MP02-02 15 YEARS OF FOURNIER'S RISK FACTORS, MICROBIOLOGY, AND OUTCOMES

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP02-02 15 YEARS OF FOURNIER'S RISK FACTORS, MICROBIOLOGY, AND OUTCOMES Jubin Matloubieh, Rutul Patel, Meenakshi Davuluri, Ethan Fram, Richard Maiman, and Franklin Lowe Jubin MatloubiehJubin Matloubieh More articles by this author , Rutul PatelRutul Patel More articles by this author , Meenakshi DavuluriMeenakshi Davuluri More articles by this author , Ethan FramEthan Fram More articles by this author , Richard MaimanRichard Maiman More articles by this author , and Franklin LoweFranklin Lowe More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003213.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Factors associated with (a/w) Fournier’s Gangrene (FG) are not fully known. We aim to assess FG risk factors (rf), scoring systems, microbiology, and outcomes. METHODS: Retrospective FG patient (pt) medical data from 2007-21 at our institution were obtained. Means were compared via t tests and associations via chi square analysis. RESULTS: Of 132 FG pts, 14% died of FG, 47% were discharged (dc) home and 39% were dc to nursing facility (NH). 9% had orchiectomy, 22% suprapubic tube (SPT), 19% colostomy, 12% thigh pouch (TP), 29% wound closure, and 22% flap/graft use (Table 1). Frequent culture isolates were E. coli, Bacteroides, Streptococcus, Enterococcus, and Candida (Figure 1). Higher FG Severity Index (FGSI) was a/w colostomy, TP, and dc to NH. Lower FGSI was a/w dc home. Higher Uludag FGSI (UFGSI) was a/w colostomy, TP, dc to NH, and FG death. Lower UFGSI was a/w dc home. Lower surgical APGAR (sAPGAR) was a/w colostomy. Higher Charlson index (CI) was a/w FG death. Lower CI was a/w dc home. Actinomyces was a/w closure and f/g. Bacteroides was a/w shorter intensive care unit (ICU) stay, colostomy, and fewer vasopressors. Candida was a/w FG death, longer hospital stay, and shorter time to death (TtoD). Pseudomonas was a/w shorter TtoD, SPT, and TP. Proteus was a/w orchiectomy and FG death. Streptococcus was a/w dc home, longer ICU stay, and longer TtoD. Interestingly, lower hemoglobin A1c (A1c) was a/w orchiectomy and FG death, while higher A1c was a/w f/g. Culture-discordant empiric antibiotics were a/w longer hospital stay and intubation. CONCLUSIONS: This is the largest series on FG scoring systems and the first to compare microbiology with outcomes. FGSI and UFGSI were most a/w outcomes. CI was a/w some outcomes, but this may stem from age as a CI factor. sAPGAR was less a/w outcomes suggesting divergent management of FG vs. trauma. FG microbiology is a/w multiple outcomes and shows a shift away from prior pathogens. These findings and unexpected findings like higher A1c being a/w FG death warrant further study into whether reassessing empiric antibiotics or nutritional optimization may improve outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e10 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jubin Matloubieh More articles by this author Rutul Patel More articles by this author Meenakshi Davuluri More articles by this author Ethan Fram More articles by this author Richard Maiman More articles by this author Franklin Lowe More articles by this author Expand All Advertisement PDF downloadLoading ...