Fournier's gangrene--current concepts.

Area of Science:

• Urology
• Infectious Diseases
• Dermatology

Background:

• Fournier's gangrene (FG) is a rapidly progressive necrotizing fasciitis of the perineal, genital, or perianal regions.
• It is a life-threatening condition often considered a urological emergency, with underreporting in women.
• Predisposing factors include diabetes mellitus, hypertension, alcoholism, and advanced age, with a reported increase in patient age.

Purpose of the Study:

• To highlight the characteristics, epidemiology, and management of Fournier's gangrene.
• To emphasize the underrecognition in women and the evolving patient demographics.
• To discuss the prognostic indicators and microbial etiology of FG.

Main Methods:

• Review of literature on Fournier's gangrene.
• Analysis of epidemiological trends, including patient age.
• Discussion of diagnostic criteria and prognostic scoring systems like the Fournier's Gangrene Severity Index (FGSI).

Main Results:

• The mean age of FG patients is increasing, reported around 53-55 years.
• Mortality rates remain high, typically 20-40%, with a wide reported range (4-80%).
• Common causative agents include Gram-positive, Gram-negative, and anaerobic bacteria, with emerging roles for CA-MRSA and, rarely, fungi.

Conclusions:

• Fournier's gangrene requires prompt diagnosis and aggressive parenteral antibiotic therapy.
• Understanding the changing epidemiology and diverse microbial causes is essential for effective management.
• The Fournier's Gangrene Severity Index aids in prognosis, but high mortality persists despite medical advancements.