Gangrene Severity Index Research Articles

Comparative analysis of scoring systems for predicting mortality in Fournier gangrene: single center, 15years experience.

To compare 5 published scoring systems (Fournier gangrene severity index [FGSI], Uludag FGSI [UFGSI], age-adjusted Charlson Comorbidity Index [ACCI] and the Quick Sequential Organ Failure Assessment (qSOFA) and the Laboratory Risk Indicator for Necrotizing fasciitis (LRINEC) scores and to evaluate risk factors for outcome prediction in patients with Fournier gangrene (FG). Between 2010 and 2024, 311 patients were included in the study. The data of 276 survivors and 55 non-survivors were compared. Univariate and multivariate analyses were performed to determine which of the 5 scoring systems calculated according to demographic, laboratory and clinical data predicted mortality better. In addition, a cut-off value for these scoring systems was determined by ROC analysis. The mortality rate was 17.6% in FG patients. In all 5 scoring systems, univariate analyses showed higher values in non-survivor patients, while UFGSI and FGSI scoring systems were superior to other scoring systems in multivariate analyses (p < 0.001). ROC analysis using mortality-based sensitivity and specificity revealed that the optimal cut-off values for FGSI, UFGSI, ACCI, SOFA and LRINEC should be equal to or higher than 10, 12, 4, 2 and 8, respectively. UFGSI and FGSI scores had the highest AUC values among all scores. This was followed by ACCI, qSOFAand LRINEC. For a UFGSI score ≥ 12, the sensitivity was 84%, specificity 97%, PPV 85% and NPV 97%. Among the scoring systems used to predict mortality, UFGSI was the most accurate, while LRINEC was the least accurate.

Outcome of Fournier's gangrene in relation to Fournier Gangrene Severity Index (FGSI) score.

Fournier's gangrene is a rapidly progressive necrotizing fasciitis, involving perineum mainly. The purpose of the study is to evaluate etiology, treatment, and outcome of Fournier's gangrene so that such type patient's management can be done by primary care physicians with best outcomes. This was a retrospective study including 156 patients, treated for Fournier's gangrene, between Jan 2012 and Dec 2018. The outcome and prognosis of Fournier's gangrene were reviewed. The mean age and mode among survival patients were 47.94 ± 14.9 and 60 years, and the mean age and mode in nonsurvival patients was 47.64 ± 15.9 and 65 years. The most common predisposing factor was diabetes mellitus (n = 49, 31.4%) having mortality rate was 9% (n = 14). Most common causative bacteria were E. coli. In the study, the survival rate was 100% in patients having Fournier Gangrene Severity Index (FGSI)≤3. As FGSI increased from 3, the mortality rate increased. Fournier gangrene is a surgical emergency. Early diagnosis, serial surgical debridement, and broad-spectrum antibiotics decrease the mortality and morbidity of patients. The sensitivity and specificity of FGSI determine the prognosis of Fournier's gangrene. FGSI is a simple method to know the severity and prognosis.

Analysis of factors predisposing to increased number of complications and mortality in patients with Fournier’s gangrene

Introduction and objective: Fournier’s gangrene is an infectious disease affecting the soft tissues of the groin area. The primary cause is bacterial infection of the tissues, which can quickly lead to necrosis and even systemic infection. Analysing the risk factors allows for estimating the potential course and complications of the disease. Materials and methods: An analysis was conducted on a group of 53 patients with Fournier’s gangrene hospitalised between 2010 and 2022 in the Military Institute of Medicine – National Research Institute, to assess the most common risk factors with a view to determining if their occurrence affects the length of hospitalisation, the severity of the disease, inflammatory parameters, kidney function, and mortality. Results: Diabetes, infection with resistant bacteria, and previous urological procedures did not significantly affect any of the examined parameters. Cardiovascular diseases, poor social status, and other cancers significantly increased the severity of the disease determined by the Fournier’s Gangrene Severity Index (FGSI). Cardiovascular diseases significantly worsened kidney function parameters. Cardiovascular and gastrointestinal diseases were the only ones significantly increasing mortality in the studied group. Hospitalisation during the COVID-19 pandemic only led to a significant increase in inflammatory parameters. No correlation was found between the number of risk factors and the length of hospitalisation, while a positive correlation was shown between the risk factors and the FGSI score. Conclusions: Patients diagnosed with Fournier’s gangrene and having cardiovascular or gastrointestinal diseases should undergo closer clinical observation to reduce mortality and the risk of complications. Patients with a higher number of risk factors present a more severe course of infection, as assessed by the FGSI.

Comparing scoring systems for Fournier gangrenes in predicting morbidity and mortality: Is FGSI still reliable?

IntroductionCompare scoring systems using Fournier gangrene severity index (FGSI), Uludag Fournier gangrene severity index (UFGSI), Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC), and neutrophil-lymphocyte ratio (NLR) to predict the outcome of patients with Fournier gangrene. Materials and methodsThis is a retrospective cohort study that includes FG patients from 2012 to 2021. NLR, FGSI, UFGSI, and LRINEC values were calculated and analyzed. Each scoring system was analyzed using a receiver-operating curve (ROC) analysis to determine its sensitivity, specificity, and area under the curve (AUC). Statistical analysis was performed using SPSS version 25. ResultsA total of 158 patients were included in this study. Regarding the mortality outcome, FGSI comprised the highest value of AUC with 80.9, with a sensitivity of 91.7% and specificity of 68.5%. LRINEC comprised the AUC value of 61.1, with 79.2% sensitivity and 64.2% specificity. NLR comprised an AUC value of 63.7, 91.7% of sensitivity, and 98.1% of specificity. In terms of length of stay, LRINEC and NLR were associated as significant predictor. ConclusionFGSI, UFGSI, and NLR are significant predictors associated with mortality in patients with Fournier gangrene. FGSI and UFGSI comprised the highest sensitivity and specificity value in predicting mortality prognosis. Moreover, this study highlighted the role of NLR and LRINEC as significant predictors for the length of hospitalization. This study shows that FGSI is still a reliable scoring system for predicting mortality in patients with Fournier Gangrene. Level of evidenceII.

Fournier's gangrene: a review of predictive scoring systems and practical guide for patient management.

This article aims to provide a practical guide for patient management and an overview of the predictive scorings for Fournier's gangrene (FG) that are available to aid clinicians. A literature was performed reviewing currently used scoring systems for FG and presenting a practical guide for its management based on the available evidence. There are four specific scoring systems available for the assessment of FG although few other non-specific and generic tools also exist. These specific tools include Laboratory Risk Indicator for Necrotizing Fasciitis, Fournier's Gangrene Severity Index, Uludag Fournier's Gangrene Severity Index, and Simplified Fournier's Gangrene Severity Index and help calculate expected mortality. Our proposed algorithm covers primary assessment, resuscitative interventions, initial investigations, urgent care, post-operative care, and long-term follow-up. The management of the FG patient can be divided into initial resuscitation, surgical debridement, ongoing ward management with antibiotic therapy, wound reconstruction, and long-term follow-up. Each facet of care is vital and requires multidisciplinary team expertise for optimal outcomes. Whilst mortality continues to improve, it remains significant, reflecting the severe and life-threatening nature of FG. More research is certainly needed into how this care is individualised, and to ensure that long-term outcomes in FG include quality of life measures after discharge.

Clinical features and treatment outcomes of Fournier's gangrene in a single tertiary emergency hospital: Simplified Fournier's Gangrene Severity Index score is a predictor for death.

To assess the predictive reliability of the Simplified Fournier's Gangrene Severity Index Score (SFGSI) for mortality in Japanese patients with Fournier's gangrene (FG), we compared the clinical features and outcomes of a patient sample with the SFGSI. The medical records of 36 patients diagnosed with FG at our hospital between October 2007 and September 2022 were reviewed retrospectively. Clinical and laboratory variables, including SFGSI, were evaluated and predictive factors for fatality were investigated using multivariate logistic regression analysis. The median age and body mass index were 65 and 24.2, respectively. Eight patients had cooccurring chronic kidney disease and 23 had diabetes. None were taking sodium-glucose co-transporter-2 (SGLT-2) inhibitors. The causative organisms were diverse, and no specific trends in causative organisms were observed. 26 patients underwent debridement of necrotic tissue including eight colostomies, two orchiectomies, and one cystectomy. Multivariate logistic regression analysis revealed that SFGSI alone was an independent predictor of case fatality, with an odds ratio of 20.167 (95% CI: 1.66-245.53). In conclusion, the fatality rate was 19.4%, which was comparable to that reported in other studies. The SFGSI was an independent predictor of mortality in this study.

Clinical and microbiological evaluation in patients with Fournier’s gangrene

Introduction: Necrotising fasciitis (Fournier’s gangrene) is a bacterial inflammation of the subcutaneous tissues and skin, involving the urogenital area. The treatment is complex, with a high risk of systemic infection. A key aspect of treatment is antibiotic therapy. Materials and methods: The analysis involved 30 hospitalised patients with Fournier’s gangrene. An attempt was made to determine the relationship between laboratory parameters, types of pathogens, patterns of antibiotic susceptibility/resistance, and treatment outcomes. Results: The average value of Fournier’s Gangrene Severity Index (FGSI) was 4.37 ± 2.87. In the study group, a total of 18 (60%) patients had an infection caused by a single bacterial strain, while 12 (40%) had infections caused by multiple strains. The most commonly identified bacteria was Escherichia coli (53.33%) – 50% of monocultural infections and 58.33% of polyculture infections. The majority of bacteria were sensitive to piperacillin–tazobactam – 22 (73.33%) patients, clindamycin – 20 (66.66%) patients, and metronidazole – 18 (60%) patients. The highest percentage of antibiotic resistance was observed for cefuroxime – 19 (63.33%) patients, ciprofloxacin – 19 (63.33%) patients, and ceftriaxone – 17 (56.66%) patients. The average hospitalisation length was 30.03 ± 23.01 days. The overall mortality rate was 13.33% (n = 4). No correlation was found between the type of pathogen, hospitalisation length or mortality. No differences were observed in the results of laboratory parameters, FGSI, or length of hospitalisation in the analysed subgroups. Conclusions: Effective treatment of Fournier’s gangrene requires performing a wound swab culture as quickly as possible and implementing a targeted antibiotic therapy. There is no single laboratory parameter that can predict treatment outcomes and patient prognosis. There are no differences in the clinical course and prognosis between multibacterial and monobacterial infections.

Evaluation of Negative Pressure Wound Therapy in the Management of Fournier's Gangrene.

Introduction Necrotizing soft tissue infections (NSTIs), including Fournier's gangrene (FG), are severe polymicrobial bacterial infections characterized by rapidly spreading inflammation and tissue necrosis. This study aims to compare the clinical outcomes of vacuum-assisted closure (VAC) dressing and conventional dressing in patients with FG. Materials and methods A prospective study was conducted from December 2020 to May 2022, including patients with clinical features suggestive of FG. Patients were divided into two groups: conventional dressing and VAC dressing. Relevant clinical data, including age, duration of hospital stay, wound status, Fournier's gangrene severity index (FGSI) scores, sepsis markers (C-reactive protein (CRP), neutrophil-to-lymphocyte ratio, and procalcitonin), and pain assessment, were recorded and compared between the two groups. Results A total of 84 patients were included in the study, with 42 patients in each group. The mean age was 57.48 ± 15.74 years in the conventional dressing group and 50.83 ± 13.95 years in the VAC dressing group. VAC dressing was associated with a significantly shorter duration of hospital stay (8.14 ± 3.13 days) compared to conventional dressing (11.36 ± 4.75 days). The average time taken for wound closure was significantly reduced in the VAC dressing group (63 ± 14.81 days) compared to the conventional dressing group (112.56 ± 13.82 days). FGSI scores showed significant improvement after debridement in both groups, with lower scores in the VAC dressing group at discharge. Sepsis markers such as CRP and serum procalcitonin exhibited a significant decrease after VAC application. Discussion The study demonstrates that VAC therapy is associated with better clinical outcomes in FG, including reduced duration of hospital stay, faster wound closure, improved FGSI scores, decreased sepsis markers, and reduced pain. These findings align with previous studies highlighting the advantages of VAC therapy over conventional dressing methods. Conclusion VAC therapy provides significant benefits in the management of FG, leading to improved clinical outcomes and patient quality of life. It offers advantages such as shorter hospital stays, faster wound closure, and reduced sepsis markers. The application of VAC dressing should be considered a valuable treatment modality for FG.

The Value of Fournier's Gangrene Scoring Systems on Admission to Predict Mortality: A Systematic Review and Meta-Analysis.

To systematically review and meta-analyze the predictive value of the Fournier gangrene severity index (FGSI), the simplified FGSI (SFGSI), and the Uludag FGSI (UFGSI) on mortality in patients affected by Fournier's Gangrene (FG). A search was performed in PubMed, Web of Science, Embase, and the Cochrane Library, from January 2000 to May 2023, to identify original cohorts comparing data between surviving and non-surviving FG patients. The statistical analysis consisted of two parts. First, the mean and standard deviation (SD) of the FGSI, SFGSI, and UFGSI at admission were extrapolated from each study, and the pooled mean difference (MD) with 95% confidence interval (95% CI) was obtained using the Der Simonian-Laird random-effect model. Second, to evaluate the accuracy of the FGSI, SFGSI, and UFSGI in predicting mortality, true positive (TP), false positive (FP), true negative (TN), and false negative (FN) values were extracted where possible and reported in 2 × 2 contingency tables. The sensitivity, specificity, and AUC values were pooled, and summary receiver operating characteristic (SROC) curves were constructed. Overall, forty studies comprising 2257 patients were included. The pooled analysis revealed that the FGSI, SFGSI, and UFGSI values at admission were higher in non-survivors than survivors (MD: 5.53 (95% CI: 4.68-6.37); MD: 2.41 (95% CI: 1.06-3.77); and MD: 5.47 (95% CI: 3.68-7.26), respectively). Moreover, the AUC values of the FGSI, SFGSI, and UFGSI were 0.90 (95% CI: 0.87-0.92), 0.84 (95% CI: 0.80-0.87), and 0.94 (95% CI: 0.92-0.96), respectively. The higher scores of the FGSI, SFGSI, and UFGSI on admission were associated with mortality. Moreover, when comparing accuracy rates, the UFGSI exhibited the highest AUC value.

Comparison of different scoring systems for predicting in-hospital mortality for patients with Fournier gangrene

PurposeTo compare different scoring systems for predicting in-hospital mortality in patients with Fournier gangrene (FG).MethodsA comprehensive literature search was performed to find all scoring systems that have been proposed previously as a predictor for in-hospital mortality in patients with FG. Data of all patients with FG who were hospitalized in one of Indonesia’s largest tertiary referral hospitals between 2012 and 2022 were used. The receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the scoring systems.ResultsTen scoring systems were found, i.e., Fournier’s Gangrene Severity Index (FGSI), Uludag FGSI, simplified FGSI, NUMUNE Fournier score (NFS), Laboratory Risk Indicator for Necrotizing Fasciitis, age-adjusted Charlson comorbidity index, sequential organ failure assessment (SOFA), quick SOFA, acute physiology and chronic health evaluation II, and surgery APGAR score (SAS). Of 164 FG patients included in the analyses, 26.4% died during hospitalization. All scoring systems except SAS could predict in-hospital mortality of patients with FG. Three scoring systems had areas under the ROC curve (AUROC) higher than 0.8, i.e., FGSI (AUROC 0.905, 95% confidence interval (CI) 0.860–0.950), SOFA (AUROC 0.830, 95% CI 0.815–0.921), and NFS (AUROC 0.823, 95% CI 0.739–0.906). Both FGSI and SOFA had sensitivity and NPV of 1.0, whereas NFS had a sensitivity of 0.74 and an NPV of 0.91.ConclusionThis study shows that FGSI and SOFA are the most reliable scoring systems to predict in-hospital mortality in FG, as indicated by the high AUROC and perfect sensitivity and NPV.

Favorable Safety Outcomes of Delayed Primary Closure of Large Fournier’s Gangrene Skin Defects

To assess the feasibility and safety of delayed primary closure (DPC) in Fournier's gangrene (FG) patients with large genital defects. A single institution retrospective review was performed from October 2020 to December 2022 of adult males that underwent DPC for FG. All patients underwent standard medical management and were assessed for DPC eligibility by the urology service. Clinical data on patient factors and outcomes were collected, and descriptive statistics were assessed. Of 16 patients that underwent DPC, the average age was 61.1years and body mass index was 34.6kg/m2. Median Charlson Comorbidity Index was 3.5 (IQR 2-5.3) and Fournier's Gangrene Severity Index was 6.5 (IQR 4.8-8). Median number of debridements was 2.5 (IQR 2-3), with a time to closure of 6.5days (IQR 3-11) and length of stay of 13days (IQR 9-16.3). Mean genital defect size was 119cm2 (range 44-346cm2). Eight patients (50%) were closed using scrotal flaps alone while other patients had advancement flaps using the inner thigh, lower abdomen, and perineum. The majority of patients were discharged home directly (63%). There were four Clavien-Dindo III complications: two partial flap necrosis, one wound dehiscence, and one instance of bleeding. Of patients with follow-up, 6/15 (40.0%) had no known complications. DPC is safe and effective for a range of patients presenting with FG. Patients with large defects may benefit from less complex wound management and direct discharge home.

Can HALP score, a new prognostic tool, take the place of traditional scoring systems in Fournier's gangrene?

Fournier's Gangrene (FG) is a fatal condition, therefore prognosis prediction is a crucial step before treatment planning. We aimed to investigate the predictive value of Hemoglobin, Albumin, Lymphocyte and Platelet (HALP) score which is frequently employed in vascular disorders and malignancies, on disease severity and survival in FG patients and to compare HALP score with well-known scoring systems on this aspect. Eighty-seven men who had surgical debridement for FG between December 2006 and January 2022 were included in this study. Their symptoms, physical examination findings, laboratory tests, medical histories, vital signs, extent and timing of the surgical debridement and antimicrobial therapies were noted. The HALP score, Age-adjusted Charlson Comorbidity Index (ACCI) and Fournier's Gangrene Severity Index (FGSI) were evaluated for their predictive values for survival. FG patients were grouped as survivors (Group 1, n = 71) and non-survivors (Group 2, n = 16) and the results were compared. The mean ages of survivors (59 ± 12.55years) and non-survivors (64.5 ± 14.6years) were similar (p = 0.114). The median size of necrotized body surface area was 3% in Group 1 and 4.8% in Group 2 (p = 0.013). On admission, hemoglobin, albumin and serum urea levels and white blood cell counts were significantly different in two study groups. Two study groups were similar for HALP scores. However, ACCI and FGSI scores were greater significantly in non-survivors. Our results indicated that HALP score does not predict a survival successfully in FG. However, FGSI and ACCI are successful outcome predictors in FG.

A Disease-Specific Antibiogram to Evaluate Empiric Coverage Patterns in Fournier’s Gangrene

To analyze our local antibiogram and antibiotic resistance patterns given concern for multidrug-resistant and fungal organisms in contemporary series detailing causative organisms in Fournier's Gangrene (FG). All patients from 2018 to 2022 were identified from the institutional FG registry. Microorganisms and sensitivities were collected from operative tissue cultures. The primary outcome of this study was the adequacy of our empiric. Secondary outcomes included the rate of bacteremia, the concordance of blood cultures and tissue cultures, and the rate of fungal tissue infections. Escherichia coli and Streptococcus anginosus were most common, identified in 12 patients each (20.0%). Enterococcus faecalis (9, 15.0%), S agalactiae (8, 13.3%) and mixed cultures without a predominant organism (9, 15.0%) were also common. A fungal organism was identified in 9 (15.0%) patients. Patients who were started on Infectious Diseases Society of America guideline adherent antibiotic regimen were not significantly different in terms of bacteremia rate (P=.86), mortality (P=.25), length of stay (P=.27), or final antibiotic duration (P=.43) when compared to those on alternative regimens. Patients with a tissue culture positive for a fungal organism were not significantly different in terms of Fournier's Gangrene Severity Index (P=.25) or length of stay (P=.19). Local disease-specific antibiograms can be a powerful tool to guide empiric antibiotic therapy in FG. Although fungal infections are responsible for a majority of the gaps in empiric antimicrobial coverage at our institution they were present in only 15% of patients and their effect on outcomes does not justify addition of empiric antifungal agents.

MP15-12 VALIDATION OF THE FOURNIER'S GANGRENE SEVERITY INDEX AND OUTCOMES OF A DECADE OF FOURNIER'S GANGRENE EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023MP15-12 VALIDATION OF THE FOURNIER'S GANGRENE SEVERITY INDEX AND OUTCOMES OF A DECADE OF FOURNIER'S GANGRENE EXPERIENCE Bruce N. Haik, Akhil A. Saji, Muhammad S. Choudhury, and Daniel C. Rosen Bruce N. HaikBruce N. Haik More articles by this author , Akhil A. SajiAkhil A. Saji More articles by this author , Muhammad S. ChoudhuryMuhammad S. Choudhury More articles by this author , and Daniel C. RosenDaniel C. Rosen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fournier’s Gangrene (FG) is a life-threatening but rare urologic emergency. The prognosis depends on several factors, many of which are captured by the Fournier Gangrene Severity Index (FGSI). We aimed to identify predictors of mortality, prolonged length of stay, and home discharge in a patient sample from a single center over a 11-year period. METHODS: Patients treated for FG at a tertiary care facility between 2011-2022 were identified using diagnosis codes and then data from the index hospitalizations were manually extracted. Captured data included demographic and baseline comorbidities, FGSI, operative treatment, and postoperative course and outcomes. Univariate logistic regression analyses were performed for mortality, composite mortality or >6-week length of stay (LOS), and home discharge. RESULTS: Predictors of mortality were FGSI >=14 (β=3.8, p=0.015) and Charlson comorbidity index (CCI) >=8 (β=3.1, p=0.028); predictors of composite mortality or >6-week LOS were FGSI >=10 (β=2.5, p=0.009), delay before presentation >=2 days (β=-2.4, p=0.046), and abdominal involvement (β=2.6, p=0.007); and the predictor of home discharge was CCI <4 (β=3.3, p=0.012). CONCLUSIONS: FGSI was an accurate predictor of mortality in this cohort. Baseline health, rather than disease severity, was the strongest predictor of ability to be discharged directly to home. Presentation within one day of symptom onset may indicate fulminant disease and was associated with poor outcomes. Finally, empiric antimicrobial therapy should include antifungal coverage, as Candida species were found in a quarter of wound cultures. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e196 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bruce N. Haik More articles by this author Akhil A. Saji More articles by this author Muhammad S. Choudhury More articles by this author Daniel C. Rosen More articles by this author Expand All Advertisement PDF downloadLoading ...

A contemporaneous narrative review of Fournier's gangrene.

Fournier's gangrene is a necrotizing infection of the external genitalia, perineal or perianal regions and is mainly seen in males. Its main risk factors include diabetes, chronic alcoholism, HIV and other immune-compromised states. Fournier's gangrene has an aggressive course associated with a mortality rate of 20%-30%, making early diagnosis and management very important. The Fournier Gangrene Severity Index (FGSI) has been traditionally used to predict the severity and prognosis. More recently, simplified FGSI (sFGSI) has been proposed and is helpful. However, timely diagnosis, supportive medical management and complete surgical debridement are still the cornerstones of treatment. These must be complemented with early and timely re-look debridements and appropriate reconstruction to cover soft tissue defects. This literature review aims to look at recent relevant research regards risk factors and prognostic features of Fournier's gangrene. A search was conducted on Google Scholar and PubMed databases for all articles related to Fournier's Gangrene. These included clinical reviews, case reports, case series and retrospective studies. Reports or studies which were not published in English were not reviewed. Various reconstructive techniques to cover the defects have also been revisited. Broad-spectrum antibiotics and urgent surgical debridement are the core management principles of Fournier's gangrene. Repeat debridement after 24 h is also recommended. Adjunctive therapies such as hyperbaric oxygen and vacuum-assisted closure are supported in most aspects of recent literature. Expectedly, there is a lack of randomised controlled studies in such emergency surgical conditions, which limits the widespread use of newer therapies to patients unresponsive to conventional management. Fournier's gangrene is a urological emergency with a high mortality rate. The aggressive nature of the infection necessitates early recognition and immediate surgical intervention. Negative pressure dressing and occasional hyperbaric oxygen as adjuncts should be used more routinely, especially if there is a delayed response to conventional treatment or in severe infections.

The Antimicrobial Resistance Index and Fournier Gangrene Severity Index of Patients Diagnosed with Fournier's Gangrene in a Tertiary Hospital in North Eastern Romania.

Background: Although rare, Fournier's gangrene is a major urological emergency. We aimed to learn more about the pathogenesis of Fournier's gangrene and assess the antibiotic resistance patterns in individuals with this disease. Methods: We retrospectively evaluated the patients diagnosed with and treated for Fournier's gangrene in a Neamt county hospital and "CI Parhon" Clinical Hospital in Iasi, Romania between 1 January 2016 and 1 June 2022. Results: We included a total of 40 patients, all males; of these, 12.5% died. In our study, in the patients that died, the adverse prognostic factors were a higher body temperature (38.12 ± 0.68 vs. 38.94 ± 0.85 °C; p = 0.009), an elevated WBC (17.4 ± 5.46 vs. 25.23 ± 7.48; p = 0.003), obesity (14.28% vs. 60%; p = 0.04), and a significantly higher FGSI (4.17 ± 2.80 vs. 9.4 ± 3.2; p = 0.0002) as well as MAR index (0.37 ± 0.29 vs. 0.59 ± 0.24; p = 0.036). These patients were more likely to have liver affections than those in the group who survived, but the difference was not significant. The most frequently identified microorganism in the tissue secretions culture was E. coli (40%), followed by Klebsiella pneumoniae (30%) and Enterococcus (10%). The highest MAR index was encountered in Acinetobacter (1), in a patient that did not survive, followed by Pseudomonas (0.85) and Proteus (0.75). Conclusions: Fournier's gangrene remains a fatal condition, a highly resistant causative microorganism that is not always correlated with a poor prognosis.

Fournier's Gangrene: Microbiological Profile and Risk Factors for Mortality: Review of 97 Cases.

Fournier's gangrene (FG) is a rare necrotizing fasciitis affecting genital and perianal areas. This study aimed to provide data on predicting factors, mortality rates, and factors affecting mortality in comparison of survivors and non-survivors in patients with FG. This study included a retrospective analysis of patients diagnosed with FG between 2008 and 2018. A total of 97 patients with FG were included in this study. Of the patients, 72 (74%) were male. The mean age was 56.03±13.92 years, and the median was 57 (21-90). The mortality rate was 21.6%. The most frequently isolated microorganism from tissue and blood cultures was Escherichia coli (43%-42%). The median Fournier's Gangrene Severity Index (FGSI) and Uludağ FGSI (UFGSI) scores were 4 (0-20) and 5 (1-22), respectively. In the univariate model, mortality risk increases 7.18 times (p=0.001) in patients with two or more comorbidities, 1.31 times as the FGSI score increases (p<0.001), 1.28 times as the UFGSI score increases (p<0.001). When the cut-off value was set as 8 for the FGSI score, the sensitivity was 71.43%, and the specificity was 73.68%. The sensitivity was 73.43%, and the specificity was 75% when the cut-off value was set as 6 for the UFGSI score. In the univariate model, the mortality risk of those with hypotension was 6.07 times higher (p=0.003); as the platelet count increased, mortality risk decreased (odds ratio [OR]=0.99; p=0.02). The mortality risk of those hospitalized in the intensive care unit (ICU) was 16.5 times higher than those followed in the ward (p<0.001). In the multivariate model, this ratio was 6.49. We concluded that FGSI and UFGSI scores could be used to predict mortality. Management of FG requires a multidisciplinary approach. Empiric treatment should include carbapenems and be de-escalated once getting the culture results. Authors from different centers should report their experiences to help reveal the ideal treatment and evaluate the consequences.

Predictive factors for mortality in intensive care patients with Fournier's gangrene: five years' experience from a single center in Turkey.

The aim of this study was to analyze mortality-related factors and scoring systems in order to better manage the treatment process of patients monitored in the intensive care unit (ICU) due to Fournier's gangrene (FG). The study included 28 male patients who were monitored in the surgical ICU with the diagnosis of FG between December 2018 and August 2022. The patients' comorbidities, acute physiological and chronic health evaluation scoring system II (APACHE II), Fournier gangrene severity index (FGSI), sequential organ failure assessment (SOFA) scores, and laboratory data were evaluated retrospectively. Of the patients, 67.9% (n=19) had diabetes mellitus, 78.6% (n=22) had hypertension, and 71.4% (n=20) had coronary artery disease. The mortality rate was 42% (n=11). There was no statistically significant difference between the patients who died and those who survived in terms of the SOFA score, comorbidities, and albumin, glucose, and procalcitonin values (p > 0.05), but age, APACHE II and FGSI scores, and the C-reactive protein (CRP) value were significantly higher in the non-survivor group. There was a positive correlation between the FGSI, APACHE II, and SOFA scores. Older age, high CRP levels at the time of admission, and the presence of comorbidity are still determining factors in the prediction of mortality in patients with FG. We also determined that in predicting mortality in patients monitored in the ICU with the diagnosis of FG, in addition to the routinely used FGSI, the APACHE II score was also useful, but the SOFA score did not have significant predictive value.

Fournier’s Gangrene 5-Year Experience and Validity of Fournier Gangrene Severity Index

Objectives: To evaluate the validity of Fournier gangrene severity index in the assessment of disease severity. Materials and Methods: This Retrospective study was conducted in Pakistan Institute of Medical Sciences Islamabad. In this study we enrolled 35 patients with FG. The primary outcome in our study was mortality rate. Fournier’s Gangrene Severity Index was used to evaluate the severity of disease. The patients were divided into two group survival group and deceased group. Results: Total 36 patients with FG were enrolled, 80.6% were male and 29.4% were female with mean age of 43.30 ±10.5 years. The mortality rate was 19.4%. 41.7% patients had DM, 22.2% patients were smoker and 13.9% patients had high blood pressure. 61.1% cases had anal pain while 33.3% had scrotal pain. The patients were also distinguishing on the basis of origin and it was found that Proctological (72.2%), Urological (19.4%) and Gynecological (8.3%). Using an FGSI cut-off value &gt; 9.5, we find out that the mortality rate was significantly higher in the group with a FGSI score &gt;10 (100%). Practical implication: In this study we find out that FGSI is a reliable and excellent tool for the initial diagnosis of disease. So this study will help the clinical practioner to easily and at initial stages diagnose the disease. Conclusion: It is concluded that FGSI is a reliable and excellent tool for the initial diagnosis of disease. Keywords: Fournier's gangrene, Fournier's gangrene severity index, mortality

Procalcitonin as prognostic factor in patients with Fournier's gangrene.

Fournier's Gangrene (FG) has still a mortality rate up to 45%. Several studies identified prognostic factors but there is a knowledge gap concerning procalcitonin (PCT) levels and mortality risk in FG. This study is aimed to assess the role of PCT as prognostic factor in FG. The medical records of 20 male FG patients admitted at the Department of Urology of "Cattinara" Hospital, University of Trieste between January 2019 and November 2020 were retrospectively reviewed. Clinical, demographic, microbiological data were collected. The Fournier's Gangrene Severity Index (FGSI) was calculated for each patient. Thirteen (65%) of 20 patients survived. Median age was 58 years (IQR 51-88), 15 patients (75%) had a Charlson Comorbidity Index (CCI) score ⩾2, 1 (5%) equal to 0, 4 to 1 (20%). Median FGSI score was 6 (IQR 2-12) and median PCT 0.8 ng/ml (IQR 0.04-2.12). At multivariate analysis PCT levels >0.05 ng/ml were associated with an increased overall mortality risk (OR 2.14, CI 1.25-4.27, p = 0.002). CCI score ⩾2 (OR 1.51, CI 1.01-2.59, p = 0.04), Streptococcical etiology (OR 3.41, CI 2.49-4.61, p = 0.002) and FGSI score >9 (OR 1.41, CI 1.19-2.21, p = 0.004) were associated with unfavorable outcome. PCT might be a prognostic factor in FG. CCI and FGSI are useful tools in mortality risk stratification. Streptococcical etiology is associated with unfavorable outcome. Further larger clinical trials are pending.