Routine Surgical Drainage in Tubo-ovarian Abscess: Single Center Experience with Fifty Patients

Öz

Backround: Current data concerning the role of routine surgical drainage on patient outcomes and surrogate markers of infection in patients with tubo-ovarian abscess (TOA) is limited. The present retrospective study purposed to identify the impact of routine surgical drainage on patients’ outcomes and postoperative leukocyte count, CRP level and procalcitonin level which might improve our understanding on the role of surgical drainage on infectious process in patients with TOA.

 Materials and Methods: Fifty patients admitted to our institute (tertiary center) with TOA and underwent surgical abscess drainage were enrolled in this retrospective analysis. Demographic data, laboratory measurements during hospitalization, antibiotherapy and operation details were obtained from institutional electronic database. Perioperative complications were also derived from the institutional database.

Results: The most common microorganisms isolated from the abscess fluid cultures were Klebsiella pneumonia (20%), Enterobacter aerogenes (16 %) and Escherichia coli (16 %). The mean time from admission to antibiotherapy was 0.6 ± 0.2 days and time from admission to surgery was 3.2 ± 2.8 days. Time from admission to surgical drainage was 3.2 ± 2.8 days. Compared to admission values, the post-surgery (at 48th hour) leukocyte count (15.3 ± 7.1 x103/mm3 vs. 12.4 ± 5.2 x103/mm3, p < 0.001), CRP (48.4 ± 35.3 mg/L vs. 9.8 ± 3.5 mg/L, p < 0.001) and procalcitonin levels (2.2 ± 1.8 µg/L vs. 1.1 ± 0.8 µg/L, p < 0.001) were significantly lower. The overall complication rate was 8 %.

Conclusions: Routine TOA drainage leads to a significant decline in levels of infectious markers such as leukocyte count, CRP and procalcitonin levels, within 48 hours of the surgery. Routine surgical abscess drainage appears as a safe and effective way of treating patients with TOA.

Anahtar Kelimeler

• Tubo-ovarian abscess,surgical drainage,C-reactive protein,procalcitonin

Kaynakça

1. References1. Czeyda-Pommersheim F, Kalb B, Costello J, Liau J, Meshksar A, Arif Tiwari H, et al. MRI in pelvic inflammatory disease: a pictorial review. Abdominal radiology (New York). 2017;42(3):935-50. Epub 2016/12/10. doi: 10.1007/s00261-016-1004-4. PubMed PMID: 27933478.
2. 2. Lareau SM, Beigi RH. Pelvic inflammatory disease and tubo-ovarian abscess. Infectious disease clinics of North America. 2008;22(4):693-708. Epub 2008/10/29. doi: 10.1016/j.idc.2008.05.008. PubMed PMID: 18954759.
3. 3. Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. The New England journal of medicine. 2015;372(21):2039-48. Epub 2015/05/21. doi: 10.1056/NEJMra1411426. PubMed PMID: 25992748.
4. 4. Ford GW, Decker CF. Pelvic inflammatory disease. Disease-a-month : DM. 2016;62(8):301-5. Epub 2016/04/25. doi: 10.1016/j.disamonth.2016.03.015. PubMed PMID: 27107781.
5. 5. Gradison M. Pelvic inflammatory disease. American family physician. 2012;85(8):791-6. Epub 2012/04/27. PubMed PMID: 22534388.
6. 6. Ross JD. Pelvic inflammatory disease. BMJ clinical evidence. 2013;2013. Epub 2013/12/18. PubMed PMID: 24330771; PubMed Central PMCID: PMCPMC3859178.
7. 7. Revzin MV, Mathur M, Dave HB, Macer ML, Spektor M. Pelvic Inflammatory Disease: Multimodality Imaging Approach with Clinical-Pathologic Correlation. Radiographics : a review publication of the Radiological Society of North America, Inc. 2016;36(5):1579-96. Epub 2016/09/13. doi: 10.1148/rg.2016150202. PubMed PMID: 27618331.
8. 8. Spain J, Rheinboldt M. MDCT of pelvic inflammatory disease: a review of the pathophysiology, gamut of imaging findings, and treatment. Emergency radiology. 2017;24(1):87-93. Epub 2016/09/21. doi: 10.1007/s10140-016-1444-8. PubMed PMID: 27646971.

9. 9. Bugg CW, Taira T, Zaurova M. Pelvic inflammatory disease: diagnosis and treatment in the emergency department [digest]. Emergency medicine practice. 2016;18(12 Suppl Points & Pearls):S1-s2. Epub 2017/07/27. PubMed PMID: 28745849.
10. 10. Granberg S, Gjelland K, Ekerhovd E. The management of pelvic abscess. Best practice & research Clinical obstetrics & gynaecology. 2009;23(5):667-78. Epub 2009/02/24. doi: 10.1016/j.bpobgyn.2009.01.010. PubMed PMID: 19230781.
11. 11. Garbin O, Verdon R, Fauconnier A. [Treatment of the tubo-ovarian abscesses]. Journal de gynecologie, obstetrique et biologie de la reproduction. 2012;41(8):875-85. Epub 2012/11/14. doi: 10.1016/j.jgyn.2012.09.012. PubMed PMID: 23146745.
12. 12. Karakulak M, Pala HG, Aydın Y, Saatli B, Güçlü S. Tuboovarian abseli olguların değerlendirilmesi. Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi. 2008;22(1):9-14.
13. 13. Kuo CF, Tsai SY, Liu TC, Lin CC, Liu CP, Lee CM. Clinical characteristics and treatment outcomes of patients with tubo-ovarian abscess at a tertiary care hospital in Northern Taiwan. Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi. 2012;45(1):58-64. Epub 2011/12/14. doi:10.1016/j.jmii.2011.09.021. PubMed PMID: 22154676.
14. 14. Kairys N, Roepke C. Abscess, Tubo-Ovarian. StatPearls [Internet]: StatPearls Publishing; 2017.
15. 15. Long B, April MD. What Antibiotic Regimen Is Most Efficacious in Treating Pelvic Inflammatory Disease? Annals of emergency medicine. 2017;70(6):840-2. Epub 2017/08/22. doi: 10.1016/j.annemergmed.2017.07.002. PubMed PMID: 28822590.
16. 16. Savaris RF, Fuhrich DG, Duarte RV, Franik S, Ross J. Antibiotic therapy for pelvic inflammatory disease. The Cochrane database of systematic reviews. 2017;4:Cd010285. Epub 2017/04/25. doi: 10.1002/14651858.CD010285.pub2. PubMed PMID: 28436019; PubMed Central PMCID: PMCPMC6478260.
17. 17. Kuru O, Şen S, Saygılı H, Berkman S. Tubo-ovarian Abscess: Risk factors for failed response to conservative treatment. Journal of Turkish Society of Obstetrics and Gynecology. 2012;9(2):106-9.
18. 18. Gungorduk K, Guzel E, Asicioglu O, Yildirim G, Ataser G, Ark C, et al. Experience of tubo-ovarian abscess in western Turkey. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2014;124(1):45-50. Epub 2013/10/22. doi: 10.1016/j.ijgo.2013.07.017. PubMed PMID: 24139472.
19. 19. Inal ZO, Inal HA, Gorkem U. Experience of Tubo-Ovarian Abscess: A Retrospective Clinical Analysis of 318 Patients in a Single Tertiary Center in Middle Turkey. Surgical infections. 2018;19(1):54-60. Epub 2017/11/18. doi: 10.1089/sur.2017.215. PubMed PMID: 29148955.
20. 20. 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 in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2007;29(1):65-9. Epub 2006/12/16. doi: 10.1002/uog.3890. PubMed PMID: 17171628.
21. 21. Kakizawa H, Toyota N, Hieda M, Hirai N, Tachikake T, Matsuura N, et al. Gynecologic abscess: CT-guided percutaneous drainage. Hiroshima journal of medical sciences. 2006;55(3):97-100. Epub 2006/09/26. PubMed PMID: 16995496.
22. 22. Tyrrel RT, Murphy FB, Bernardino ME. Tubo-ovarian abscesses: CT-guided percutaneous drainage. Radiology. 1990;175(1):87-9. Epub 1990/04/01. doi: 10.1148/radiology.175.1.2315507. PubMed PMID: 2315507.