Gracilis Muscle Interposition to Fill the Perianal Dead Space May Decrease Hospital Length of Stay in Fournier's Gangrene.

PURPOSE: The treatment of Fournier's gangrene (FG) includes aggressive debridement of the affected necrotic area, broad-spectrum antibiotic therapy, and reconstructive procedures, respectively. One of the main reasons of unfavorable outcomes in FG surgery is that the dead space occurs in the perianal region because of destruction of fascias and soft tissues. In this study, we aimed to evaluate the results of gracilis muscle flap transposition to fill the FG-associated perianal dead spaces. METHODS: Patients treated for FG-associated dead spaces in their perianal region between the years 2017 and 2021 were included in the study. The patients who underwent the pedicled gracilis muscle flap surgery were included in group 1, whereas group 2 consisted of the patients with no additional surgical procedure for dead spaces but only the reconstruction of the soft tissue defects. Demographic data (age, sex), comorbid diseases, localization and length of perianal dead space, and management method for the soft tissue defects and complications were noted. The length of hospital stay and discharge day after surgery were also recorded. RESULTS: In group 1, the mean duration of hospital stay was 23.5 ± 5.0 (range, 14-48) days, whereas the mean period between the surgery and discharge was 5.1 ± 2.2 (range, 3-12) days. These numbers were 31 ± 8.3 (range, 19-58) days and 12.7 ± 6.1 (range, 7-22) days in group 2, respectively. Statistical comparison of the periods between the surgery and discharge was found to be significantly different ( P = 0.022). The duration of hospital stay was also shorter in the patients with gracilis muscle flap ( P = 0.039). CONCLUSIONS: Perianal dead spaces accompanying many of the patients with FG provide appropriate conditions for bacterial colonization. Filling these pouches by the gracilis muscle flap prevented the progression of infection and enabled the patients to return to their normal life earlier.

A rare case of male Fournier's gangrene with mixed Actinomyces turicensis infection.

BACKGROUND: Fournier's gangrene (FG), a urological emergency with high mortality, is an infectious necrotizing fasciitis of the perineal and genital regions. The majority of FG is caused by polymicrobial organisms involving mixed aerobes and anaerobes but rarely reveals Actinomyces species. CASE PRESENTATION: We report a healthy 67-year-old Asian male who presented with rapidly progressive painful swelling of the scrotum. Clinically diagnosed with FG, the patient underwent an emergency radical debridement, followed by broad-spectrum antibiotics and negative pressure wound therapy. The identification of the causative microorganisms showed Actinomyces turicensis and the antibiotic treatment was adjusted accordingly. After wound bed preparation, we took split-thickness skin grafts to cover the scrotal wound. Active management to minimize faecal contamination was applied throughout the whole course of treatment and repair. The patient was satisfied with the outcome. This was an extremely rare case of A. turicensis as the main causative pathogen of FG. CONCLUSIONS: FG due to Actinomyces species is rarely reported, but we should still consider this pathogenic microorganism that has long been neglected.

Fournier's gangrene: Presentation and predictors of mortality in Zaria, Nigeria.

Background: Fournier's gangrene is an infectious urological emergency with associated morbidity and varying rates of mortality in the world. Various predictors of mortality such as advancing age, Fournier's Gangrene Severity Index (FGSI), anatomical extent of the disease, or presence of risk factors have been studied in the literature, though with conflicting results. Aim: The aim of the study was to determine the presentation and predictors of mortality in our environment, Nigeria. Patients and Methods: A review of medical records of all the patients managed from April 2012 to December 2018 at a tertiary referral center in Nigeria was conducted. Data on clinical presentation, FGSI, management, and outcome were retrieved and analyzed. Statistical Analysis: Descriptive studies using mean and standard deviation were used for continuous variables, Fischer's exact test was used to compare categorical variables among survivors and nonsurvivors, and logistic regression analysis was used to describe the relationships of these variables with mortality. Results: The mean age of the 31 patients was 60 ± 12 years. All were men, with 9 (29.0%) patients without clinical evidence of immunosuppression or predisposing factor (idiopathic). Fourteen (45%) had documented evidence of immunosuppression. All the patients had a polymicrobial infection; however, Escherichia coli was the most common organism cultured seen in 26 (83.9%) patients. The initial empirical antibiotic regimen of choice was a combination of intravenous ceftriaxone and metronidazole in 26 (83.8%) patients and intravenous ciprofloxacin and metronidazole in 5 (16.1%) patients. Mortality was recorded in three patients representing a rate of 9.6%. Anatomical extent of the disease, anemia requiring blood transfusion, severity of infection, and FGSI were all found to be the statistically significant variable of mortality in these patients using the Fischer exact test. Furthermore, on regression analysis only the FGSI and blood transfusion were significant with P < 0.05. Conclusion: Fournier's gangrene is a disease of the older men with a higher mortality rate when the FGSI is >9 or anemia requiring blood transfusion is present.

RésuméContexte: La gangrène de Fournier est une urgence urologique infectieuse associée à une morbidité et à des taux de mortalité variables Dans le monde. Divers prédicteurs de mortalité tels que l'âge avancé, l'indice de gravité de la gangrène de Fournier (FGSI), l'étendue anatomique. De la maladie ou la présence de facteurs de risque ont été étudiés dans la littérature, mais avec des résultats contradictoires. Objectif: le but du L'étude visait à déterminer la présentation et les prédicteurs de la mortalité dans notre environnement, au Nigeria. Patients et méthodes: un examen de la Des dossiers de tous les patients pris en charge d'avril 2012 à décembre 2018 dans un centre de référence tertiaire au Nigéria ont été réalisés. Les données Sur la présentation clinique, FGSI, la gestion et les résultats ont été récupérés et analysés. Analyse statistique: études descriptives Utilisant la moyenne et l'écart type ont été utilisés pour les variables continues, le test exact de Fischer a été utilisé pour comparer les variables catégorielles Parmi les survivants et les non-survivants, et une analyse de régression logistique a été utilisée pour décrire les relations de ces variables avec Mortalité. Résultats: l'âge moyen des 31 patients était de 60 ± 12 ans. Tous étaient des hommes, avec 9 (29,0%) patients sans preuve clinique D'immunosuppression ou de facteur prédisposant (idiopathique). Quatorze (45%) avaient des preuves documentées d'immunosuppression. Tout Les patients avaient une infection polymicrobienne; cependant, Escherichia coli était l'organisme le plus couramment cultivé chez 26 (83,9%) Les patients. Le schéma antibiotique empirique initial de choix était une association de ceftriaxone intraveineuse et de métronidazole. 26 (83,8%) patients et ciprofloxacine et métronidazole par voie intraveineuse chez 5 (16,1%) patients. La mortalité a été enregistrée chez trois patients Représentant un taux de 9,6%. Étendue anatomique de la maladie, anémie nécessitant une transfusion sanguine, gravité de l'infection et FGSI Ont tous été trouvés comme étant la variable statistiquement significative de la mortalité chez ces patients en utilisant le test exact de Fischer. En outre, Sur l'analyse de régression, seuls le FGSI et la transfusion sanguine étaient significatifs avec P <0,05. Conclusion: la gangrène de Fournier est une Maladie des hommes plus âgés avec un taux de mortalité plus élevé lorsque le FGSI est> 9 ou une anémie nécessitant une transfusion sanguine est présente.

Fournier Gangrene as a Complication of a Perinephric Abscess After Kidney Transplant: A Case Report.

Fournier gangrene is a progressive necrotizing infection of the external genitalia or perineum that constitutes a urologic emergency. Incidence of Fournier gangrene is rising because of population aging, increasing comorbidities, and widespread use of immunosuppressive therapy, including immunosuppressive regimens used in kidney transplants. This is a rapidly progressive and potentially lethal disease without treatment, and early recognition of the disease, proper management of the predisposing factors, and aggressive surgical debridement are the most essential interventions. We report a rare case of Fournier gangrene in the early postoperative period of a kidney transplant due to a perinephric abscess.

Gas Where It Shouldn't Be! Imaging Spectrum of Emphysematous Infections in the Abdomen and Pelvis.

OBJECTIVE. The purpose of this article is to review the spectrum, etiopathogenesis, clinical presentation, imaging features, differential diagnoses, and management of emphysematous infections of the abdomen and pelvis. CONCLUSION. Emphysematous infections are associated with high morbidity and mortality and thus need urgent medical and surgical interventions. CT is the most sensitive modality to detect gas; CT provides definitive diagnosis in most cases and can depict the extent of involvement.

Fournier's Gangrene in Females: Presentation and Management at a Tertiary Center.

OBJECTIVE: To report and compare presentation and management of Fournier's Gangrene (FG) in female vs male patients at a single tertiary care center. METHODS: Patient demographics, clinical characteristics, treatments and outcomes were summarized and compared between males and females who were treated for FG from 2011 to 2018 at a single institution. RESULTS: Of the 143 patients treated for FG at our institution, 33 (23%) were female. Female patients were predominantly white (82%), with a median (IQR) age of 55 (46, 59). Median female boby mass index (BMI) was 42.1 (32, 50.4). Female patients' wound cultures were polymicrobial mix of gram positive and gram negative organisms. Median number of debridements for females was 2 (1,3). The most common anatomic region of gangrene involvement in females was labia (76%) followed by perineum (55%) and gluteus/buttocks (42%). Mortality rate during initial admission was 6% for females. Female patients had a higher median BMI than males (42.1 vs 33.7 respectively; P = .003). FG severity index, length of hospital stay, number of debridements, and wound cultures were comparable to males. The surgical team managing initial debridements differed with females managed primarily by general surgery and males primarily by urology. Mortality rate was comparable to men (6% vs 7%, P >.05). CONCLUSION: Female patients with FG have greater BMI but similar clinical presentation, microbiologic characteristics and mortality rate compared to men. Urologists have little involvement during initial management for females at our institution.

Microorganisms and Antibiogram Patterns in Fournier's Gangrene: Contemporary Experience from a Single Tertiary Care Center.

PURPOSE: We evaluate the prevalent microorganisms, antibiotic sensitivity patterns and associated outcomes in patients with Fournier's gangrene. MATERIALS AND METHODS: A retrospective chart review of patients with Fournier's gangrene was conducted between October 2011 and April 2018 at our institution. Univariate analysis was performed using the independent t-test or Kruskal-Wallis H test for continuous variables and exact test for categorical variables. RESULTS: Of the 143 patients included in this study, wound culture was available in 131 (92%) patients with a median number of 3 microorganisms per wound. The most commonly grown pathogens were Staphylococcus species (66, 46%), Streptococcus species (53, 37%), Bacteroides species (34, 24%), Candida species (31, 22%), Escherichia coli (28, 20%) and Prevotella species (26, 18%). Most bacteria were sensitive to ampicillin-sulbactam, ceftriaxone, piperacillin-tazobactam, amikacin and cefepime, and resistant to ampicillin, trimethoprim-sulfamethoxazole, levofloxacin and clindamycin. Enterococcus faecalis and Streptococcus anginosus were resistant to vancomycin. The overall Fournier's gangrene mortality count was 14 (10%) patients. No association was noted between the type of infection and Fournier's gangrene severity index, length of hospital stay or mortality. CONCLUSIONS: At our institution Candida is a prevalent pathogen in the wound culture of patients with Fournier's gangrene. The resistance patterns for clindamycin and vancomycin are concerning. Addition of an antifungal agent to the empiric treatment should be considered based on clinical presentation.

Monomicrobial Fournier's Gangrene Caused by Panton-Valentine Leukocidin-negative Methicillin-susceptible Staphylococcus aureus ST8 in Japan.

Methicillin-resistant Staphylococcus aureus USA300, belonging to sequence type (ST) 8, is a rare cause of necrotizing fasciitis in the USA. We herein report a case of monomicrobial Fournier's gangrene caused by an ST8, methicillin-susceptible Staphylococcus aureus (designated ksw1). Whole-genome sequencing and analyses for virulence determinants revealed that, unlike USA300, ksw1 lacked virulence genes, such as Panton-Valentine leukocidin and SCCmec, while harboring the toxic shock syndrome toxin-1 gene. These genomic features correlate with ST8 CA-MRSA/J, which is the major genotype of ST8 in Japan.

Etiology of Fournier gangrene as a prognostic factor in mortality: Analysis of 121 cases. / Etiología de la gangrena de Fournier como factor pronóstico de mortalidad: análisis de 121 casos.

OBJECTIVE: Evaluate the origin of Fournier gangrene (FG) as a prognostic factor of morbidity and mortality. MATERIAL AND METHODS: Patients who came to our clinic with a diagnosis of FG from 2010 to 2017 were included retrospectively. Patients were categorized depending on the origin of the infection. Three severity factors were determined in each group: days of hospital stay, the FG severity index, and mortality. Logistic regression test was performed to analyze the data. RESULTS: Of the 130 patients evaluated, the origin was established in 121 based on the clinical history and radiological and surgical findings. Thirty-five patients had an intestinal origin with a mortality of 20.68%, 46 patients had a testicular origin with a mortality of 2.22%, 12 patients had a urinary origin with a mortality of 0%, and 28 patients with a cutaneous origin with a mortality of 16.6%. The testicular origin was the most frequent (38%) in addition to presenting a lower hospital stay, a lower FG severity index, and a lower mortality than those with an intestinal origin (P=.022). CONCLUSIONS: The origin of the infection has a significant prognostic value in the mortality of the patient.

Fournier's Gangrene: 10-Year Experience of a Plastic Surgery and Burns Department at a Tertiary Hospital.

INTRODUCTION: Fournier gangrene is a polymicrobial life threatening infection of perineal subcutaneous soft tissues with its point of origin in urologic, colorectal or skin diseases. Although more frequent in elderly and men, it can affect all genders and age groups. Perianal abscess, diabetes mellitus and Escherichia coli are the most frequent cause, predisposing comorbidity, and microorganism found in tissue culture analysis respectively. The objective of this study was to describe the experience of a Plastic Surgery Department of a tertiary Hospital in reconstructing Fournier's gangrene perineal defects and its detailed demography. MATERIAL AND METHODS: The sample is composed of all patients with Fournier gangrene admitted in the Plastic Surgery and Burns Department. The authors retrospectively collected and analyzed demographic and clinical data during a period of 10 years including gender, age, length of stay, cause, number of debridements, predisposing factors, microbial culture results, surgical reconstructive techniques and its associated complications, additional surgical procedures and outcomes. RESULTS: Fifteen patients were identified: 14 males (93%) and one female (7%); mean age was 66.9 years (range: 46 - 86); mean, length of stay was 46.8 days (range: 20 - 71 days) and mean number of debridements was 3.3 (range: 1 - 4). The most frequent predisposing factor was diabetes mellitus, the major cause was perianal (n = 2) and skin abscess (n = 2). Eight (53.3%) patients had no identifiable source of Fournier gangrene. Various types of reconstructive techniques were employed; and 5 additional surgical interventions (33.3%) were undertaken (one cystostomy, two orchidectomy, two ileostomy); six patients (40%) presented reconstructive technique complications with adequate final outcome. DISCUSSION: In contrast with the literature, where Escherichia coli was the most frequently isolated agent, Staphylococcus aureus was the most frequent microorganism found in tissue biopsy/pus collection analysis. A higher than expected number of patients (n = 8) had no identifiable source of Fournier gangrene. This findings can be explained by the retrospective non-multicentre study limitation, with a potencial source of bias patients that were transferred from other hospitals in advanced stage, without point of origin of Fournier's gangrene identified. CONCLUSION: Early recognition and extensive necrotic tissue debridement, along with prompt and adequate antimicrobial treatment, are the mainstay of Fournier gangrene management, thus reducing morbidity and mortality in these patients. Surgical reconstruction challenges derived from this condition should be addressed by specialized teams due to the risk of dysfunctional sequelae and conspicuous deformities. Taking in account the single-center and retrospective observational character of the present study, these premises require proper validation from a multicenter prospective study.

Introdução: A gangrena de Fournier é uma infeção polimicrobiana potencialmente fatal que afeta os tecidos moles do períneo com ponto de origem em patologias urológicas, coloretais ou cutâneas. Apesar de ser mais frequente no sexo masculino e em idosos, pode afetar ambos os géneros e qualquer idade. O abcesso perianal, a diabetes mellitus e a Escherichia coli são respetivamente a causa, a co-morbilidade e o micro-organismo mais frequentemente encontrados. Este estudo teve como objetivo descrever a experiência de um Serviço de Cirurgia Plástica e Queimados de um Hospital terciário no tratamento e reconstrução de defeitos perineais causados por gangrena de Fournier, disponibilizando detalhes sobre a sua demografia. Material e Métodos: A amostra é constituída por todos os doentes internados no serviço de Cirurgia Plástica e Queimados com o diagnóstico de gangrena de Fournier. Os autores realizaram uma colheita e análise retrospetiva de dados clínicos e demográficos durante um período de 10 anos incluindo género, idade, tempo de internamento, causa, número de desbridamentos, fatores predisponentes, resultados microbiológicos de culturas de pus, técnicas reconstrutivas cirúrgicas e suas complicações, intervenções cirúrgicas adicionais e o resultado final. Resultados: Foram identificados 15 doentes: 14 homens (93%) e uma mulher (7%); a idade média foi 66,9 anos (amplitude: 46 - 86); tempo médio de internamento foi 46,8 dias (amplitude: 20 - 71 dias) e o número médio de desbridamentos foi 3,3 (amplitude: 1 - 4). O fator predisponente mais frequente foi a diabetes mellitus, e as causas mais frequentes o abcesso perianal (n = 2) e o abcesso cutâneo (n = 2). Em oito (53,3%) doentes não foi identificada a causa da gangrena de Fournier. Foram utilizadas várias técnicas reconstrutivas e realizadas conco (33,3%) intervenções cirúrgicas adicionais (uma cistostomia, duas orquidectomias, duas ileostomias); seis doentes (40%) apresentaram complicações de técnicas reconstrutivas com resultado final adequado. Discussão: O micro-organismo mais frequentemente isolado nas culturas de pus foi o Staphylococcus aureus, o que contrasta com a literatura onde a Escherichia coli é o agente mais frequentemente isolado. Foi identificado um número superior ao esperado de doentes sem causa identificável (n = 8) de gangrena de Fournier. Estes achados podem ser explicados pelo facto de se tratar de um estudo retrospetivo multicêntrico, com um potencial viés por existirem doentes que foram transferidos de outras institucões em estado avançado de doença, sem foco de origem de gangrena de Fournier identificado. Conclusão: O precoce reconhecimento e extenso desbridamento do tecido necrosado, em conjunto com um adequado tratamento antibiótico, são os pilares do tratamento da gangrena de Fournier reduzindo assim a morbilidade e mortalidade destes doentes. Os desafios cirúrgicos reconstrutivos que advêm desta patologia devem ser abordados por uma equipa especializada, pelo risco de sequelas funcionais e estéticas. Tendo em conta o carater observacional, retrospetivo e unicêntrico do presente estudo, estas premissas requerem uma validação adequada através de um estudo prospetivo e multicêntrico.

Rare isolation of Fusobacterium varium from a case of Fournier's gangrene.

Fusobacterium is a gram negative obligate anaerobic bacilli, a normal inhabitant of gastrointestinal tract, oropharynx and female genital tract. Here we report a case of Fourniers gangrene from which Fusobacterium varium has been isolated along with certain other pathogens. There are only a few reported cases of Fusobacterium varium in literature and it has never been reported from Fournier's gangrene. Through this report we intend to shed some light on the pathogenic potential of anaerobes which are considered as normal flora.

Acute promyelocytic leukaemia presenting as necrotising fasciitis of the perineum (Fournier gangrene).

We present a case of an unusual presentation of acute promyelocytic leukaemia (APML), which presented with Fournier gangrene (FG). A 38-year-old man presented with malaise, groin swelling, anal bleeding, fever and was found to have FG. Initial workup revealed pancytopaenia, borderline low fibrinogen, prolonged international normalized ratio (INR), which raised the suspicion for leukaemia. The peripheral blood differential revealed leucopaenia with absolute neutropaenia and a 5% abnormal promyelocytes but no blasts, suspicious for APML. Bone marrow biopsy was performed and fluorescence in situ hydridization (FISH), karyotype and PCR confirmed a t(15;17) translocation, establishing a diagnosis of APML. After 1 month of therapy for intermediate risk APML with All-trans retinoic acid (ATRA) and arsenic trioxide (ATO), repeat chromosomal analysis and repeat bone marrow biopsy revealed no evidence of residual APML. After the consolidation phase was started with ATRA and ATO regimen, the wound healed after 2 months and the patient achieved complete remission.

Fatal Fournier's gangrene caused by Clostridium ramosum in a patient with central diabetes insipidus and insulin-dependent diabetes mellitus: a case report.

BACKGROUND: Clostridium ramosum is a generally non-pathogenic enteric anaerobe, and Fournier's gangrene is a rare necrotizing soft tissue infection with male predisposition affecting the perineum and the genital area. We report, to our knowledge, the first case of Fournier's gangrene caused by C. ramosum in a female patient with multiple underlying conditions. CASE PRESENTATION: A 44-year-old woman with a 6-year history of insulin-dependent diabetes mellitus after total pancreatectomy and an 11-year history of central diabetes insipidus developed a pain in the genital area after a month of urinary catheter use. The lower abdominal pain worsened gradually over 2 weeks, and the pain, general fatigue, and loss of appetite prompted the patient's hospital admission. As she had severe edema in her pelvic and bilateral femoral areas, ceftriaxone was started empirically after collecting two sets of blood cultures. On hospital day 2, CT examination revealed the presence of necrotizing faciitis in the genital and pelvic areas, and the antibiotics were changed to a combination of meropenem, vancomycin, and clindamycin. Gram-positive cocci and gram-positive rods were isolated from blood cultures, which were finally identified as Streptococcus constellatus and C. ramosum using superoxide dismutase and 16S rDNA sequencing. An emergent surgery was performed on hospital day 2 to remove the affected tissue. Despite undergoing debridement and receiving combined antimicrobial chemotherapies, the patient's clinical improvement remained limited. The patient's condition continued to deteriorate, and she eventually died on hospital day 8. In the present case, the underlying diabetes mellitus, urinary incontinence due to central diabetes insipidus, undernutrition, and edema served as the predisposing conditions. CONCLUSIONS: C. ramosum is a potentially opportunistic pathogen among immunosuppressed persons and a rare cause of necrotizing fasciitis.

[Escherichia coli productora de betalactamasas de espectro extendido como agente causal de gangrena de Fournier de origen urogenital asociada a mayor mortalidad]. / Escherichia coli producer of extended-spectrum beta-lactamases as causative agent of Fournier gangrene of urogenital origin associated with higher mortality.

ANTECEDENTES: La gangrena de Fournier (GF) es una fascitis necrotizante que pone en peligro la vida del paciente. El objetivo de este trabajo fue determinar la etiología y el impacto del agente aislado en el cultivo de la herida y de orina. MÉTODO: Se llevó a cabo un análisis retrospectivo de una cohorte de 66 pacientes con GF de origen urogenital. Los valores cualitativos medidos se expresaron como frecuencia y porcentaje, y se compararon con la prueba de ji al cuadrado y la prueba de Fisher. La diferencia se consideró estadísticamente significativa con p < 0.05. RESULTADOS: Los pacientes que murieron presentaban con mayor frecuencia cultivos de orina y herida positivos para Escherichia coli productora de betalactamasas de espectro extendido (BLEE): orina, sobrevivientes 14.5% vs. muertes 44.4%; herida, sobrevivientes 20.8% vs. muertes 66.6% (p < 0.001). CONCLUSIONES: Durante la valoración integral del paciente con GF es fundamental realizar cultivos de orina y de herida con el fin de iniciar el manejo antibiótico dirigido de manera temprana. Los pacientes con GF que mueren presentan mayor número de cultivos positivos para E. coli BLEE. BACKGROUND: Fournier gangrene (FG) is a necrotizing fasciitis that endangers the patient's life. The objective of this study was to determine the etiology and impact of the agent isolated on wound and urine culture. METHOD: We performed a retrospective analysis within a cohort of 66 patients with FG of urogenital origin. The measured qualitative values were expressed as frequency and Percentage and compared with the chi square test and Fisher's test. The difference was considered statistically significant at p < 0.05. RESULTS: Patients who died had more frequent cultures of urine and wound positive for extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli: urine, survivors 14.5% vs. deaths 44.4%; wound, 20.8% vs. 66.6% (p < 0.001). CONCLUSIONS: During the integral evaluation of the patient with FG it is essential to perform the urine and surgical wound cultures in order to initiate the antibiotic management directed at an early stage. Patients with GF who die present a greater number of cultures positive for E. coli ESBL.

Isolated Involvement of Penis in Fournier's Gangrene: A Rare Possibility.

skin and subcutaneous tissue. Penis may be secondarily affected in some cases; however, primary isolated involvement of penis is rare. A 48-year male smoker presented with pain and blackish discoloration of the distal part of penis for the last 4 days which developed following rupture of a papulo-vesicular lesion over the prepuce of penis. It rapidly progressed to involve half of the skin of the penis. The patient was hospitalized and broad spectrum antibiotics were administered parenterally. Emergency wound debridement and urinary diversion by suprapubic cystostomy was done. After repeated wound debridement and dressings, the wound healed. Our case was unusual as the penis was the sole site of affection, which is very unusual and only few such cases are reported in the literature.

Risk factors for mortality in fournier's gangrene in a general hospital: use of simplified founier gangrene severe index score (SFGSI)

ABSTRACT Objective To evaluate risk factors for mortality in patients with Fournier's gangrene (FG), with emphasis in the Simplified Fournier Gangrene Severe Index Score (SFGSI). Materials and Methods This was a cross-sectional study that was carried out from January 2010 to December 2014, with 124 patients treated for FG in a General Hospital. Several clinical and laboratory variables, including SFGSI, were evaluated and correlated with mortality through univariate analysis and logistic regression. Results Of the 124 patients, 99 were men (79.8%), the mean age was 50.8±19.5 years and the main comorbidity was diabetes mellitus (51.6%). The mortality rate was 25.8%. Variables that presented independent correlation with mortality were the extension of the lesion to the abdomen (OR=4.0, CI=1.10-14.68, p=0.03), hematocrit (OR=0.81, CI=0.73-0.90, p<0.0001), potassium (OR=2.41, CI=1.13-5.10, p=0.02) and creatinine (OR=2.15, CI= 1.04-4.41, p=0.03). When hematocrit, potassium and creatinine were tested together, as part of the SFGSI, a >2 result was the largest of the independent predictors of mortality (OR=50.2; CI=13.18-191.47; p<0.0001). Conclusion The SFGSI >2 presented a higher correlation with mortality than any variable tested alone. It seems to be a promising alternative to evaluate predictors of mortality in Fournier's gangrene. The main advantage is easy applicability because it contains only three parameters and can be used immediately after patient's admission.

Use of photodynamic inactivation for in vitro reduction of prevalent bacteria in Fournier's Gangrene

ABSTRACT Fournier's Gangrene (FG) is an infectious disease caused by several synergic microbes, with high morbidity and mortality rates; therefore, the search for new less invasive and mutilating treatments, with faster recovery, has been proposed. Surgical intervention, the use of several systemic and topic antibiotics, and hyperbaric oxygen therapy are currently the best approach for the treatment of these patients. The use of Photodynamic Inactivation (PDI) aims to lower morbidity and mortality, by reducing bacterial microbiota and speeding wound healing. In the present study, viable bacteria were separated in four groups: Group L-/F- (no irradiation with red laser and absence of methylene blue photosensitizer), Group L-/F+ (no irradiation with red laser and presence of methylene blue), Group L+/F- (irradiation with red laser and absence of methylene blue) and L+/F+ (irradiation with red laser associated to methylene blue). In all groups, exposure time to treatment was 5, 10 and 15 minutes. The concentration of methylene blue photosensitizer was 0.1mg/L, and the dose of red laser (660nm wave length) was 176.9mW/cm2. Following irradiation, the reduction of number of bacteria was evaluated, and the results were expressed in colony forming units (CFU) and as exponential reduction. As the main results, in the L+/F+ group, there were no Clostridium perfringens and Staphylococcus aureus CFUs and there was a reduction of Escherichia coli that was not observed in the other groups.