Progress in Multidisciplinary Treatment of Fournier's Gangrene

The microbiological profile of necrotising fasciitis at a secondary level hospital in Gauteng

Background

Necrotising fasciitis (NF) is a fulminant soft tissue infection that requires timely diagnosis, urgent surgical debridement, and appropriate antimicrobial therapy. The choice of empiric antimicrobial therapy depends on the microorganisms cultured and the antimicrobial resistance profile of the institution. Necrotising fasciitis has not been studied in our setting.

Objectives

The aim of the study was to audit the microbiological profile of NF and antimicrobial susceptibility profile.

Method

This was a retrospective study in a secondary level hospital from the period of 2014-2020. The patients' demographic data, clinical features, location of infection, comorbidities, laboratory and microbiological profiles were analysed.

Results

There were 53 patients during 2014-2020 with median age of 45.5 (38.5-56.0) years. The majority of the patients were males (35 [66.04%]), had no comorbidities (25 [47.17%]), and the lower limb was the most common anatomic site (17 [32.08%]). Type II (monomicrobial) NF was the predominant type (31 [58.49%]). Staphylococcus aureus was the most prevalent Gram-positive bacteria (18 [38%]) and Escherichia coli, the main species isolated in the Gram-negative bacteria (14 [36%]) with susceptibility to cloxacillin (94%) and amoxicillin and/or clavulanic acid (92%), respectively.

Conclusion

Staphylococcus aureus and Escherichia coli were the most common bacteria with low rate of antimicrobial resistance. Amoxicillin and/or clavulanic acid and an adjunctive clindamycin are appropriate antimicrobial therapy for empiric treatment for NF in our setting.

Contribution

Amoxicillin and/or clavulanic acid and an adjunctive clindamycin can be used as an empiric treatment for NF.

Prognostic determinants and treatment outcomes of Fournier's Gangrene treatment in a resource-limited setting: A retrospective study

BACKGROUND

Fournier's gangrene (FG) is a destructive necrotizing infection with a generally poor prognosis. This study aims to share our experience in handling FG patients in a resource-limited setting and identify prognostic factors for FG mortality.

METHODS

A retrospective study of thirty-six patients diagnosed with FG and treated at our teaching hospital between Jun 2010 to Oct 2022 was conducted. Laboratory and nonlaboratory data and patients' outcomes were gathered. A univariate analysis was computed for identifying prognostic factors for FG mortality.

RESULT

The main age was 68.30 ± 5.61years and most (69.4%) were older than 65 years. The overall survival was 63.9% and the mortality rate was 36.1%. Univariate analysis showed that advanced age (p = 0.02), delayed in hospital presentation (p = 0.024), involvement of larger area (p = 0.001), a history of diabetes mellitus (p < 0.006), end-stage renal disease (p = 0.018), heart failure (p = 0.005), cerebrovascular accident (p = 0.003), liver cirrhosis (p = 0.001), presence of multiple comorbidities (p = 0.001), septic conditions at admission (p = 0.048), need for mechanical ventilation (p = 0.001), hypoalbuminemia (p < 0.001), and elevated blood urea nitrogen (p = 0.002) were found to be risk factors for mortality in patients with FG.

CONCLUSIONS

Fournier's gangrene is a fulminant condition with a high mortality rate, especially in resource-limited settings. In this study, the mortality rate was 36.1%. Advanced age, delayed in hospital presentation, involvement of larger area, a history of diabetes mellitus, end-stage renal disease, heart failure, cerebrovascular accident, liver cirrhosis, presence of multiple comorbidities, septic conditions at admission, need for mechanical ventilation, hypoalbuminemia, and elevated blood urea nitrogen were associated with FG mortality.

Advances in Management of Fournier's Gangrene by Coupling Intensive Hospital Treatment With Innovative Post-discharge Hyperbaric Oxygen Therapy Rehabilitation: A Case Report

Fournier's gangrene (FG) is a rare form of necrotizing soft tissue infection characterized by an acute, aggressive, and rapidly progressive course. In this case report, we describe advanced therapy combining critical care, surgery, pharmacotherapy, extended biochemical/cellular blood diagnostics, and post-discharge hyperbaric oxygen therapy rehabilitation. Such an intervention resulted in survival and improved health status and quality of life of the patient with FG and septic shock.