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Fournier's gangrene in diabetic and renal failure patients
Abdulmalik M Tayib1, Hisham A Mosli, Mohamed H Abdulwahab
1Department of Urology, King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia. srraaams@hotmail.com
Insights
Aggressive management, including debridement and antimicrobial therapy, improved outcomes for Fournier
Area of Science:
- Urology
- Infectious Diseases
- Surgical Management
Background:
- Fournier's gangrene is a severe necrotizing infection of the perineum and genitalia.
- Early recognition and prompt intervention are critical for patient survival.
Purpose of the Study:
- To describe the experience with 9 Fournier's gangrene patients.
- Identify prognostic factors and evaluate aggressive treatment outcomes.
Main Methods:
- Retrospective review of 9 patients treated between 1999-2002.
- Analysis of demographics, predisposing factors, microbiology, management, and prognosis.
Main Results:
- Mean age 68 years; 66.6% were diabetic, 3 on hemodialysis.
- Polymicrobial infections common; no anaerobes cultured.
- Aggressive debridement and antibiotics successful in 7/9 patients; 22.2% mortality.
Conclusions:
- Fournier's gangrene demands urgent recognition and specialist referral.
- Aggressive debridement and appropriate antimicrobial therapy improve patient outcomes and reduce mortality.
Objective:
To report our experience in the management of 9 patients with Fournier's gangrene seen in our institute, to identify the most common prognostic variables in our patients, and to evaluate the outcome of aggressive management in patients with Fournier's gangrene.
Methods:
We reviewed the medical records of 9 patients admitted to King Abdul-Aziz University Hospital (KAUH) in Jeddah, Kingdom of Saudi Arabia from November 1999 until November 2002. Their age, sex, clinical presentation, predisposing factors, microbiology testing, management and prognosis were studied.
Results:
Nine male patients were diagnosed and treated. The mean age was 68 years, 6 patients (66.6%) were diabetics and one of them had renal insufficiency not requiring dialysis, while 3 patients were on regular hemodialysis. Bacterial culture results revealed a single organism in 44.4%, and more than one organism in 55.6% of the cases. No anaerobes could be cultured, and one patient had Candida albicans. All patients had temporary suprapubic catheter diversion while stool diversion by colostomy was required in only one patient. In 7 patients, aggressive debridement and parental antimicrobial were successful to eradicate the infection, whereas 2 patients (22.2% of the cases) died of uncontrolled sepsis.
Conclusion:
Fournier's gangrene is a very serious disease, understanding the criteria of early recognition of the disease, referral to the specialist, and aggressive debridement with the use of appropriate antimicrobial therapy will improve the outcome of the patients and decrease the mortality rate.
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