title: Emergence of antibiotic-resistant bacteria in patients with Fournier gangrene.
abstract: BACKGROUND
  This study was conducted to investigate the bacteriology and associated patterns of antibiotic resistance Fournier gangrene.
  
  
  METHODS
  Patients with Fournier's gangrene from 2008 to 2012 were identified from the computerized database in a medical center in southern Taiwan. The medical records of all patients with Fournier's gangrene were reviewed retrospectively.
  
  
  RESULTS
  There were 61 microorganisms, including 60 bacteria and one Candida spp, isolated from clinical wound specimens from 32 patients. The most common isolates obtained were Streptococcus spp. (n=12), Peptoniphilus spp. (n=8), Staphylococcus aureus (n=7), Escherichia coli (n=7), and Klebsiella pneumoniae (n=7). Among 21 strains of gram-negative bacilli, five (23.8%) were resistant to fluoroquinolones, and three isolates were resistant to ceftriaxone. Two E. coli strains produced extended-spectrum beta-lactamase. Four of the seven S. aureus isolates were methicillin-resistant. Among 15 anaerobic isolates, nine (60%) were resistant to penicillin, and eight (53.3%) were resistant to clindamycin. Four (26.7%) isolates were resistant to metronidazole. The only independent risk factor associated with mortality was inappropriate initial antibiotic treatment (p=0.021).
  
  
  CONCLUSIONS
  Antibiotic-resistant bacteria are emerging in the clinical setting of Fournier gangrene. Clinicians should use broad-spectrum antibiotics initially to cover possible antibiotic-resistant bacteria.
authors.affiliation: 1 Department of Trauma, Chi Mei Medical Center , Tainan, Taiwan .
authors.forename: Wei-Ting
authors.initials: WT
authors.lastname: Lin
authors.forename: Chien-Ming
authors.initials: CM
authors.lastname: Chao
authors.forename: Hsin-Lan
authors.initials: HL
authors.lastname: Lin
authors.forename: Ming-Chran
authors.initials: MC
authors.lastname: Hung
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Lai
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001419:Bacteria / Q000187:drug effects*; D002175:Candida / Q000187:drug effects; D024881:Drug Resistance, Bacterial; D005260:Female; D018934:Fournier Gangrene / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents