Étude clinique et thérapeutique et analyse pronostique des gangrènes du périnée

Jarboui, Slim; Jarraya, H.; Daldoul, S.; Sayari, S.; Moussa, Mounir Ben; Abdesselem, Mohamed Morched; Zaouche, A

doi:10.1016/j.lpm.2007.08.018

Cited by 5 publications

(4 citation statements)

References 9 publications

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“…Some authors estimate the prevalence of Diabetes mellitus among Fournier’s gangrene patients between 50 and 70 percent [23, 25]. Diabetes mellitus has been reported in literature as a risk factor for Fournier’s gangrene and associated with a more progressive and fatal outcome resulting from decreased phagocytic and intracellular bactericidal activity and neutrophil dysfunction [24],…”

Section: Discussionmentioning

confidence: 99%

Fournier’s gangrene at a tertiary health facility in northwestern Tanzania: a single centre experiences with 84 patients

et al. 2015

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BackgroundFournier’s gangrene (FG) is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia and perineum, leading to soft-tissue necrosis. Despite antibiotics and aggressive debridement, the mortality rate of FG remains high. This study describes our experiences in the management of FG and identifies prognostic factors.MethodsThis was a descriptive retrospective study of patients with FG treated at Bugando Medical Centre between November 2006 and April 2014.ResultsA total of 84 patients (M:F = 41:1) were studied. The median age was 34 years (range 15–76 years). The most common predisposing factor was diabetes mellitus (16.7 %). Nine (11.3 %) patients were HIV positive. Bacterial culture results were obtained in only 46 (54.8 %) patients. Of these, 38(82.6 %) had polymicrobial bacterial growth while 8 (17.4 %) had monomicrobial bacterial growth. Escherichia coli (28.3 %) were the most frequent bacterial organism isolated. All the microorganisms isolated showed high resistance to commonly used antibiotics except for Meropenem and imipenem, which were 100 % sensitive each respectively. All patients were treated with a common approach of resuscitation, broad-spectrum antibiotics, and wide surgical excision. The median length of hospital stay (LOS) was 28 days and mortality rate was 28.6 %. Systemic inflammatory response syndrome and diabetes mellitus were significantly associated with prolonged LOS (p < 0.001), whereas advancing age (>60 years), late presentation (>48 h), systemic inflammatory response syndrome on admission, diabetes mellitus, extension of infection to the abdominal wall, FG severity score >9 and HIV infection with CD4 count <200 μl/cells) were independent predictors of mortality (p < 0.001).ConclusionFournier’s gangrene remains a very severe disease with high mortality rates. Early recognition of infection associated with invasive and aggressive treatment is essential for attempting to reduce mortality rates associated with this disease in our setting.

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Section: Discussionmentioning

confidence: 99%

Fournier’s gangrene at a tertiary health facility in northwestern Tanzania: a single centre experiences with 84 patients

et al. 2015

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“…In this field, extent to abdominal wall (Figure 1) has been reported to be directly related to mortality [22,34,35], which was confirmed in our series. Ultimately, occurrence of septic shock and need for postoperative mechanical ventilation, have been demonstrated as a powerful (even late) factors of mortality [8,9,24,36]. Furthermore, Yanar et al found that the presence of sepsis was as the only significant independent risk factor for mortality in FG [3].…”

Section: Discussionmentioning

confidence: 99%

Fournier’s gangrene: our experience with 50 patients and analysis of factors affecting mortality

et al. 2013

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IntroductionFournier’s gangrene is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia and perineum. Case series have shown a mortality rate of 20% to 40% with an incidence of as high as 88% in some reports. In this study we aimed to share our experience in the management of Fournier’s gangrene and to identify risk factors that affect mortality.MethodsThe medical records of 50 patients with Fournier’s gangrene who presented at the University Hospital Hassan II of Fez from January 2003 to December 2009 were reviewed retrospectively to analyze the outcome and identify the risk factors and prognostic indicators of mortality.ResultsTen males and five females were enrolled in the study. The mean age was 54 years (range 23–81). The most common predisposing factor was diabetes mellitus (34%). E. coli was the most frequent bacterial organisms cultured. All patients were treated with a common approach of resuscitation, broad-spectrum antibiotics, and wide surgical excision. The mortality rate was 24%. The advanced age, renal failure on admission, extension of infection to the abdominal wall, occurrence of septic shock and need for postoperative mechanical ventilation are the main prognostic factors of mortality. In multivariate analysis, none of these variables is an independent predictor of mortality.ConclusionsFournier’s gangrene is still a very severe disease with high mortality rates. Early recognition of infection associated with invasive and aggressive treatment is essential for attempting to reduce these prognostic indices.

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“…Diabetes mellitus is estimated to affect 50 to 70% of Fournier’s gangrene patients by some authors [ 24 , 26 ]. Diabetes mellitus has been identified as a risk factor for Fournier’s gangrene, with a more progressive and fatal outcome due to decreased phagocytic and intracellular bactericidal activity, as well as neutrophil dysfunction [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Variables that predict hospital stay and the outcome of Fournier gangrene at King Abdulaziz University Hospital: a retrospective study

Alhubaishy,

Bahassan,

Alsabban

et al. 2024

BMC Urol

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Background The aggressive nature of Fournier gangrene and the associated health issues can result in a more complex clinical course and potentially a longer hospital stay. This study aimed to assess factors that affect the length of hospital stay (LHS) and its relation to the outcome of Fournier gangrene patients. Methods A retrospective study was performed at King Abdulaziz University Hospital (KAUH), Saudi Arabia, on patients diagnosed with Fournier gangrene between 2017 and 2023. Data about length of hospital stay (LHS), age, BMI, clinical and surgical data and outcome was obtained. Results The mean age of the studied patients was 59.23 ± 11.19 years, the mean body mass index (BMI) was 26.69 ± 7.99 kg/m2, and the mean duration of symptoms was 10.27 ± 9.16 days. The most common presenting symptoms were swelling or induration (64%), 88% had comorbidities with diabetes mellitus (DM) (84%), and 76% had uncontrolled DM. of patients, 24% had a poly-microbial infection, with E. coli being the most common (52%). The mean length of hospital stay (LHS) was 54.56 ± 54.57 days, and 24% of patients had an LHS of more than 50 days. Longer LHS (> 50 days) was associated with patients who did not receive a compatible initial antibiotic, whereas shorter LHS was associated with patients who received Impenem or a combination of vancomycin and meropenem as alternative antibiotics following incompatibility. Reconstruction patients had significantly longer LHS and a higher mean temperature. However, none of the studied variables were found to be predictors of long LHS in the multivariate regression analysis. Conclusion Knowledge of the values that predict LHS allows for patient-centered treatment and may be useful in predicting more radical treatments or the need for additional treatment in high-risk patients. Future multicenter prospective studies with larger sample sizes are needed to assess the needed variables and predictors of long LHS.

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Étude clinique et thérapeutique et analyse pronostique des gangrènes du périnée

Cited by 5 publications

References 9 publications

Fournier’s gangrene at a tertiary health facility in northwestern Tanzania: a single centre experiences with 84 patients

Fournier’s gangrene at a tertiary health facility in northwestern Tanzania: a single centre experiences with 84 patients

Fournier’s gangrene: our experience with 50 patients and analysis of factors affecting mortality

Variables that predict hospital stay and the outcome of Fournier gangrene at King Abdulaziz University Hospital: a retrospective study

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