Emergence of multi-drug resistant organisms (MDROs) causing Fournier's gangrene
Introduction
Fournier's gangrene is a necrotizing infection of the deep fascial tissues involving the perineal, genital, and/or perianal regions. It was first reported in the medical literature by Bauriene in 1764, but referred to in ancient civilizations.1, 2 Infection typically begins in the genital area and the close proximity of multiple fascial planes in the region enables the rapid spread of pathogens resulting in necrosis and systemic toxicity. Risk factors traditionally have included diabetes mellitus, recent surgical procedure, and immunosuppression.
Mortality rates among Fournier's gangrene cases remain high and have been estimated as ~20%.3 Optimizing patient outcomes requires both urgent surgical debridement and the initial use of effective antibiotics against the causative pathogen(s). To help inform antimicrobial management decisions for Fournier's gangrene cases, we sought to determine the types and susceptibility patterns of causative pathogens using a contemporary series of Fournier's gangrene cases. Additionally, although historically Fournier's gangrene has been considered a rare entity, the diagnosis may be increasingly common prompting this study which also examined the incidence and risk factors of this life-threatening condition.
Section snippets
Methods
We performed a retrospective study of all cases of Fournier's gangrene from 2006 to 2015 at a large (~500 bed) urban academic teaching hospital in San Diego, California. We initially identified potential Fournier's gangrene cases by searching the hospital discharge records for specific ICD codes (ICD-9: 608.83, V13.89; ICD-10: N49.3, Z87.438). The authors then performed an in-depth review of the medical records to confirm that the treating clinician(s) had diagnosed the patient with an
Results
A total of 59 cases of Fournier's gangrene were identified with an overall incidence rate of 31.8 cases per 100,000 admissions during the 10-year study period. The number of cases appeared to increase over time, although this did not reach statistical significance (p = 0.17) (Fig. 1).
The characteristics of the Fournier's gangrene cases are shown in Table 1. The mean age was 56 years (range 18–91 years), 71% were male, and 44% were Caucasian. Being overweight or obese was the most common
Discussion
Fournier's gangrene is a fulminant necrotizing infection of the perineal and genitourinary regions. Despite advancements in medicine, it remains a life-threatening disease that warrants contemporary evaluation of the causative pathogens to optimize treatment outcomes. Traditionally, Fournier's gangrene was thought to be caused by a polymicrobial combination of low-virulent organisms that resulted in a necrotizing infection via synergy with one another.8 In our study, we found a considerable
Conclusions
Our study demonstrated a high incidence rate of Fournier's gangrene suggesting that this condition may represent an emerging infection, although further studies from diverse geographic setting are needed to confirm this finding. Further, MDROs are an increasing cause of these infections, with MRSA being found in 14% of all cases in our study. As these infections are associated with high morbidity and mortality rates, this study's findings advocate for the initial use of antibiotics with
Conflict of interest
The authors have no potential conflicts of interest to report. Both authors had access to the data and contributed to the writing the manuscript.
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Cited by (0)
Funding source related to this manuscript: None.
This work is accepted as a poster presentation at ID Week, October 4–8, 2017, San Diego, CA.