Emergence of multi-drug resistant organisms (MDROs) causing Fournier's gangrene

Chia, Laura; Crum-Cianflone, Nancy F.

doi:10.1016/j.jinf.2017.09.015

Cited by 34 publications

(33 citation statements)

References 17 publications

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“…Multidrug-resistant organisms, e.g. extended spectrum blactamase-producing Escherichia coli or Klebsiella spp., are reportedly emerging in different parts of the world [61,66,67]. In Fournier's gangrene the importance of anaerobic bacteria may have been underestimated [68].…”

Section: Microbiologymentioning

confidence: 99%

Necrotizing skin and soft-tissue infections in the intensive care unit

Peetermans

Prost

Eckmann

et al. 2020

Clinical Microbiology and Infection

101

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Background: Necrotizing skin and soft-tissue infections (NSTI) are rare but potentially life-threatening and disabling infections that often require intensive care unit admission. Objectives: To review all aspects of care for a critically ill individual with NSTI. Sources: Literature search using Medline and Cochrane library, multidisciplinary panel of experts. Content: The initial presentation of a patient with NSTI can be misleading, as features of severe systemic toxicity can obscure sometimes less impressive skin findings. The infection can spread rapidly, and delayed surgery worsens prognosis, hence there is a limited role for additional imaging in the critically ill patient. Also, the utility of clinical scores is contested. Prompt surgery with aggressive debridement of necrotic tissue is required for source control and allows for microbiological sampling. Also, prompt administration of broad-spectrum antimicrobial therapy is warranted, with the addition of clindamycin for its effect on toxin production, both in empirical therapy, and in targeted therapy for monomicrobial group A streptococcal and clostridial NSTI. The role of immunoglobulins and hyperbaric oxygen therapy remains controversial. Implications: Close collaboration between intensive care, surgery, microbiology and infectious diseases, and centralization of care is fundamental in the approach to the severely ill patient with NSTI. As many aspects of management of these rare infections are supported by low-quality data only, multicentre trials are urgently needed.

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Section: Microbiologymentioning

confidence: 99%

Necrotizing skin and soft-tissue infections in the intensive care unit

Peetermans

Prost

Eckmann

et al. 2020

Clinical Microbiology and Infection

101

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“…3,4 Despite the aggressive management, previous publications reported various mortality rates ranging from 3.6 to 45%. [5][6][7][8][9][10][11][12][13][14] The diverse mortality not only shows the complicated nature of FG, but also indicates the need for a practical risk-stratification scoring system for first-line physicians and care providers.…”

Section: Introductionmentioning

confidence: 99%

“…Early surgical debridement has been suggested to be beneficial for survival outcome in FG patients. 11,13,23,24 However, just two studies had ever focused on the discussion of the surgical timing in FG. Korkut et al defined surgical timing as the interval from the onset of clinical symptoms to the initial surgical intervention, and reported a small series of 45 FG patients with significantly lower mortality if receiving surgical intervention within 7 days.…”

Section: Introductionmentioning

confidence: 99%

Incorporating Simplified Fournier's Gangrene Severity Index with early surgical intervention can maximize survival in high‐risk Fournier's gangrene patients

Lin

Cheng

et al. 2019

Int J of Urology

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Objectives To determine the optimal surgical timing in high‐risk patients with Fournier's gangrene by the Simplified Fournier's Gangrene Severity Index. Methods From 1989 to 2018, 118 male patients diagnosed with Fournier's gangrene with complete medical records were retrospectively reviewed. Patients’ demographics, laboratory parameters at initial diagnosis, Fournier's Gangrene Severity Index and Simplified Fournier's Gangrene Severity Index, and the time interval from emergency room arrival to surgical intervention were collected. The Fournier's gangrene patients were categorized into low‐risk (Simplified Fournier's Gangrene Severity Index ≤2) and high‐risk groups (Simplified Fournier's Gangrene Severity Index >2). Differences between the variables within the two groups were analyzed. The optimal surgical timing was analyzed with the receiver operating characteristic curve in high‐risk Fournier's gangrene patients. Results The overall mortality of 118 Fournier's gangrene patients was 14.4%. After risk stratification with the Simplified Fournier's Gangrene Severity Index scoring system, the mortality of low‐risk and high‐risk Fournier's gangrene patients was 1.3% and 41.0%, respectively. In the high‐risk group, the time interval from emergency room arrival to surgical intervention was the only variable with a significant difference between survivors and non‐survivors (P = 0.039). The optimal surgical timing was determined at 14.35 h, which allowed the highest sensitivity (0.688) and specificity (0.762) to affect mortality. The mortality was significantly lower in high‐risk Fournier's gangrene patients with early surgical intervention compared with late intervention (23.8% vs 68.8%, P = 0.007). Conclusions The Simplified Fournier's Gangrene Severity Index is a quick and reliable screening tool for first‐line physicians to identify high‐risk patients with Fournier's gangrene (Simplified Fournier's Gangrene Severity Index >2) who have poor survival outcomes. We recommended early surgical intervention within 14.35 h to maximize the survival of high‐risk Fournier's gangrene patients.

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“…6,8,13 In this regard, antibiotic resistance may be a growing concern in Fournier's gangrene with methicillin-resistant Staphylococcus aureus (MRSA) being the most commonly cultured resistant organism. 15 Patients with multiple drug resistant organisms have shown a trend towards having poorer outcomes. 15…”

Section: Alcoholismmentioning

confidence: 99%

“…15 Patients with multiple drug resistant organisms have shown a trend towards having poorer outcomes. 15…”

Section: Alcoholismmentioning

confidence: 99%