Emergence of Multi-Drug-Resistant Organisms (MDROs) Causing Fournier’s Gangrene

Abstract

Background Fournier’s gangrene is an uncommon but often devastating infection. There are few contemporary data on the risk factors and evolving microbiologic trends including drug-resistant organisms implicated in these life-threatening infections.Methods A retrospective study of Fournier’s gangrene from 2006 to 2015 at a large academic hospital was conducted. Cases were identified using ICD codes (ICD-9: 608.83, V13.89; ICD-10: N49.3, Z87.438), and a review of medical and pathology records was performed to confirm each case. Data collected included socio-demographics, medical conditions, bacterial pathogens and their resistance patterns, treatments, and outcome. Descriptive and univariate statistics were performed.ResultsIn total, 59 cases were evaluated with an incidence of 31.8 cases per 100,000 admissions over the study period. Mean age was 56 years (range 18–91), 71% were male, and 45% white. Diabetes was noted among 26 (44%) with a mean A1c of 9.6%. Other risk factors included: overweight/obesity (61%), immunocompromised state (34%), and substance use (32%). A causative organism was identified in all but two cases; 12 patients (21%) had an MDRO with MRSA being the most common pathogen (n = 8, 14% of all cases), followed by ESBL E. coli (n = 3) and MDRO Acinetobacter (n = 1). MRSA was the sole pathogen in five (63%) of the eight cases involving this organism. Among those with an aerobic Gram-negative rod (GNR) isolated, 31% were fluoroquinolone-resistant. An MDRO infection was significantly associated with an immunocompromised state (OR 5.5, P = 0.01) and chronic wounds (OR 7.0, P = 0.02). Overall, 30% of all cases had an adverse outcome (15% died and an additional 15% had loss of an organ). Those with MDRO were more likely to experience an adverse outcome (42% vs. 28%), although this was not statistically significant (P = 0.48); of note most (83%) MDRO cases were treated with an initial antibiotic with efficacy against the MDRO.Conclusion This report suggests a much higher incidence of Fournier’s gangrene than previously described and highlights the emergence of MDROs as an important cause of these infections including MRSA and drug-resistant GNRs. Antibiotics should be chosen with broad-spectrum, anti-MDRO activity given the high morbidity and mortality associated with these infections.Disclosures All authors: No reported disclosures.

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

“…This fulminant disease can be fatal, and should be regarded as a urological emergency that necessitates broad‐spectrum antimicrobial therapy, intensive care and early surgical intervention . Despite the aggressive management, previous publications reported various mortality rates ranging from 3.6 to 45% . 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.…”

“…Early surgical debridement has been suggested to be beneficial for survival outcome in FG patients . However, just two studies had ever focused on the discussion of the surgical timing in FG.…”