[Fournier gangrene. A retrospective study of 41 cases].
BACKGROUND
Fournier's gangrene is a rapidly progressing necrotizing fascitis that affects the perineal and genital area. Mortality still remains high. The aim of this study was to evaluate the epidemiological progression and morbidity-mortality of Fournier's gangrene at our centre over the past 10 years.


METHODS
Retrospective study of 41 patients treated for Fournier's gangrene between 1998 and 2007. Variables studied included, demographic variables, aetiology, microbiology, surgical and antibiotic treatment, morbidity, and mortality.


RESULTS
The mean age of the patients was 60, and 93% were male. The most common co-morbidity was diabetes (49%), followed by alcoholism (46%) and immunosuppression or neoplasia (34%). The origin was perianal in 66% of cases, followed by a urological origin (32%). The median time from the onset of symptoms to diagnosis was 3 days. Several surgical debridements were required in 49% of the patients, and the mortality rate was 29%. Most cases had positive cultures (93%), and in 76% more than one microorganism was isolated (enterobacteriaceae and anaerobic flora). In the bivariate analysis, antimicrobial treatment with carbapenems and the absence of systemic complications were associated with lower mortality.


CONCLUSIONS
Fournier's gangrene continues to be a severe surgical emergency, with a high mortality rate. Early diagnosis and aggressive surgical and antibiotic therapy are necessary for adequate management.
Torremadé Barreda
Jose
J
Servicio de Urología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
Millán Scheiding
Mónica
M
Suárez Fernández
Cristina
C
Cuadrado Campaña
Jose María
JM
Rodríguez Aguilera
José
J
Franco Miranda
Eladio
E
Biondo
Sebastiano
S
D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D005260:Female; D018934:Fournier Gangrene / Q000188:drug therapy / Q000601:surgery*; D005836:Genitalia, Female; D005837:Genitalia, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum; D012189:Retrospective Studies; D055815:Young Adult
D000890:Anti-Infective Agents