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Ozgul H, Cakir RC, Celik O, Dogan U. Role of C-Reactive Protein/Lymphocyte and Neutrophil/Lymphocyte Ratios in Predicting Mortality in Patients with Fournier's Gangrene. J INVEST SURG 2024; 37:2432958. [PMID: 39592135 DOI: 10.1080/08941939.2024.2432958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Revised: 11/09/2024] [Accepted: 11/11/2024] [Indexed: 11/28/2024]
Abstract
BACKGROUND AND OBJECTIVES Fournier's gangrene (FG) is a polymicrobial-induced necrotizing fasciitis that affects the deep and superficial tissues of the perineal, perianal, scrotal, and genital regions. This study aimed to investigate the role of C-reactive protein (CRP)/lymphocyte and neutrophil/lymphocyte ratios, which are objective markers of inflammatory response, in predicting mortality in patients with FG. PATIENTS AND METHODS Seventy-one patients who underwent surgery for FG between 2019 and 2023 were evaluated retrospectively. Demographic and clinical characteristics, laboratory results, the FG severity index (FGSI) score, and the CRP/lymphocyte and neutrophil/lymphocyte ratios were analyzed for the patient groups with and without in-hospital mortality. RESULTS The characteristics of the patients with and without mortality were compared. A total of 71 patients, 51 (71.8%) males and 20 (28.2%) females, were evaluated. Eight patients died during treatment. The median age was 67 (56-86) years in the mortality group and 58 (27-82) years in the non-mortality group. Statistically significant differences were observed between the two groups in terms of age, lymphocyte count, CRP/lymphocyte, neutrophil/lymphocyte, potassium, blood urea nitrogen, and FSGI. In the receiver operating characteristic analysis of the CRP/lymphocyte and neutrophil/lymphocyte ratios, the cutoff values were calculated as 183.3 and 19.93, respectively. By comparing the data between the mortality and non-mortality groups, the sensitivity and specificity rates of these ratios were also determined. CONCLUSION The CRP/lymphocyte and neutrophil/lymphocyte ratios may be important parameters in predicting mortality in patients with FG.
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Affiliation(s)
- Halit Ozgul
- Department of General Surgery, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Remzi Can Cakir
- Department of General Surgery, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Omer Celik
- Department of General Surgery, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Ugur Dogan
- Department of General Surgery, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
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Puia D, Gheorghincă Ş, Pricop C. The Antimicrobial Resistance Index and Fournier Gangrene Severity Index of Patients Diagnosed with Fournier's Gangrene in a Tertiary Hospital in North Eastern Romania. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040643. [PMID: 37109603 PMCID: PMC10144816 DOI: 10.3390/medicina59040643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/02/2023] [Accepted: 03/22/2023] [Indexed: 04/29/2023]
Abstract
Background: Although rare, Fournier's gangrene is a major urological emergency. We aimed to learn more about the pathogenesis of Fournier's gangrene and assess the antibiotic resistance patterns in individuals with this disease. Methods: We retrospectively evaluated the patients diagnosed with and treated for Fournier's gangrene in a Neamt county hospital and "CI Parhon" Clinical Hospital in Iasi, Romania between 1 January 2016 and 1 June 2022. Results: We included a total of 40 patients, all males; of these, 12.5% died. In our study, in the patients that died, the adverse prognostic factors were a higher body temperature (38.12 ± 0.68 vs. 38.94 ± 0.85 °C; p = 0.009), an elevated WBC (17.4 ± 5.46 vs. 25.23 ± 7.48; p = 0.003), obesity (14.28% vs. 60%; p = 0.04), and a significantly higher FGSI (4.17 ± 2.80 vs. 9.4 ± 3.2; p = 0.0002) as well as MAR index (0.37 ± 0.29 vs. 0.59 ± 0.24; p = 0.036). These patients were more likely to have liver affections than those in the group who survived, but the difference was not significant. The most frequently identified microorganism in the tissue secretions culture was E. coli (40%), followed by Klebsiella pneumoniae (30%) and Enterococcus (10%). The highest MAR index was encountered in Acinetobacter (1), in a patient that did not survive, followed by Pseudomonas (0.85) and Proteus (0.75). Conclusions: Fournier's gangrene remains a fatal condition, a highly resistant causative microorganism that is not always correlated with a poor prognosis.
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Affiliation(s)
- Dragoş Puia
- "Grigore T. Popa" Department of Urology, University of Medicine and Pharmacy, 700115 Iași, Romania
- "C. I. Parhon" Hospital, Department of Urology, 700503 Iași, Romania
| | | | - Cătălin Pricop
- "Grigore T. Popa" Department of Urology, University of Medicine and Pharmacy, 700115 Iași, Romania
- "C. I. Parhon" Hospital, Department of Urology, 700503 Iași, Romania
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Vadi S, Ismail A, Kapoor D. Fournier's gangrene and diabetic ketoacidosis with lower-than-anticipated glucose levels associated with SGLT-2 inhibitor: A double trouble. Med J Armed Forces India 2023; 79:225-228. [PMID: 36969130 PMCID: PMC10037052 DOI: 10.1016/j.mjafi.2020.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/24/2020] [Indexed: 11/18/2022] Open
Abstract
Empagliflozin has a demonstrated cardiovascular benefit. It is co-prescribed as a glucose-lowering medication in patients with type II diabetes mellitus. Herein, we discuss dual-emergency side-effects, Fournier's gangrene (FG) and diabetic ketoacidosis with lower-than-anticipated glucose levels in a patient on Empagliflozin, a sodium-glucose transport protein 2 inhibitor (SGLT-2i). The pathophysiologic mechanism of FG in correlation with SGLT-2i is not yet elucidated. SGLT-2i increase predisposition to genital mycotic and urinary infections, a mechanism favouring FG. A patient with type II diabetes mellitus on SGLT-2i presented with acute necrotic infection of the scrotum and simultaneous diabetic ketoacidosis with lower-than-anticipated glucose levels. This dual emergency was managed with debridement and medical treatment on lines of diabetes ketoacidosis, respectively. A re-look at this group of glucose-lowering medications from bedside towards benchtop research may help to prod into any other mechanistic basis of these life-threatening clinical occurrences.
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Affiliation(s)
- Sonali Vadi
- Consultant Intensivist, Kokilaben Dhirubhai Ambani Hospital and Medical Research Center, Mumbai, India
| | - Attar Ismail
- Consultant Urologist & Renal Transplant Surgeon, Kokilaben Dhirubhai Ambani Hospital and Medical Research Center, Mumbai, India
| | - Dheeraj Kapoor
- Consultant Endocrinologist, Kokilaben Dhirubhai Ambani Hospital and Medical Research Center, Mumbai, India
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Practice Patterns in Fournier's Gangrene in Europe and Implications for a Prospective Registry Study. Antibiotics (Basel) 2023; 12:antibiotics12020197. [PMID: 36830108 PMCID: PMC9952046 DOI: 10.3390/antibiotics12020197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Fournier's gangrene (FG) is a life-threatening, necrotizing infection. Due to the rareness of the disease, it is challenging to plan robust prospective studies. This study aims to describe current practice patterns of FG in Europe and identify implications for planning a prospective FG registry. METHODS Online non-validated 17-items survey among urologists treating FG in in European hospitals. Questionnaires were analyzed with LimeSurvey (LimeSurvey GmbH Hamburg, Germany). RESULTS 229 responses from ten different European countries were submitted, and 117 (51.1%) urologists completed the questionnaire. The departments treat a mean of 4.2 (SD 3.11) patients per year. The urology department mostly takes the lead in treating FG patients (n = 113; 96.6%). The practice in FG is very heterogenic and mostly case-based all over Europe, e.g., vacuum-assisted wound closure (VAC) is mostly used (n = 50; 42.7%) as adjunct wound. The biggest challenges in FG are the short time to diagnosis and treatment, standardization and establishment of guidelines, and disease awareness. Additionally, participants stated that an international registry is an outstanding initiative, and predictive models are needed. CONCLUSIONS There is no standard of care in the diagnosis, treatment, and long-term care of FG all over Europe. Further research could be conducted with a prospective registry.
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He R, Li X, Xie K, Wen B, Qi X. Characteristics of Fournier gangrene and evaluation of the effects of negative-pressure wound therapy. Front Surg 2023; 9:1075968. [PMID: 36684293 PMCID: PMC9857754 DOI: 10.3389/fsurg.2022.1075968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/06/2022] [Indexed: 01/09/2023] Open
Abstract
Fournier gangrene (FG) is a life-threatening disease affecting the soft tissues of the genital, perineal, and perianal regions. This retrospective study aimed to summarize the characteristics of FG and evaluate the effects of negative-pressure wound therapy (NPWT). We analyzed clinical data of 36 patients with FG admitted to our department. Thirty-four cases had perianal and external genital infections, and the other two had secondary infection of the urinary fistula after trauma and retroperitoneal abscess, respectively. Monomicrobial, polymicrobial, culture-negative, and fungal infections were identified in 16, 17, 2, and 1 cases, respectively. Escherichia coli, Enterococcus faecalis, Enterococcus faecium, Klebsiella pneumoniae, and Staphylococcus haemolyticus were the most common pathogens. The mortality rate was 8%. Twenty-seven and nine patients were treated with NPWT (group A) and conventional dressing (group B), respectively. The length of stay was 38.0 ± 16.1 and 51.0 ± 17.3 days, number of operations were 3 (3,6) and 13 (4,17), and wound healing times were 39.2 ± 18.1 and 66.5 ± 17.1 days in groups A and B, respectively. Taken together, clinicians should always consider the possibility of perianal or external genital infections progressing to FG in the daily work, especially for patients with diabetes mellitus. Enterobacteriaceae, Enterococcus, and Staphylococcus haemolyticus are the most common causative pathogens, and NPWT is an effective adjuvant therapy for wound management with fewer operations and a shorter wound healing time.
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Affiliation(s)
- Rui He
- Department of Plastic Surgery and Burn, Peking University First Hospital, Beijing, China
| | - Xiangyan Li
- Department of Anti-Infection, Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
| | - Kun Xie
- Department of Plastic Surgery and Burn, Peking University First Hospital, Beijing, China
| | - Bing Wen
- Department of Plastic Surgery and Burn, Peking University First Hospital, Beijing, China
| | - Xin Qi
- Department of Plastic Surgery and Burn, Peking University First Hospital, Beijing, China,Correspondence: Xin Qi
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He X, Xiang X, Zou Y, Liu B, Liu L, Bi Y, Kan D. Distinctions between Fournier's gangrene and lower extremity necrotising fasciitis: microbiology and factors affecting mortality. Int J Infect Dis 2022; 122:222-229. [PMID: 35598736 DOI: 10.1016/j.ijid.2022.05.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 05/03/2022] [Accepted: 05/17/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES In this study, we aimed to illustrate distinctions between Fournier's gangrene (FG) and lower extremity necrotising fasciitis (NF) and screen out possible risk factors of poor prognosis for each cohort. METHODS The medical records of qualified patients with NF admitted to the Second People's Hospital of Yibin from January 2016 to June 2021 were retrospectively reviewed. All participants were anatomically categorised into FG and lower extremity NF groups, and their baseline data and microbiological results were compared. Further comparisons of critical parameters were conducted between survivors and nonsurvivors within each group. RESULTS A total of 49 patients were included in the study with a median age of 58 years, and overall mortality was 20.4%. There were 18 patients with FG and 31 patients with lower extremity NF. A microbiology distinction was found-the predominance of gram-negative infection in FG and gram-positive infection in lower extremity NF. High Fournier's gangrene severity index scores (greater than 7), advanced age, procalcitonin and D-dimer value were identified as risk factors for FG, and the presentation of sepsis was an alarming indicator for lower extremity NF. CONCLUSIONS The distinction of microbiology might provide advice for appropriate antibacterial administrations. In addition, with practical prognostic predicting tools, clinicians might be able to identify patients at increased risk and intervene promptly to avoid unfavourable outcomes.
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Affiliation(s)
- Xuefeng He
- Department of Plastic and Burn Surgery, the Second People's Hospital of Yibin (the Yibin Hospital of West China Hospital, Sichuan University), Sichuan, China.
| | - Xin Xiang
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Yong Zou
- Department of Plastic and Burn Surgery, the Second People's Hospital of Yibin (the Yibin Hospital of West China Hospital, Sichuan University), Sichuan, China.
| | - Bing Liu
- Department of Plastic and Burn Surgery, the Second People's Hospital of Yibin (the Yibin Hospital of West China Hospital, Sichuan University), Sichuan, China
| | - Lili Liu
- Department of Plastic and Burn Surgery, the Second People's Hospital of Yibin (the Yibin Hospital of West China Hospital, Sichuan University), Sichuan, China
| | - Yaodan Bi
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Daohong Kan
- Department of Plastic and Burn Surgery, the Second People's Hospital of Yibin (the Yibin Hospital of West China Hospital, Sichuan University), Sichuan, China
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Herrera Ortiz AF, Arámbula JG, Del Castillo V, Eltawil Y, Almarie B. Fournier’s Gangrene With Retroperitoneal Extension as the First Manifestation of the Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS). Cureus 2021; 13:e20517. [PMID: 35070552 PMCID: PMC8765673 DOI: 10.7759/cureus.20517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 11/28/2022] Open
Abstract
Fournier’s gangrene (FG) is an atypical, life-threatening polymicrobial infection characterized by the rapid destruction of soft tissue, predominantly in the perineal region. Retroperitoneal spread of FG represents an uncommon condition described in a few case reports, and its presentation as the first manifestation of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is even more infrequent. Here, we present the case of a 40-year-old male who was admitted to the emergency department with a low-grade fever of 37.8°C, abdominal pain, and four-day history of sharp, bilateral testicular pain and swelling. On physical examination, the patient was hypotensive with necrotic tissue in the perineum. A computed tomography study displayed an extensive retroperitoneal spread of suspected FG. Due to the massive spread of the infection, an HIV test was requested, yielding positive results, which indicated that HIV/AIDS had first manifested as FG with retroperitoneal extension. This is an extremely rare initial presentation of HIV/AIDS. To treat the patient and address the severe necrosis, a peritoneal lavage, surgical debridement, right orchiectomy, and colostomy were performed. After the procedure, antiretroviral therapy was established with tenofovir, emtricitabine, and efavirenz.
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Kranz J, Dräger DL, Schneidewind L. [New aspects in Fournier's gangrene - a rapid review]. Aktuelle Urol 2021; 52:360-366. [PMID: 33882584 DOI: 10.1055/a-1472-5553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Fournier's gangrene (FG) is a sporadic, life-threatening, necrotising infection affecting the perineum, perineal region and genitals. Published literature provides hints that the outcome of this disease has failed to improve in recent years. We have therefore performed a rapid evidence synthesis by searching the database MEDLINE. The literature from 2020 was studied to identify new aspects to improve the care of FG patients and plan further therapeutic research. 18 publications were chosen for this review, 15 of these were original research and three systematic reviews. 12 were retrospective case series, 2 epidemiological studies, with one prospective clinical study, one systematic review and 2 systematic reviews, together with a meta-analysis. Most of the authors of the studies concluded that FG is still a severe disease with unacceptable mortality rates, so that there is urgent need for therapy improvement. New risk factors for higher mortality in FG have been identified in these studies, namely dyslipoproteinemia, diabetes mellitus, heart disease, as well as both acute and chronic kidney failure. Furthermore, 4 of the included studies investigated the association of SGLT2- and DDP4-inhibitors, which are drugs used in diabetes mellitus, and the incidence of FG. No studies reported a significant association between these drugs and FG, especially not a meta-analysis with 84 included studies. New promising concepts for wound conditioning are hyperbaric oxygenation (HBO), vacuum-assisted wound closure (VAC) and Maggot therapy (blowfly larvae). In summary, FG is still a severe disease, the prognosis has not improved in recent years and so there is an urgent need for improved therapy. This could only be achieved with further research in FG. In our opinion and due to the rarity of FG, this would be possible with a national registry study. For example, it might be possible to calculate risk stratification from this registry to identify patients who would benefit from treatment in a centre or with special wound conditioning.
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Affiliation(s)
- Jennifer Kranz
- St-Antonius-Hospital gGmbH, Klinik für Urologie und Kinderurologie, Eschweiler
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale)
| | - Desiree L. Dräger
- Universitätsmedizin Rostock, Urologische Klinik und Poliklinik, Rostock
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Cipriani C, Iacovelli V, Sandri M, Bertolo R, Maiorino F, Antonucci F, Micali S, Rocco B, Puliatti S, Ferrarese P, Benedetto G, Minervini A, Cocci A, Pastore AL, Al Salhi Y, Antonelli A, Morena T, Volpe A, Poletti F, Celia A, Zeccolini G, Leonardo C, Proietti F, Finazzi Agrò E, Bove P. The microbiological profile of patients with Fournier's gangrene: A retrospective multi-institutional cohort study. Urologia 2021; 89:437-443. [PMID: 34024222 DOI: 10.1177/03915603211018441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the role of the microbiological profile and of disease-related factors in the management of patients affected with Fournier's gangrene (FG). PATIENTS AND METHODS Data regarding patients admitted for FG at nine Italian Hospitals (March 2007-June 2018) were collected. Patients were stratified according to the number of microorganisms documented: Group A - one microorganism; Group B - two microorganisms; Group C - more than three microorganisms. Baseline blood tests, dedicated scoring systems, predisposing risk factors, disease's features, management and post-operative course were analyzed. UpSet technique for visualizing set intersections in a matrix layout and Cuzick's nonparametric test for trend across ordered groups were used. RESULTS Eighty-one patients were available for the analysis: 18 included in Group A, 32 in Group B, 31 in Group C. The most common microorganism isolated was Escherichia coli. In Group B-C, Escherichia coli was often associated to Enterococcus faecalis, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Statistically significant positive association was highlighted among the number of pathogens (Group A vs B vs C) and serum C-reactive Protein (p < 0.001), procalcitonin (p = 0.02) and creatinine (p = 0.03). Scoring systems were associated with the number of microorganisms detected (p < 0.02). A significant association between the number of microorganisms and the use of VAC therapy and need of a fecal diversion was found (p < 0.02). The number of microorganisms was positively associated with the length of stay (LOS) (p = 0.02). Ten weeks after initial debridement, wound closure was achieved in 11 (91.7%), 22 (84.6%) and 20 (80%) patients in Group A, B, and C, respectively, with no differences in overall survival. CONCLUSION Polymicrobial infections in FG are positively associated with inflammatory scores, the need for fecal diversion and the LOS. This results may help the counseling and the clinical management of this rare niche of patients.
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Affiliation(s)
- Chiara Cipriani
- Urology Unit, San Carlo di Nancy Hospital - GVM Care and Research, Rome, Italy
| | - Valerio Iacovelli
- Urology Unit, San Carlo di Nancy Hospital - GVM Care and Research, Rome, Italy.,Department of Surgical Sciences, University Tor Vergata, Roma, Italy
| | - Marco Sandri
- Big and Open Data Innovation Laboratory (BODaI-Lab), University of Brescia, Brescia, Italy
| | - Riccardo Bertolo
- Urology Unit, San Carlo di Nancy Hospital - GVM Care and Research, Rome, Italy
| | - Francesco Maiorino
- Urology Unit, San Carlo di Nancy Hospital - GVM Care and Research, Rome, Italy
| | | | - Salvatore Micali
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Cocci
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | | | | | - Alessandro Antonelli
- University Hospital of Verona, Department of Surgery, Dentistry, Paediatrics and Gynaecology, Urology Unit, Verona and Confortini - Borgo General Hospital, Trento, Italy
| | - Tonino Morena
- Department of Urology, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Filippo Poletti
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | | | | | - Flavia Proietti
- Department of Urology, La Sapienza University of Rome, Rome, Italy
| | | | - Pierluigi Bove
- Urology Unit, San Carlo di Nancy Hospital - GVM Care and Research, Rome, Italy.,Department of Surgical Sciences, University Tor Vergata, Roma, Italy
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[Contemporary practice patterns in the treatment of Fournier's gangrene in German academic medicine and their implications for planning a registry study]. Urologe A 2021; 60:610-616. [PMID: 33559696 PMCID: PMC8102281 DOI: 10.1007/s00120-021-01461-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/15/2022]
Abstract
Hintergrund Die Fournier-Gangrän (FG) ist ein seltenes, aber lebensbedrohliches Krankheitsbild, dessen Prognose in den letzten Jahren nicht wesentlich verbessert werden konnte. Ziel der Arbeit Primäres Studienziel ist die Deskription der Therapiesituation von FG an deutschen Universitätskliniken. Als sekundäres Studienziel sollen Faktoren identifiziert werden, die mit einer erhöhten Letalität assoziiert sind. Außerdem sollen die Daten zur Planung einer Registerstudie dienen. Material und Methoden Es wurde ein Fragebogen mit 29 Fragen an die Mitglieder des Verbands Universitätsklinika Deutschlands sowie eine 3‑malige Erinnerung zur Studienteilnahme im Zeitraum April bis Juni 2020 versandt. Die Datenverwaltung und statistische Analyse erfolgte mit SPSS 26.0 (SPSS Inc., Chicago, Il, USA). Ergebnisse Die Antwortrate betrug 88,9 %. Im Median werden jährlich 5 Patienten mit einem medianen Alter von 60 Jahren an deutschen Universitätsklinika mit der Diagnose FG therapiert. Insgesamt stellt sich die Therapiesituation sehr heterogen dar, insbesondere hinsichtlich der empirischen Erstantibiose. Ein signifikanter Risikofaktor für eine Letalität > 20 % konnte identifiziert werden: Intensivaufenthalt von größer gleich 10 Tagen (p = 0,039). Die Hälfte (50,0 %) der Befragten geben an, dass sich die Prognose der Erkrankung nicht wesentlich verbessert hat. Weiterhin halten viele der Befragten die Letalität für inakzeptabel hoch, daher befürworten 84,4 % eine Registerstudie. Aus den Kommentaren der Befragten konnten zahlreiche Vorschläge sowie Implikationen für die Planung einer solchen Studie abgeleitet werden, wie z. B. die histologische Sicherung der FG. Schlussfolgerung Die Therapiesituation der FG ist heterogen. Allerdings sind die Therapieergebnisse weiterhin inakzeptabel und schwer prognostizierbar.
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Wöhler A, Schwab R, Güsgen C, Schaaf S, Weitzel C, Jänig C, Willms A. [Diagnosis and Treatment of Severe Fournier's Gangrene: Introduction of a Surgical Approach, Evaluation of Risk Factors, Microbiological Characteristics and Review of the Literature]. Zentralbl Chir 2021; 147:480-491. [PMID: 33556981 DOI: 10.1055/a-1319-1734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Fournier's gangrene is a necrotising fasciitis type I occurring in the perineal and genital region. The disease expands progressively and still has poor outcome, especially in critical ill patients. This study's focus was placed on the evaluation of risk factors and comorbidities, on the bacteriological spectrum, laboratory analyses, mortality and the course according to the algorithmic approach. METHOD The medical records were reviewed of 10 patients with severe Fournier's gangrene from 2010 to 2019 who underwent intensive care therapy for at least 48 hours. Ten patients with Fournier's gangrene and sepsis and intensive therapy lasting at least 48 hours were recorded and analysed descriptively. RESULTS The patient cohort consisted of six men and four women with a median age of 62 years (range 42 - 78 years). The median time between the onset of symptoms and hospitalisation was four days (range 3 - 5 days). The commonest aetiological event was a minor trauma. Predisposing factors included diabetes mellitus (30%) and overweight (80% BMI > 25). 90% of patients exhibited polymicrobial infection. All patients had systemic sepsis with SOFA-Score between 3 and 17 points. The mortality rate was 40%. Significant differences between surviving and deceased patients were shown by PCT, INR and aPTT (p < 0.05). CONCLUSION Severe Fournier's gangrene continues to be a major challenge with a high mortality rate. Only rapid diagnosis, urgent extensive surgical debridement and intensive care therapy can lead to a favourable outcome in these critically ill patients. Vacuum-assisted closure can be successfully used in the management of soft-tissue defects.
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Affiliation(s)
- Aliona Wöhler
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Deutschland
| | - Robert Schwab
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Deutschland
| | - Christoph Güsgen
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Deutschland
| | - Sebastian Schaaf
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Deutschland
| | - Carolin Weitzel
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Deutschland
| | - Christoph Jänig
- Klinik für Anästhesie, Intensivmedizin und Notfallmedizin, Bundeswehrzentralkrankenhaus Koblenz, Deutschland
| | - Arnulf Willms
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Deutschland
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Necrotizing Soft-Tissue Infections: Clinical Features and Diagnostic Aspects. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021. [PMID: 33079362 DOI: 10.1007/978-3-030-57616-5_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2023]
Abstract
The term necrotizing soft-tissue infection (NSTI) encompasses a heterogenous group of patients with necrotizing infections, involving any body part. NSTI is diagnosed by surgical exploration, where necrosis of the subcutaneous tissue and/or muscle tissue, undermining of the skin, thrombosis of the superficial veins, and deliquescent tissue can be seen. Patients can present with vague symptoms, and approximately half of patients experience severe pain. The clinical presentation and microbiological etiology vary according to affected body site, with NSTI located to the extremities being dominated by monomicrobial group A streptococcal infections, and NSTI located to the anogenital area dominated by polymicrobial infections. No set of diagnostic criteria exists, and suspicion of the diagnosis should come from careful clinical examination and signs of local or systemic severity. Laboratory blood values show no distinct pattern but resemble those of sepsis. Imaging can aid the diagnostic process but must not delay surgical intervention.
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Schneidewind L, Anheuser P, Schönburg S, Wagenlehner FME, Kranz J. Hyperbaric Oxygenation in the Treatment of Fournier's Gangrene: A Systematic Review. Urol Int 2020; 105:247-256. [PMID: 33285541 PMCID: PMC8006587 DOI: 10.1159/000511615] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/02/2020] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Fournier's gangrene (FG) is a sporadic, life-threatening, necrotizing infection affecting the perineum, perineal region, and genitals. Hyperbaric oxygenation (HBO) improves tissue perfusion and promotes angiogenesis and collagen synthesis. Despite these positive effects of HBO, the indication and the effects on outcome as adjunct therapy in FG remain controversial. Consequently, we decided to perform a systematic review to compare the treatment of FG with or without the use of HBO as an adjunct therapy. MATERIALS AND METHODS We performed a systematic review following the recommendations provided in the Cochrane Handbook of systematic Reviews and the PRISMA reporting guidelines. Due to the paucity of data and a suspected lack of randomized controlled trials, we considered all the available information for this systematic review. RESULTS The literature search for primary studies yielded 79 results. Finally, 13 studies were considered, which included a total of 376 patients with FG, of whom 202 received HBO therapy. Five of these studies had a retrospective case-control design. However, these 5 studies included a total of 319 patients; 145 of these patients were treated with adjunct HBO therapy. Overall, this leads to a mortality rate of 16.6% in the HBO group and 25.9% in the non-HBO group. Overall, risk of bias was assessed as moderate to high. CONCLUSIONS We conclude that despite the risk of bias, HBO has potential as an adjunct in FG treatment, but it is challenging to carry out further studies, mainly due to the rareness of FG and availability of HBO.
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Affiliation(s)
| | - Petra Anheuser
- Department of Urology, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Sandra Schönburg
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
| | - Florian M E Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Jennifer Kranz
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
- Department of Urology, St. Antonius Hospital Eschweiler, Eschweiler, Germany
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El Hasbani G, Vargas J, Rodrigue P, Van Cott C, Dibartholomeo T, Assaker R. Undiagnosed metastatic ileocecal carcinoma: a rare aetiology for Fournier gangrene. ANZ J Surg 2020; 91:202-204. [PMID: 32516496 DOI: 10.1111/ans.16065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/20/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Jose Vargas
- St. Vincent's Medical Center, Bridgeport, Connecticut, USA
| | - Paul Rodrigue
- St. Vincent's Medical Center, Bridgeport, Connecticut, USA
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Albasanz-Puig A, Rodríguez-Pardo D, Pigrau C, Lung M, Roldan E, Corona PS, Almirante B, Ruiz-Camps I. Necrotizing fasciitis in haematological patients: a different scenario. Ann Hematol 2020; 99:1741-1747. [PMID: 32399706 DOI: 10.1007/s00277-020-04061-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/27/2020] [Indexed: 12/19/2022]
Abstract
To describe and compare the characteristics of necrotizing fasciitis (NF) in patients with and without haematological malignancy. All adult patients diagnosed with NF and treated at our hospital were included (January 2010-March 2019). Diagnosis was based on intraoperative findings or consistent clinical/radiological characteristics, and patients were classified as group A (with haematological malignancy) or group B (without haematological malignancy). Student's t (quantitative), Fisher's exact (qualitative), and Kaplan-Meyer tests were used for the statistical analysis. The study included 29 patients: 8 in group A and 21 in group B. All haematological patients had severe neutropenia (0.2 [0.02-0.5] ×109 cells/L; p < 0.001) and positive blood cultures (100% vs. 61.9%; p = 0.04) at diagnosis. Gram-negative bacilli NF was more common in group A (87.5% vs. 9.5%; p = 0.001), predominantly due to Escherichia coli (50% vs. 9.5%; p = 0.056). Surgical treatment was less common in haematological patients (5 [62.5%] vs. 21 [100%]; p = 0.015). Overall, 9 (31%) patients died: 4 (50%) in group A and 5 (23.8%) in group B (p = 0.17). The univariate analysis showed that mortality tended to be higher (OR 3.2; 95%CI 0.57-17.7; p = 0.17) and to occur earlier (2.2 ± 2.6 vs. 14.2 ± 19.9 days; p = 0.13) in haematological patients. The LRINEC index > 6 did not predict mortality in either group. In our study, NF in patients with haematological malignancies was mainly due to Gram-negative bacilli, associated to high and early mortality rates. In our experience, the LRINEC scale was not useful for predicting mortality.
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Affiliation(s)
- A Albasanz-Puig
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Department of Medicine, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Spanish Network for Research in Infectious Pathology (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - D Rodríguez-Pardo
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Department of Medicine, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Spanish Network for Research in Infectious Pathology (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
| | - C Pigrau
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Department of Medicine, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Spanish Network for Research in Infectious Pathology (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - M Lung
- Microbiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Roldan
- Haematology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P S Corona
- Spanish Network for Research in Infectious Pathology (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Reconstructive and Septic Surgery Division, Department of Orthopedic Surgery, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - B Almirante
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Department of Medicine, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Spanish Network for Research in Infectious Pathology (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - I Ruiz-Camps
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Department of Medicine, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Spanish Network for Research in Infectious Pathology (REIPI), Instituto de Salud Carlos III, Madrid, Spain
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Vallée M, Gaborit B, Meyer J, Malard O, Boutoille D, Raffi F, Espitalier F, Asseray N. Ludwig’s angina: A diagnostic and surgical priority. Int J Infect Dis 2020; 93:160-162. [DOI: 10.1016/j.ijid.2020.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 10/25/2022] Open
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Wang T, Patel SM, Hickman A, Liu X, Jones PLS, Gantz I, Koro CE. SGLT2 Inhibitors and the Risk of Hospitalization for Fournier's Gangrene: A Nested Case-Control Study. Diabetes Ther 2020; 11:711-723. [PMID: 32052281 PMCID: PMC7048884 DOI: 10.1007/s13300-020-00771-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Based on post-marketing surveillance, concern has been raised that sodium-glucose cotransporter 2 inhibitors (SGLT2i) may increase the risk of necrotizing fasciitis of the perineum (Fournier's gangrene, FG). As a result of the low incidence of FG, data from clinical trials may be insufficient to robustly assess this issue because of the relatively limited numbers of participants. Real-world evidence may help clarify the association between SGLT2i and FG in the type 2 diabetes (T2D) population. METHODS A nested case-control study was performed using Truven Health MarketScan™ databases. Each patient with T2D hospitalized for FG between 1 April 2013 (when the first SGLT2i was available) and 31 March 2018 (latest available data) was matched (on the basis of sex, age, and cohort entry date) with six controls from the same cohort. The adjusted odds ratio (OR) of hospitalization for FG was estimated for patients receiving SGLT2i compared with those receiving two or more non-SGLT2i antihyperglycemic agents (AHAs) or insulin alone using conditional logistic regression. RESULTS The cohort included 1,897,935 patients, with 216 hospitalized for FG (incidence rate, 5.2 events per 100,000 person-years). Patients with FG ranged from 23 to 79 years of age; 201 (93.1%) were men. Among the 216 FG cases, 9 (4.2%) were current SGLT2i users; among the 1296 matched controls, 100 (7.7%) were current SGLT2i users. Approximately 93% of SGLT2i were used in combination. The adjusted OR of FG in patients treated with SGLT2i compared with patients treated with two or more non-SGLT2i AHAs or insulin alone was 0.55 [95% CI 0.25-1.18]. CONCLUSION The study did not find that treatment with SGLT2i, as compared with treatment with two or more non-SGLT2i AHAs or insulin alone, was statistically significantly associated with an increased risk of hospitalization for FG. Additional studies are needed to corroborate the findings.
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Affiliation(s)
- Tongtong Wang
- Department of Pharmacoepidemiology, Merck & Co., Inc., Kenilworth, NJ, USA.
| | - Shrita M Patel
- Department of Clinical Safety and Risk Management, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Anne Hickman
- Safety Surveillance and Risk Management, Pfizer Inc., Groton, CT, USA
| | - Xinyue Liu
- Department of Pharmacoepidemiology, Merck & Co., Inc., Kenilworth, NJ, USA
| | | | - Ira Gantz
- Department of Global Clinical Development, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Carol E Koro
- Department of Pharmacoepidemiology, Merck & Co., Inc., Kenilworth, NJ, USA
- Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, MD, USA
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AlShehri YA, AlBurshaid H, AlBassam L, AlMutairi K. Management of Fournier's gangrene with skin grafting by bagging technique of testes: case report. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2019; 8:Doc02. [PMID: 30828517 PMCID: PMC6379833 DOI: 10.3205/iprs000128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aim: To share our experience with the management of Fournier gangrene (FG) using the bagging technique of the testes, and to highlight the importance of implementing a multidisciplinary approach in managing FG. Casepresentation: A 58-year-old male with type 2 diabetes mellitus (DM) was brought to the emergency department (ED) with necrotizing fasciitis involving the genitalia; he was managed in the ED with Intravenous (IV) fluid resuscitation and IV antibiotics. The surgical team was consulted and multiple debridement procedures were done. Healthy granulation tissue was formed within one month of the serial debridement. A split-thickness skin graft using bagging technique of the testes and vacuum-assisted closure (VAC) were applied. The patient was reassessed one year following presentation, and a result with a near normal appearance was achieved with complete preservation of functional outcome. Conclusion: FG is a type of necrotizing fasciitis that could be managed either conservatively with IV antibiotics and/or hyperbaric oxygen, or surgically by debridement and applying VAC. In our case, the testes were debrided and bagging technique of the testes was used. It’s believed that with this technique, the overall cosmetic and functional results are superior.
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Affiliation(s)
- Yasir Ali AlShehri
- Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hiba AlBurshaid
- Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Layan AlBassam
- Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Khalid AlMutairi
- Department of Plastic Surgery and Burn Unit, King Fahad Military Medical Complex, Dammam, Saudi Arabia
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Pehlivanlı F, Aydin O. Factors Affecting Mortality in Fournier Gangrene: A Single Center Experience. Surg Infect (Larchmt) 2019; 20:78-82. [DOI: 10.1089/sur.2018.208] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Faruk Pehlivanlı
- Faculty of Medicine, Department of General Surgery, Kirikkale University, Kirikkale, Turkey
| | - Oktay Aydin
- Faculty of Medicine, Department of General Surgery, Kirikkale University, Kirikkale, Turkey
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Fournier Gangrene: Association of Mortality with the Complete Blood Count Parameters. Plast Reconstr Surg 2018; 142:68e-75e. [PMID: 29952902 DOI: 10.1097/prs.0000000000004516] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The authors studied the alterations in mean platelet volume, neutrophil-to-lymphocyte ratio, and red blood cell distribution width values together with the platelet count in hospitalized patients diagnosed with Fournier gangrene to determine their association with disease prognosis. METHODS Records of patients diagnosed with Fournier gangrene were analyzed retrospectively. RESULTS Seventy-four patients (49 men and 25 women) with a mean age of 57.60 ± 15.34 years (range, 20 to 95 years) were included. Sixty-eight participants were discharged and six died during follow-up. In the discharged group, during hospitalization, there was a trend downward in neutrophil-to-lymphocyte ratio and mean platelet volume values, whereas platelet count increased significantly. In the nonsurvivor group, the neutrophil-to-lymphocyte ratio and mean platelet volume after first débridement and at the end of hospitalization were significantly higher; platelet counts at admission, after the first débridement, and at the end of hospitalization were significantly lower compared with the survivor group (p < 0.05). In correlation analysis, mortality rate was negatively correlated with platelet count at admission and after first débridement and positively correlated with the neutrophil-to-lymphocyte ratio and mean platelet volume after first débridement. Regarding the receiver operating characteristic curve analyses, a platelet count of 188,500/µl at admission and 196,000/µl after the first débridement, a neutrophil-to-lymphocyte ratio of 13.71, and a mean platelet volume of 9.25 fl after the first débridement were defined as the cutoff levels having the best sensitivities and specificities. CONCLUSIONS This study suggests that platelet count at admission and platelet count, mean platelet volume, and neutrophil-to-lymphocyte ratio after first débridement and during discharge may be included among the prognostic scores of Fournier gangrene. The authors defined some threshold values that can be used during patient follow-up. Larger prospective studies are warranted to determine the exact role of those parameters in the prognosis of Fournier gangrene. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Kranz J, Schlager D, Anheuser P, Mühlstädt S, Brücher B, Frank T, Barski D, Mayr R, Lunacek A, Macharia-Nimietz EF, Steffens JA, Grolle J, Pelzer A, Schneidewind L. Desperate need for better management of Fournier's gangrene. Cent European J Urol 2018; 71:360-365. [PMID: 30386661 PMCID: PMC6202618 DOI: 10.5173/ceju.2018.1740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/09/2018] [Accepted: 09/02/2018] [Indexed: 12/11/2022] Open
Abstract
Introduction To compare earlier and later patient groups with Fournier's gangrene, specifically with the incidence of rising antibiotic resistance rates in mind. Primary endpoints were to compare therapy, outcomes, and resistance rates. Material and methods A multicentric, retrospective, multi-national study was performed. Two groups with different time frames of treatment were defined: Group 1 (n = 50) and Group 2 (n = 104). Demographics and outcomes were analysed using Student-t test, chi-square test, or Fisher exact test. Survival data were estimated using the Kaplan Meier method and compared by Log rank testing. Results There were no significant demographic differences. Nor was there any significant difference in therapy or outcomes in the groups except for the duration of intensive care unit treatment, which lasted a mean 6.3 days in Group 1 and 11.5 days in Group 2 (p = 0.018). Survival time did not improve over the years (p = 0.268). We fortunately did not observe an increased rate of multi-resistant organisms (p = 1.000). This study's limitations are mainly due to its retrospective study design. Conclusions Despite increasing antibiotic resistance rates worldwide, it was not apparent in our population. But the situation for these patients is alarming, since final outcome failed to improve over the last ten years despite more intensive critical-care therapy.
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Affiliation(s)
- Jennifer Kranz
- St. Antonius Hospital, Department of Urology, Eschweiler, Germany
| | - Daniel Schlager
- University of Freiburg Medical Centre, Department of Urology, Freiburg, Germany
| | - Petra Anheuser
- Asklepios Hospital St. Georg, Department of Urology, Hamburg, Germany
| | - Sandra Mühlstädt
- University Medical Centre Halle (Saale), Department of Urology, Halle (Saale), Germany
| | - Benedict Brücher
- University Hospital Muenster, Department of Urology and Paediatric Urology, Munster, Germany
| | - Tanja Frank
- RoMed Hospital Rosenheim, Department of Urology and Paediatric Urology, Rosenheim, Geramny
| | - Dimitri Barski
- Lukas Hospital Neuss, Department of Urology, Neuss, Germany
| | - Roman Mayr
- University of Regensburg Medical Centre, Department of Urology, Regensburg, Germany
| | - Andreas Lunacek
- Hanusch Hospital Vienna, Department of Urology, Vienna, Austria
| | | | | | | | - Alexandre Pelzer
- Hospital Wels-Grieskirchen, Department of Urology, Wels, Austria
| | - Laila Schneidewind
- University Medicine Greifswald, Department of Haematotology/Oncology, Greifswald, Germany
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