Abstract
Introduction: Fournier gangrene (FG) is a rare, life-threatening condition of the genital, perineal, scrotal, and abdominal regions. Common risk factors include male sex, diabetes, and advanced age. Mortality ranges from 5 to 20% or higher. The main treatment approach is surgical debridement with empirical antibiotics. This study examines the microbiological spectrum in relation to diabetes, age, infection parameters, and clinical outcomes. Methods: We conducted a single-center retrospective analysis of 50 FG patients between 2012 and 2023. The microbiological spectrum was analyzed in relation to age, diabetes, infection parameters, intensive care unit (ICU) stay, and mortality using multinomial logistic regression. The most frequent pathogens were identified, and an autoregressive integrated moving average (ARIMA) model was used to assess potential temporal shifts in pathogen prevalence. AI tools were used in the writing of this manuscript. The principles of the Helsinki Declaration were followed. Results: The median age of the male cohort was 68.5 years (interquartile ranges [IQRs], 68.5–76). Diabetes was present in 20/50 (40%). Infection parameters at admission were 17 mg/L (IQR 8–29.2) for C-reactive protein and 14.8 × 109/L (IQR 11.6–21.1) for leukocyte count. Thirty-two (64%) patients required ICU treatment after surgery. The median ICU stay was 4.5 days (IQR 2–9), and the median hospitalization was 12 days (IQR 8–22). Mortality was 14% (7/50). The microbiological spectrum was unaffected by infection parameters or age. Diabetes, however, was significantly associated with anaerobic pathogens (RRR: 8.0; 95% CI: 1.17–54.7). ARIMA analysis showed no temporal shift in pathogens. Conclusion: Diabetes mellitus is a significant risk factor for FG, promoting infection via microangiopathy, glucosuria, and hyperglycemia-induced tissue hypoxia. Management requires urgent debridement and broad-spectrum antibiotics, with extended anaerobic coverage in diabetic patients.
