Significance of Hyperbaric Oxygenation in the Treatment of Fournier’s Gangrene: A Comparative Study

Anheuser, Petra; Mühlstädt, Sandra; Kranz, Jennifer; Schneidewind, Laila; Steffens, J.; Fornara, Paolo

doi:10.1159/000493898

Cited by 19 publications

(31 citation statements)

References 16 publications

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“…found “poor and biased” evidence and the need for randomized controlled trials 63 . The same conclusion was drawn by Anheuser et al ., who carried out a retrospective multicenter analysis of the influence of HBO on Fournier's gangrene 64 .…”

Section: Discussionmentioning

confidence: 99%

Clostridial Gas Gangrene ‐ A Rare but Deadly Infection: Case series and Comparison to Other Necrotizing Soft Tissue Infections

Leiblein

Wagner

Adam

et al. 2020

Orthopaedic Surgery

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Objective: Clostridial gas gangrene (GG) or clostridial myonecrosis is a very rare but life-threatening necrotizing soft tissue infection (NSTI) caused by anaerobic, spore-forming, and gas-producing clostridium subspecies. It is the most rapidly spreading and lethal infection in humans, also affecting muscle tissue. The high mortality, of up to 100%, in clostridial GG is mediated by potent bacterial exotoxins. Necrotizing fasciitis (NF) is an important differential diagnosis, most often caused by group A streptococci, primarily not affecting musculature but the subcutaneous tissue and fascia. In the early stages of the infection, it is difficult to distinguish between GG and NF. Therefore, we compare both infection types, identify relevant differences in initial clinical presentation and later course, and present the results of our patients in a retrospective review. Methods: Patients diagnosed with GG from 2008 to 2018 in our level one trauma center were identified. Their charts were reviewed retrospectively and data analyzed in terms of demographic information, microbiological and histological results, therapeutic course, outcome, and mortality rates. The laboratory risk indicator for NF (LRINEC) score was applied on the first blood work acquired. Results were compared to those of a second group diagnosed with NF. Results: Five patients with GG and nine patients with NF were included in the present study. Patients with GG had a mortality rate of 80% compared to 0% in patients with NF. In eight patients with NF, affected limbs could be salvaged; one NF underwent amputation. LRINEC did not show significant differences between the groups; however, C-reactive protein was significantly increased (P = 0.009) and hemoglobin (Hb) was significantly decreased (P = 0.02) in patients with GG. Interleukin-6 and procalcitonin levels did not show significant difference. Patients with GG were older (70.2 vs 50 years). Of the isolated bacteria, 86% were sensitive to the initial calculated antibiotic treatment with ampicillin-sulbactam or imipenem plus metronidazole plus clindamycin. Conclusion: Both GG and NF need full-scale surgical, antibiotic, and intensive care treatment, especially within the first days. Among patients with NSTI, those with clostridial GG have a significantly increased mortality risk due to early septic shock caused by clostridial toxins. In the initial stages, clinical differences are hardly detectable. Immediate surgical debridement is the key to successful therapy for NSTI and needs to be performed as early as possible. However, patients should be treated in a center with an experienced interdisciplinary intensive care team based on a predetermined treatment plan.

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Section: Discussionmentioning

confidence: 99%

Clostridial Gas Gangrene ‐ A Rare but Deadly Infection: Case series and Comparison to Other Necrotizing Soft Tissue Infections

Leiblein

Wagner

Adam

et al. 2020

Orthopaedic Surgery

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“…A taxa de mortalidade encontrada no presente estudo foi de 14 , em estudo realizado com 17 pacientes tratados com OHB, a taxa de mortalidade foi de 0,0%.…”

Section: Discussionunclassified

“…Os dados do presente estudo demonstram a eficácia da terapia adjuvante com OHB devido à melhora da patologia através da alta médica, corroborando com pesquisas publicadas por diversos autores 7,8,9,12,13,14,15 .…”

Section: Discussionunclassified

“…A OHB estimula a ativação dos leucócitos em hipóxia que apresentam dificuldade na fagocitose de micro-organismo e a síntese de colágeno pelos fibroblastos aumenta com a maior disponibilidade de oxigênio. O aumento da oxigenação tecidual restaura a angiogênese capilar, aumentando a proliferação tecidual e a formação do tecido de granulação 14,15 . Nos pacientes usuários da OHB ocorre um aumento na pressão parcial de oxigênio no sangue arterial com elevação do oxigênio entre os capilares e os tecidos, aumentando a oxigenação celular e quebrando o ciclo vicioso da isquemia, levando a vasoconstrição e consequente redução de edemas e de pressões compartimentais 14,15 .…”

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Perfil dos pacientes com gangrena de Fournier utilizando a oxigenoterapia hiperbárica como tratamento adjuvante

Tikami

Simão

Passerotti³

et al. 2020

Medicina (Ribeirão Preto)

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Objetivo: Avaliar os resultados obtidos da oxigenoterapia hiperbárica (OHB) como tratamento adjuvante na Gangrena de Fournier (GF). Casuística e Método: Estudo transversal, retrospectivo e descritivo baseado na análise de prontuários físicos de pacientes portadores de GF submetidos a oxigenoterapia hiperbárica, através da câmara hiperbárica no período de fevereiro de 2008 a maio de 2018, atendidos em uma clínica de oxigenoterapia hiperbárica na cidade de Bauru, SP. Os dados coletados foram: idade, sexo, etiologia, comorbidades, localização e extensão da lesão, número total de sessão e mortalidade. Resultado: Trinta e oito pacientes foram analisados, sendo 76% do sexo masculino, com média de idade de 55,6 anos. Entre os pacientes, 17 (44,7%) obtiveram alta médica, 18 (47,4%) interromperam o tratamento antes do término e ocorreram três (8,21%) óbitos. A principal etiologia foi o abcesso e os principais comorbidades predisponentes foram a diabetes mellitus e a hipertensão arterial. A localização e extensão com áreas mais afetadas foram na região escrotal, seguida pela região perineal. Conclusão: Os resultados deste estudo demostraram que o efeito da OHB como tratamento adjuvante oferece vantagem no tratamento da GF, resultando em considerável alta médica dos pacientes e baixa mortalidade.

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“…inten-sivmedizinische Betreuung. Dies stellt seit Jahren den Therapiestandard dar [20]. Inwieweit andere Therapieformen, wie z.…”

Section: Hintergrund Und Fragestellungunclassified

Behandlungssituation der Fournier-Gangrän an deutschen Universitätskliniken – eine nationale Umfrage zur Deskription aktueller Standards und resultierende Implikationen zur Planung einer Registerstudie

Kranz

Wagenlehner

Steffens

et al. 2021

Urologe

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Zusammenfassung Hintergrund Die Fournier-Gangrän (FG) ist ein seltenes, aber lebensbedrohliches Krankheitsbild, dessen Prognose in den letzten Jahren nicht wesentlich verbessert werden konnte. Ziel der Arbeit Primäres Studienziel ist die Deskription der Therapiesituation von FG an deutschen Universitätskliniken. Als sekundäres Studienziel sollen Faktoren identifiziert werden, die mit einer erhöhten Letalität assoziiert sind. Außerdem sollen die Daten zur Planung einer Registerstudie dienen. Material und Methoden Es wurde ein Fragebogen mit 29 Fragen an die Mitglieder des Verbands Universitätsklinika Deutschlands sowie eine 3‑malige Erinnerung zur Studienteilnahme im Zeitraum April bis Juni 2020 versandt. Die Datenverwaltung und statistische Analyse erfolgte mit SPSS 26.0 (SPSS Inc., Chicago, Il, USA). Ergebnisse Die Antwortrate betrug 88,9 %. Im Median werden jährlich 5 Patienten mit einem medianen Alter von 60 Jahren an deutschen Universitätsklinika mit der Diagnose FG therapiert. Insgesamt stellt sich die Therapiesituation sehr heterogen dar, insbesondere hinsichtlich der empirischen Erstantibiose. Ein signifikanter Risikofaktor für eine Letalität > 20 % konnte identifiziert werden: Intensivaufenthalt von größer gleich 10 Tagen (p = 0,039). Die Hälfte (50,0 %) der Befragten geben an, dass sich die Prognose der Erkrankung nicht wesentlich verbessert hat. Weiterhin halten viele der Befragten die Letalität für inakzeptabel hoch, daher befürworten 84,4 % eine Registerstudie. Aus den Kommentaren der Befragten konnten zahlreiche Vorschläge sowie Implikationen für die Planung einer solchen Studie abgeleitet werden, wie z. B. die histologische Sicherung der FG. Schlussfolgerung Die Therapiesituation der FG ist heterogen. Allerdings sind die Therapieergebnisse weiterhin inakzeptabel und schwer prognostizierbar.

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Significance of Hyperbaric Oxygenation in the Treatment of Fournier’s Gangrene: A Comparative Study

Cited by 19 publications

References 16 publications

Clostridial Gas Gangrene ‐ A Rare but Deadly Infection: Case series and Comparison to Other Necrotizing Soft Tissue Infections

Clostridial Gas Gangrene ‐ A Rare but Deadly Infection: Case series and Comparison to Other Necrotizing Soft Tissue Infections

Perfil dos pacientes com gangrena de Fournier utilizando a oxigenoterapia hiperbárica como tratamento adjuvante

Behandlungssituation der Fournier-Gangrän an deutschen Universitätskliniken – eine nationale Umfrage zur Deskription aktueller Standards und resultierende Implikationen zur Planung einer Registerstudie

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