Can the Need for Invasive Intervention in Tubo-ovarian Abscess Be Predicted? The Implication of C-reactive Protein Measurements

Ribak, Rachel; Schonman, Ron; Sharvit, Merav; Schreiber, H; Raviv, Oshrat; Klein, Zvi

doi:10.1016/j.jmig.2019.04.027

Cited by 19 publications

(9 citation statements)

References 22 publications

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“…The only biochemical marker in our data set that was predictive of tubo‐ovarian abscess outcome on univariate analysis was C‐reactive protein. Ribak et al 25 similarly found C‐reactive protein to be more sensitive than white cell count in predicting the need for surgical intervention in tubo‐ovarian abscesses (AUC = 0.92 vs 0.75, respectively). Its serum concentration is proportional to the intensity of the inflammatory process, with levels peaking at 48 h. We speculate that the reason that C‐reactive protein was more significant than white cell count is due to the delay in presentation to health care from the onset of symptoms.…”

Section: Discussionmentioning

confidence: 99%

Tubo‐ovarian abscess: A proposed new scoring system to guide clinical management

Yongue

Mollier

Anin

et al. 2021

Intl J Gynecology & Obste

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Objective 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. Methods 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. Results 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. Conclusion 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.

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Section: Discussionmentioning

confidence: 99%

Tubo‐ovarian abscess: A proposed new scoring system to guide clinical management

Yongue

Mollier

Anin

et al. 2021

Intl J Gynecology & Obste

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“…The 47% concomitant gynecological malignancy risk in postmenopausal women with TOA may lead the clinicians to decide favors surgical therapy. 34 Antibiotic therapy failure was defined as no clinical improvement after 48-72 h of medical therapy in most of the studies [5][6][7][8][9][10][11]13,14,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] included in the meta-analysis. The findings of the previous reports and this meta-analysis suggest that surgical intervention should not be delayed more than 48 h in women with identified risk factors.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for antibiotic therapy failure in women with tubo‐ovarian abscess: A systematic review and meta‐analysis

Kinay,

Akay,

Aksoy

et al. 2024

J of Obstet and Gynaecol

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AimMedical therapy with antibiotics only and surgical drainage are the treatment options of tubo‐ovarian abscess (TOA). It is not yet known exactly which cases need surgical treatment. The aim of this systematic review and meta‐analysis was to evaluate the risk factors leading antibiotic therapy failure in women with TOA.MethodsWe searched the following databases from inception to June 1, 2022: PubMed, Ovid MEDLINE, The Cochrane Library, and Scopus. We also searched reference lists of eligible articles and related review articles. The observational cohort, cross‐sectional, and case–control studies were included in the meta‐analysis. At least four review authors independently selected eligible articles, assessed risk of bias, and extracted data. The random effect model was used in the meta‐analysis.ResultsA total of 29 studies, including 2890 women, were included in the study. The age, abscess size, history of intrauterine device use, postmenopausal status, history of diabetes mellitus, fever, white blood cell count, erythrocyte sedimentation rate, C‐reactive protein level, and history of pelvic inflammatory disease were found as significant risk factors for antibiotic therapy failure in women with TOA.ConclusionsThe findings of this study clarified the risk factors for antibiotic therapy failure in women with TOA.

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“…An early intervention strategy including drainage along with intravenous antibiotics seems the best treatment approach to avoid long term complications of TOAs. In a prospective cohort study, CRP was demonstrated to be a sensitive and specific inflammatory marker for predicting TOA in patients with complicated PID, which significantly correlated with success or failure of conservative management [9]. To et al [5] demonstrated that patients who received antibiotics alone were more likely to require further surgical intervention when compared with patients who additionally received image-guided drainage.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopy versus open surgery for the surgical management of tubo-ovarian abscess (TOA). Is there a beneficial impact of early endoscopic intervention in terms of fertility rates?

Sönmezer

Saçıntı²,

Varlı³

et al. 2023

Ginekol Pol

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Objectives: To compare success rates and complications in women undergoing laparoscopic versus open surgical management of tubo-ovarian abscess. We further examined whether early laparoscopic intervention has any impact on pregnancy rates in a subgroup of infertile patients following frozen-thawed embryo transfer. Material and methods: Hospital records of 48 patients diagnosed with TOA between January 2015 and December 2020, who underwent surgical intervention or received only medical treatment were analyzed. All patients were hospitalized, and parenteral antibiotics were commenced on admission initially. Laparoscopic or open surgery was performed within 48 hours course of intravenous antibiotherapy (early intervention) or later according to the clinical findings and antibiotherapy response. Results: Of 48 patients with TOA, 18 (37.5%) underwent laparoscopic and 30 (62.5%)underwent open surgical intervention. The median postoperative hospital stay was shorter (4.5 days vs 7.5 days, respectively; p = 0.035), and postoperative opioid analgesic requirement was lesser in the laparoscopy group compared to open surgery group (22% vs 53%, respectively; p = 0.034). Intra-and post-operative complication rates were similar between the groups. Of these 48 patients, seven were diagnosed to have TOA following oocyte retrieval, and four of these conceived with frozen thawed embryo transfer all of whom underwent laparoscopic surgery within 48 hours of diagnosis. Conclusions:Minimal invasive surgery should be preferred even in the presence of severely adhesive and inflammatory TOA in order to improve postoperative outcomes. Moreover, early laparoscopic intervention may be considered in infertile patients with an aim to optimize pregnancy rates in a subsequent frozen-thawed embryo transfer.

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Can the Need for Invasive Intervention in Tubo-ovarian Abscess Be Predicted? The Implication of C-reactive Protein Measurements

Cited by 19 publications

References 22 publications

Tubo‐ovarian abscess: A proposed new scoring system to guide clinical management

Tubo‐ovarian abscess: A proposed new scoring system to guide clinical management

Risk factors for antibiotic therapy failure in women with tubo‐ovarian abscess: A systematic review and meta‐analysis

Laparoscopy versus open surgery for the surgical management of tubo-ovarian abscess (TOA). Is there a beneficial impact of early endoscopic intervention in terms of fertility rates?

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