title: Prognostic aspects, survival rate, and predisposing risk factors in patients with Fournier's gangrene and necrotizing soft tissue infections: evaluation of clinical outcome of 55 patients.
abstract: OBJECTIVE
  To determine predisposing or prognostic factors and mortality rates of patients with Fournier's gangrene compared to other necrotizing soft tissue infections (NSTI).
  
  
  METHODS
  Data of 55 intensive care patients (1981-2010) with NSTI were evaluated. Data were collected prospectively.
  
  
  RESULTS
  43.4% of the patients were in septic condition and 27.3% were hemodynamically unstable. Half of the patients showed predisposing factors (52.7%). The lower extremity (63.2%), abdomen (30.9%), and perineum (14.5%) were most affected. Polymicrobial infections were frequent (65.5%, mean 2.8, range: 1-4). The mortality rate was 16.4% (n = 9). An increase was shown for diabetes mellitus (20%), cardiac insufficiency (22.3%), septic condition at presentation (33.3%), abdominal affection (47.1%), and hemodynamic instability (46.7%). Comparing survivors and nonsurvivors, statistical significance was seen with age (p < 0.001), septic condition at admission (p < 0.001), hemodynamic instability (p < 0.001), low blood pressure (p < 0.001), and abdominal affection (p < 0.001). In laboratory findings, an increase of creatine kinase (p < 0.001) and lactate (p < 0.001) and a decrease of antithrombin III (p < 0.007) and the Quick value (p < 0.01) proved to be significant.
  
  
  CONCLUSIONS
  Patients with Fournier's gangrene do not differ in all aspects from those with other NSTI. Successful treatment consists of immediate surgical debridement, broad-spectrum antibiotic treatment, and critical care management. Supportive hyperbaric oxygen therapy should be considered.
authors: Department of Urology, Federal Armed Forces Hospital of Ulm, Ulm, Germany. Martinschek @ web.de
authors: A
authors: A
authors: Martinschek
authors: B
authors: B
authors: Evers
authors: L
authors: L
authors: Lampl
authors: H
authors: H
authors: Gerngroß
authors: R
authors: R
authors: Schmidt
authors: C
authors: C
authors: Sparwasser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D060085:Coinfection; D003422:Critical Care / Q000379:methods; D003646:Debridement / Q000379:methods; D005260:Female; D018934:Fournier Gangrene / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011446:Prospective Studies; D012307:Risk Factors; D018461:Soft Tissue Infections / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents