Objective: To determine predisposing or prognostic factors and mortality rates of patients with Fournier’s gangrene compared to other necrotizing soft tissue infections (NSTI). Material and Methods: Data of 55 intensive care patients (1981–2010) with NSTI were evaluated. Data were collected prospectively. Results: 43.4% of the patients were in septic condition and 27.3% were hemodynamically unstable. Half of the patients showed predisposing factors (52.7%). The lower extremity (63.2%), abdomen (30.9%), and perineum (14.5%) were most affected. Polymicrobial infections were frequent (65.5%, mean 2.8, range: 1–4). The mortality rate was 16.4% (n = 9). An increase was shown for diabetes mellitus (20%), cardiac insufficiency (22.3%), septic condition at presentation (33.3%), abdominal affection (47.1%), and hemodynamic instability (46.7%). Comparing survivors and nonsurvivors, statistical significance was seen with age (p < 0.001), septic condition at admission (p < 0.001), hemodynamic instability (p < 0.001), low blood pressure (p < 0.001), and abdominal affection (p < 0.001). In laboratory findings, an increase of creatine kinase (p < 0.001) and lactate (p < 0.001) and a decrease of antithrombin III (p < 0.007) and the Quick value (p < 0.01) proved to be significant. Conclusion: Patients with Fournier’s gangrene do not differ in all aspects from those with other NSTI. Successful treatment consists of immediate surgical debridement, broad-spectrum antibiotic treatment, and critical care management. Supportive hyperbaric oxygen therapy should be considered.

Journal Section:
Editor's choice
Keywords:
Necrotizing soft tissue infection, Fournier’s gangrene, Necrotizing fasciitis, Gas gangrene, Hyperbaric oxygen therapy
1.
Cainzos M, Gonzalez-Rodriguez FJ: Necrotizing soft tissue infections. Curr Opin Crit Care 2007:13:433–439.
https://doi.org/10.1097%2FMCC.0b013e32825a6a1b
2.
McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA: Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 1995;221:558–563, discussion 63–65.
https://doi.org/10.1097%2F00000658-199505000-00013
3.
Baurienne H: Sur une plaie contuse qui s’est terminée par la sphacele de la scrotum. J Med Chir Pharm 1794;20:251–256.
4.
Fournier J: Gangrene foudroyante de la verge. Med Pract 1883;4:589–597.
5.
Jones J: Investigation upon Nature, Causes and Treatment of Hospital Gangrene as It Prevailed in the Confederate Armies 1861–1865. Surgical Memories of the War of Rebellion. New York, US Sanitary Commission, 1871.
6.
Meleny F: Hemolytic streptococcal gangrene. Arch Surg 1924;9:317–331.
https://doi.org/10.1001%2Farchsurg.1924.01120080083007
7.
Moses AE: Necrotizing fasciitis: flesh-eating microbes. Isr J Med Sci 1996;32:781–784.
8.
Heitmann C, Pelzer M, Bickert B, Menke H, Germann G: Surgical concepts and results in necrotizing fasciitis (in German). Chirurg 2001;72:168–173.
https://doi.org/10.1007%2Fs001040051287
9.
Czymek R, Hildebrand P, Kleemann M, et al: New insights into the epidemiology and etiology of Fournier’s gangrene: a review of 33 patients. Infection 2009;37:306–312.
https://doi.org/10.1007%2Fs15010-008-8169-x
10.
Wilson B: Necrotizing fasciitis. Am Surg 1952;18:416–431.
11.
Lampl L, Frey G, Fischer D, Fischer S: Hyperbaric oxygenation: utility in intensive therapy – part 2 (in German). Anasthesiol Intensivmed Notfallmed Schmerzther 2009;44:652–658.
https://doi.org/10.1055%2Fs-0029-1242433
12.
Bone RC, Sibbald WJ, Sprung CL: The ACCP-SCCM consensus conference on sepsis and organ failure. Chest 1992;101:1481–1483.
[PubMed]
https://doi.org/10.1378%2Fchest.101.6.1481
13.
Kaul R, McGeer A, Low DE, Green K, Schwartz B: Population-based surveillance for group A streptococcal necrotizing fasciitis: clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases. Ontario Group A Streptococcal Study. Am J Med 1997;103:18–24.
14.
Stephens BJ, Lathrop JC, Rice WT, Gruenberg JC: Fournier’s gangrene: historic (1764–1978) versus contemporary (1979–1988) differences in etiology and clinical importance. Am Surg 1993;59:149–154.
15.
Eke N: Fournier’s gangrene: a review of 1726 cases. Br J Surg 2000;87:718–728.
[PubMed]
https://doi.org/10.1046%2Fj.1365-2168.2000.01497.x
16.
Yanar H, Taviloglu K, Ertekin C, et al: Fournier’s gangrene: risk factors and strategies for management. World J Surg 2006;30:1750–1754.
[PubMed]
https://doi.org/10.1007%2Fs00268-005-0777-3
17.
Faucher LD, Morris SE, Edelman LS, Saffle JR: Burn center management of necrotizing soft-tissue surgical infections in unburned patients. Am J Surg 2001;182:563–569.
[PubMed]
https://doi.org/10.1016%2FS0002-9610%2801%2900785-1
18.
Pessa ME, Howard RJ: Necrotizing fasciitis. Surg Gynecol Obstet 1985;161:357–361.
19.
Anaya DA, Dellinger EP: Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis 2007;44:705–710.
https://doi.org/10.1086%2F511638
20.
Singh G, Sinha SK, Adhikary S, Babu KS, Ray P, Khanna SK: Necrotising infections of soft tissues – a clinical profile. Eur J Surg 2002;168:366–371.
https://doi.org/10.1080%2F11024150260284897
21.
Mulla ZD, Gibbs SG, Aronoff DM: Correlates of length of stay, cost of care, and mortality among patients hospitalized for necrotizing fasciitis. Epidemiol Infect 2007;135:868–876.
https://doi.org/10.1017%2FS0950268806007448
22.
Kihiczak GG, Schwartz RA, Kapila R: Necrotizing fasciitis: a deadly infection. J Eur Acad Dermatol Venereol 2006;20:365–369.
https://doi.org/10.1111%2Fj.1468-3083.2006.01487.x
23.
Kaiser RE, Cerra FB: Progressive necrotizing surgical infections – a unified approach. J Trauma 1981;21:349–355.
https://doi.org/10.1097%2F00005373-198105000-00003
24.
Sorensen MD, Krieger JN, Rivara FP, Klein MB, Wessells H: Fournier’s gangrene: management and mortality predictors in a population based study. J Urol 2009;182:2742–2747.
https://doi.org/10.1016%2Fj.juro.2009.08.050
25.
Hirn M: Hyperbaric oxygen in the treatment of gas gangrene and perineal necrotizing fasciitis. A clinical and experimental study. Eur J Surg Suppl 1993;570:1–36.
26.
Pizzorno R, Bonini F, Donelli A, Stubinski R, Medica M, Carmignani G: Hyperbaric oxygen therapy in the treatment of Fournier’s disease in 11 male patients. J Urol 1997;158:837–840.
[PubMed]
https://doi.org/10.1097%2F00005392-199709000-00039
27.
Dahm P, Roland FH, Vaslef SN, et al: Outcome analysis in patients with primary necrotizing fasciitis of the male genitalia. Urology 2000;56:31–35, discussion 5–6.
[PubMed]
https://doi.org/10.1016%2FS0090-4295%2800%2900604-X
28.
Brown DR, Davis NL, Lepawsky M, Cunningham J, Kortbeek J: A multicenter review of the treatment of major truncal necrotizing infections with and without hyperbaric oxygen therapy. Am J Surg 1994;167:485–489.
https://doi.org/10.1016%2F0002-9610%2894%2990240-2
29.
Frey G, Lampl L, Radermacher P, Bock KH: Hyperbaric oxygenation. An area for the anesthetist (in German)? Anaesthesist 1998;47:269–289.
https://doi.org/10.1007%2Fs001010050558
30.
Riseman JA, Zamboni WA, Curtis A, Graham DR, Konrad HR, Ross DS: Hyperbaric oxygen therapy for necrotizing fasciitis reduces mortality and the need for debridements. Surgery 1990;108:847–850.
31.
Mindrup SR, Kealey GP, Fallon B: Hyperbaric oxygen for the treatment of Fournier’s gangrene. J Urol 2005;173:1975–1977.
https://doi.org/10.1097%2F01.ju.0000158129.56571.05
32.
George ME, Rueth NM, Skarda DE, Chipman JG, Quickel RR, Beilman GJ: Hyperbaric oxygen does not improve outcome in patients with necrotizing soft tissue infection. Surg Infect (Larchmt) 2009;10:21–28.
https://doi.org/10.1089%2Fsur.2007.085
33.
Korhonen K, Klossner J, Hirn M, Niinikoski J: Management of clostridial gas gangrene and the role of hyperbaric oxygen. Ann Chir Gynaecol 1999;88:139–142.
34.
Wong CH, Khin LW, Heng KS, Tan KC, Low CO: The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infection. Crit Care Med 2004;32:1535–1541.
https://doi.org/10.1097%2F01.CCM.0000129486.35458.7D
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2012
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