Evaluation of factors affecting mortality in Fournier's Gangrene: Retrospective clinical study of sixteen cases.
OBJECTIVE
Fournier's gangrene is a progressive, necrotizing fasciitis due to synergistic infection of the perineum and external genitalia that is associated with high mortality and morbidity. The purpose of this study is to review the diagnostic and treatment methods that effect mortality in Fournier's gangrene.


METHODS
Sixteen patients who were diagnosed and treated at our clinic between 2011 and 2013 due to Fournier's gangrene were retrospectively analyzed. The surviving and non-surviving patient groups were compared in terms of age, sex, onset time of symptoms, isolated microorganisms, concomitant diseases, Fournier's gangrene severity index (FGSI), and length of hospital stay.


RESULTS
Ten of our cases (62.5%) were male and six (37.5%) were female, with a mean age of 61.2±12.3 (42-73) years. The mortality rate was 18.8% (3 cases). The mean duration of symptoms before admission was 4.31±1.81 (2-8) days. This period was 6.67±1.52 days in patients who succumbed to death, and 3.77±1.42 days in patients who survived (p=0.007). Ten cases (62.5%) had concomitant diabetes mellitus. The most common organism isolated in wound cultures was Escherichia coli (68.7%), and Acinetobacter baumannii, Proteus mirabilis, methicillin-resistant Staphylococcus aureus and Enterococcus spp. in the remaining patients. The mean FGSI of surviving patients was 3.84±1.77, and 7.66±0.57 in fatal cases (p=0.003). The mean length of hospital stay was 25.5 days (2-57) and duration of hospitalization was significantly longer in survivors (p<0.05).


CONCLUSIONS
The delay in diagnosis and higher FGSI may be responsible for worsening of prognosis and mortality in Fournier's gangrene. Early diagnosis and determination of the severity of the disease, aggressive surgical debridement and appropriate antimicrobial therapy may improve prognosis.
Clinic of Gastrointestinal Surgery, İzmir Bozyaka Teaching and Training Hospital, İzmir, Turkey.
Erkan
E
Oymacı
Clinic of General Surgery, İzmir Bozyaka Teaching and Training Hospital, İzmir, Turkey.
Ali
A
Coşkun
Clinic of General Surgery, İzmir Bozyaka Teaching and Training Hospital, İzmir, Turkey.
Savaş
S
Yakan
Clinic of General Surgery, İzmir Bozyaka Teaching and Training Hospital, İzmir, Turkey.
Nazif
N
Erkan
Clinic of General Surgery, İzmir Bozyaka Teaching and Training Hospital, İzmir, Turkey.
Ahmet Deniz
AD
Uçar
Clinic of General Surgery, İzmir Bozyaka Teaching and Training Hospital, İzmir, Turkey.
Mehmet
M
Yıldırım
Fournier’s gangrene; necrotizing fasciitis; soft tissue infection; treatment