Evaluation of factors affecting mortality in Fournier’s Gangrene: Retrospective clinical study of sixteen cases

Abstract

Objective: Fournier's gangrene is a progressive, necrotizing fasciitis due to synergistic infection of the perineum and external genitalia that is associated with high mortality and morbidity. The purpose of this study is to review the diagnostic and treatment methods that effect mortality in Fournier's gangrene. Material and Methods:Sixteen patients who were diagnosed and treated at our clinic between 2011 and 2013 due to Fournier's gangrene were retrospectively analyzed. The surviving and non-surviving patient groups were compared in terms of age, sex, onset time of symptoms, isolated microorganisms, concomitant diseases, Fournier's gangrene severity index (FGSI), and length of hospital stay.Results: Ten of our cases (62.5%) were male and six (37.5%) were female, with a mean age of 61.2±12.3 (42-73) years. The mortality rate was 18.8% (3 cases). The mean duration of symptoms before admission was 4.31±1.81 (2-8) days. This period was 6.67±1.52 days in patients who succumbed to death, and 3.77±1.42 days in patients who survived (p=0.007). Ten cases (62.5%) had concomitant diabetes mellitus. The most common organism isolated in wound cultures was Escherichia coli (68.7%), and Acinetobacter baumannii, Proteus mirabilis, methicillin-resistant Staphylococcus aureus and Enterococcus spp. in the remaining patients. The mean FGSI of surviving patients was 3.84±1.77, and 7.66±0.57 in fatal cases (p=0.003). The mean length of hospital stay was 25.5 days (2-57) and duration of hospitalization was significantly longer in survivors (p<0.05). Conclusion:The delay in diagnosis and higher FGSI may be responsible for worsening of prognosis and mortality in Fournier's gangrene. Early diagnosis and determination of the severity of the disease, aggressive surgical debridement and appropriate antimicrobial therapy may improve prognosis.

Fournier’s gangrene: A retrospective analysis of 25 patients

“…Many studies have shown that perianal infections are the most common etiological factor in Fournier's gangrene. [2,6,9,11,14] In our study, 52% of the patients had a perianal origin, and 16% had a urogenital origin; no clear etiology could be revealed in 32% of the patients due to the lack of records.…”

“…[5,6,9,13] The reason for its decreased prevalence in women is explained by the simpler drainage of the female perineum via the vaginal route. Furthermore, many reports on this condition have been published by urology clinics in which men predominated in samples, which led to males being over-represented in reports.…”

“…[2,3,12,19,20] Among these factors, DM is the most common. [2,4,6,7,9,12,13,15] Diabetes leads to increased susceptibility to infections owing to the suppression of chemotaxis, phagocytosis, and immune functions. Most of our study population (80%) was diabetic.…”

“…[2,[6][7][8][9][10][11][12] Although Fournier's gangrene is more common among men and the elderly, it may affect both sexes and every age group. [5,8,9,13] The basic principles of its management include broad-spectrum antibiotics and aggressive surgical debridement.…”

“…[3,10] Despite advances in its diagnosis and treatment, the mortality rate due to Fournier's gangrene remains as high as 16-50%. [2,6,[14][15][16] Here we analyze etiological and predisposing factors and outcomes associated with vacuum-assisted closure (VAC) in patients who were followed up and treated for Fournier's gangrene over a 5-year period at our clinic, Umraniye Training and Research Hospital, Istanbul, Turkey.…”