MICROBIOLOGICAL PROFILE, ANTIBIOTIC SENSITIVITY AND PROGNOSIS OF PATIENTS WITH FOURNIER’S GANGRENE: A PROSPECTIVE, HOSPITAL BASED STUDY FROM NORTH INDIA

Background: Fournier's gangrene (FG) is a devastating disease that is characterized by necrotizing fasciitis of the perineal, genital, or perianal region. Broad-spectrum antibiotics are the key component of its treatment. However, there is paucity of data regarding the optimal empirical antibiotic therapy for FG. Materials and Methods: Data from patients who underwent surgery for FG was retrieved from a prospectively collected departmental FG database. Demographics, clinical characteristics, causative pathogens and drug susceptibility/resistance were evaluated. Outcome was also assessed in terms of mortality. Results: Fifty patients with a median age of 58.5 (40-83) years were included. The perianal region and scrotum (88%) were the most commonly affected. Diabetes mellitus (DM) was the most common comorbidity (92%). The median time to onset of symptoms was 7 (2-15) days, and the median duration of hospital stay was 22 (4-65) days. Ventilator requirement was required in 15 (30%) patients. The median UFGSI score was 9.5 (3-15). The overall mortality rate was 26%. A positive growth was found in specimen cultures of 48 (96%) patients. The median number of bacterial strains that grew in the cultures was 3 (0-10). Amikacin was the antibiotic with the highest frequency of sensitivity (74%), while the highest resistance was observed against ampicillin-sulbactam (64%). Escherichia coli was the most common microorganism (68%). Acinetobacter baumannii and Klebsiella pneumonia were signicantly more common in patients who required mechanical ventilation. The mortality rate was 26%. An Uludag Fournier's Gangrene Severity Index (UFGSI) score of > 9.5 and ventilatory support requirement were factors associated with an increased rate of mortality. Acinetobacter baumannii was the only microorganism which was associated with an increased mortality rate. Conclusion: Causative pathogens in FG appeared to be shifting; thus, empirical antibiotic treatment for this disease should be modied. We recommend 3rd-generation cephalosporin, metronidazole and amikacin for empirical therapy.

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The effectiveness of Dakin’s solution in wound care after debridement in Fournier’s gangrene

International Surgery Journal ◽

10.18203/2349-2902.isj20202812 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2156

Author(s):

Onur Karsli ◽

Fatih Gokalp

Keyword(s):

Mortality Rate ◽

Average Length ◽

Wound Care ◽

Length Of Hospital Stay ◽

Fournier’S Gangrene ◽

Concomitant Disease ◽

Perianal Region ◽

Fournier's Gangrene ◽

War Wounds ◽

Fournier Gangrene

Background: Fournier's gangrene (FG) is a specific form of necrotizing fasciitis seen in the external genital organs and perianal region. The basic management of Fournier's gangrene is based on critical surgical debridement. Dakin's solution (sodium hypochlorite) was originally developed to treat war wounds. In this study, we aimed to show potentially efficient of Dakin’s solution on wound healing and reoperation rate.Methods: Thirty-three patients who were debrided due to Fournier Gangrene during 2012-2020 were included in the study. After debridement, wound care was done twice a day by dressing with a sponge moistened with Dakin's solution. Patients' age, concomitant disease, involvement site, re-debridement requirement, complications, and discharge times were recorded.Results: The mean age of 33 male patients who participated in the study was (51-74) 63.93±15.36. Although all patients had scrotal involvement, nine patients had perineal (27.2%), 12 patients had inguinal (36.3%), four patients had a penis and pubic spread (12.1%). The mortality rate was 6%. The average length of hospital stay was 13.1±4.2 days, and the average number of debridements was 1.Conclusions: Fournier gangrene is an important disease characterized by necrotizing infection of the genital, perineal, and perianal region and progresses with high mortality. Our mortality rate was lower than literature and we have linked our mortality rate to using Dakin's solution for wound care. Dressing with Dakin's solution is an effective and reliable method for wound care in FG patients.

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Gangrena de Fournier. Reporte de caso

Studies in the Economic History of Southern Africa ◽

10.22201/fm.24484865e.2020.63.5.04 ◽

2020 ◽

Vol 63 (5) ◽

pp. 26-30

Author(s):

Paloma Pérez Ladrón de Guevara ◽

Georgina Cornelio Rodríguez ◽

Oscar Quiroz Castro

Keyword(s):

Mortality Rate ◽

Necrotizing Fasciitis ◽

Broad Spectrum ◽

Soft Tissues ◽

Fournier’S Gangrene ◽

Type Ii ◽

Necrotic Tissue ◽

Fournier's Gangrene ◽

Necrotizing Fascitis ◽

Key Words Fournier's Gangrene

Fournier’s Gangrene is a type II necrotizing fascitis that leads to thrombosis of small subcutaneous vessels and spreads through the perianal and genital regions and the skin of the perineal. Most cases have a perianal or colorectal focus and in a smaller proportion it originates from the urogenital tract. The mortality rate varies between 7.8 and 50%1-3, only timely diagnosis decreases the morbidity and mortality of this condition. Treatment includes surgical debridement of all necrotic tissue and the use of broad-spectrum antibiotics. Key words: Fournier’s gangrene; gangrene; necrotizing fasciitis; infectious necrotizing of soft tissues.

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Fournier's gangrene: Report on two cases

Urologia Journal ◽

10.1177/039156039706400218 ◽

1997 ◽

Vol 64 (2) ◽

pp. 266-268

Author(s):

F. Laganà ◽

E. Cossaro ◽

C. Ronconi ◽

F. Sercia ◽

M. Marchini

Keyword(s):

Mortality Rate ◽

Chronic Diseases ◽

High Mortality ◽

Hyperbaric Oxygenation ◽

Fournier’S Gangrene ◽

Fournier's Gangrene ◽

Tissue Ischemia ◽

First Choice

– Fournier's gangrene is a rare pathology that generally occurs in weakened patients with chronic diseases, like diabetes, which imply tissue ischemia and even today a high mortality rate. Two cases are presented, one of which is interesting for its pathogenesis. The authors confirm that first choice treatment should be surgical associated with antiobiotics and hyperbaric oxygenation whenever possible.

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Analysis of prognostic factors affecting mortality in Fournier’s gangrene: A study of 72 cases

Canadian Urological Association Journal ◽

10.5489/cuaj.3192 ◽

2015 ◽

Vol 9 (11-12) ◽

pp. 800 ◽

Cited By ~ 8

Author(s):

Mohamed Tarchouli ◽

Ahmed Bounaim ◽

Mohamed Essarghini ◽

Moulay Brahim Ratbi ◽

Mohamed Said Belhamidi ◽

...

Keyword(s):

Prognostic Factors ◽

Mortality Rate ◽

Patient Survival ◽

Length Of Hospital Stay ◽

Severity Index ◽

Fournier’S Gangrene ◽

Fournier's Gangrene ◽

Predisposing Factor ◽

Duration Of Symptoms ◽

Factors Affecting

Introduction: Fournier’s gangrene is a rapidly progressing necrotizing fasciitis of the perineum and genital area associated with a high mortality rate. We presented our experience in managing this entity and identified prognostic factors affecting mortality.Methods: We carried out a retrospective study of 72 patients treated for Fournier’s gangrene at our institution between January 2005 and December 2014. Patients were divided into survivors and nonsurvivors and potential prognostic factors were analyzed.Results: Of the 72 patients, 64 were males (89%) and 8 females (11%), with a mean age of 51 years. The most common predisposing factor was diabetes mellitus (38%). The mortality rate was 17% (12 patients died). Statistically significant differences were not found in age, gender, and predisposing factors, except in heart disease (p = 0.038). Individual laboratory parameters significantly correlating with mortality included hemoglobin (p = 0.023), hematocrit (p = 0.019), serum urea (p = 0.009), creatinine (p = 0.042), and potassium (p = 0.026). Severe sepsis on admission and the extent of affected surface area also predicted higher mortality. Others factors, such as duration of symptoms before admission, number of surgical debridement, diverting colostomy and length of hospital stay, did not show significant differences. The median Fournier’s Gangrene Severity Index (FGSI) was significantly higher in non-survivors (p = 0.002).Conclusion: Fournier’s gangrene is a severe surgical emergency requiring early diagnosis and aggressive therapy. Identification of prognostic factors is essential to establish an optimal treatment and to improve outcome. The FGSI is a simple and valid method for predicting disease severity and patient survival.

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Re: Bjurlin et al.: Causative Pathogens, Antibiotic Sensitivity, Resistance Patterns, and Severity in a Contemporary Series of Fournier's Gangrene (Urology 2013;81:752-759)

Urology ◽

10.1016/j.urology.2013.03.051 ◽

2013 ◽

Vol 82 (2) ◽

pp. 494

Author(s):

Wei-Ting Lin ◽

Chien-Ming Chao

Keyword(s):

Antibiotic Sensitivity ◽

Fournier’S Gangrene ◽

Fournier's Gangrene ◽

Resistance Patterns

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Which Role for Hyperbaric Oxygen Therapy in the treatment of Fournier’s gangrene? A Retrospective Study.

10.21203/rs.3.rs-60959/v1 ◽

2020 ◽

Author(s):

Roberta Tutino ◽

Francesco Colli ◽

Giovanna Rizzo ◽

Leo Licari ◽

Gaetano Gallo ◽

...

Keyword(s):

Mortality Rate ◽

Hospital Stay ◽

Fournier’S Gangrene ◽

University Hospital ◽

Surgical Operation ◽

Fournier's Gangrene ◽

Great Loss ◽

Hospital Stays ◽

Hyperbaric Therapy ◽

The University

Abstract Background: In Fournier’s gangrene the surgical debridement plus broad-spectrum antimicrobial therapy is the mainstay treatment but can cause a great loss of tissue. Moreover, the local poor blood supply, the infection and the damage to the vessels can delay the healing. Consequently, the disease needs long hospital stays and, despite all, has high mortality rate. The aim of our study is to investigate the improvement offered by hyperbaric therapy in Fournier’s gangrene.Methods: We retrospectively evaluated data on 23 consecutive patients admitted for Fournier’s gangrene at the University hospital “P.Giaccone” of Palermo from 2011 to 2018. The relation between hyperbaric therapy, hospital stay and mortality was evaluated. Factors related to mortality were also examined.Results: The use of hyperbaric therapy was offered to 13(56.5%) patients. Hospital stay was longer in patients treated with HBOT[mean11(C.I.0.50-21,89)vs25(C.I.18.02-31.97);p=0.02]. Mortality occurred in three patients(13.1%), two of whom treated with HBOT. Mortality was not statistically related to sex(p=0.20), BMI(p=0.53), renal failure (p=1.00), diabetes(p=0.49), age>65 years old(p=0.55), simplified FGSI>2(p=0.05), higher ASA scores(>=4)(p=0.47), symptoms at admission lasting since more than 72 hours (p=0.28), HBOT(p=1.00), need of colostomy(p=0.06), several operations(p=1.00), several operations plus HBOT(P=1.00). Conversely, the delay between admission and surgical operation was statistically related to mortality, 1.7 days(C.I.0.9-3.5) in survivals vs 6.8 days(C.I.3.5-13.4) in death patients(p=0.001).Conclusions: Our study proves that a delay in the treatment of patients with Fournier’s gangrene has a correlation with the mortality rate, while the use of HBOT seems to not improve the survival rate, increasing the hospital stay instead.

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Predisposition Factors Analysis for Fournier’s Gangrene Defects Closure Complication

Jurnal Rekonstruksi dan Estetik ◽

10.20473/jre.v5i1.24318 ◽

2021 ◽

Vol 5 (1) ◽

pp. 13

Author(s):

Bayu Fasi Bermani ◽

Sitti Rizaliyana ◽

Ira Handriani

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Medical Records ◽

Early Recognition ◽

Severe Disease ◽

Case Series ◽

Fournier’S Gangrene ◽

Defect Closure ◽

Fournier's Gangrene ◽

Fournier Gangrene

Background: Fournier’s gangrene is a rare and rapidly progressive, necrotizing fasciitis affecting the external genitalia and perineum. Based on the case series that have been reported, the incidence rate of this case is 88% with mortality rate of 20%-40%. The study aims to share our policy in managing Fournier’s gangrene and identifying risk factors that can affect the outcome of defect closure.Method: The medical records of 10 patients with Fournier’s gangrene who presented at the Dr. Soetomo Hospital Surabaya from January 2017 to December 2018 were reviewed retrospectively. We analyzed characteristics of the patients, risk factors, methods of defect closure, and case outcome. There are 10 Fournier’s gangrene patients at Dr. Soetomo Academic General Hospital from January 2017 to December 2018. We analyzed the patient’s medical records retrospectively on the patient’s characteristics, risk factors, method of closing Fournier’s gangrene defects, and the final outcome of the case.Results: There were ten men enrolled in the study, and the mean age was 49.3 ± 11.51 years. All patients received broad-spectrum antibiotic therapy, and extensive surgical excision. This study found that diabetes mellitus and uncontrolled patient blood sugar levels, statistically there is no effect on failure of defect closure in Fournier gangrene patients, but clinically, the relative risk value shows that blood glucose levels have a risk factor of 6 times. increasing the incidence of failure to close the Fournier gangrene defect.Conclusions: Fournier’s gangrene is still considered a severe disease with fairly high mortality rate. Early recognition of predisposition factors associated with invasive and aggressive treatment options is very important in efforts to to reduce morbidity.

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Sodium–Glucose Cotransporter 2 Inhibitor Use Associated With Fournier's Gangrene: A Review of Case Reports and Spontaneous Post-Marketing Cases

10.2337/figshare.15147888 ◽

2021 ◽

Author(s):

Bao Anh Tran ◽

Wendy H. Updike ◽

Krystal Bullers ◽

Erini Serag-Bolos

Keyword(s):

Mortality Rate ◽

Case Reports ◽

Fournier’S Gangrene ◽

Boxed Warning ◽

Sglt2 Inhibitors ◽

Fournier's Gangrene ◽

Sodium Glucose Cotransporter ◽

Potential Development ◽

Post Marketing ◽

The U.S

Sodium–glucose cotransporter 2 (SGLT2) inhibitors are effective for glycemic control and have demonstrated cardiorenal benefits. The U.S. Food and Drug Administration (FDA) released a boxed warning in 2018 regarding the potential development of Fournier’s gangrene (FG) with the use of SGLT2 inhibitors. FG is a serious perineal infection with a mortality rate of up to 88% in some cases.

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Perianal Infections in Patients With Hematologic Malignancy: The Risk of Fournier’s Gangrene Leading to Mortality and Irreversible Organ Damage

WOUNDS A Compendium of Clinical Research and Practice ◽

10.25270/wnds/091421.02 ◽

2021 ◽

Author(s):

Arife Simsek

Keyword(s):

Medical Therapy ◽

Surgical Intervention ◽

Hematologic Malignancy ◽

Organ Damage ◽

Fournier’S Gangrene ◽

Abscess Formation ◽

Anal Pain ◽

Perianal Region ◽

Fournier's Gangrene ◽

Diverting Ostomy

Introduction. The efficacy of surgical intervention for perianal infection in patients with hematologic malignancy is not well-established. Objective. This article presents a case series of perianal infection progressing to Fournier’s gangrene (FG) in patients with hematologic malignancy to guide physicians, because to the author’s knowledge, there were no randomized or prospective studies presenting the management strategies reported herein. It was hypothesized that surgery might reduce mortality and morbidity in patients with inflammation spreading beyond the perianal region, in patients with abscess formation, and in those who show no improvement with medical therapy. Materials and Methods. The data of 4 adults with hematologic malignancy who developed perianal infection progressing to FG between January 2010 and December 2018 were reviewed retrospectively. Patients younger than 18 years and patients without hematologic malignancies or FG were excluded. The primary outcome was mortality. The secondary outcome was irreversible organ damage. Results. Four male patients with a mean age of 36.75 years ± 13.1 standard deviation (range, 23–52 years) reported fever and dull anal pain during treatment for hematologic malignancy. A broad-spectrum antibiotic regimen was administered as initial empiric therapy at onset of fever and was de-escalated based on the culture results and clinical response. However, FG arose in all cases approximately 8.75 days ± 6.94 (range, 3–17 days) after onset of anal pain. All patients underwent surgical debridement, and diverting ostomy was performed in 3 cases. One patient died of overwhelming sepsis (25%), and 1 patient required orchiectomy (25%). Conclusions. Clinical suspicion of FG may be effective in reducing mortality in patients with hematologic malignancy, especially in cases with fever accompanied by anal pain. Surgical intervention may improve the prognosis for patients with inflammation spreading beyond the perianal region, patients with abscess formation, those who show no improvement in medical therapy, and those who develop FG. Diverting ostomy may improve survival in patients with FG.

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