Inpatient Management of Tubo-Ovarian Abscesses

Abstract

INTRODUCTION: Although parenteral antibiotic treatment is a standard approach for tubo-ovarian abscesses, a significant proportion fail therapy and require interventional radiology–guided drainage. Unfortunately, there is no consensus of clinical parameters to guide initial antibiotic treatment. The objective of this study is to assess whether specific clinical factors are associated with antibiotic treatment failure. METHODS: A retrospective medical record review of patients hospitalized for tubo-ovarian abscesses from 2001 through 2012 was performed. Clinical characteristics were compared for patients undergoing successful parental antibiotic treatment only, failed parental antibiotic treatment requiring interventional radiology–guided drainage, and initial interventional radiology–guided drainage with concurrent parental antibiotic treatment, with univariate analyses and multivariate logistic regression models (failed antibiotic treatment compared with age, tubo-ovarian abscess diameter, white blood count [WBC]). RESULTS: A total of 113 patients admitted for inpatient treatment were identified. Demographic factors were similar among groups. Sixty-one (54%) patients initially underwent parental antibiotic treatment. Within this group, treatment failed for 24.6%, requiring interventional radiology–guided drainage. Mean WBC (18.7±5.94 compared with 13.9±5.12) [P=.003], mean tubo-ovarian abscess size (maximum diameter [cm]) (6.8±2.9 compared with 5.2±2.0) [P=.03], and length of stay (days) (9.47±7.43 compared with 4.59±2.4) [P=.002] were significantly greater for failed parental antibiotic treatment requiring interventional radiology–guided drainage compared with parental antibiotic treatment only. Respective tubo-ovarian abscess size for failed parental antibiotic treatment requiring interventional radiology–guided drainage and initial interventional radiology–guided drainage with concurrent parental antibiotic treatment was similar. Admission WBC higher than 16,000 was predictive of antibiotic treatment failure (odds ratio: 22.0, 95% confidence interval 2.3–201.2, P trend .006). CONCLUSION: Admission WBC higher than 16,000 and tubo-ovarian abscess size larger than 5.2 cm are associated with antibiotic treatment failure. Consideration of these factors may provide useful guidance for initial selection of interventional radiology–guided drainage at the time of admission to optimize treatment efficacy.