Less is more? Antibiotic duration and outcomes in Fournier’s gangrene

Lauerman, Margaret H.; Kolesnik, Olga; Sethuraman, Kinjal N.; Rabinowitz, Ronald; Joshi, Manjari; Clark, Emily G.; Stein, Deborah M.; Scalea, Thomas M.; Henry, Sharon M.

doi:10.1097/ta.0000000000001562

Cited by 34 publications

(33 citation statements)

References 31 publications

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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%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Introductionmentioning

confidence: 99%

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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“…For empirical antibiotic therapy, regimens such as glycopeptides or linezolid with broad-spectrum antibiotics such as carbapenems or piperacillin/tazobactam are recommended; clindamycin in combination with penicillin is recommended for monomicrobial NF caused by group A streptococci [20] . Antibiotic treatment must continue until the patient requires no further debridement and shows hemodynamic recovery, and this duration must be determined for each patient based on their individual circumstances [21] . Treatment durations varied among our patients, with antibiotherapy ranging from as short as nine days to as long as 68 days.…”

Section: Discussionmentioning

confidence: 99%

Necrotising Fasciitis: Clinical Evaluation and Treatment Results of 18 Patients

Öztürk¹,

Akyol²,

Süer³

et al. 2019

mjima

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“…Length of antibiotic duration varies widely as there are no clear guidelines on management. One study compared outcomes in patients who received antibiotics for a scheduled number of days versus patients who stopped receiving antibiotics following surgical debridement and normalization of clinical indicators of infection and found that there was no significant difference in recurrence of infection [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Fournier’s Gangrene of the Penis following a Human Bite Wound

Overholt

Hajiran

Ueno

et al. 2018

Case Reports in Urology

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Fournier's gangrene isolated to the penis is exceedingly rare. It is an urologic emergency that requires emergent parenteral antibiotics as well as aggressive irrigation and debridement. While human bite wounds can be overlooked as a serious cause of injury and infection, they can result in highly dangerous, polymicrobial infections in affected patients. Here, we report a case of penile Fournier's gangrene caused by a human bite wound managed with broad spectrum antibiotics, irrigation and debridement, penile reconstruction, and skin grafting with successful preservation of a normal penile structure and function.

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Less is more? Antibiotic duration and outcomes in Fournier’s gangrene

Abstract: Therapeutic, level IV.

Cited by 34 publications

References 31 publications

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

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

Necrotising Fasciitis: Clinical Evaluation and Treatment Results of 18 Patients

Fournier’s Gangrene of the Penis following a Human Bite Wound

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