Global outcomes and lessons learned in the management of Fournier’s gangrene from high-volume centres: findings from a literature review over the last two decades

Bowen, Daniel J.; Juliebø‐Jones, Patrick; Somani, Bhaskar K.

doi:10.1007/s00345-022-04139-4

Cited by 14 publications

(11 citation statements)

References 77 publications

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“… 12 Commonly grown pathogens include Staphylococcus species, Streptococcus species, Escherichia coli , Pseudomonas species, Bacteroides species, with Candida species representing the most common nonbacterial causative pathogens. Different studies present different profiles of microorganism prevalence, 10 highlighting the importance of local microbial guidelines and antimicrobial resistance.…”

Section: Pathogenesismentioning

confidence: 99%

“…The intensive care team should also be informed pre-operatively as FG patients will commonly need high-dependency beds post-operatively, with 17.5–30% of patients requiring at least single-system support such as mechanical ventilation or dialysis. 10 Depending on the location and extent of the necrosis, the input of a colorectal surgeon should be sought where faecal diversion is indicated. A group and save should be taken with the initial blood tests and units of packed red cells can be cross-matched in the cases of anaemia on presentation or need for extensive debridement.…”

Section: Managementmentioning

confidence: 99%

“… 8 Mortality for FG has traditionally been estimated at 15–40%, 2 , 8 , 9 although a recent meta-analysis found a lower mean mortality rate of 7.3%. 10 …”

Section: Introductionmentioning

confidence: 99%

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Fournier’s gangrene: a review of predictive scoring systems and practical guide for patient management

Bowen,

Hughes,

Juliebø-Jones

et al. 2024

Therapeutic Advances in Infection

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This article aims to provide a practical guide for patient management and an overview of the predictive scorings for Fournier’s gangrene (FG) that are available to aid clinicians. A literature was performed reviewing currently used scoring systems for FG and presenting a practical guide for its management based on the available evidence. There are four specific scoring systems available for the assessment of FG although few other non-specific and generic tools also exist. These specific tools include Laboratory Risk Indicator for Necrotizing Fasciitis, Fournier’s Gangrene Severity Index, Uludag Fournier’s Gangrene Severity Index, and Simplified Fournier’s Gangrene Severity Index and help calculate expected mortality. Our proposed algorithm covers primary assessment, resuscitative interventions, initial investigations, urgent care, post-operative care, and long-term follow-up. The management of the FG patient can be divided into initial resuscitation, surgical debridement, ongoing ward management with antibiotic therapy, wound reconstruction, and long-term follow-up. Each facet of care is vital and requires multidisciplinary team expertise for optimal outcomes. Whilst mortality continues to improve, it remains significant, reflecting the severe and life-threatening nature of FG. More research is certainly needed into how this care is individualised, and to ensure that long-term outcomes in FG include quality of life measures after discharge.

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Section: Pathogenesismentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

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Fournier’s gangrene: a review of predictive scoring systems and practical guide for patient management

Bowen,

Hughes,

Juliebø-Jones

et al. 2024

Therapeutic Advances in Infection

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“…Diagnostisch steht eine Ausbreitungsdiagnostik mittels CT-Abdomen/Becken im Vordergrund. Die initiale Therapie erstreckt sich von einer Breitbandantibiose über ein radikales Debridement des betroffenen Gebietes und einer anschließenden intensivmedizinischen Behandlung [28].…”

Section: Arterielle Gefäßverschlüsseunclassified

Notfälle in der medikamentösen Tumortherapie – Operative Indikationen unter Systemtherapie

Rieger,

Pfister,

Heidenreich

2023

Aktuelle Urol

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ZusammenfassungOperative Indikationen aufgrund von Nebenwirkungen unter Systemtherapie bei einem metastasierten Tumor des Urogenitaltrakts sind selten. Nichtsdestotrotz gibt es eine Reihe von Notfällen, welche eine rasche Intervention erfordern und von jedem Uroonkologen erkannt werden sollten. Die folgende Übersichtarbeit wird wichtige Nebenwirkungen mit der Notwendigkeit einer operativen Therapie herausarbeiten, indem die wesentlichen Symptome sowie das initiale Management dargestellt werden.

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“…12 However, a recent study found that the mean mortality of FG patients from 2000 to 2021 was 7.5%, which has decreased compared with previous years. 13 There are many factors significantly related to the prognosis of FG patients, including early diagnosis, waiting period to surgery and comorbidity. Surgery is the cornerstone of the treatment of FG, any factors delaying surgical intervention predicts a poorer prognosis.…”

Section: Mortality and Prognosis Predicationmentioning

confidence: 99%

Progress in Multidisciplinary Treatment of Fournier’s Gangrene

Zhang¹,

Shi²,

Chen³

et al. 2022

IDR

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Fournier's gangrene (FG) is a life-threatening and special form of necrotizing fasciitis, characterized by occult onset, rapid progress and high mortality, occurring mainly in men over 50 years of age. Risk factors of FG include diabetes, HIV infection, chronic alcoholism and other immunosuppressive state. FG was previously considered as an idiopathic disease, but in fact, three quarters of the infections originated from the skin, urethra and gastrointestinal tract. Initial symptoms of FG are often inconsistent with severity and can progress promptly to fatal infection. Although the treatment measures of FG have been improved in recent years, the mortality does not seem to have decreased significantly and remains at 20% -30%. The time to identify FG and the waiting period before surgical debridement are directly related to the prognosis. Therefore, in addition to the combination of intensive fluid resuscitation and broad-spectrum antibiotics, treatment of FG should particularly emphasize the importance of early surgical debridement assisted with fecal diversion and skin reconstruction when necessary. This paper is to briefly summarize the progress in the definition, epidemiology, clinical manifestations, diagnosis, treatment and prognosis of Fournier's gangrene in recent years, more importantly, illustrates the importance of multidisciplinary cooperation in the management of FG.

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Global outcomes and lessons learned in the management of Fournier’s gangrene from high-volume centres: findings from a literature review over the last two decades

Cited by 14 publications

References 77 publications

Fournier’s gangrene: a review of predictive scoring systems and practical guide for patient management

Fournier’s gangrene: a review of predictive scoring systems and practical guide for patient management

Notfälle in der medikamentösen Tumortherapie – Operative Indikationen unter Systemtherapie

Progress in Multidisciplinary Treatment of Fournier’s Gangrene

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