Diagnosis and treatment outcomes of Fournier’s gangrene from a tertiary hospital

Abstract

   Introduction: Fournier’s gangrene (FG) is a severe necrotizing fasciitis, caused by polymicrobial agents. This study aims to evaluate the clinical and paraclinical characteristics, treatment outcomes, and factors related to mortality in patients with FG at People’s Hospital 115.

   Methods: A retrospective cohort study was conducted on all adult patients diagnosed with FG at People’s Hospital 115 from January 2018 to October 2024. Data analysis was performed using SPSS version 26.0 (IBM, USA). Frequencies and percentages were used to present categorical data, while medians and interquartile ranges were used to express numerical variables.

   Results: A total of 60 patients (47 males and 13 females) were enrolled with the mean age was 58.2 ± 12.6 years. The most common infection origins were from skin infections (36.7%), followed by the gastrointestinal tract (31.7%) and the genitourinary tract (30%). Most patients presented with symptoms such as perineal pain (98.3%), perianal swelling (91.7%), fever (48.3%), lower abdominal fluid collection (43.3%), and purulent discharge or perineal necrosis (31.7%). The most prevalent risk factors were diabetes mellitus (61.8%). Pathogenic bacteria could be isolated that were commonly Escherichia coli, Klebsiella, and Proteus species.

Treatment involved both medical management (resuscitation, broad-spectrum antibiotics, wound care) and surgical interventions (debridement, necrotic tissue excision, fecal and urinary diversion). The overall mortality rate was 18.3%. Factors significantly associated with mortality included advanced age, female sex, a history of long-term corticosteroid use, underlying malignancies, high severity index scores, and the need for permanent fecal diversion via colostomy.

   Conclusion: FG is an uncommon urological emergency which is a rapidly progressing disease with a high mortality rate. Early detection and aggressive treatment approaches to achieve better outcomes.

DOI: 10.59715/pntjmp.4.2.13