Abstract
INTRODUCTION AND OBJECTIVE:
Factors associated with (a/w) Fournier’s Gangrene (FG) are not fully known. We aim to assess FG risk factors (rf), scoring systems, microbiology, and outcomes.
METHODS:
Retrospective FG patient (pt) medical data from 2007-21 at our institution were obtained. Means were compared via t tests and associations via chi square analysis.
RESULTS:
Of 132 FG pts, 14% died of FG, 47% were discharged (dc) home and 39% were dc to nursing facility (NH). 9% had orchiectomy, 22% suprapubic tube (SPT), 19% colostomy, 12% thigh pouch (TP), 29% wound closure, and 22% flap/graft use (Table 1). Frequent culture isolates were E. coli, Bacteroides, Streptococcus, Enterococcus, and Candida (Figure 1). Higher FG Severity Index (FGSI) was a/w colostomy, TP, and dc to NH. Lower FGSI was a/w dc home. Higher Uludag FGSI (UFGSI) was a/w colostomy, TP, dc to NH, and FG death. Lower UFGSI was a/w dc home. Lower surgical APGAR (sAPGAR) was a/w colostomy. Higher Charlson index (CI) was a/w FG death. Lower CI was a/w dc home. Actinomyces was a/w closure and f/g. Bacteroides was a/w shorter intensive care unit (ICU) stay, colostomy, and fewer vasopressors. Candida was a/w FG death, longer hospital stay, and shorter time to death (TtoD). Pseudomonas was a/w shorter TtoD, SPT, and TP. Proteus was a/w orchiectomy and FG death. Streptococcus was a/w dc home, longer ICU stay, and longer TtoD. Interestingly, lower hemoglobin A1c (A1c) was a/w orchiectomy and FG death, while higher A1c was a/w f/g. Culture-discordant empiric antibiotics were a/w longer hospital stay and intubation.
CONCLUSIONS:
This is the largest series on FG scoring systems and the first to compare microbiology with outcomes. FGSI and UFGSI were most a/w outcomes. CI was a/w some outcomes, but this may stem from age as a CI factor. sAPGAR was less a/w outcomes suggesting divergent management of FG vs. trauma. FG microbiology is a/w multiple outcomes and shows a shift away from prior pathogens. These findings and unexpected findings like higher A1c being a/w FG death warrant further study into whether reassessing empiric antibiotics or nutritional optimization may improve outcomes.
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Source of Funding:
None
