Hao-Ming Li1, Fung-Chang Sung2, Shang-Chieh Li1, Ying-Kai Huang3, Yu Chang4, Chi-Chang Chang4,5, S Joseph Huang4,5,6, Cheng-Li Lin2,7, Chia-Hung Kao8,9,10. 1. a Department of Radiology , E-Da Hospital , Kaohsiung , Taiwan. 2. b Management Office for Health Data, China Medical University Hospital , Taichung , Taiwan. 3. c Department of Radiology , Kaohsiung Municipal Min-Sheng Hospital , Kaohsiung , Taiwan. 4. d Department of Obstetrics and Gynecology , E-Da Hospital , Kaohsiung , Taiwan. 5. e School of Medicine , I-Shou University , Kaohsiung , Taiwan. 6. f Department of Obstetrics and Gynecology, College of Medicine , University of South Florida , Tampa , FL , USA. 7. g College of Medicine , China Medical University , Taichung , Taiwan. 8. h Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine , China Medical University , Taichung , Taiwan. 9. i Department of Nuclear Medicine and PET Center , China Medical University Hospital , Taichung , Taiwan. 10. j Department of Bioinformatics and Medical Engineering , Asia University , Taichung , Taiwan.
Abstract
AIMS: Concerns about acute pelvic inflammatory disease (PID) after hysterosalpingography (HSG) have been raised since 1980. However, the effectiveness of prophylactic antibiotics remains unclear. This study investigated the effect of antibiotic prophylaxis in women undergoing HSG. METHODS: Women undergoing HSG between 2000 and 2012 were screened from the Taiwan National Health Insurance Research Database for eligibility. The prophylactic cohort included patients using any antibiotics of 1st-generation cephalosporins, doxycycline, clindamycin, and metronidazole, within 7 days before HSG (n = 3257). Patients not using any antibiotics were registered as the non-prophylactic cohort (n = 4662). An unconditional logistic regression model was applied to calculate the odds ratio (OR) and 95% confidence interval (CI) of acute PID after HSG associated with prophylactic antibiotics. RESULTS: The cumulative incidences of acute PID after HSG were 0.46% and 1.42% in the prophylactic and non-prophylactic cohorts, respectively. Prophylactic patients had a significantly reduced estimated relative risk of acute PID compared with non-prophylactic patients (adjusted OR = 0.33, 95% CI = 0.19-0.58; p = .001). Doxycycline users had the lowest adjusted OR of 0.20 (95% CI = 0.04-0.81; p = .02), followed by users of 1st-generation cephalosporins (adjusted OR = 0.35, 95% CI = 0.18-0.68; p = .002). Multivariate sub-group analysis verified this protective effect for almost all sub-groups of prophylactic patients. CONCLUSIONS: Antibiotic prophylaxis is associated with a decreased estimated relative risk of acute PID in HSG patients. Doxycycline and 1st-generation cephalosporins may be effective prophylactic regimens for HSG.
AIMS: Concerns about acute pelvic inflammatory disease (PID) after hysterosalpingography (HSG) have been raised since 1980. However, the effectiveness of prophylactic antibiotics remains unclear. This study investigated the effect of antibiotic prophylaxis in women undergoing HSG. METHODS:Women undergoing HSG between 2000 and 2012 were screened from the Taiwan National Health Insurance Research Database for eligibility. The prophylactic cohort included patients using any antibiotics of 1st-generation cephalosporins, doxycycline, clindamycin, and metronidazole, within 7 days before HSG (n = 3257). Patients not using any antibiotics were registered as the non-prophylactic cohort (n = 4662). An unconditional logistic regression model was applied to calculate the odds ratio (OR) and 95% confidence interval (CI) of acute PID after HSG associated with prophylactic antibiotics. RESULTS: The cumulative incidences of acute PID after HSG were 0.46% and 1.42% in the prophylactic and non-prophylactic cohorts, respectively. Prophylactic patients had a significantly reduced estimated relative risk of acute PID compared with non-prophylactic patients (adjusted OR = 0.33, 95% CI = 0.19-0.58; p = .001). Doxycycline users had the lowest adjusted OR of 0.20 (95% CI = 0.04-0.81; p = .02), followed by users of 1st-generation cephalosporins (adjusted OR = 0.35, 95% CI = 0.18-0.68; p = .002). Multivariate sub-group analysis verified this protective effect for almost all sub-groups of prophylactic patients. CONCLUSIONS: Antibiotic prophylaxis is associated with a decreased estimated relative risk of acute PID in HSG patients. Doxycycline and 1st-generation cephalosporins may be effective prophylactic regimens for HSG.
Authors: Inez Roest; Nienke van Welie; Velja Mijatovic; Kim Dreyer; Marlies Bongers; Carolien Koks; Ben Willem Mol Journal: Hum Reprod Open Date: 2020-01-15