Clinical & Microbiological profile of Fournier’s Gangrene in a Tertiary Care Hospital in Bangladesh : A prospective observational study

Abstract

Background: Fournier’s gangrene is the necrotising fasciitis of the genitalia and perineum, with associated poly microbial infection. Evidence based data in the very recent years suggest that it is associated with significant and potential risk of organ failure or death.Aim: This study was designed to be conducted among the patients suffering from Fournier’s gangrene with a view to assess the probable prevalence rate of potentially adverse clinical consequences during course of treatment, overall mortality and to observe the microbiological pattern in our surgical practice.Method & materials: This cross sectional study was conducted among the 69 patients of Fournier’s gangrene in BIRDEM General Hospital, Dhaka, Bangladesh from Jan 10.2013 to Sept 01 .2016, using the purposive sampling method.Results: The results of this study reflects that majority (43.4%) of the study population were in 51 to 60 years age group( Mean age 43±1.7 years) in study population. By using the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, it was found that in most of the patients (approx 56.5%), a suspicious score ranging 06-08 was observed and only in 10.1% patients, a specific score of ?08 was observed. In 27.5% patients systemic complications like DIC, ARDS, MODS, MSOF and severe sepsis were observed in 1.4%, 4.3%, 10.1%, 4.3% and 5.7% cases respectively. Mortality rate was approximately 4.3%. Majority (84.1%) of the patients were associated with type 1 (Polymicrobial) bacterial infection, whereas in case of 15.9% patients, it was associated with type 2 (Monomicrobial) infection. Escherichia coli was the most frequently observed micro-organisms associated with approximately 39.1% of all cases. S. aureus, Staphylococcus pyogenes, Enterococci species, E.coli and Pseudomonas species were recorded to be associated with 17.4%, 27.5%, 21.7%, 39.1 and 10.1% cases respectively.Conclusion: This study suggests that Fournier’s gangrene is associated with significant systemic complications. Poly microbial infections are most predominant and E coli infection was commonest organism involved.Bangladesh Crit Care J March 2017; 5(1): 28-32

Prevalence, Pattern and Early Treatment Outcomes Predictors of Patients with Fournier's Gangrene at University of Dodoma Affiliated Teaching Hospitals

“…The study done in south Africa, similarly reported the mean hospital length of stay (LoS) being 26 days, overall mortality rate was 11.4% and 13.6% patients were identified as requiring ICU admission based on the need for organ support [23]. However, the review of studies reveals that there is improvement in management of Fournier's gangrene due to recorded reduced mortality from studies done in past two decades like that of turkey with mortality of 40% [24] and others done in India reported the mortality of more than 24% [4] compared to the current study with mortality of 16% and that of Northern Tanzania with mortality of 17% [6].…”

“…Founded by jean alfred Fournier's hence the name. The most common isolates are Escherichia coli, Staphylococcus aureus, Saphylococcus pyogenes, Enterococci species and pseudomonas species with E. coli reported to be commonest isolated organism [4][5][6].…”

“…Of the study participants, complete wound healing by secondary closure was achieved in majority of participants. Also, skin grafting was applied in few patients with penile skin defect [6].…”

“…This may be because patients with comorbidities as reported in this study which are DM and HIV with lowered immunity leading to death. Also, abdominal extension of the disease may reflect the delayed treatment hence leading to mortality among these patients [6].…”