Tubo-ovarian abscess: A proposed new scoring system to guide clinical management.
antibiotics
mathematical modeling
pelvic inflammatory disease
radiological drainage
risk score
surgery
tubo-ovarian abscess
Journal
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
ISSN: 1879-3479
Titre abrégé: Int J Gynaecol Obstet
Pays: United States
ID NLM: 0210174
Informations de publication
Date de publication:
Jun 2022
Jun 2022
Historique:
revised:
02
09
2021
received:
01
07
2021
accepted:
15
09
2021
pubmed:
18
9
2021
medline:
18
5
2022
entrez:
17
9
2021
Statut:
ppublish
Résumé
To create a risk scoring system comprised of clinical and radiological characteristics that can predict the likelihood of antibiotic treatment failure of tubo-ovarian abscesses. The score should guide clinicians in identifying patients to whom early intervention should be offered instead of a prolonged trial of antibiotics. A multicenter, retrospective cohort study carried out between January 1, 2013 and September 30, 2019, identified consecutive patients with tubo-ovarian abscess. Using a chronological split, patients were allocated to two groups for the development and subsequent validation of the postulated scoring system. Univariate and bivariate analyses were performed to identify statistically significant variables for the failure of intravenous antibiotic treatment. In total, 214 consecutive patients with tubo-ovarian abscesses were identified. Data from the first 150 patients were used for the development of the postulated scoring system; data from the subsequent 64 patients were used for validation. Statistically significant clinical features between those having successful and unsuccessful management were: temperature (median = 37.1℃ vs 38.2℃, P = 0.0001), C-reactive protein (151 mg/L vs 243 mg/L, P = 0.0001), and tubo-ovarian abscess diameter (6.0 cm vs 8.0 cm, P = 0.0001). These parameters were used to create a risk prediction score. A score of four or more was predictive of requiring surgical/radiological intervention of tubo-ovarian abscess (P < 0.001). The score had a sensitivity of 69% and a specificity of 88%, with area under the curve (AUC) = 0.859. Currently, there is no guidance for clinicians on when to operate on a tubo-ovarian abscess. Our prediction score is simple, using only three easily obtained clinical characteristics.
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
588-597Informations de copyright
© 2021 International Federation of Gynecology and Obstetrics.
Références
Granberg S, Gjelland K, Ekerhovd E. The management of pelvic abscess. Best Pract Res Clin Obstet Gynaecol. 2009;23(5):667-678.
Workowski K, Bolan G, CDC. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep. 2015;64:1-137.
Ross J, Cole M, Evans C, Lyons D, Gi D, Cousins D. 2018 United Kingdom National Guideline for the Management of Pelvic Inflammatory Disease. Br Assoc Sex Heal HIV [Internet]. 2018. Accessed June 28, 2021. https://www.bashhguidelines.org/media/1170/pid-2018.pdf
Munro K, Gharaibeh A, Nagabushanam S, Martin C. Diagnosis and management of tubo-ovarian abscesses. Obstet Gynaecol [internet]. 2018;20(1):11-19. doi:10.1111/tog.12447
Chappell CA, Wiesenfeld HC. Pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and tuboovarian abscess. Clin Obstet Gynecol [internet]. 2012;55(4):893-903. Accessed June 28, 2021. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00003081-201212000-00008
Gjelland K, Ekerhovd E, Granberg S. Transvaginal ultrasound-guided aspiration for treatment of tubo-ovarian abscess: a study of 302 cases. Am J Obstet Gynecol. 2005;193(4):1323-1330.
Timor-Tritsch IE, Lerner JP, Monteagudo A, Murphy KE, Heller DS. Transvaginal sonographic markers of tubal inflammatory disease. Ultrasound Obstet Gynecol. 1998;12(1):56-66.
Revzin MV, Mathur M, Dave HB, Macer ML, Spektor M. Pelvic inflammatory disease: multimodality imaging approach with clinical-pathologic correlation. Radiographics. 2016;36(5):1579-1596.
Ross J, Guaschino S, Cusini M, Jensen J. 2017 European guideline for the management of pelvic inflammatory disease. Int J STD AIDS. 2018;29(2):108-114. doi:10.1177/0956462417744099
Silva F, Silva J, Rocha I, et al. Surgical approach of tubo-ovarian abscesses from theory to our minimally invasive practice. Gynecol Minim Invasive Ther [internet]. 2015;4(3):72-75. Accessed June 28, 2021. http://www.sciencedirect.com/science/article/pii/S2213307015000556
Jiang X, Shi M, Sui M, et al. Clinical value of early laparoscopic therapy in the management of tubo-ovarian or pelvic abscess. Exp Ther Med [Internet]. 2019;18(2):1115-1122. Accessed June 28, 2021. https://pubmed.ncbi.nlm.nih.gov/31384333
Goharkhay N, Verma U, Maggiorotto F. Comparison of CT- or ultrasound-guided drainage with concomitant intravenous antibiotics vs. intravenous antibiotics alone in the management of tubo-ovarian abscesses. Ultrasound Obstet Gynecol. 2007;29:65-69.
Farid H, Lau TC, Karmon AE, Styer AK. Clinical characteristics associated with antibiotic treatment failure for tuboovarian abscesses. Infect Dis Obstet Gynecol. 2016;2016:1-7.
Habboub AY. Middlemore hospital experience with tubo-ovarian abscesses: an observational retrospective study. Int J Womens Health. 2016;8:325-340.
Rosen M, Breitkopf D, Waud K. Tubo-ovarian abscess management options for women who desire fertility. Obstet Gynecol Surv. 2009;64:681-689.
Chu L, Ma H, Liang J, et al. Effectiveness and adverse events of early laparoscopic therapy versus conservative treatment for tubo-ovarian or pelvic abscess: a single-center retrospective cohort study. Gynecol Obstet Invest [internet]. 2019;84(4):334-342. doi:10.1159/000493855
Gockley AA, Manning-Geist BL, Boatin AA, Gu X, Cohen S. Tubo-ovarian abscesses in postmenopausal women: clinical presentation and outcomes. Maturitas. 2019;125:20-26. doi:10.1016/j.maturitas.2019.04.206
Chan GMF, Fong YF, Tubo-Ovarian NKL. Tubo-ovarian abscesses: epidemiology and predictors for failed response to medical management in an Asian population. Infect Dis Obstetr Gynecol. 2019;2019:1-8. doi:10.1155/2019/4161394
Alay I, Kaya C, Karaca I, et al. The effectiveness of neutrophil to lymphocyte ratio in prediction of medical treatment failure for tubo-ovarian abscess. J Obstetr Gynaecol Res. 2019;45(6):1183-1189. doi:10.1111/jog.13946
Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):801. doi:10.1001/jama.2016.0287
Kinay T, Unlubilgin E, Cirik DA, Kayikcioglu F, Akgul MA, Dolen I. The value of ultrasonographic tubo-ovarian abscess morphology in predicting whether patients will require surgical treatment. Int J Gynecol Obstetr. 2016;135(1):77-81. doi:10.1016/j.ijgo.2016.04.006
Köstü B, Özer A. Analysis of risk factors predicting surgery in cases with tubo-ovarian abscess. J Clin Anal Med [internet]. 2017;8(4):267-270. Accessed June 28, 2021. http://www.jcam.com.tr/en/index.php?pg=archive_detail&article_id=4853
Fouks Y, Cohen A, Shapira U, Solomon N, Almog B, Levin I. Surgical intervention in patients with tubo-ovarian abscess: clinical predictors and a simple risk score. J Minim Invasive Gynecol [internet]. 2019;26(3):535-543. Accessed June 28, 2021. http://www.sciencedirect.com/science/article/pii/S1553465018303352
Lin P-C, Chen K-T, Hsu C-C. Tubo-ovarian abscess in an emergency department: clinical presentation, diagnosis, and treatment [Internet]. Clin Exp Obstet Gynecol. 2018;45:809-812. Accessed June 28, 2021. https://ceog.imrpress.com
Ribak R, Schonman R, Sharvit M, Schreiber H, Raviv O, Klein Z. Can the need for invasive intervention in tubo-ovarian abscess be predicted? The implication of C-reactive protein measurements. J Minim Invasive Gynecol. 2020;27(2):541-547. doi:10.1016/j.jmig.2019.04.027
Stirling AD, Moran NR, Kelly ME, Ridgway PF, Conlon KC. The predictive value of C-reactive protein (CRP) in acute pancreatitis - is interval change in CRP an additional indicator of severity? HPB (Oxford). 2017;19(10):874-880.
Yeung DE, Peterknecht E, Hajibandeh S, Hajibandeh S, Torrance AW. C-reactive protein can predict anastomotic leak in colorectal surgery: a systematic review and meta-analysis. Int J Colorectal Dis. 2021;36(6):1147-1162. doi:10.1007/s00384-021-03854-5