To provide better management of Fournier’s gangrene, mortality-associated comorbidities and common etiologies were identified.
A systematic search was conducted using 12 databases, followed by ...meticulous screening to select relevant articles. Meta-analysis and meta-regression (for possible cofounders) were both done for all possible outcomes.
Out of 1186 reports screened, 38 studies were finally included in the systematic review and meta-analysis. A higher risk of mortality was detected in patients with diabetes, heart disease, renal failure, and kidney disease, with risk ratios (RR) and 95% confidence intervals (95% CI) of 0.72 (0.59–0.89), 0.39 (0.24–0.62), 0.41 (0.27–0.63), and 0.34 (95% CI 0.16–0.73), respectively. However, there was no association between mortality rates and comorbid hypertension, lung disease, liver disease, or malignant disease (p > 0.05). The highest mortality rates were due to sepsis (76%) and multiple organ failure (66%), followed by respiratory (19.4%), renal (18%), cardiovascular (15.7%), and hepatic (5%) mortality.
Modifications to the Fournier’s Gangrene Severity Index (FGSI) are recommended, in order to include comorbidities as an important prognostic tool for FG mortality. Close monitoring of the patients, with special interest given to the main causes of mortality, is an essential element of the management process.
Fournier's gangrene is a necrotizing fasciitis of the scrotal and inguinal region, associating high mortality and complication rates. It is extremely rare in the neonatal period and may be life ...threatening. We present an exceptional case of a 24-day-old boy who consulted to the emergency department for fever (39 °C) and an indurated, fluctuating and painful erythema in both groins, left hemiscrotum, left anterior femoral region and perineum for the last 6 hours. Blood analysis showed increased acute phase reactants without leukocytosis. Ultrasound revealed significant soft-tissue involvement. Due to high clinical suspicion and hemodynamic instability (tachycardia and prolonged capillary filling), urgent fasciotomy, placement of Penrose drains and intensive irrigation was performed. Wound care with irrigations was performed 3 times a day. During the 12 days neonatal intensive care unit admission, he required hemodynamic support and orotracheal intubation and sedation for pain control. Broad-spectrum antibiotic therapy (with cefotaxime, clindamycin and cloxacillin) was administered for 2 weeks. Ampicillin-sensitive Streptococcus pyogenes (Group A) was isolated in blood culture at 4th day of admission allowing antibiotic de-escalation. He was discharged on postoperative day 24. He has minimal, inconspicuous scars and no functional sequelae. Fever in neonates requires close observation considering the use of empirical broad-spectrum antibiotics and hospitalization. Early diagnosis, prompt surgical management and broad-spectrum antibiotic therapy are essential to prevent complication. Early fasciotomy with intensive irrigation and close survey may avoid extensive skin debridement.
Case series reported 20-40% mortality rates for patients with Fournier's gangrene with some series as high as 88%. This literature comes almost exclusively from referral centers.
We identified and ...analyzed inpatients with Fournier's gangrene who had a surgical debridement or died in the US State Inpatient Databases.
One thousand six hundred and forty one males and 39 females with Fournier's gangrene represented <0.02% of hospital admissions. Overall, the incidence was 1.6 cases per 100,000 males and case fatality was 7.5%. Sixty six percent of hospitals cared for no cases per year, 17% cared for 1 case per year, 10% cared for 2 cases per year, 4% cared for 3 cases per year, 1% cared for 4 cases per year, and only 1% cared for ≥5 cases per year. Teaching hospitals had higher mortality (adjusted OR 1.9) due primarily to more acutely ill patients. Hospitals treating more than 1 Fournier's gangrene case per year had an adjusted 42-84% lower mortality (p < 0.0001).
Most hospitals rarely care for Fournier's gangrene patients. The population-based mortality rate (7.5%) was substantially lower than the case series from tertiary care centers. Hospitals that treated more number of Fournier's gangrene patients had lower mortality rates, thereby supporting the rationale that regionalized care worked well for patients with this rare disease.
Fournier's gangrene is a rare and potentially fatal condition that affects the external genitalia and perineum as a necrotizing soft-tissue infection. It is equally prevalent in men and women and ...although there are many ways to manage the condition, it must be done so effectively because there is a chance that life-threatening complications could develop. This retrospective study set out to fill any knowledge gaps, compare reconstructive options to those described in the literature, and promote reflection on current management. Between January 2010 and January 2020, all perineal debridement operation notes were examined. The primary conclusions were that a large majority of defects could be repaired using split skin grafts to reduce surgical time and donor site morbidity. To avoid secondary contracture and the need for revision surgery, full-thickness skin grafts should be used whenever possible to treat penile defects.
Background
Recent studies of patients with Fournier's gangrene (FG) highlight the importance of early surgical intervention in improving mortality rates. We prospectively determined subgroups of ...patients with FG at high risk of severe local morbidity.
Methods
We prospectively evaluated all patients diagnosed with FG at a tertiary hospital (1 January 2018 to 1 January 2021). Data were collated on demographics, comorbidity, infection source, treatment and clinical outcomes.
Results
We identified 14 consecutive male patients with a median (interquartile range) age of 57 (50–64) years. Most common risk factors were diabetes (n = 10, 71%) and obesity (n = 10, 71%). Median (range) HbA1c was 11.20 (7.5–15.3), and body mass index of 41.25 (23.7–70.0). Seven patients had adjacent organ involvement (AOI), involving the corporal bodies (57%) and testes (43%). The most common suspected source was dermatological (50%), followed by genitourinary (29%) and gastrointestinal (GI) (21%). Median (interquartile range) hospital length of stay (LOS) was 32 (8.5–30.75) days. Patients with AOI were more likely to have a suspected GI source, need mechanical ventilation (p = 0.023), a significantly longer LOS (p = 0.015) and time to wound closure (p = 0.04). Patients with suspected dermatological origin of infection, had a significantly lower rate of AOI (p = 0.029), mechanical ventilation (p = 0.029) and a shorter LOS (p = 0.035).
Conclusion
In our prospective series, FG is associated with a high rate of AOI and suspected non‐dermatological origin of infection, which confers significant perioperative morbidity including the need for mechanical ventilation, LOS and longer time from initial debridement to wound closure.
This prospective series of patients diagnosed with Fournier gangrene at a tertiary hospital demonstrated a higher rate of adjacent organ involvement and non‐dermatological origin of infection than the currently published literature. Fournier gangrene patients with adjacent organ necrosis and suspected non‐dermatological origin of infection were associated with significant perioperative morbidity, including increased duration of mechanical ventilation, length of stay and time from initial debridement to wound closure.
Study Type – Prognosis (outcome)
Level of Evidence 2b
What's known on the subject? and What does the study add?
Reportedly, Fournier's gangrene has a high mortality rate, ∼7.5–40%, and experts ...recommend early surgical debridement.
This study examines 379 patients and shows that an early intervention, i.e. within 2 hospital days could halve the mortality rate compared with later intervention.
OBJECTIVE
•
To examine how early surgical intervention influenced cases of Fournier's gangrene (FG) fatality.
PATIENTS AND METHODS
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Patients with FG (defined as an International Classification of Diseases‐10 code of M72.6 necrotizing fasciitis at the perineum or external genitalia), who received surgical intervention ≤5 days after admission, were identified from the Diagnosis Procedure Combination database for the 6‐month period July to December, in the years 2007–2010.
•
Data included age, sex, comorbidities, ambulance use, operations and debridement ranges.
•
Multivariate logistic regression analysis of mortality was performed to show whether early (≤2 hospital days) or delayed (3–5 hospital days) surgical treatment affected FG outcomes.
RESULTS
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A total of 302 male and 77 female patients with FG were identified for which the overall case fatality rate was 17.1% (65 cases).
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There were no significant differences in patient characteristics between the early operation group (n= 327) and the delayed operation group (n= 52), with the exception of ambulance use (33.3% vs 17.3%, P= 0.020).
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Cystostomy, colostomy, orchiectomy/penectomy (male patients only), or debridement ≥3000 cm2 were performed on 42 (8.8%), 56 (11.5%), 46 (10.8%) and 17 (4.4%) patients, respectively.
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Multivariate analysis showed that there was a significantly lower case fatality rate among the early operation group (odds ratio OR= 0.38; P= 0.031).
•
Older age (OR 1.80, for 10‐year increments), Charlson comorbidity index score (OR = 1.33, for 1‐point increments), sepsis or disseminated intravascular coagulation at admission (OR 4.01), and debridement range ≥3000 cm2 (OR 5.22, compared with other operations) were significantly associated with a higher case fatality rate.
CONCLUSION
•
Early (≤2 hospital days) surgical intervention for FG is significantly associated with lower mortality than delayed (3–5 hospital days) action.
Fournier's gangrene (FG) is a life-threatening infection of the genital, perineal, and perianal regions with a morbidity range between 3 and 67%. Our aim is to report our experience in treatment of ...FG and to assess whether three different scoring systems can accurately predict mortality and morbidity in FG patients.
All patients that were treated for FG at the Department of Urology of the University Hospital Basel between June 2012 and March 2017 were included and assessed retrospectively by chart review. Furthermore, we calculated Fournier's Gangrene Severity Index (FGSI), the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC), and the neutrophil-lymphocyte ratio (NLR) in every patient and assessed whether those scores correlate with the patients' morbidity and mortality.
Twenty patients were included, with a median (IQR) age of 66 (46-73) years. Fifteen of twenty (75%) patients required treatment on an intensive care unit, and three died (mortality rate: 15%). The mean FGSI, LRINEC, and NLR scores were 13.0, 9.3, and 45.3 for non-survivors and 7.7, 6.5, and 26 for survivors, respectively. None of the risk scores correlated significantly with mortality; however, all three significantly correlated with infection- and surgically-induced morbidity.
In our series, Fournier's gangrene was associated with a mortality rate of 15% despite maximum multidisciplinary therapy at a specialized center. All risk scores were able to predict the morbidity of the disease in terms of local extent and the required surgical measures.
Fournier's gangrene current approaches Ozkan, Omer F; Koksal, Neset; Altinli, Ediz ...
International wound journal,
October 2016, Letnik:
13, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Fournier's gangrene is a rare but highly mortal infectious disease characterised by fulminant necrotising fasciitis involving the genital and perineal regions. The objective of this study is to ...analyse the demographics, clinical feature and treatment approaches as well as outcomes of Fournier's gangrene. Data were collected retrospectively from medical records and operative notes. Patient data were analysed by demographics, aetiological factors, clinical features, treatment approaches and outcomes. Twelve patients (five female and seven male) were enrolled in this study. The most common aetiology was perianal abscess (41·6%). Wound cultures showed a mixture of microorganisms in six (50%) patients. For faecal diversion, while colostomy was performed in six cases (50%), Flexi‐Seal was used in two cases (16·6%). In four patients (33·4%), no faecal diversion was performed. Negative pressure wound therapy (NPWT) system was effective in the last four patients (33·4%). The mean hospitalisation period in patients who used NPWT was 18 days, while it was 20 days in the others. NPWT in Fournier's gangrene is a safe dressing method. It promotes granulation formation. Flexi‐Seal faecal management is an alternative method to colostomy and provides protection from its associated complications. The combination of two devices (Flexi‐Seal and NPWT) is an effective and comfortable method in the management of Fournier's gangrene in appropriate patients.
Antibiotic management of Fournier's gangrene (FG) is without evidence-based guidelines and is based on expert opinion. The effect of duration of antibiotic therapy on outcomes in FG is unknown.
A ...retrospective review was performed of FG patients from 2012 to 2015 at a single institution. Patients were managed by our institutional practice of complete primary wound closure as possible, with antibiotic duration according to physician judgment. Patients were stratified into multiple durations of antibiotic administration.
Overall, 168 patients with FG were included. When examining multiple stratifications of antibiotic therapy of 7 days or less, 8 days to 10 days, 11 days to 14 days, or 15 days or more of antibiotics, there was no significant difference in mortality (p = 0.11), primary closure (p = 0.75), surgical site infection (SSI) (p = 0.52), or Clostridium difficile infection (p = 0.63). There were no cases of recurrent FG in any antibiotic stratification. Mortality was not increased (p = 1.00) and ability to achieve primary closure was not decreased (p = 0.08) with initial antibiotic therapy exclusive of cultured organisms.
Shorter antibiotic courses for patients in whom source control is obtained and initial antibiotic selection exclusive of many resistant organisms were not associated with worse outcomes in FG.
Therapeutic, level IV.
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