Fournier’s gangrene: our experience with 50 patients and analysis of factors affecting mortality

Abstract

IntroductionFournier’s gangrene is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia and perineum. Case series have shown a mortality rate of 20% to 40% with an incidence of as high as 88% in some reports. In this study we aimed to share our experience in the management of Fournier’s gangrene and to identify risk factors that affect mortality.MethodsThe medical records of 50 patients with Fournier’s gangrene who presented at the University Hospital Hassan II of Fez from January 2003 to December 2009 were reviewed retrospectively to analyze the outcome and identify the risk factors and prognostic indicators of mortality.ResultsTen males and five females were enrolled in the study. The mean age was 54 years (range 23–81). The most common predisposing factor was diabetes mellitus (34%). E. coli was the most frequent bacterial organisms cultured. All patients were treated with a common approach of resuscitation, broad-spectrum antibiotics, and wide surgical excision. The mortality rate was 24%. The advanced age, renal failure on admission, extension of infection to the abdominal wall, occurrence of septic shock and need for postoperative mechanical ventilation are the main prognostic factors of mortality. In multivariate analysis, none of these variables is an independent predictor of mortality.ConclusionsFournier’s gangrene is still a very severe disease with high mortality rates. Early recognition of infection associated with invasive and aggressive treatment is essential for attempting to reduce these prognostic indices.

Fournier’s gangrene: A retrospective analysis of 25 patients

“…Although radiological techniques such as X-rays, ultrasonography, computed tomography, and magnetic resonance imaging are helpful for making a diagnosis, Fournier's gangrene is typically diagnosed by performing a physical examination. [13,14,17,18] Pain, inflammation, edema, necrosis, and subcutaneous crepitation are often noted in the involved region upon performing a physical examination. Fournier's gangrene was diagnosed by performing a physical examination in our study.…”

“…[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.…”

Clinical Value of the Monocyte-to-Lymphocyte Ratio for Determining Number of Debridements in Treatment of Fournier’s Gangrene

“…However, most cases were related to an identifiable cause, like perianal and urinary tract infections, with the most common initial port of entry being local trauma. 1,2 In our study, predisposing factors and wound culture results were compared between the single and multiple debridement groups, wound culture result positivity showed statistical significance. However, in our study wound culture result showed aerobic culture positivity than anaerobic colonies than expected.…”

“…Despite being a well-described entity, the disease has a mortality rate ranging from 20% to 50%. 2 Many of the underlying etiologic factors have been described in the literature. These include diabetes mellitus, malignant conditions, chronic alcoholism and other immunosuppressive conditions.…”

“…It is a polymicrobial infection of aerobic and anaerobic bacteria and characterized by obliterative endarteritis of subcutaneous tissue leading to gangrene. 1,2 Although first described by French physician H. Baurienne in 1764, the disease was named after French venereologist Jean Alfred Fournier, who presented in 1883 the case of a young male with perineal gangrene of sudden onset. 3 FG affects mainly males (the male/female rate is 10:1) and patients over 50 years of age.…”