title: Fournier's gangrene: is the female gender a risk factor?
abstract: OBJECTIVE
  Fournier's gangrene is a necrotizing fasciitis that affects the perineal, genital, or perianal regions. The objective of this study was to highlight this uncommon condition with a particular focus on the disease course in females.
  
  
  METHODS
  From 1996 to 2008, we prospectively collected data from 38 patients with Fournier's gangrene (12 women, 26 men) and retrospectively analyzed relevant parameters.
  
  
  RESULTS
  The mean age was 60.9 +/- 11.3 years for females (group I) and 56.2 +/- 11.7 years for males (group II). In both groups, the main predisposing factors were diabetes mellitus and obesity (body mass index of 30 or higher). Twelve men (46.2%), but no women, had chronic alcoholism. The most commonly isolated agents were Escherichia coli (n = 22), streptococcal species (n = 18), Pseudomonas aeruginosa (n = 9), and Staphylococcus aureus (n = 7). Mortality was significantly higher among females (50%) than males (7.7%; p = 0.011). Peritonitis was present in seven group I patients (58.3%) and in two group II patients (7.7%). The retroperitoneum was involved in seven female patients (58.3%) and four male patients (15.4%).
  
  
  CONCLUSIONS
  The female gender is a risk factor for mortality in patients with Fournier's gangrene and is associated with a higher incidence of inflammation of the retroperitoneal space and abdominal cavity. Differences in male and female genital anatomy may be the reason for the rapid spread of infection to the retroperitoneum and the fatal outcome in women. Fournier's gangrene as a high-risk disease in females should attract exceeding attention.
authors.affiliation: Department of Surgery, University of Luebeck Medical School, Ratzeburger Allee 160, Lübeck, Germany. ralf_czymek@web.de
authors.forename: Ralf
authors.initials: R
authors.lastname: Czymek
authors.forename: Philine
authors.initials: P
authors.lastname: Frank
authors.forename: Stefan
authors.initials: S
authors.lastname: Limmer
authors.forename: Andreas
authors.initials: A
authors.lastname: Schmidt
authors.forename: Thomas
authors.initials: T
authors.lastname: Jungbluth
authors.forename: Uwe
authors.initials: U
authors.lastname: Roblick
authors.forename: Conny
authors.initials: C
authors.lastname: Bürk
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Bruch
authors.forename: Peter
authors.initials: P
authors.lastname: Kujath
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015984:Causality; D002423:Cause of Death; D003646:Debridement; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D018934:Fournier Gangrene / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011446:Prospective Studies; D012727:Sex Characteristics; D017678:Sex Distribution; D018709:Statistics, Nonparametric
chemical_list: D000900:Anti-Bacterial Agents