Outcome management of Fournier’s gangrene cases at tertiary hospital: 7 Years experience

Wirjopranoto, Soetojo; Azmi, Yufi Aulia

doi:10.1177/03915603211046483

Cited by 5 publications

(7 citation statements)

References 11 publications

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“…We estimated that the in-hospital mortality rate of FG patients in our study population was 26.2%. In Indonesia, it has previously been identified that the mortality rate of FG ranged from 17 to 28% [ 9 , 10 ]. Ergo, our findings are in line with such previous findings.…”

Section: Discussionmentioning

confidence: 99%

“…In the latest review, the mortality in high-income countries rates between 20% and 40% (Sorensen and Krieger 2016). In developing countries, the mortality rate was between 17% and 28% [ 9 , 10 ]. Several variables have been identified as risk factors for mortality in patients with FG, including older age, congestive heart failure, renal failure, and coagulopathy [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Factors for In-Hospital Mortality in 145 Male Patients with Fournier’s Gangrene: A 10-Year Observational Study from a Single Tertiary Referral Center in Indonesia

et al. 2022

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Background Fournier’s gangrene (FG) is a potentially fatal necrotizing infection. Due to the rapid progression of the disease, the fatality rate remains high despite advances in therapy. This 10-year observational study from a single tertiary referral center in Indonesia aimed to identify the risk factors for in-hospital mortality from 145 male patients diagnosed with FG. Material/Methods This retrospective cohort study was conducted at one of Indonesia’s largest tertiary referral hospitals. The risk factors of in-hospital mortality were analysed using data collected through hospital medical records. All patients diagnosed with FG from January 2012 until December 2021 were included. Outcome measured was sociodemographic factors, comorbidities, laboratory findings, length of stay, culture results, and disease outcome. The microbiological culture was performed on FG lesions isolates. The statistical analysis was conducted using SPSS version 26.0. Results The analysis included 145 male patients with a median age of 52 (IQR, 43–61) years. Of them, 38 (26.20%) patients died. There were more patients with diabetes mellitus (DM) in non-survivor groups compared to survivor groups (76.3% vs 57%, p=0.035). On multivariate analysis, DM and Clostridium perfringens infection were found to be independent factors of in-hospital mortality [adjusted odds ratio (aOR)2.583, 95% confidence interval (CI)=1.061–6.289, aOR 5.982,95% CI=1.241–28.828, respectively]. Conclusions The mortality rate for FG was considerably high. DM and Clostridium perfringens infection were shown to be independent risk factors for mortality among men.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors for In-Hospital Mortality in 145 Male Patients with Fournier’s Gangrene: A 10-Year Observational Study from a Single Tertiary Referral Center in Indonesia

et al. 2022

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“…Commonly used antibiotics include metronidazole, penicillin, third-generation cephalosporins, gentamicin, carbapenems, vancomycin, fluoroquinolones, and teicoplanin. 7 , 49 – 52 Often, a cocktail of antibiotics is needed and microbiology advice may be necessary. Becerra et al .…”

Section: Managementmentioning

confidence: 99%

“…They also noted a high prevalence of Candida infections in their dataset 24% compared with other similar studies in other institutions (1–5%). 51 , 52 They proposed that empirical antifungals should be considered in patients with known chronic candiduria, recent intensive care unit admission, diabetes mellitus, or immunocompromised status. The antimicrobial regime is reviewed with cultures from the blood, urine, and wound debridement.…”

Section: Managementmentioning

confidence: 99%

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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“…Thus, this study aimed to evaluate the diagnostic performance of all scoring systems that have been proposed to predict mortality in patients with FG. To this end, we used data from Indonesia, a country with high rate of in-hospital mortality among patients with FG [ 4 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of different scoring systems for predicting in-hospital mortality for patients with Fournier gangrene

Azmi,

Alkaff,

Renaldo

et al. 2023

World J Urol

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Purpose To compare different scoring systems for predicting in-hospital mortality in patients with Fournier gangrene (FG). Methods A comprehensive literature search was performed to find all scoring systems that have been proposed previously as a predictor for in-hospital mortality in patients with FG. Data of all patients with FG who were hospitalized in one of Indonesia’s largest tertiary referral hospitals between 2012 and 2022 were used. The receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the scoring systems. Results Ten scoring systems were found, i.e., Fournier’s Gangrene Severity Index (FGSI), Uludag FGSI, simplified FGSI, NUMUNE Fournier score (NFS), Laboratory Risk Indicator for Necrotizing Fasciitis, age-adjusted Charlson comorbidity index, sequential organ failure assessment (SOFA), quick SOFA, acute physiology and chronic health evaluation II, and surgery APGAR score (SAS). Of 164 FG patients included in the analyses, 26.4% died during hospitalization. All scoring systems except SAS could predict in-hospital mortality of patients with FG. Three scoring systems had areas under the ROC curve (AUROC) higher than 0.8, i.e., FGSI (AUROC 0.905, 95% confidence interval (CI) 0.860–0.950), SOFA (AUROC 0.830, 95% CI 0.815–0.921), and NFS (AUROC 0.823, 95% CI 0.739–0.906). Both FGSI and SOFA had sensitivity and NPV of 1.0, whereas NFS had a sensitivity of 0.74 and an NPV of 0.91. Conclusion This study shows that FGSI and SOFA are the most reliable scoring systems to predict in-hospital mortality in FG, as indicated by the high AUROC and perfect sensitivity and NPV.

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Outcome management of Fournier’s gangrene cases at tertiary hospital: 7 Years experience

Cited by 5 publications

References 11 publications

Factors for In-Hospital Mortality in 145 Male Patients with Fournier’s Gangrene: A 10-Year Observational Study from a Single Tertiary Referral Center in Indonesia

Factors for In-Hospital Mortality in 145 Male Patients with Fournier’s Gangrene: A 10-Year Observational Study from a Single Tertiary Referral Center in Indonesia

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

Comparison of different scoring systems for predicting in-hospital mortality for patients with Fournier gangrene

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