2/d, IV or PO, and metronidazole 500mg×3/d, IV or PO for 14days (grade B). Drainage of TOA is indicated if the collection measures more than 3cm (grade B). Follow-up is required in women with sexually transmitted infections (STI) (grade C). The use of condoms is recommended (grade B). Vaginal sampling for microbiological diagnosis is recommended 3 to 6months after PID (grade C), before the insertion of an intra-uterine device (grade B), before elective termination of pregnancy or hysterosalpingography. Targeted antibiotics on identified bacteria are better than systematic antibioprophylaxis in those conditions.
Current management of PID requires easily reproducible investigations and antibiotics adapted to STI and vaginal microbiota.
提供盆腔炎（PID）管理的最新指南。
最初使用与PID相关的关键词对Cochrane数据库、PubMed和Embase进行检索，以识别1990年1月至2012年1月间以任何语言发表的报告，并于2018年进行更新。纳入所有以法语和英语发表的、与重点领域相关的已识别报告。根据可用数据的质量为每个重点领域应用证据级别，并用于制定指南。
当自发性盆腔疼痛伴有诱发性附件区或子宫疼痛时，必须怀疑PID（B级）。盆腔超声检查对于排除输卵管卵巢脓肿（TOA）是必要的（C级）。微生物学诊断需要采集宫颈和TOA样本进行分子和细菌学分析（B级）。单纯性PID的一线治疗方案为头孢曲松1g，单次肌内注射（IM）或静脉注射（IV），多西环素100mg×2/d，甲硝唑500mg×2/d口服（PO），共10天（A级）。复杂性PID的一线治疗方案为静脉注射头孢曲松1至2g/d，直至临床改善，多西环素100mg×2/d，静脉注射或口服，甲硝唑500mg×3/d，静脉注射或口服，共14天（B级）。如果脓肿直径超过3cm，则需对TOA进行引流（B级）。性传播感染（STI）女性需要进行随访（C级）。建议使用避孕套（B级）。建议在PID后3至6个月（C级）、宫内节育器置入前（B级）、选择性终止妊娠或子宫输卵管造影术前进行阴道微生物学诊断采样。在这些情况下，针对已识别细菌的靶向抗生素优于系统性抗生素预防。
目前PID的管理需要易于重复的检查以及适用于STI和阴道微生物群的抗生素。
