Lis Maternity Hospital, Department of Obstetrics and Gynecology, Sourasky Medical Center, Tel Aviv, Israel (Drs. Fouks, Cohen, Solomon, Almog, Levin).
Lis Maternity Hospital, Department of Obstetrics and Gynecology, Sourasky Medical Center, Tel Aviv, Israel (Drs. Fouks, Cohen, Solomon, Almog, Levin).
J Minim Invasive Gynecol. 2019 Mar-Apr;26(3):535-543. doi: 10.1016/j.jmig.2018.06.013. Epub 2018 Aug 11.
To identify the clinical characteristics associated with surgical intervention in patients with tubo-ovarian abscess (TOA).
Retrospective cohort study (Canadian Task Force classification II-2).
Tertiary university-affiliated hospital.
Three hundred thirty-five patients were diagnosed with TOA based on sonographic and clinical criteria. Patients who underwent surgical intervention were compared with patients managed conservatively.
Electronic medical records were used to identify patients who were diagnosed with TOA between 2007 and 2015. All patients received the same antibiotic regimen upon admission. The data extracted included microbial and pathologic reports. Clinical characteristics such as disease severity and outcomes were compared. The clinical predictors available on patient admission for surgical intervention were identified retrospectively. A logistic regression was used to determine the independent predictors of treatment failure. A risk score was created by giving a nominal weight to each predictor. The score was validated by a random bootstrap analysis. An additional validation cohort that consisted of patients diagnosed with TOA during the 2 years after the original study period was applied to the final score.
The following variables of patients who underwent surgical intervention in comparison with those successfully treated and were enrolled into the score analysis differed significantly: age at admission (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.3-3.5), mean leukocytosis at admission (OR, 2.2; 95% CI, 1.3-3.6), ultrasonographic measurement of abscess diameter (OR, 3.6 95% CI, 2.0-6.3), and the presence of bilateral abscess (OR, 2.2; 95% CI, 1.3-3.9). Risk groups A, B, C, and D were positively correlated with the need for surgical intervention. Those in the highest risk group D had an antibiotic failure rate of 92%, as compared with those with the lowest risk group, in which there was a 20% risk of antibiotic failure.
Antibiotic treatment failure for TOA can be predicted on patient admission using a novel risk assessment score.
确定与输卵管卵巢脓肿（TOA）患者手术干预相关的临床特征。
回顾性队列研究（加拿大任务组分类 II-2）。
三级大学附属医院。
根据超声和临床标准，诊断出 335 名 TOA 患者。将接受手术干预的患者与接受保守治疗的患者进行比较。
使用电子病历确定 2007 年至 2015 年间诊断为 TOA 的患者。所有患者入院时均接受相同的抗生素治疗方案。提取的数据包括微生物和病理报告。比较疾病严重程度和结局等临床特征。回顾性确定入院时用于手术干预的临床预测因素。使用逻辑回归确定治疗失败的独立预测因素。通过为每个预测因素赋予名义权重来创建风险评分。通过随机引导分析验证评分。将原始研究期间后 2 年诊断为 TOA 的患者组成的验证队列应用于最终评分。
与成功治疗并纳入评分分析的患者相比，接受手术干预的患者有以下变量差异显著：入院时年龄（优势比[OR]，2.1；95%置信区间[CI]，1.3-3.5），入院时平均白细胞增多（OR，2.2；95%CI，1.3-3.6），脓肿直径的超声测量（OR，3.6 95%CI，2.0-6.3）和双侧脓肿的存在（OR，2.2；95%CI，1.3-3.9）。风险组 A、B、C 和 D 与手术干预的需要呈正相关。风险最高的组 D 的抗生素治疗失败率为 92%，而风险最低的组抗生素治疗失败的风险为 20%。
使用新的风险评估评分，可以在患者入院时预测 TOA 的抗生素治疗失败。
