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Kinay T, Akay A, Aksoy M, Celik Balkan F, Engin Ustun Y. Risk factors for antibiotic therapy failure in women with tubo-ovarian abscess: A systematic review and meta-analysis. J Obstet Gynaecol Res 2024; 50:298-312. [PMID: 38184888 DOI: 10.1111/jog.15870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/13/2023] [Indexed: 01/09/2024]
Abstract
AIM Medical 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. METHODS We 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. RESULTS A 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. CONCLUSIONS The findings of this study clarified the risk factors for antibiotic therapy failure in women with TOA.
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Affiliation(s)
- Tugba Kinay
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Arife Akay
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Munevver Aksoy
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Fatma Celik Balkan
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Yaprak Engin Ustun
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
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Kose C, Korpe B, Korkmaz V, Ustun YE. The role of systemic immune inflammation index in predicting treatment success in tuboovarian abscesses. Arch Gynecol Obstet 2023; 308:1313-1319. [PMID: 37354237 DOI: 10.1007/s00404-023-07107-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 06/11/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The aim of this study was to determine the predictability of the systemic immune inflammation index (SII) on the response to medical treatment in tubo-ovarian abscess (TOA). METHODS 296 patients with TOA in a tertiary center were enrolled in the study. Patients were divided into two groups: Group1 (n = 165) included patients in whom medical treatment was successful, and Group2 (n = 131) included patients in whom surgery was required. Demographic, sonographic and laboratory findings were compared between groups. SII was calculated using peripheral blood parameters [SII = (platelets ∗ neutrophils)/lymphocytes]. RESULTS Age, BMI, gravida, parity, smoking and menopausal status, CRP levels of patients were similar in both groups (p > 0.05). Mass size (4.398 ± 0.306 vs 7.683 ± 0.689, p < 0.001), white blood cell (WBC) (8685.08 ± 3981.98 vs 9994.35 ± 4468.024, p = 0.008), Hb (12.18 ± 1.65 vs 11.68 ± 1.65, p = 0.010), platelet to lymphocyte ratio (PLR) (151.26 ± 74.83 vs 230.77 ± 140.25, p < 0.001), neutrophil to lymphocyte ratio (NLR) (4.21 ± 3.27 vs 6.07 ± 6.6, p = 0.003), monocyte to lymphocyte ratio (MLR) (0.300 ± 0.177 vs 0.346 ± 0.203, p = 0.041) and SII (1014.18 ± 781.71 vs 2094.088 ± 2117.58, p < 0.001) were statistically higher in group 2. ROC Analysis was used to determine the predictability of the variables and PLR (AUC = 0.718, p < 0.001), NLR (AUC = 0.593, p = 0.593), MLR (AUC = 0.576, p = 0.024), SII (AUC = 0.723, p < 0.001) and size of mass (AUC = 0.670, p < 0.001) were found to be significant. The SII, size of mass and bilateral involvement of adnexa were found to be the strongest prognostic factors for surgical intervention (OR:1.004 (1.002-1.005), OR:1.018 (1.010-1.027), OR:3.397 (1.338-8.627); p < 0.001, p < 0.001, p = 0.010 resspectively). CONCLUSION SII, size of mass and bilaterality can be used to predict medical treatment success in patients with TOA.
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Affiliation(s)
- Caner Kose
- Ankara Etlik Zubeyde Hanım Women's Health Training and Research Hospital, 06010, Ankara, Turkey.
| | - Busra Korpe
- Ankara Etlik Zubeyde Hanım Women's Health Training and Research Hospital, 06010, Ankara, Turkey
| | - Vakkas Korkmaz
- Department of Gynecologic Oncology, Ankara Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Yaprak Engin Ustun
- Ankara Etlik Zubeyde Hanım Women's Health Training and Research Hospital, 06010, Ankara, Turkey
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Tang H, Zhou H, Zhang R. Antibiotic Resistance and Mechanisms of Pathogenic Bacteria in Tubo-Ovarian Abscess. Front Cell Infect Microbiol 2022; 12:958210. [PMID: 35967860 PMCID: PMC9363611 DOI: 10.3389/fcimb.2022.958210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
A tubo-ovarian abscess (TOA) is a common type of inflammatory lump in clinical practice. TOA is an important, life-threatening disease, and it has become more common in recent years, posing a major health risk to women. Broad-spectrum antimicrobial agents are necessary to cover the most likely pathogens because the pathogens that cause TOA are polymicrobial. However, the response rate of antibiotic treatment is about 70%, whereas one-third of patients have poor clinical consequences and they require drainage or surgery. Rising antimicrobial resistance serves as a significant reason for the unsatisfactory medical outcomes. It is important to study the antibiotic resistance mechanism of TOA pathogens in solving the problems of multi-drug resistant strains. This paper focuses on the most common pathogenic bacteria isolated from TOA specimens and discusses the emerging trends and epidemiology of resistant Escherichia coli, Bacteroides fragilis, and gram-positive anaerobic cocci. Besides that, new methods that aim to solve the antibiotic resistance of related pathogens are discussed, such as CRISPR, nanoparticles, bacteriophages, antimicrobial peptides, and pathogen-specific monoclonal antibodies. Through this review, we hope to reveal the current situation of antibiotic resistance of common TOA pathogens, relevant mechanisms, and possible antibacterial strategies, providing references for the clinical treatment of drug-resistant pathogens.
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Affiliation(s)
- Huanna Tang
- Women’s Reproductive Health Research Key Laboratory of Zhejiang Province and Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Zhou
- Department of Infectious Disease, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Hui Zhou, ; Runju Zhang,
| | - Runju Zhang
- Women’s Reproductive Health Research Key Laboratory of Zhejiang Province and Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Hui Zhou, ; Runju Zhang,
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ERTÜRK AKSAKAL S, GÜVENÇ SAÇINTI H, KİYKAC ALTINBAŞ Ş, TAPISIZ ÖL, ENGİN-ÜSTÜN Y. The role of systemic inflammatory markers in prediction of medical treatment failure in patients with tubo-ovarian abscess. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1128214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: Aimed to evaluate the role of systemic inflammatory markers and Aspartate aminotransferase to Platelet Ratio Index (APRI) sore in predicting medical treatment failure in patients with Tubo-ovarian abscess (TOA).
Materials and Methods: Patients (n=240) hospitalized with a diagnosis of TOA between August 2016 - October 2020 were included in the study. Patients' demographic and clinical characteristics and mean C-Reactive protein (CRP) level, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and APRI score measured on admission were also recorded. The role of these parameters was investigated in predicting medical treatment failure in patients who only received medical treatment or who needed surgical treatment.
Results: The mean age (40.95 ± 6.96 vs. 38.09 ± 7.69), abscess size (67.57 ± 19.86 mm vs. 52.78 ± 16.63 mm), CRP level, (140.61 ± 110.88 vs. 75.24 ± 36.64 mg/L), white blood cell count (13818.86 ± 5445.80 and 11845.31 ± 4424.39 μL), neutrophil count (11146.81 ± 5284.83 and 9242.03 ± 4278.60 μL) and NLR (9.52 ± 6.88 and 6.64 ± 6.30) of patients who received surgical treatment were significantly higher than those who received only medical treatment. In receiver operating characteristics (ROC) analysis area under the curve (AUC) 0.607 was statistically significant for CRP with a cut-off value of 11.57 to predict medical treatment failure (95% 0.531-0.682, sensitivity 63.3%, specificity 55.4%).
Conclusion: NLR, PLR and APRI score are ineffective in predicting the need for surgical treatment. CRP could be used as a marker in predicting the need for surgical treatment in patients with TOA.
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Affiliation(s)
- Sezin ERTÜRK AKSAKAL
- Jinekoloji/Ürojinekoloji Kliniği, Sağlık Bilimleri Üniversitesi, Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
| | - Huriye GÜVENÇ SAÇINTI
- Jinekoloji/Ürojinekoloji Kliniği, Sağlık Bilimleri Üniversitesi, Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
| | - Şadıman KİYKAC ALTINBAŞ
- Jinekoloji/Ürojinekoloji Kliniği, Sağlık Bilimleri Üniversitesi, Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
| | - Ömer Lütfi TAPISIZ
- Jinekoloji/Ürojinekoloji Kliniği, Sağlık Bilimleri Üniversitesi, Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
| | - Yaprak ENGİN-ÜSTÜN
- Jinekoloji/Ürojinekoloji Kliniği, Sağlık Bilimleri Üniversitesi, Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
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ERTÜRK AKSAKAL S, GÜVENÇ SAÇINTI H, KİYKAC ALTINBAŞ Ş, TAPISIZ ÖL, ENGİN-ÜSTÜN Y. The role of systemic inflammatory markers in prediction of medical treatment failure in patients with tubo-ovarian abscess. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1125743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: Aimed to evaluate the role of systemic inflammatory markers and Aspartate aminotransferase to Platelet Ratio Index (APRI) sore in predicting medical treatment failure in patients with Tubo-ovarian abscess (TOA).
Materials and Methods: Patients (n=240) hospitalized with a diagnosis of TOA between August 2016 - October 2020 were included in the study. Patients' demographic and clinical characteristics and mean C-Reactive protein (CRP) level, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and APRI score measured on admission were also recorded. The role of these parameters was investigated in predicting medical treatment failure in patients who only received medical treatment or who needed surgical treatment.
Results: The mean age (40.95 ± 6.96 vs. 38.09 ± 7.69), abscess size (67.57 ± 19.86 mm vs. 52.78 ± 16.63 mm), CRP level, (140.61 ± 110.88 vs. 75.24 ± 36.64 mg/L), white blood cell count (13818.86 ± 5445.80 and 11845.31 ± 4424.39 μL), neutrophil count (11146.81 ± 5284.83 and 9242.03 ± 4278.60 μL) and NLR (9.52 ± 6.88 and 6.64 ± 6.30) of patients who received surgical treatment were significantly higher than those who received only medical treatment. In receiver operating characteristics (ROC) analysis area under the curve (AUC) 0.607 was statistically significant for CRP with a cut-off value of 11.57 to predict medical treatment failure (95% 0.531-0.682, sensitivity 63.3%, specificity 55.4%).
Conclusion: NLR, PLR and APRI score are ineffective in predicting the need for surgical treatment. CRP could be used as a marker in predicting the need for surgical treatment in patients with TOA.
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Affiliation(s)
- Sezin ERTÜRK AKSAKAL
- Jinekoloji/Ürojinekoloji Kliniği, Sağlık Bilimleri Üniversitesi, Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
| | - Huriye GÜVENÇ SAÇINTI
- Jinekoloji/Ürojinekoloji Kliniği, Sağlık Bilimleri Üniversitesi, Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
| | - Şadıman KİYKAC ALTINBAŞ
- Jinekoloji/Ürojinekoloji Kliniği, Sağlık Bilimleri Üniversitesi, Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
| | - Ömer Lütfi TAPISIZ
- Jinekoloji/Ürojinekoloji Kliniği, Sağlık Bilimleri Üniversitesi, Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
| | - Yaprak ENGİN-ÜSTÜN
- Jinekoloji/Ürojinekoloji Kliniği, Sağlık Bilimleri Üniversitesi, Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Türkiye
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Greydanus DE, Cabral MD, Patel DR. Pelvic inflammatory disease in the adolescent and young adult: An update. Dis Mon 2021; 68:101287. [PMID: 34521505 DOI: 10.1016/j.disamonth.2021.101287] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is typically polymicrobial with classic core involvement of Neisseria gonorrhoeae and/or Chlamydia trachomatis, though other endogenous flora from the vagino-cervical areas can be involved as well. It is often a sexually transmitted disease but other etiologic routes are also noted. A variety of risk factors have been identified including adolescence, young adulthood, adolescent cervical ectropion, multiple sexual partners, immature immune system, history of previous PID, risky contraceptive practices and others. An early diagnosis and prompt treatment are necessary to reduce risks of PID complications such as chronic pelvic pain, ectopic pregnancy and infertility. Current management principles of PID are also reviewed. It is important for clinicians to screen sexually active females for common sexually transmitted infections such as Chlamydia trachomatis and provide safer sex education to their adolescent and young adult patients. Clinicians should provide comprehensive management to persons with PID and utilize established guidelines such as those from the US Centers for Disease Control and Prevention (CDC).
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Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| | - Maria Demma Cabral
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
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Hattiangadi R, McEntee K, Dahlman M. Minimally invasive approach to the management of tubo-ovarian abscesses. Curr Opin Obstet Gynecol 2021; 33:249-254. [PMID: 34155166 DOI: 10.1097/gco.0000000000000720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this publication is to review the most up-to-date literature regarding the pathogenesis, diagnosis and management of tubo-ovarian abscesses. RECENT FINDINGS Prior to the advent of broad-spectrum antibiotics, tubo-ovarian abscesses necessitated total abdominal hysterectomy and bilateral salpingo-oophorectomy. Although it carries a risk of treatment failure, antibiotic therapy enabled fertility-sparing treatment for many women. Recent studies have identified key predictors for antibiotic treatment failure, including age, BMI and abscess diameter. C-reactive protein was also found to be a strong predictor of antibiotic treatment response. Given the growing evidence of treatment failure with antibiotic therapy alone, along with increased availability and access to interventional radiology, image-guided drainage with or without catheter placement, combined with broad-spectrum antibiotics, is now considered first-line therapy. SUMMARY Tubo-ovarian abscess is a diagnostic challenge, as presentation can vary. Inadequate treatment is associated with severe morbidity and mortality. Despite adequate conservative treatment, recurrence risk is high and clinical sequelae can have devastating effects on reproductive health. Recent evidence-based developments, including a risk score system to predict antibiotic failure, serve to provide appropriately directed risk-based care. However, large-scale randomized controlled trials are needed to clarify the most appropriate treatment modalities.
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Affiliation(s)
- Rohan Hattiangadi
- Virginia Mason Medical Center, Department of Gynecology, Seattle, Washington, USA
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Tugrul Ersak D, Ersak B, Kokanalı MK. The effect of intrauterine device presence and other factors in medical treatment success of tuboovarian abscess. J Gynecol Obstet Hum Reprod 2020; 50:101983. [PMID: 33189945 DOI: 10.1016/j.jogoh.2020.101983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/25/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND To identify the epidemiologic and clinical risk factors associated with failed response to medical treatment in tuboovarian abscess (TOA) patients and whether there is a relationship between the presence of intrauterine device (IUD), duration of use and medical treatment success or not. METHODS For this study, the medical records of patients diagnosed with TOA and hospitalized in an 8-year period were analyzed retrospectively. The presence of TOA and IUD was confirmed ultrasonographically in all patients. Parenteral antibiotic treatment was initiated as the first step. Patients who did not improve with this medical treatment underwent surgery. Patients who recovered with medical treatment were defined as the successful group, while those who underwent surgery after medical treatment failure were recorded as the failed group. RESULTS There were 37 patients in successful group and 87 patients in failed group. The mean age, parity, white blood count, TOA size, duration of IUD use, rate of multigravida and multiparity were higher in the failed group. Logistic regression analysis revealed that presence of multiparity, TOA size and the duration of IUD use were significant independent factors in predicting medical treatment success of TOA. The best cut-off value for TOA size was 4.5 cm and for duration of IUD use was 5.5 years in the Receiver Operating Characteristic curve analysis. CONCLUSION The presence of long-term IUD use, increased TOA size, and multiparity were found to be risk factors related to the failure of medical treatment in TOA cases.
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Affiliation(s)
- Duygu Tugrul Ersak
- University of Health Science, Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Burak Ersak
- Department of Oncology, University of Health Science, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Mahmut Kuntay Kokanalı
- Department of Gynecology, University of Health Science, Ministry of Health Ankara City Hospital Ankara, Turkey
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Hong IK, Kwon MJ, Nam SH, Kim KH, Lee KW, Sung JH, Song T. Value of serum procalcitonin as an early predictor of antibiotic treatment response in inpatients with pelvic inflammatory disease (VALID). Taiwan J Obstet Gynecol 2020; 59:660-664. [DOI: 10.1016/j.tjog.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 10/23/2022] Open
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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; 27:541-547. [DOI: 10.1016/j.jmig.2019.04.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/24/2019] [Accepted: 04/09/2019] [Indexed: 10/26/2022]
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Levin G, Herzberg S, Dior UP, Shushan A, Gilad R, Benshushan A, Rottenstreich A. The predictive role of CA-125 in the management of tubo-ovarian abscess. A retrospective study. Eur J Obstet Gynecol Reprod Biol 2019; 238:20-24. [PMID: 31082739 DOI: 10.1016/j.ejogrb.2019.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/30/2019] [Accepted: 05/05/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Tubo-ovarian abscess (TOA) is a well-established sequel of acute pelvic inflammatory disease (PID). While as up to 25% of women will experience conservative treatment failure, the factors associated with treatment failure are not clearly-established, and the role of Cancer antigen 125 (CA-125) is under-studied. We aim to evaluate the role of CA-125 in the conservative management of TOA. STUDY DESIGN A retrospective cohort study conducted at tertiary university-affiliated hospital during 2007-2018. Ninety one patients were diagnosed with a TOA and underwent a trial of conservative management with intravenous antibiotics. Patients who eventually underwent surgical intervention were compared with patients managed conservatively. RESULTS Overall, 39/91 (42.8%) underwent an invasive intervention subsequent to failed antibiotic treatment. Patients who experienced conservative treatment failure had higher medians of inflammatory markers as CRP (15.7 vs. 10.8 mg/L, p = 0.02), WBC count (14.2 vs. 12.4 1,000/mm3, p = 0.04) and platelet count (374 vs. 295 109/L, p = 0.04) at admission. Higher levels of CA-125 at admission were found in those who required an invasive intervention (57 vs. 30 U\ml, p = 0.02) as well. The largest diameter of TOA at admission was higher in those who required an invasive intervention as compared to those who were successfully treated conservatively (75 mm vs. 57 mm, p = 0.01). CA-125 level was found to be the only independent factor associated with conservative treatment failure (OR; 95% confidence interval [CI], 1.27, 1.08-1.48, p = 0.03). CONCLUSION Elevated CA-125 serum levels were found to be associated with failure of conservative parenteral antibiotic therapy for TOA. This finding should be better evaluated in a prospective manner.
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Affiliation(s)
- Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Shmuel Herzberg
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Uri P Dior
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Asher Shushan
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ronit Gilad
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Avi Benshushan
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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