Fournier gangrene with concurrent multifocal necrotizing fasciitis: a systematic review and case report

Purpose@#A patient presented to a regional surgical center with Fournier gangrene (FG) and concurrent multifocal necrotizing fasciitis (NF). Given the rarity, it was decided to undertake a systematic review to investigate the incidence and prevalence of FG with multifocal NF and consequently determine the treatment and approach to management of such presentation. @*Methods@#Firstly, the report of the 56-year-old male patient is discussed regarding his surgical management. Secondly, a systematic review was undertaken according to PRISMA guidelines using MEDLINE, Scopus, and Embase databases. Searches used the following MeSH terms: (“fournier’s gangrene”) AND ((necrotising fasciitis) OR (necrotising soft tissue infection)). Once the search results were obtained, duplicate articles were removed. Titles, abstracts, and articles were reviewed by 2 authors. @*Results@#The search strategy using the 3 databases revealed a total of 402 studies. Fifty-seven studies were removed due to duplication. A total of 345 records were screened via title and abstract, of which 115 were excluded. Two hundred and thirty studies were reviewed for eligibility. A total of all 230 studies were excluded; 169 were excluded as they included the incorrect patient population (patients suffered from FG or NF, but not both collectively), 60 studies were excluded due to incorrect study designs, and 1 report occurred in the wrong setting. @*Conclusion@#This highlights that while being a relatively known, uncommon infection both FG and NF are well documented separately within the literature. However, FG with concurrent multifocal NF has not been documented within the literature.

Gangrena de Fournier: revisión de factores determinantes de mortalidad / Mortality risk factors in Fournier gangrene: a literature review

La gangrena de Fournier es una fascitis necrosante polimicrobiana que afecta el periné, el escroto y/o el área perianal con una tasa de mortalidad actual del 20% al 40%. El objetivo de esta revisión es describir los factores pronósticos de mortalidad reportados en la literatura mundial, para lo cual se realizó la búsqueda de artículos indexados en Medline, utilizando los respectivos términos MeSH para la búsqueda, así como una búsqueda manual de las referencias encontradas en los artículos primarios. Se reportan diversos factores con significación estadística; sin embargo, el índice de Laor predomina como herramienta de mayor significación a la hora de determinar la mortalidad de los pacientes.

Fournier gangrene is a necrotizing fasciitis caused by facultative microorganisms that affects the perineal area, the scrotum or the perianal area. It has a 20% to 40% mortality. We performed a literature review to determine its determinants of mortality. Among all factors, the Laor index (which includes temperature, heart rate, respiratory rate, serum sodium, potassium and creatine, blood leukocyte count, packed red cell volume and bicarbonate) predominates as the best tool to assess mortality risk.

Diagnóstico y manejo precoz de la gangrena de fournerr / Early diagnosis and management of fournier´s gangrene

Aim: The aim of this study is to report the results of a series of patients diagnosed with Fournier’s gangrene underwent surgical debridement plus broad-spectrum antibiotics in the emergency department of the Hospital Barros Luco-Trudeau (HBLT) between 2009 and 2013, in terms of mortality associated with the disease. Material and Methods: Between 2009 and 2013, a case series of patients with diagnosis of Fournier’s gangrene treated in the Emergency Department of the Hospital Barros Luco-Trudeau. The outcome variable was mortality attributed to the disease (MAD). Other variables were: age, sex, comorbidities, focus of origin, waiting time for antibiotic treatment and surgery to start, number of surgical debridement and agents isolated from cultures. Descriptive statistics were used, with calculation of measures of central tendency and dispersion. Results: During the study period, 56 patients were identified with diagnosis of Fournier’s gangrene (60.7 percent were male) with a mean age of 52 years (23-75 years old). The MAD was 48.2 percent. The most common comorbidity was diabetes (66.6 percent). The more prevalent focus of origin was anorectal pathology (42.9 percent). The average waiting time from diagnosis to initiation of antibiotic therapy and surgery was 40 minutes (15-80) and 580 minutes (20-4320), respectively. The required surgical debridement average was 4. Isolated on the intraoperative tissue cultures agent was E. coli (51.8 percent). Conclusion: Mortality attributable to Fournier’s gangrene is similar to that observed in the literature.

Objetivo: El objetivo de este estudio es comunicar los resultados observados en una serie de pacientes con diagnóstico de gangrena de Fournier sometidos a aseo quirúrgico con debridamiento más terapia antibiótica de amplio espectro, en el Servicio de Urgencias del Hospital Barros Luco Trudeau (HBLT), entre los años 2009 y 2013, en términos de mortalidad asociada a la enfermedad. Material y Método: Serie de casos de pacientes con diagnóstico de gangrena de Fournier tratados en el Servicio de Urgencias del Hospital Barros Luco-Trudeau entre 2009 y 2013. La variable resultado fue mortalidad atribuida a la enfermedad (MAE). Otras variables de interés fueron: edad, sexo, patologías asociadas, foco de origen, tiempo de espera para el inicio del tratamiento antibiótico y cirugía, número de aseos y agentes aislados en los cultivos. Se utilizó estadística descriptiva, con cálculo de medidas de tendencia central y dispersión. Resultados: En el período en estudio se identificaron 56 pacientes con diagnóstico de Gangrena de Fournier (60,7 por ciento eran masculinos), con un promedio de edad de 52 años (23-75 años). La MAE fue 48,2 por ciento. La patología asociada más frecuente fue la diabetes (66,6 por ciento). El foco de origen más prevalente fue la patología anorrectal (42,9 por ciento). El tiempo promedio de espera desde el diagnóstico hasta el inicio de la terapia antibiótica y la cirugía fue de 40 minutos (15-80) y 580 minutos (20-4320) respectivamente. El promedio de aseos requeridos fue de 4. El agente más aislado en los cultivos de tejido intraoperatorio fue Escherichia coli (51,8 por ciento). Conclusión: La mortalidad atribuible a la Gangrena de Fournier es similar a la observada en la literatura.