Prognostic Aspects, Survival Rate, and Predisposing Risk Factors in Patients with Fournier’s Gangrene and Necrotizing Soft Tissue Infections: Evaluation of Clinical Outcome of 55 Patients

Abstract

Objective: To determine predisposing or prognostic factors and mortality rates of patients with Fournier’s gangrene compared to other necrotizing soft tissue infections (NSTI). Material and Methods: Data of 55 intensive care patients (1981–2010) with NSTI were evaluated. Data were collected prospectively. Results: 43.4% of the patients were in septic condition and 27.3% were hemodynamically unstable. Half of the patients showed predisposing factors (52.7%). The lower extremity (63.2%), abdomen (30.9%), and perineum (14.5%) were most affected. Polymicrobial infections were frequent (65.5%, mean 2.8, range: 1–4). The mortality rate was 16.4% (n = 9). An increase was shown for diabetes mellitus (20%), cardiac insufficiency (22.3%), septic condition at presentation (33.3%), abdominal affection (47.1%), and hemodynamic instability (46.7%). Comparing survivors and nonsurvivors, statistical significance was seen with age (p < 0.001), septic condition at admission (p < 0.001), hemodynamic instability (p < 0.001), low blood pressure (p < 0.001), and abdominal affection (p < 0.001). In laboratory findings, an increase of creatine kinase (p < 0.001) and lactate (p < 0.001) and a decrease of antithrombin III (p < 0.007) and the Quick value (p < 0.01) proved to be significant. Conclusion: Patients with Fournier’s gangrene do not differ in all aspects from those with other NSTI. Successful treatment consists of immediate surgical debridement, broad-spectrum antibiotic treatment, and critical care management. Supportive hyperbaric oxygen therapy should be considered.

Fournier's Gangrene: Review of 120 Patients and Predictors of Mortality

“…Median debridement count was three (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Majority of the debridements were performed under spinoepidural anesthesia; however, twenty-seven patients (22.5%) required general anesthesia.…”

“…There are several studies showing DM as a risk factor for patients with FG. [1,3,6,7] Nevertheless, there are also some studies where DM has been reported as one of the most frequent comorbidities in patients with FG although not influencing outcomes. [8][9][10][11]16,19] Although it was the most common co-morbidity among all patients, DM was not determined as a risk factor for mortality (p=0.429).…”

“…[3,4] In spite of the widely varying microorganisms in the etiology, its treatment is unique for all cases including emergency removal of the devitalized tissues, adequate resuscitation, and intravenous (iv) administration of wide-spectrum antibiotics. [1][2][3][4][5][6][7] spectively maintained departmental FG database. Only adult patients admitted or referred to our department and diagnosed with FG were included in the study.…”

The modern view on the rare purulent-necrotic diseases of the external genitalia in men (review of literature)

“…Результаты патоморфологических исследований при ГФ представлены в немногочисленных публика-циях в виде данных биопсий и интраоперационных ис-следований [1,6,9,57,58,72,77,81,83,100,113,118]. Выделяют ранние и поздние патоморфологические изменения при ГФ: в сроки 0 -4 суток (в среднем, в течение первых 24 часов) и в сроки свыше 4 суток от начала заболевания, соответственно [5,118].…”

“…Cроки госпитализации варьируют от 2 до 278 койко/дней (в среднем, для выживших пациентов -34,8 ± 18,8 койко/дней, для умерших -61,6 ± 38,9 койко/ дней) [83,113]. Более чем в 65% случаев средние сроки госпитализации превышают 20 койко/дней.…”