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[Our caseload in Fournier's disease]
J M Monge Mirallas1, J A Portillo Martín, B Martín García
1Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
Abstract:
We reviewed the records of 17 cases of Fournier's gangrene that had been diagnosed and treated in the Urology Service of the Marques de Valdecilla Hospital from 1982-1991. The series comprised male patients aged 32 to 77. Eleven cases (64.7%) were due to a known cause, above all infection. Most of the patients had factors that predisposed to the development and progression of the disease, predominantly diabetes mellitus (5 cases, 29.4%). The clinical features frequently corresponded to those of acute infection, with high fever, chills, pain, nausea and vomiting that could progress to a septic state. The local symptoms and signs included pain, swelling, erythema and necrosis, depending on the compromised area. Infection was usually caused by Gram-negative bacteria, particularly E. coli, although Gram-positive bacteria and anaerobes have been observed. Mixed bacterial infections have also been observed. Treatment must be instituted early using a combination of broad spectrum antibiotics that cover both aerobes and anaerobes, and wide surgical debridement of the compromised area. In some cases hyperbaric oxygen therapy may be warranted. The disease continues to be severe. In the present series, the outcome was favorable in 12 cases (70.5%) and there were 5 deaths (29.4%).
Insights
Fournier's gangrene is a severe condition often linked to infections and predisposing factors like diabetes. Early treatment with antibiotics and surgical debridement improves outcomes, though mortality remains significant.
Area of Science:
- Urology
- Infectious Diseases
- Dermatology
Context:
- Fournier's gangrene is a rare but serious necrotizing fasciitis of the genitalia and perineum.
- This study reviews cases from a single institution over a decade to understand disease characteristics and outcomes.
Purpose:
- To analyze the clinical presentation, predisposing factors, microbial etiology, treatment strategies, and outcomes of Fournier's gangrene.
Summary:
- The review included 17 male patients (32-77 years) with Fournier's gangrene.
- Common predisposing factors included diabetes mellitus (29.4%).
- Infections were often polymicrobial, with Gram-negative bacteria like E. coli being prevalent.
- Treatment involved broad-spectrum antibiotics and aggressive surgical debridement, with hyperbaric oxygen therapy considered in select cases.
- The overall mortality rate was 29.4%, with 70.5% of patients experiencing a favorable outcome.
Impact:
- Highlights the critical role of prompt, aggressive management in improving survival rates for Fournier's gangrene.
- Emphasizes the need for broad-spectrum antibiotic coverage and extensive surgical intervention.
- Underscores the association with diabetes mellitus and polymicrobial infections, guiding diagnostic and therapeutic approaches.