Microorganisms and Antibiogram Patterns in Fournier’s Gangrene: Contemporary Experience from a Single Tertiary Care Center

Becerra, Clara M. Castillejo; Jaeger, Christopher; Rose, Justin; Beecroft, Nicholas; Shah, Nayan C.; Posid, Tasha; Jenkins, Lawrence C.; Baradaran, Nima

doi:10.1097/ju.0000000000001194

Cited by 20 publications

(10 citation statements)

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“…While the role of bacteria in hidradenitis suppurativa pathogenesis is not fully elucidated, sinus tracts provide a direct pathway for bacterial exacerbation [ 10 ] . S. aureus , commonly found in hidradenitis suppurativa flare-ups [ 4 ] , was identified in our case along with S. agalactiae . Although the presence of S. aureus aligns with its prevalence on the skin and in hidradenitis suppurativa patients, the identification of S. agalactiae , typically residing in the genital and gastrointestinal tracts, is noteworthy [ 4 ] .…”

Section: Discussionmentioning

confidence: 56%

“…S. aureus , commonly found in hidradenitis suppurativa flare-ups [ 4 ] , was identified in our case along with S. agalactiae . Although the presence of S. aureus aligns with its prevalence on the skin and in hidradenitis suppurativa patients, the identification of S. agalactiae , typically residing in the genital and gastrointestinal tracts, is noteworthy [ 4 ] . This unexpected presence could be attributed to either direct external contamination from faecal or urinary sources, or indicative of fistulisation connecting the internal mucosa to the epithelial tissue [ 10 ] .…”

Section: Discussionmentioning

confidence: 56%

“…In our patient, the score was 15, primarily due to abnormalities in temperature, heart rate, serum creatinine, haematocrit, bicarbonate, and white blood cell count. Treatment of Fournier’s gangrene includes surgical debridement, fluid resuscitation and broad-spectrum antibiotics [ 4 ] .…”

Section: Discussionmentioning

confidence: 99%

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The concomitant occurrence of hidradenitis suppurativa and Fournier’s gangrene

Khattar,

Bou Sanayeh,

Makram

et al. 2024

European Journal of Case Reports in Internal Medicine

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Background: Fournier’s gangrene represents a life-threatening necrotising infection affecting the perineal region, while hidradenitis suppurativa is characterised by a chronic inflammatory skin condition. The simultaneous occurrence of both conditions is exceedingly rare. Case description: A 42-year-old female with a documented history of severe untreated hidradenitis suppurativa presented for shortness of breath, fever and lethargy, along with extensive wounds and skin breakdown involving the left axilla, perineum, lower back, lumbosacral region and bilateral gluteal areas, extending to the perineum. Upon presentation, the patient was in a state of septic shock, and a diagnosis of actively manifesting Fournier’s gangrene was established at the site of the pre-existing hidradenitis suppurativa lesions. Despite the implementation of an aggressive multidisciplinary approach incorporating surgical interventions, antibiotic therapy and intensive care measures, the patient’s condition deteriorated, culminating in septic shock, multi-organ failure and eventual demise. In this report, we discuss both clinical entities, their similarities and differences, and the possible mechanisms by which they may have co-occurred. Conclusion: The co-existence of hidradenitis suppurativa and Fournier’s gangrene poses unique challenges, given the rapid progression of Fournier’s gangrene within the context of hidradenitis suppurativa, potentially suggesting the latter as a predisposing factor. This case underscores the importance of vigilant screening and management of hidradenitis suppurativa.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 56%

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The concomitant occurrence of hidradenitis suppurativa and Fournier’s gangrene

Khattar,

Bou Sanayeh,

Makram

et al. 2024

European Journal of Case Reports in Internal Medicine

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“…Becerra et al . 53 found that in their study of 131 patients, 86% of cases grew multiple bacteria with 55% growing Gram-positive and Gram-negative bacteria in the same culture. They also noted a high prevalence of Candida infections in their dataset 24% compared with other similar studies in other institutions (1–5%).…”

Section: Managementmentioning

confidence: 96%

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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“…Most infections were polymicrobial (54%-90%) in published series. 4,5 Early surgical debridement is a key prognostic factor identified in NSTI in general. In our study, most of patients (70%) underwent surgery within 24 hours of hospital admission and more than half of patients were transferred from another hospital (65.5%), underlying the specificity and complexity of management of FG.…”

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confidence: 99%