ABSTRACT

Objectives:

To define the epidemiologic, clinical and laboratory risk factors associated with failed response to conservative antibiotic therapy in tubo-ovarian abscess (TOA).

Material and methods:

The charts of 108 patients, admitted with clinically and sonographically diagnosed TOA between 1988 and 2010 were reviewed. On admission, all patients were treated with broad-spectrum antibiotics, and were divided into two groups according to the response to medical treatment. 47 patients, responding to antibiotic therapy, constituted group A, whereas 61 patients who did not respond and were further treated by surgery, were included in group B. The groups were compared with respect to patient characteristics, clinical and sonographic presentation, laboratory findings.

Results:

There was no statistical difference between the mean age of patients (38±2,8) responding to medical therapy (group A) and the age of patients who did not respond (group B) (38±3,4)(p>0,05). The gravidity, parity, use of intrauterin device (IUD) and history of tubal ligation were similar between the groups (p>0,05). The size and bilaterality of TOA, evaluated sonographically were significantly increased in group B compared with group A (p=0,008 and p=0,002, respectively). On admisson, fever >38,0°C was determined in %32 of group B and %8 of group A (p=0,003.) The only laboratory finding differentiating between two groups was C-reactive protein (CRP), being significantly higher in group B (p=0,03). The duration of hospitalization was significantly shorter in group A (8,21 ± 1,9)(p<0,05). %85 of patients in group A were treated with Clindamycin+ Gentamycin ± (Amoxicillin+Clavulonic acid) regimen (p=0,0043).

Conclusion:

In the presence of certain risk factors, if conservative treatment fails in TOA; additional interventions (surgery, drainage) may be necessary.