Outcomes of patients with Fournier’s Gangrene: 12-year experience from a tertiary care referral center

Abstract

Objective: To highlight changing trends of the clinical spectrum, and compare the management options and predictors of Fournier's gangrene (FG) outcomes in a tertiary care referral center. Material and methods: This study included patients with FG between August 2005 and July 2017. Patients were classified as "responders" and "nonresponders." We compared the baseline characteristics, clinical spectrum, biochemical data, management modalities, outcomes, and FG severity index (FGSI) and age-adjusted Charlson Comorbidity Index (ACCI) between responders and nonresponders. Results: We studied 72 patients and further divided them to responders (60 patients) and non-responders (12 patients). All were males; the mean age was 56.27+19.27 years (range, 47-85 years). The most common complaints were perineal discomfort (n= 62; 86.1%) and fever (n= 48; 66.7%). FG originated from the penoscrotal region in 64 patients (88.8%) and perineal region in 8 patients. Diabetes mellitus was the most common comorbidity (36%). The mean duration of the presentation was 10.19 days (range, 7-30 days). Sixteen patients underwent split skin grafting. The mortality rate was 8.3%. Nonresponders had distinct findings relative to responders: advanced age (71.5±7.17 vs. 53.23±19.85 years; p= 0.00); high blood sugar (245.83±116.26 vs. 139.06±35.64 mg/dL; p<0.01); leukocytosis (27166.67±10295.75 vs. 10558.4±3130.64 cumm; p<0.01); elevated serum creatinine (3.78±1.43 vs. 1.38±1.00; p<0.01); hyponatremia (127.33±11.84 vs. 137.33±3.42 meq/l; p<0.01), elevated international normalized ratios (1.66±0.28 vs. 1.32±0.07; p<0.01); and high FGSI (9.83±1.11 vs. 6.46±1.68;p<0.01) and ACCI scores (6.33±0.49 vs. 5±0.82; p<0.01). On univariate and multivariate regression analysis, raised blood sugar and deranged international normalized ratios at presentation were significantly associated with decreased response to treatment (p<0.05). Conclusion: An advanced age, diabetes mellitus, renal impairment, leukocytosis, altered sensorium, shock at presentation, deranged international normalized ratios, and high FGSI and ACCI scores can be used as predictors for poor response. FG risk scores adequately characterize the severity and prognosis of FG, but clinician's judgement is vital. The management comprises of a multidisciplinary approach, including parenteral antibiotics, urgent surgical debridement, and comorbidities optimization.

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

“…Fournier's gangrene is a necrotizing fascitis whose occurrence and healing process is mostly related to the balance of the immune system of the host involved. 6 In our findings, patients with increasing age are at increased risk of developing Fournier's gangrene. The mean age of our study subjects was 50.89 years, not much different from the findings of Garg et al 6 with a mean age of 56.27 years.…”

“…6 In our findings, patients with increasing age are at increased risk of developing Fournier's gangrene. The mean age of our study subjects was 50.89 years, not much different from the findings of Garg et al 6 with a mean age of 56.27 years. This can be related to the susceptibility of the elderly to infections and associated with degenerative diseases.…”

“…11 FGSI is one of the scores used to evaluate the severity of Fournier's gangrene and is directly proportional to the incidence of mortality in patients. 6,12 In this study, the mortality rate was 17.04%, and all of them had an FGSI rate >9. This finding is in line with the study of Garg et al, which showed that patients who did not respond to therapy had a higher FGSI value.…”

“…This finding is in line with Garg's research, which states that 36.1% of patients affected by Fournier's gangrene have a history of diabetes mellitus. 6 The most common cause of Fournier's gangrene in our study was perianal abscess of 42.96%. This was also confirmed by the findings of culture results from study subjects, which 32.59% were caused by enterobacteriaceae.…”

Evaluation of the effectiveness of vacuum-assisted closure in the treatment of Fournier gangrene

“…Mortality rates associated with FG vary between 4% and 80% [6,7]. The mortality rate was 16% in a comprehensive study in which 1726 patients were evaluated [2], 8% in a study by Garg et al [27] and 4.7% in a compilation covering the years 2004 and 2012 [28]. In this study, the mortality rate was 6.3%.…”