The evaluation of risk factors for failed response to conservative treatment in tubo-ovarian abscesses

Abstract

Objective:The aim of our study is to assess the risk factors for medical treatment failure and to predict the patients who will require the surgical therapy as well as to predict the factors affecting treatment success. Material and Methods:This was a cross-sectional study including 76 women with tubo-ovarian abscesses (TOA) who were either conservatively or surgically treated and were admitted to two gynecology units over a 4-year period. The demographic characteristics of the patients, gynecologic and obstetric histories, size and localization of abscesses were recorded. Gentamicin plus clindamycin treatment protocol was implemented for all patients. Ampicillin treatment was added in three patients with the positive culture of Actinomyces. Response to treatment was evaluated after 48-72 h. Patients who fail to respond to medical treatment required surgery or percutaneous drainage. We compared clinical and laboratory factors between the groups. Results:In surgery group, patients were significantly older than the others (44.9±5.4 versus 39.1±7.6 years). Fifty-six patients (74%) responded to antibiotics and 20 of the patients required surgical intervention. Patients treated with antibiotics were hospitalized for an average of 6.32±2.8 days versus 12.75±5.6 days for those who required surgery (p=0.021). Patients who were surgically treated had a mean size of TOA of 67.9±11.2 mm versus 53.6±9.4 mm for those treated with antibiotics alone (p=0.036). There were no significant differences between groups in laboratory parameters, except for initial white blood cell (WBC) counts. The complications of surgery included in descending order of frequency blood transfusions, surgical wound infections, bowel injury, and bladder injury. Conclusion:An increased size of pelvic mass, higher initial WBC counts, advanced age, and smoking were all associated with failed response to conservative treatment. It is important to identify the risk factors to distinguish patients who will respond to antibiotic therapy and those who will need a surgical treatment. Thus, the required early intervention can result in a reduction in the morbidity associated with TOA. (J Turk Ger Gynecol Assoc 2015; 16: 226-30) Keywords: Antibiotic therapy, pelvic abscess, surgery, tubo-ovarian abscesses Received: 01 July, 2015 Accepted: 06 August, 2015 Available Online Date: 02 November, 2015 The evaluation of risk factors for failed response to conservative treatment in tubo-ovarian abscesses Material and MethodsThis was a cross-sectional study including 76 women with TOA who were either treated conservatively (group 1) and surgically (group 2) and were admitted to two gynecology units over a 4-year period. The study was subject to local ethics committee's approval, and written informed consent was obtained from patients who participated in this study. All authors and the study protocol have complied with the World Medical Association Declaration of Helsinki regarding the ethical conduct of research involving human subjects. In this study, some of t...

The effectiveness of neutrophil to lymphocyte ratio in prediction of medical treatment failure for tubo‐ovarian abscess

“…However, Akkurt et al . observed no significant difference in CRP values in patients who responded to medical treatment or who failed in TOA patients (48.6 ± 38.9 mg/dL vs 59.5 ± 39.3 mg/dL P = 0.41, respectively) . Yıldırım et al .…”

“…Greenstein et al ., reported that increasing WBC count, TOA size, older age and increasing parity were significant predictors of medical treatment failure . Akkurt et al ., found that the mean age was significantly higher in the medical treatment failure group . Güngördük et al ., reported that CRP values were significantly higher in TOA patients with and without treatment failure (32.9 ± 23.8 mg/dL vs14.2 ± 7.0 mg/dL, respectively) .…”

“…In previous studies, the risk factors such as age, intrauterine device, TOA size, WBC count, related to medical treatment failure in TOA patients were evaluated . Farid et al ., reported that both WBC greater than 16 K/μL and TOA size greater than 5.18 cm were predictive values in medical treatment failure .…”

Effectiveness and Adverse Events of Early Laparoscopic Therapy versus Conservative Treatment for Tubo-Ovarian or Pelvic Abscess: A Single-Center Retrospective Cohort Study

“…Nevertheless, studies of the pregnancy outcomes of pelvic abscess and TOA are rare. In the present study, pregnancy outcomes could not be evaluated, but more bilateral adhesions were found in the late [6,26,27], parity [19,26,28], high levels of WBC [6,26,29], high levels of CRP [20], and smoking [6] as high risk factors for failure to conservative treatment in patients with pelvic abscesses. In contrast to those findings, Topcu et al [5] and Mizushima et al [30] reported that age, levels of WBC and CRP, gravida, parity, body temperature, and rate of smoking were not high risk factors predicting antibiotic therapy failure.…”

“…TOA and pelvic abscess are severe complications of PID and can threaten patients' lives because of rupture or sepsis [4]. Risk factors for adverse outcomes vary among studies but generally include abscess size, initial white blood cells (WBC) count, age, and smoking [5,6].…”