Risk factors, microbiological resistance, and prognostic scoring in Fournier's gangrene: a retrospective cohort study

BACKGROUND: Fournier’s gangrene is a rapidly progressing necrotizing fasciitis of the perineal and genital regions with high mortality. This study aimed to identify prognostic factors and evaluate scoring systems for risk stratification. METHODS: A retrospective analysis of 228 Fournier’s gangrene patients was conducted. Baseline data, comorbidities, laboratory findings, microbial cultures, and antimicrobial susceptibility profiles were reviewed. Univariate and Firth’s penalized likelihood logistic regression identified independent mortality predictors. The prognostic value of LRINEC, FGSI, UFGSI, and ACCI scores was assessed via ROC analysis. RESULTS: Mortality was 9.6%. Independent predictors included sepsis (OR = 14.270, P = 0.0008), paraplegia (OR = 18.786, P = 0.0114), and elevated lactate (OR = 1.117, P = 0.0017). Acinetobacter baumannii infection and carbapenem resistance were associated with poor outcomes. UFGSI achieved the best prognostic performance (AUC = 0.933, sensitivity 90.9%, specificity 83.0%). CONCLUSION: Gram-negative and mixed infections, particularly those involving Acinetobacter baumannii, represent high-risk subtypes of Fournier’s gangrene associated with increased mortality. Extensive antimicrobial resistance among Gram-negative pathogens underscores the need to revise empirical treatment strategies. Sepsis, paraplegia, and elevated lactate levels independently predict death, while the UFGSI demonstrates superior prognostic accuracy. Early recognition of these risk factors and timely intervention are crucial for improving patient outcomes.