Fournier's Gangrene: clinical case review and analysis of risk factors for mortality.

BACKGROUND: Fournier's Gangrene is a severe surgical infectious disease, and various risk factors can increase its mortality rate. The purpose of this study is to retrospectively analyze the clinical characteristics and laboratory data of Fournier's Gangrene patients, followed by an analysis of mortality-related risk factors. This study has no secondary objectives. METHODS: This study included 46 hospitalized patients diagnosed with Fournier's Gangrene at Suzhou Traditional Chinese Medicine Hospital from December 2013 to March 2024. Clinical data for all patients were extracted from the electronic medical records system. The collected data included gender, age, duration of illness, length of hospital stay, sites of infection involvement, comorbidities, white blood cell count, hematocrit, albumin, blood glucose, creatinine, serum sodium, serum potassium upon admission, microbial culture results, and patient outcomes (survival/death). The Simplified Fournier Gangrene Severe Index (SFGSI) was used to score all patients. Patients were categorized into survival and death groups based on clinical outcomes. Differences between categorical variables were compared using the χ² test or Fisher's exact test. Differences between numerical variables were compared using Student's t-test or the Mann-Whitney U test. Binary logistic regression was employed to analyze the risk factors for mortality in Fournier's Gangrene. RESULTS: Among the 46 Fournier's Gangrene patients, 39 were male (84.8%) and 7 were female (15.2%). The age ranged from 17 to 86 years, with a median age of 61 years. Fourteen cases (30.4%) were confined to the perianal area, 26 cases (56.5%) had fascial necrosis involving the perianal, perineal, and genital regions, while 6 cases (13.0%) extended to the abdominal wall. At a 3-month postoperative follow-up, 43 patients (93.5%) survived, while 3 patients (6.5%) died shortly after admission due to severe illness. Based on the outcome, patients were divided into survival and death groups with 43 and 3 cases, respectively. Significant differences were observed between the two groups in terms of age (P<0.05), extension to the abdominal wall (P<0.01), hematocrit (P<0.01), albumin (P<0.01), SFGSI (P<0.01), and SFGSI>2 (P<0.01). Binary logistic regression analysis indicated that decreased hematocrit was an independent risk factor for mortality in Fournier's Gangrene patients. CONCLUSION: This study provides a detailed analysis of the clinical characteristics and risk factors for mortality in Fournier's Gangrene patients. The primary outcome of this study is that a decreased hematocrit is an independent risk factor for predicting mortality in FG patients. These findings offer valuable prognostic insights for clinicians, underscoring the importance of early identification and correction of reduced hematocrit to improve patient outcomes and survival rates.

Prognostic factors and clinical outcomes in Fournier's Gangrene: a retrospective study of 35 patients.

BACKGROUND: Fournier's gangrene is a severe form of infectious necrotizing fasciitis affecting the perineum, perianal, and genital areas; it is associated with substantial morbidity and mortality. Hence, it is important to identify prognostic factors that can predict clinical outcomes and guide treatment strategies. Thus, our study aimed to analyze patient characteristics and determine prognostic factors affecting clinical outcomes in Fournier's gangrene. METHODS: This retrospective study involved examining medical records spanning 18 years for patients with Fournier's gangrene at our institution. Considering the exclusion criteria, data from 35 patients were included in this study. RESULTS: A total of 35 patients were included in the analysis. The mean age of the patients showed no statistically significant difference between the survivor and non-survivor groups. The Charlson Comorbidity Index, American Society of Anesthesiologists score, and Acute Physiology and Chronic Health Evaluation II score were not significantly different between the two groups. Notably, the initial Sequential Organ Failure Assessment score was significantly higher in the non-survivor group than that in the survivor group. The overall in-hospital mortality rate was 17.1%. Moreover, the prevalence of multidrug resistant bacterial infection was markedly higher in the non-survivor group than that in the survivor group. Coagulation dysfunction was significantly more prevalent in the non-survivor group than that in the survivor group, and had the most significant impact on in-hospital mortality. A multivariable logistic regression analysis identified multidrug resistant bacterial infection to be independently associated with high in-hospital mortality. CONCLUSIONS: Coagulation dysfunction and multidrug resistant bacterial infection were identified as independent negative prognostic factors, highlighting the need for prompt monitoring and proactive strategies against Fournier's gangrene.

Gangrena de Fournier secundaria a cuerpo extraño: Reporte de caso / Fournier's gangrene secondary to a foreign body: Case report

Introducción. La gangrena de Fournier es un proceso infeccioso progresivo que compromete piel, tejido celular subcutáneo, grasa y fascia subyacente, con una incidencia de 1,6 pacientes por cada 100.000 personas/año. Se considera una urgencia quirúrgica, que requiere de manejo oportuno, ya que puede llegar a ser fatal, con una tasa de mortalidad del 20 al 35 %, que es más alta en hombres, en la tercera década de la vida y en pacientes inmunocomprometidos. Caso clínico. Se presenta el caso clínico de un paciente masculino de 44 años de edad, quien cursó con gangrena de Fournier secundaria a una espina de pescado de 5 cm de largo, incrustada en la unión anorrectal. Resultados. El paciente fue manejado por urología y cirugía general, requirió hospitalización en la Unidad de Cuidados Intensivos y curaciones por parte de terapia enterostomal, con resultados satisfactorios. Conclusiones. Sus posibles causas son múltiples y en ocasiones puede ser desencadenada por un factor externo, como un cuerpo extraño. Uno de los factores predisponentes es la obesidad. El diagnóstico oportuno y un tratamiento con intervención multidisciplinaria mejoran la sobrevida y la calidad de vida de los pacientes.

Introduction. Fournier's gangrene is a progressive infectious process that involves skin, subcutaneous tissue, fat and underlying fascia, with an incidence of 1.6 per 100,000 people/year. It is considered a surgical emergency, which requires timely management since it can be fatal, with a mortality rate of 20 to 35%, which is higher in men, in the third decade of life and in immunocompromised patients. Clinical case. Clinical case. A 44-year-old male patient is presented with Fournier's gangrene secondary to a 5 cm long fishbone embedded in the anorectal junction. Results. The patient was managed by urology and general surgery, requiring hospitalization in the ICU and treated by enterostomal therapy with satisfactory results. Conclusions. Its possible causes are multiple and sometimes it can be triggered by an external factor, such as a foreign body. One of the predisposing factors is obesity. Timely diagnosis and treatment with multidisciplinary intervention improve survival and quality of life of patients

Can the SIARI score be used at initial admission to predict testes involvement in patients with fournier's gangrene; a single-centre, retrospective study.

BACKGROUND: To predict testicular involvement in patients diagnosed with Fournier's gangrene (FG) using the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score and the site other than lower limb (SIARI) score. METHODS: The medical records of 51 patients operated for FG in our clinic between December 2012 and April 2022 were evaluated retrospectively in this study. Patients' demographics, and laboratory test results were compared with the testisticular involvement status. Patients with testisticular involvement (n = 10) were compared with patients without testicular involvement (n = 41). The SIARI score at initial admission was analysed using logistic regression analyses for its performance in predicting testicular involvement with FG. Receiver operating characteristics (ROC) curves and the area under the receiver operating characteristic curve (AUROC) were used to evaluate its discriminating ability. RESULTS: The SIARI score had modest performance for diagnosing testicular involvement in FG patients, with ROC analysis showing an AUROC value of 0.83 (p < 0.001). With a SIARI cut-off score of ≥ 3, the sensitivity was 90% and the specificity was 68%. For a SIARI cut-off score of ≥ 5, the sensitivity was 40% and the specificity was 97%. CONCLUSIONS: The ability of the SIARI score to discriminate FG with testicular involvement is modest. The SIARI score should be employed cautiously as a routine diagnostic tool for the prediction of testicular involvement in FG at the initial admission. More research is needed to develop a better understanding of the relationship between the SIARI score and testicular involvement in FG.

Development of Fournier's gangrene after chemotherapy for the recurrence of testicular cancer despite the absence of anorectal lesions: A case report.

BACKGROUND: Fournier's gangrene usually occurs when a specific bacterium intrudes into soft tissue, causing a wound or tumor. We encountered a patient with Fournier's gangrene due to severe myelosuppression after chemotherapy, despite the absence of an initial lesion on the anus and rectum. CASE PRESENTATION: A 54-year-old man with a left testicular cancer recurrence had undergone chemotherapy. He had asymptomatic hepatitis and high hepatitis B virus DNA levels, which were normalized by administering tenofovir alafenamide fumarate. Twelve days after the start of chemotherapy, he complained of severe pain around the anus. The following day, he went into septic shock. Visual inspection showed dark purple skin discoloration on the left side of the anus. Laboratory data revealed severe neutropenia. Computed tomography showed a high density of soft tissue on the left side of the anus and gas bubbles in the left femoral ring. We diagnosed the patient with Fournier's gangrene due to a severe immunosuppressive state resulting from chemotherapy. We emergently removed necrotic tissue to the fullest extent possible. However, because the patient was in severe sepsis status, careful management in the intensive care unit was required for 32 days. After the first emergency operation, we performed several additional excisions. Finally, 391 days after the initial surgery, the patient was discharged from our hospital. The tumor has not recurred, and he is under outpatient observation in the urology department. CONCLUSION: Fournier's gangrene should be considered in patients who are in a severe myelosuppressive state due to chemotherapy, have normal hepatitis B virus DNA levels but high hepatitis B surface antigen after tenofovir administration, complain of severe pain in the perianal area, and have a dark purple skin discoloration around the anus, despite having no initial anorectal lesions.

Association between Insurance Status and Outcomes of Hospitalizations for Necrotizing Soft Tissue Infections.

Background: Lack of insurance is associated with poorer outcomes in hospitalized patients. However, few studies have explored this association in hospitalizations for necrotizing soft tissue infections (NSTIs). This study examined the impact of insurance status on the outcome of NSTI admissions. Methods: All adult hospitalizations for necrotizing fasciitis, gas gangrene, and Fournier gangrene between 2016 and 2018 were examined using the Nationwide Inpatient Sample database. Insurance status was categorized as insured (including Medicare, Medicaid, and Private, including Health maintenance organization (HMO) or uninsured (Self-pay). Outcome measures included mortality rates, limb loss, length of hospital stay, prolonged hospital stay, and critical care admissions. Statistical analysis included weighted sample analysis, chi-square tests, multivariate regression analysis, and negative binomial regression modeling. Results: Approximately 29,705 adult hospitalizations for NSTIs were analyzed. Of these, 57.4% (17,065) were due to necrotizing fasciitis, 22% (6,545) to gas gangrene, and 20.5% (6,095) to Fournier gangrene. Approximately 9.7% (2,875) were uninsured, whereas 70% (26,780) had insurance coverage. Among the insured, Medicare covered 39.6% (10,605), Medicaid 29% (7,775), and private insurance 31.4% (8,400). After adjustments, Medicare insurance was associated with greater odds of mortality (adjusted odds ratio [aOR]: 1.81; 95% confidence interval [CI]: 1.33-2.47; p = 0.001). Medicaid insurance was associated with increased odds of amputation (aOR: 1.81; 95% CI: 1.33-2.47; p < 0.001), whereas private insurance was associated with lower odds of amputation (aOR: 0.70; 95% CI: 0.51-0.97; p = 0.030). Medicaid insurance was associated with greater odds of prolonged hospital stay (aOR: 1.34; 95% CI: 1.09-1.64; p < 0.001). No significant association was observed between the lack of insurance or self-pay and the odds of primary or secondary outcomes. Conclusion: Medicare insurance was correlated with greater odds of mortality, whereas Medicaid insurance was associated with increased odds of amputation and longer hospital stay. Uninsured status was not associated with significant differences in NSTI outcomes.

[Treatment of Fournier's gangrene with "firebreak" drainage based on skin preservation].

Objective: To observe the clinical efficacy of a new type of "firebreak" drainage with skin preservation in the treatment of Fournier's gangrene. Methods: This technique is suitable for patients with perianal necrotizing fasciitis who can tolerate surgery without large area of skin blackness and necrosis. Procedure and key points: (1) The dividing line between inflammatory tissue and normal tissue was determined according to imaging examination and intraoperative exploration; (2) The abscess cavity was cut along the most obvious part of the abscess fluctuation, with a long diameter of 3~4 cm and a short diameter of 1~2 cm; (3) Necrotic tissue was discreetly separated and removed from the main incision to the outer edge of the infection. A fusiform incision was made every 3 to 5 cm, with a long diameter of 2 to 3 cm and a short diameter of 1 cm, and discreetly separated until the normal tissue, and a hose was hung between the adjacent incisions for drainage. (4) Each adjacent edge cut between the stealth separation and hanging hose drainage, forming a "firebreak"; (5) Rinse the wound repeatedly; (6) If the infection invades the rectum, colostomy is performed as required. The case data of 11 patients with perianal necrotizing fasciitis admitted to the Second Affiliated Hospital of Nanjing University of Chinese Medicine from July 2019 to February 2023 were retrospectively analyzed. All patients were treated with emergency surgical debridement by "firebreak" drainage with skin preservation. Results: All 11 cases were cured with 100%. One case underwent multiple operations. The hospitalization time was 11-46 days, with an average of 22 days. The wound healing time was 28-75 days, with an average of 43 days. Except for 1 patient with trauma, all the other patients had no significant anal function injury after surgery. All the 11 patients recovered and were discharged from hospital with a median follow-up of 136 (115-413) days. Conclusions: The "firebreak" drainage based on skin preservation has the advantages of less trauma and faster recovery, and do not cause obvious anal function damage.

Volumetric computed tomography measurements as predictors for outcomes in a cohort of Fournier's gangrene patients.

PURPOSE: This study evaluates the prognostic value of CT findings, including volumetric measurements, in predicting outcomes for patients with Fournier gangrene (FG), focusing on mortality, ICU admission, hospital stay length, and healthcare costs. METHODS: A retrospective study was conducted on 38 FG patients who underwent CT scans before surgical debridement. We analyzed demographic data, CT volumetric measurements, and clinical outcomes using logistic and linear regression models. RESULTS: No single CT measurement significantly predicted mortality or ICU admission. The best model for mortality prediction included age, air volume, NSTI score, and male sex, with an AUC of 0.911. Intubation likelihood was modeled with an AUC of 0.913 using age, NSTI score, and visceral to subcutaneous fat ratio. The ICU admission model achieved an AUC of 0.677. Hospital stay was predicted by air volume (ß = 0.0002656, p = 0.0505) with an adjusted R-squared of 0.1287. Air volume significantly predicted hospital costs (ß = 2.859, p = 0.00558), resulting in an adjusted R-squared of 0.2165. CONCLUSION: Volumetric CT findings provide valuable prognostic insights for FG patients, suggesting a basis for informed clinical decisions and resource allocation. Further validation in larger, multi-center studies is recommended to develop robust predictive models for FG outcomes.

Comparing scoring systems for Fournier gangrenes in predicting morbidity and mortality: Is FGSI still reliable?

INTRODUCTION: Compare scoring systems using Fournier gangrene severity index (FGSI), Uludag Fournier gangrene severity index (UFGSI), Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC), and neutrophil-lymphocyte ratio (NLR) to predict the outcome of patients with Fournier gangrene. MATERIALS AND METHODS: This is a retrospective cohort study that includes FG patients from 2012 to 2021. NLR, FGSI, UFGSI, and LRINEC values were calculated and analyzed. Each scoring system was analyzed using a receiver-operating curve (ROC) analysis to determine its sensitivity, specificity, and area under the curve (AUC). Statistical analysis was performed using SPSS version 25. RESULTS: A total of 158 patients were included in this study. Regarding the mortality outcome, FGSI comprised the highest value of AUC with 80.9, with a sensitivity of 91.7% and specificity of 68.5%. LRINEC comprised the AUC value of 61.1, with 79.2% sensitivity and 64.2% specificity. NLR comprised an AUC value of 63.7, 91.7% of sensitivity, and 98.1% of specificity. In terms of length of stay, LRINEC and NLR were associated as significant predictor. CONCLUSION: FGSI, UFGSI, and NLR are significant predictors associated with mortality in patients with Fournier gangrene. FGSI and UFGSI comprised the highest sensitivity and specificity value in predicting mortality prognosis. Moreover, this study highlighted the role of NLR and LRINEC as significant predictors for the length of hospitalization. This study shows that FGSI is still a reliable scoring system for predicting mortality in patients with Fournier Gangrene. LEVEL OF EVIDENCE: II.

Fournier's gangrene originating from the perianal region or the urogenital area: does it make a difference?

OBJECTIVE: Fournier's gangrene (FG) is a rare and serious disorder which is associated with high mortality. In the literature, there is no study evaluating clinician-, patient- and disease-related factors affecting disease outcomes according to aetiological variation in FG. In our study, laboratory results and Uludag Fournier's Gangrene Severity Index (UFGSI) score, clinical characteristics and mortality rates were compared between FG originating from perianal or from urogenital regions. METHOD: Platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) and UFGSI risk scores were calculated in patients with FG at presentation to the emergency department. The patients were assigned to two groups according to FG aetiology. RESULTS: It was observed that the number of debridement interventions and the need for colostomy were significantly greater in the perianal FG group, while the need for flap or reconstruction was significantly (p=0.002) higher in the genitourinary FG group. No significant difference was detected in mortality between groups and the difference in aetiology had no significant effect on the results of the neutrophil-to-lymphocyte ratio, LRINEC or UFGSI scores. CONCLUSION: Laboratory results and UFGSI score were helpful in assessing disease severity independently from aetiology. The higher number of debridement interventions to protect anal function in the perianal group and the greater need for reconstructive surgery in the urogenital group were identified as factors that prolonged length of hospital stay.

Scrotal reconstruction after Fournier's Gangrene using the superficial circumflex iliac artery perforator (SCIP) propeller flap: A case report.

INTRODUCTION: Fournier's gangrene, a rare infectious condition affecting the external genitalia, often requires aggressive medical-surgical interventions, resulting in variable scrotal tissue loss. Despite numerous proposed reconstruction techniques, achieving a consensus on the most effective approach that balances aesthetics and function remains elusive. This case report presents a one-year follow-up on scrotal reconstruction using a pedicled Superficial Circumflex Iliac Artery Perforator (SCIP) propeller flap. CASE REPORT: A 56-year-old patient with significant scrotal tissue loss due to Fournier's gangrene underwent scrotal reconstruction using a pedicled SCIP propeller flap. Optimal placement was ensured through a subcutaneous tunnel, with a thin thigh skin graft applied to cover the penile skin defect. DISCUSSION: The SCIP flap is distinguished by its thin and pliable characteristics, rapid harvesting and featuring a discreet donor site. It stands as a compelling alternative to skin grafts, providing advantages in sensory restoration, color congruence, and resilience against tension. Considering the thickness of the reconstruction helps both in recovering testicular function and improving the appearance by restoring the natural contour. CONCLUSION: The utilization of the pedicled SCIP propeller flap for scrotal tissue loss resulting from Fournier's gangrene has demonstrated both aesthetic and functional success, underscoring its potential as an effective reconstructive option.

Fournier's Gangrene as an Adverse Event Following Treatment with Sodium Glucose Cotransporter 2 Inhibitors.

We present the case of a 51-year-old male with known congestive heart failure and acute myocarditis who presented to the emergency department (ED) with swollen testicles and urinary symptoms two weeks after the initiation of sodium glucose cotransporter 2 (SGLT2) inhibitor treatment. Abdominal and pelvic computed tomography (CT) scan was consistent with the diagnosis of Fournier's gangrene (FG). Intravenous antibiotics were administered and surgical exploratory intervention and excision of necrotic tissue were performed, stopping the evolution of necrotizing fasciitis. FG, a reported adverse event, may rarely occur when SGLT2 inhibitors are administered in patients with diabetes. To our knowledge, there have been no reported cases of FG in Romania since SLGT2 inhibitors were approved. The distinguishing feature of this case is that the patient was not diabetic, which emphasizes that patients without diabetes who are treated for heart failure with SGLT2 inhibitors may also be at risk of developing genitourinary infections. The association of predisposing factors may have contributed to the development of FG in this case and even though the benefits of SGLT2 inhibitors outweigh the risks, serious adverse events need to be voluntarily reported in order to intervene promptly, verify the relationship, and minimize the risk of bias.

Evaluating prognostic indicators for in-hospital mortality in Fournier's gangrene: a 7-year study in a tertiary hospital.

BACKGROUND: Fournier's Gangrene Scoring Index (FGSI), Simplified FGSI (SFGSI), Uludag FGSI (UFGSI), Laboratory Risk Indicator for Necrotizing (LRINEC), Neutrophil-Lymphocyte ratio (NLR), and Platelet-lymphocyte ratio (PLR) have been devised to assess the risk of mortality in Fournier's Gangrene (FG) patients. However, the effectiveness of these indicators in predicting mortality at the time of admission remains uncertain. The aim of this study is to assess the prognostic efficacy of FG's various indicators on in-hospital mortality. METHODS: This study analyzed 123 patients from Dr. Soetomo General Hospital's emergency department in Indonesia from 2014 to 2020. Data included demographics, wound cultures, and parameters like FGSI, UFGSI, SFGSI, NLR, PLR, and LRINEC. In-hospital mortality status was also recorded. The data was subjected to comparative, sensitivity, specificity and regression analyses. RESULTS: In our study of 123 patients, the median age was 52, with a mortality rate of 17.9%. The majority of patients were male (91.1%) and the most common location was scrotal (54.5%). Non-survivors had a shorter median stay (6.5 days) compared to survivors (14 days). Diabetes was the most prevalent comorbidity (61.8%). The highest sensitivity and specificity were found in FGSI and UFGSI indicators. Multivariate logistic regression identified LoS and FGSI as independent predictors of mortality. CONCLUSIONS: FGSI and UFGSI, upon admission, demonstrated the highest sensitivity and specificity, with hospital stay duration and FGSI as key mortality determinants.

Lymphocyte-to-C-reactive protein ratio as a new biomarker for predicting mortality and morbidity in Fournier's gangrene.

OBJECTIVE: The purpose of this study was to research the neutrophil-lymphocyte ratio (NLR), lymphocyte-to-C-reactive protein ratio (LCR), and Fournier's Gangrene Severity Index (FGSI) for predicting prognosis and mortality in patients with Fournier's gangrene (FG). MATERIAL AND METHODS: Patients diagnosed with FG and treated in a tertiary referral hospital in the period from January 2013 to June 2020 were reviewed. LCR, FGSI, and NLR values were calculated. RESULTS: Our series included a total of 41 patients. Of the patients, 78% survived and 21.9% (n = 9) died. Survivors were significantly younger than non-survivors (p = 0.009). Hospital costs were higher in non-survivors and close to statistical significance (p = 0.08). The ROC analysis revealed that the FGSI, LCR, and NLR parameters were significant in identifying survivors and non-survivors (AUC = 0.941 [0.870-1.000], p < 0.001; AUC = 0.747 [0.593-0.900], p = 0.025; and AUC = 0.724 [0.548-0.900], p = 0.042). CONCLUSION: A low LCR value can be used as a marker to assess mortality and disease severity in patients with Fournier's gangrene.

OBJETIVO: Investigar el cociente neutrófilos-linfocitos (CNL), el cociente linfocitos-proteína C reactiva (CLP) y el índice de gravedad de la gangrena de Fournier (IGGF) para predecir el pronóstico y la mortalidad en pacientes con gangrena de Fournier (GF). MÉTODO: Se revisaron los pacientes diagnosticados de GF y atendidos en un hospital de tercer nivel de referencia en el período de enero de 2013 a junio de 2020. Se calcularon los valores de CLP, IGGF y CNL. RESULTADOS: Nuestra serie incluyó 41 pacientes, de los cuales el 78% sobrevivieron y el 21.9% (n = 9) fallecieron. Los supervivientes eran significativamente más jóvenes que los no supervivientes (p = 0.009). Los costes hospitalarios fueron mayores en los no supervivientes y cercanos a la significación estadística (p = 0.08). El análisis ROC reveló que los parámetros IGGF, CLP y CNL fueron significativos para identificar supervivientes y no supervivientes (AUC: 0.941 [0.870-1.000], p < 0.001; AUC: 0.747 [0.593-0.900], p = 0.025; AUC: 0.724 [0.548-0.900], p = 0.042). CONCLUSIONES: Un valor bajo de CLP se puede utilizar como marcador para evaluar la mortalidad y la gravedad de la enfermedad en pacientes con GF.

Acute Myelomonocytic Leukemia Presenting as Fournier's Gangrene.

INTRODUCTION: Acute myelomonocytic leukemia is a type of acute myeloid leukemia with monocytic expansion. Both the disease and its treatment can be immunocompromising. Immunocompromised patients are more susceptible to infections, such as Fournier's gangrene, a rare necrotizing infection of the groin. CASE PRESENTATION: A 56-year-old male presented to the emergency department with abdominal pain, leukocytosis, and perineal ecchymosis. Overnight, his perineal discoloration and tenderness worsened. He underwent irrigation and debridement for Fournier's gangrene and received broad-spectrum antimicrobial therapy. Subsequent workup revealed acute myeloid leukemia with leukemia cutis and central nervous system involvement, necessitating chemotherapy initiation prior to complete wound healing. DISCUSSION/CONCLUSIONS: This case highlights the challenges in the diagnosis and management of acute leukemia in the setting of a concomitant life-threatening soft tissue infection, as both the hematologic disease and treatment thereof can exacerbate infectious complications.

Variables that predict hospital stay and the outcome of Fournier gangrene at King Abdulaziz University Hospital: a retrospective study.

BACKGROUND: The aggressive nature of Fournier gangrene and the associated health issues can result in a more complex clinical course and potentially a longer hospital stay. This study aimed to assess factors that affect the length of hospital stay (LHS) and its relation to the outcome of Fournier gangrene patients. METHODS: A retrospective study was performed at King Abdulaziz University Hospital (KAUH), Saudi Arabia, on patients diagnosed with Fournier gangrene between 2017 and 2023. Data about length of hospital stay (LHS), age, BMI, clinical and surgical data and outcome was obtained. RESULTS: The mean age of the studied patients was 59.23 ± 11.19 years, the mean body mass index (BMI) was 26.69 ± 7.99 kg/m2, and the mean duration of symptoms was 10.27 ± 9.16 days. The most common presenting symptoms were swelling or induration (64%), 88% had comorbidities with diabetes mellitus (DM) (84%), and 76% had uncontrolled DM. of patients, 24% had a poly-microbial infection, with E. coli being the most common (52%). The mean length of hospital stay (LHS) was 54.56 ± 54.57 days, and 24% of patients had an LHS of more than 50 days. Longer LHS (> 50 days) was associated with patients who did not receive a compatible initial antibiotic, whereas shorter LHS was associated with patients who received Impenem or a combination of vancomycin and meropenem as alternative antibiotics following incompatibility. Reconstruction patients had significantly longer LHS and a higher mean temperature. However, none of the studied variables were found to be predictors of long LHS in the multivariate regression analysis. CONCLUSION: Knowledge of the values that predict LHS allows for patient-centered treatment and may be useful in predicting more radical treatments or the need for additional treatment in high-risk patients. Future multicenter prospective studies with larger sample sizes are needed to assess the needed variables and predictors of long LHS.

Role of diverting colostomy and reconstruction in managing Fournier's gangrene-a narrative review.

OBJECTIVE: To examine the role of bowel diversion and reconstructive surgeries in managing Fournier's gangrene (FG) to facilitate multidisciplinary collaboration between urologists, colorectal and plastic surgery teams. METHODS: A review of the literature was conducted using the databases Medline, Embase, PubMed in June 2023. The review included studies that evaluated the outcomes of FG following reconstructive surgeries or diverting colostomies. RESULTS: The existing evidence suggests that bowel diversion and colostomy formation could reduce the need for further debridement, shorten the time to wound healing, and facilitate skin graft or flap uptake in patients with FG. Additionally, the psychological impact of a stoma was shown not to be a major concern for patients. However, stoma carries a risk of perioperative complications and therefore may prolong the length of hospital stay. In reviewing the evidence for reconstruction in FG, large and deep defects seem to benefit from skin grafts or flaps. Noticeably, burial of testicles in thigh pockets has grown out of favour due to concerns regarding the thermoregulation of the testicles and the psychological impact on patients. CONCLUSION: The use of bowel diversion and reconstructive surgeries in managing FG is case dependent. Therefore, it is important to have close discussions with colorectal and plastic surgery teams when managing FG.

Risk Factors for Mortality Among Patients With Fournier Gangrene: A Systematic Review.

Background: Fournier gangrene (FG) is a form of necrotizing fasciitis involving the perineal, peri-anal, and genital structures, and has exceptionally high mortality rates. To help in early detection of high-risk patients, we aimed to systematically review factors associated with mortality from FG. Patients and Methods: Searches were conducted in PubMed, Embase and Scopus. In our review, a minimum of five patients were required and this was to exclude studies with exceedingly small sample sizes, such as case reports and small case series, with minimal relevance in comparison to larger scale studies. Patient characteristics, causative microbes, anatomic areas of infection, presence of comorbidities, severity scores, causes of FG, and complications were extracted and compared to identify factors related to mortality. Results: A total of 57 studies were included in the review. Across 3,646 study participants, the mortality rate of FG was 20.41%. The mean age of non-survivors was 61.27 years. There were more total male deaths, however, the mortality rate was higher in females. Diabetes mellitus was the most common comorbidity in those who died, but the highest mortality rate was seen in HIV patients (54.17%). Mortality rates did not differ widely among antibiotic agents. Regarding causative organisms, fungal infections had the highest rates of mortality (68.18%) and the most common microbe leading to death was Escherichia coli. Conclusions: Female gender, comorbidities, anatomic distribution, development of sepsis, and fungal infection all increased risk for mortality. Early identification of risk factors, and provision of appropriate treatment are crucial in reducing mortality rates of high-risk patients with FG.