Single-step transvaginal aspiration and drainage for suspected pelvic abscesses refractory to antibiotic therapy.
OBJECTIVE: For treatment of suspected pelvic abscesses, the use of the trocar technique avoids many of the technical challenges of the Seldinger method. The purpose of this study was to evaluate the effectiveness and safety of sonographically guided transvaginal aspiration or drainage with the trocar technique in suspected pelvic abscesses that were refractory to antibiotic treatment. METHODS: We retrospectively reviewed 22 patients with suspected pelvic abscesses refractory to antibiotic therapy who underwent single-step transvaginal pelvic aspiration or drainage between 1995 and 2000. RESULTS: Transvaginal aspiration or drainage was successful in 19 (86%) of the 22 patients. Of the 3 patients in whom aspiration or drainage failed, all ultimately went on to have surgery despite undergoing repeated drainage procedures. Drainage catheters were placed in 15 (68%) of the 22 patients and left in place an average of 3.7 days. Aspiration alone resulted in a 100% success rate, whereas drainage with catheter placement resulted in an 80% success rate. No complications, including bleeding, bowel perforation, and death, were reported in any of the procedures. CONCLUSIONS: Transvaginal ultrasonographically guided aspiration or catheter placement with the trocar technique is a safe and effective treatment for suspected pelvic abscesses refractory to antibiotic therapy. (+info)
Comparative in vitro activities of ertapenem against bacterial pathogens from patients with acute pelvic infection.
This study compared the in vitro activities of ertapenem, ceftriaxone, co-amoxiclav, ciprofloxacin and piperacillin-tazobactam against 314 aerobic bacteria and of ertapenem, piperacillin-tazobactam, cefoxitin, ceftriaxone, chloramphenicol, ticarcillin-clavulanate, ampicillin-sulbactam, clindamycin and metronidazole against 500 anaerobic bacteria from 212 patients with acute pelvic infection. Antimicrobial susceptibilities were determined by broth microdilution (aerobes) or agar dilution (anaerobes), following NCCLS guidelines. The most common isolates were Enterobacteriaceae and Peptostreptococcus spp. Ertapenem was the most active drug tested against Enterobacteriaceae (100% susceptible) and anaerobes (99.8% susceptible); the least active agents were co-amoxiclav (79% of Enterobacteriaceae susceptible) and ceftriaxone (85.9% of anaerobes susceptible). All agents tested had excellent activity against beta-haemolytic streptococci and methicillin-susceptible Staphylococcus aureus. (+info)
Ertapenem once a day versus piperacillin-tazobactam every 6 hours for treatment of acute pelvic infections: a prospective, multicenter, randomized, double-blind study.
OBJECTIVE: To compare ertapenem therapy with piperacillin-tazobactam therapy for the management of acute pelvic infections. METHODS: In a multicenter, double-blind study, 412 women with acute pelvic infection were assigned to one of two strata, namely obstetric/postpartum infection or gynecologic/postoperative infection, and were then randomized to ertapenem, 1 g once a day, or piperacillin-tazobactam, 3.375 g every 6 hours, both administered intravenously. RESULTS: In total, 163 patients in the ertapenem group and 153 patients in the piperacillin-tazobactam group were clinically evaluable. The median duration of therapy was 4.0 days in both treatment groups. The most common single pathogen was Escherichia coli. At the primary efficacy endpoint 2-4 weeks post therapy, 93.9% of patients who received ertapenem and 91.5% of those who received piperacillin-tazobactam were cured (95% confidence interval for the difference, adjusting for strata, -4% to 8.8%), indicating that cure rates for both treatment groups were equivalent. Cure rates for both treatment groups were also similar when compared by stratum and severity of infection. The frequency and severity of drug-related adverse events were generally similar in both groups. CONCLUSIONS: In this study, ertapenem was as effective as piperacillin-tazobactam for the treatment of acute pelvic infection, was generally well tolerated, and had an overall safety profile similar to that of piperacillin-tazobactam. (+info)
Etiology of persistent tubo-ovarian abscess in Nairobi, Kenya.
OBJECTIVE: To study the microbial etiology of tubo-ovarian abscess (TOA). METHODS: We recruited 11 women in Nairobi, Kenya who failed antibiotic therapy alone and required surgical drainage of a presumptive TOA. Pus from the nine abscesses and two pyosalpinges were collected and cultured for aerobic, facultative and anaerobic microorganisms. RESULTS: Eleven women suspected of having a TOA were hospitalized and treated for a median of 6 days (range 3-14 days) prior to surgical drainage of the abscess. Nine (82%) specimens were culture positive. Aerobes were present in all nine specimens. Seven of the nine positive cultures (78%) were polymicrobial and five of the polymicrobial cultures contained both anaerobes and aerobes. Anaerobic Gram-negative bacilli (Prevotella sp., Porphyromonas sp. and Bacteroides sp., Escherichia coli) and Streptococcus sp. (S. viridans and S. agalactiae) were the most common microorganisms isolated. Neisseria gonorrhoeae and Chlamydia trachomatis were not isolated by culture or detected by polymerase chain reaction. CONCLUSIONS: In Kenya, persistent TOAs are associated with endogenous flora similar to that normally found in the gastrointestinal tract. (+info)
Treatment of polymicrobial infections: post hoc analysis of three trials comparing ertapenem and piperacillin-tazobactam.
The efficacy of ertapenem 1 g once a day for the treatment of polymicrobial complicated intra-abdominal, complicated skin/skin-structure and acute pelvic infections was compared with piperacillin-tazobactam 3.375 g every 6 h in a post hoc analysis of data from three large randomized double-blind trials. Of the 1,558 treated patients in the three trials, no pathogen was identified in 345 (22.1%), 423 (27.2%) had a monomicrobial infection and 790 (50.7%) had a polymicrobial infection. At the test-of-cure assessment, there were no significant differences in outcome between the two treatment groups for any of the three infections. Cure rates (clinical and microbiological for intra-abdominal infection, clinical for skin/skin-structure and pelvic infections) in microbiologically evaluable patients for ertapenem and piperacillin-tazobactam, respectively, were 85.6% (154/180 evaluable patients) and 82.5% (127/154) for polymicrobial intra-abdominal infection, 80.3% (53/66) and 78.7% (48/61) for polymicrobial skin/skin-structure infection, and 95.7% (88/92) and 92.6% (88/95) for polymicrobial pelvic infection. Respective cure rates for all evaluable patients in the original trials were: 83.6% and 80.4% for intra-abdominal, 83.9% and 85.3% for skin/skin-structure, and 93.9% and 91.5% for pelvic infections. These data show that in the three trials, ertapenem 1 g once a day was highly effective for the treatment of polymicrobial infections and as effective as piperacillin-tazobactam 3.375 g every 6 h. (+info)
Pelvic actinomycosis: still a cause for concern.
Three cases of pelvic actinomycosis, which presented over a short period of time, are described. In all three cases the diagnosis was only considered following laparotomy, although there were characteristic diagnostic clues at presentation. In two cases imaging of the pelvis by ultrasound and computed tomography was unhelpful in distinguishing the condition from pelvic neoplasia. (+info)
Vaginal disinfection with povidone iodine immediately before oocyte retrieval is effective in preventing pelvic abscess formation without compromising the outcome of IVF-ET.
PURPOSE: In this study, the method of employing preretrieval vaginal douching with aqueous povidone iodine is examined to see if it can decrease the incidence of pelvic abscess without compromising the clinical outcome of IVF-ET. METHODS: Patients with ovarian endometrioma and received IVF-ET treatment were retrospectively classified into two groups according to the difference of vaginal douching solution immediately before oocyte retrieval. RESULTS: There was no difference in the fertilization rate (81.2% versus 79.8%, P > 0.05), implantation rate (19.2% versus 23.3%, P > 0.05), clinical pregnancy rate (39.3% versus 46.2%, P > 0.05) between the two groups. There was no infection in patients of group two but two cases in group one developed pelvic abscess and needed surgical intervention. CONCLUSIONS: Vaginal douching with aqueous povidone iodine followed by normal saline irrigation immediately before oocyte retrieval is effective in preventing the pelvic infection without compromising the outcome of IVF treatment. (+info)
Pelvic abscess due to Ochrobactrum intermedium [corrected] in an immunocompetent host: case report and review of the literature.
Ochrobactrum intermedium [corrected] infection is rare in humans and is generally associated with immunocompromised hosts with indwelling foreign bodies. We report a case of pelvic abscess with O. intermedium [corrected] after a routine appendectomy in an immunocompetent patient and review the literature on O. intermedium [corrected] infection in patients with normal immune function. (+info)