Impact of Antibiotic Stewardship on the Management of Pelvic Inflammatory Disease: A Multicenter Gynecological and Public Health Perspective in Pakistan.

BACKGROUND

Pelvic inflammatory disease (PID) is a significant gynecological and public health concern, frequently exacerbated by inappropriate antibiotic use and rising antimicrobial resistance.

OBJECTIVE

This study aimed to evaluate the impact of an Antibiotic Stewardship Program (ASP) on individual clinical outcomes (recovery, recurrence, and treatment adherence) and broader public health indicators (antibiotic resistance trends, hospital admissions, and referrals) in the management of PID across multiple tertiary healthcare centers.

MATERIALS AND METHODS

This descriptive observational study was conducted at the Departments of Gynecology of the Pakistan Institute of Medical Sciences (PIMS), Islamabad; Shalamar Hospital, Lahore; City Hospital, Multan; Lady Reading Hospital (LRH), Peshawar; and Hayatabad Medical Complex (HMC), Peshawar, from August 2022 to July 2024. A total of 390 women aged 15-45 diagnosed with PID were enrolled - 190 prior to and 200 following the implementation of an ASP. Statistical analysis was performed using IBM SPSS Statistics for Windows version 26, employing descriptive statistics, Chi-square tests for categorical variables, and independent t-tests for continuous variables. A p-value of <0.05 was considered statistically significant.

RESULTS

Following the intervention, treatment adherence significantly improved from 108 patients (56.84%) to 169 patients (84.50%) (p < 0.001). The number of patients experiencing symptom recurrence declined from 23 patients (12.11%) to nine patients (4.50%) (p = 0.014), while complete clinical recovery increased from 119 patients (62.63%) to 158 patients (79.00%) (p = 0.002). In addition, hospital admissions due to PID decreased from 73 patients (38.42%) to 49 patients (24.50%) (p = 0.006), and the average treatment duration was reduced from 11.6 days to 9.2 days (p < 0.001). Referrals related to antibiotic resistance also fell from 26 patients (13.68%) to 11 patients (5.50%) (p = 0.009). Although complications declined, the change was not statistically significant (p = 0.318).

CONCLUSION

Implementation of antibiotic stewardship across multiple tertiary care centers significantly improved clinical outcomes, enhanced treatment adherence, and contributed to a reduction in recurrence and resistance-associated referrals in PID management, supporting the value of coordinated antimicrobial policies from both gynecological and public health perspectives.