Rare Infections After Medically Induced Abortions Likely Not Drug-Related

Since 2000, five women in North America who had medically induced abortions (MIAs) died from toxic shock caused by a Clostridium sordellii infection. This has led some people to question the safety of the combination of the drugs mifepristone and misoprostol frequently used in MIA procedures.

A new review of C. sordellii infections and an accompanying editorial, both published in the Dec. 1 issue of Clinical Infectious Diseases and currently available online, place these MIA-C. sordellii deaths in perspective and help to clear up misapprehensions.

According to the review by Michael Aldape, PhD, of the Veteran's AffairsMedicalCenter in Boise, ID, nearly 2 million women in Europe have used mifepristone and no C. sordellii infections or deaths have been reported. Since 2000, more than 600,000 women in the United States have undergone mifepristone-induced abortion, with four reported deaths. Also, prior to the cases in the United States, one woman in Canada who had had a MIA subsequently acquired a fatal C. sordellii infection.

In addition, Aldape reviews 40 other deaths caused by C. sordellii infections. These infections most commonly followed childbirth, injection drug use, trauma, or surgery.

Aldape said, "while there have been a handful of C. sordellii-related deaths stemming from mifepristone/misoprostol usage in the past few years, I believe the problem is more global....There are many examples of non-gynecological infections due to C. sordellii in the literature, of which more than half were fatal."

Beverly Winikoff, MD, MPH, of the Gynuity Health Projects organization and author of an accompanying editorial, argues against theories that there is a connection between C. sordellii infections and the drugs mifepristone and misoprostol.  She said, "The importance of articles like [Aldape's review] is to point out that C. sordellii infections are a broader problemit's a big intellectual and strategic error to focus on medical abortions. This is an infectious diseases issue."

In her editorial, Winikoff points out that most of the explanations that have been put forward to connect C. sordellii with mifepristone do not have sufficient scientific basis. Nevertheless, what she calls "a large natural experiment" is now occurring in this country as many large clinical systems, including Planned Parenthood, have decided to stop using misoprostol vaginally, opting instead for use of this medication by mouth. "We will have to wait," she writes, "perhaps many months or years, but eventually we may see if this change in practice is accompanied by any measurable change in the rate of these tragic deaths."

Aldape and Winikoff agree that there are no clear measures yet identified to prevent this infection.  The infections are difficult to identify and, in the early stages, can mimic other, more common infections.  Both authors stress the need for further research to discover the factors that predispose to these infections so that preventive measures can be designed. 

Source: Infectious Diseases Society of America (IDSA)