Risk factors and interventions: Fournier gangrene in a tertiary hospital: A 10-year experience

@#<p style="text-align: justify;"><strong>Objective.</strong> The study aimed to describe the patient demographic characteristics, clinical factors, surgical interventions, and quality of care parameters in non-survivors and survivors of Fournier's gangrene (FG).</p><p style="text-align: justify;"><strong>Methods.</strong> A total of 131 cases of Fournier's gangrene (FG) were included in a retrospective chart review in the Philippine General Hospital over 10 years using the Department of Surgery research database. We collected data for various direct and derived variables from the identified population. The primary outcome was mortality rate, while other factors studied were genital and colorectal manipulation, bowel diversion, laboratory parameters (white blood cell count, creatinine, hemoglobin).</p><p style="text-align: justify;"><strong>Results.</strong> The mortality rate was 15%. Diabetes mellitus was common comorbidity among patients with Fournier's disease. The following were statistically more common in the non-survivor group: female sex, concomitant bowel diversion surgery. Admission data in the non-survivor group showed a lower serum hemoglobin, a higher serum creatinine, and an increased percentage of patients with an abnormal white blood cell count; these did not statistically differ between cohorts, however. The median time to first antibiotic infusion was six hours. The median time to surgery was 13 hours.</p><p style="text-align: justify;"><strong>Conclusions.</strong> Among patients with Fournier's gangrene, the proportion of women and those undergoing bowel diversion was higher in those who did not survive. The time of infusion of antibiotics or time to surgery did not differ significantly between survivors and non-survivors.</p>

A retrospective analysis of Fournier's gangrene at a tertiary government hospital in the Philippines

BACKGROUND@#Fournier's gangrene is a serious illness which involves the external genitalia and perineum.It is rare but a life-threatening form of necrotizing fasciitis. Despite aggressive treatment, the mortalityrate is still high. In this study, the authors will discuss the risk factors and mortality of the saiddisease.@*METHODS@#This is a descriptive retrospective study of patients with Fournier's gangrene treated at atertiary government hospital in the Philippines between January 2014 to December 2016.@*RESULTS@#The data from a total of 16 patients (M:F = 15:1) were analyzed. The most number of patientswere in the 5th decade of life (range 17-75 years). The most commonly-associated morbidity wasdiabetes mellitus (50%). Bacterial culture results were obtained in only 15 (93.7%) patients. Of these,13 (86.6%) had polymicrobial bacterial growth while 2 (13.3%) had monomicrobial bacterial growth.Escherichia coli (93.3%) was the most frequent bacterial organism isolated. All the microorganismsisolated showed high resistance to commonly-used antibiotics except for Meropenem, Piperacillin-Tazobactam, and Ceftriaxone. All patients were treated with broad-spectrum antibiotics, and emergentsurgical debridement. The median length of hospital stay (LOS) was 14.3 days and mortality rate was6.25 %.@*CONCLUSION@#Fournier's gangrene is still a grave disease that can be treated by determining the cause ofinfection and prompt surgical treatment is needed to improve patient outcome.

Fascitis necrotizante perineal: Gangrena de Fournier / Perineal necrotizing fasciitis: Fournier's gangrene

La gangrena de Fournier o fascitis necrotizante perineal es una entidad infecciosa que afecta las fascias perineales y/o sus dependencias. Es prevalente en hombres de la 5ta o 6tadécada de su vida, y es más común en diabéticos, obesos, enolistas o inmunodeprimidos. El sostén metabólico, la antibioticoterapia, eldebridamiento de tejidos necróticos y la reparación de tejidos son los pilares del tratamiento. Reporte de casos: En el presente artículo presentamos unarevisión bibliográfica de esta enfermedad, y presentamos 3 casos dediferente resolución en nuestro hospital, a modo de ejemplo, con susrespectivos registros fotográficos. Discusión: La fascitis necrotizante perineal es una grave entidad infecciosa que requiere diagnóstico temprano, tratamiento oportuno multidisciplinario y reconstrucción de tejidos según el caso, para lo cual existen varias opciones...

Fournier's gangrene or perineal necrotizing fasciitis is an infectious entity affecting perineal fascias and / or its dependencies. It is more prevalent in men in the 5th or 6thdecade of life and is more common in diabetics, obese, alcoholics or immunodeppressed. Metabolic support, antibiotic therapy, debridement of necrotic tissue and tissue repair arethekey of treatment. Cases Report: In this article we present a literature review of the disease and present 3 cases of different resolution in ourhospital, as examples, with their photographic records. Discussion: The perineal necrotizing fasciitis is aseriousinfectious entity that requires early diagnosis, early multidisciplinary treatment and tissue reconstruction according to case, for which there are several options...

Gangrena de Fournier / Fournier’s gangrene

Catalogada como urgencia urológica, la gangrena de fournier es una enfermedad infecciosa de los genitales y del periné, rápidamente progresiva, que aparece a cualquier edad en hombres y aun en mujeres. Fournier en 1884 describió cinco casos de fascitis necrosante de genitales externos por causa desconocida; a la fecha se reconocen diversos factores etiológicos como lesión o infección del tracto genitourinario, focos infecciosos anorrectales, diabetes mellitus, inmunosupresion, HIV positivo. El proceso fisiopatológico consiste en la diseminación bacteriana linfática o hematógena o por contigüidad celular, que produce edema y disminución del aporte de oxígeno, infección linfática, venenosa y trombosis, estableciendo un medio propicio para la proliferación bacteriana y la destrucción tisular. Se produce enfisema tisular por infiltrado de gas cuando los agentes causantes son anaerobios, sobreviniendo la toxemia. Por todas estas razones es que la importancia radica en la rápida acción del médico cirujano de la aplicación de las medidas necesarias para salvar la vida del paciente.

Classified as a medical urgency, fournier’s gangrene is a rapidly progressive bacterial infection of the skin that affects the genitals and perineum common in men and women of any age. Fournier in 1884 discovered five cases of necrotizing fasciitis of genitals for unknown cause. Now it is known that there are a number of risk factors such as infection of genitourinary tract, anorectal infection, diabetes mellitus, immune system disorders and HIV positive.Lymphatic and hematogenous dissemination of the bacteria causes edema, lymphatic, venous and thrombotic infection caused by bacterial proliferation and tissue destruction. There will also be subcutaneous emphysema because the air gets into the tissues when the causative agents are anaerobics . Due to all these reasons it is important surgical intervention to save the life of the patient.