Materiały źródłowe

• #1 Gangrene: Types, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/gangrene

  How common is gangrene? (Epidemiology) There are few data, if any, on the prevalence or incidence of gangrene, which may reflect the fact that it occurs with accompanying conditions. […] Gangrene can affect any part of the body but most often affects the extremities, ie the fingers and toes. Gangrene can also affect the internal body organs, particularly the gastrointestinal tract.

• #2 Gangrene – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560552/

  Ischemic/dry gangrene occurs as tissue loss most commonly seen with progressive peripheral artery disease (PAD). Critical limb ischemia/chronic limb-threatening ischemia (CLI/CLTI) is the most advanced stage of peripheral artery disease, with an incidence of 1% of the United States population over 50 years old and up to twice that over 70 years old. Lower extremity peripheral artery disease itself affects more than 200 million people worldwide, and up to 10% of people with PAD have CLI/CLTI. Over five years, between 5-10% of patients with asymptomatic PAD or minimal symptoms with intermittent claudication, may progress to CLI/CLTI. […] Gas gangrene typically occurs after trauma, with anaerobic bacteria’s introduction into a previously protected tissue space. Gas gangrene has been identified after traffic accidents, crush injuries, gunshot wounds, and postoperative complications related to infection. Non-traumatic gas gangrene has also been documented from hematogenous spread, and multiple case studies have demonstrated an association with a metastatic gut malignancy. Gas gangrene is relatively rare, with approximately 1000 cases per year in the United States; 50% are attributed to traumatic injuries, 30% to postoperative complications, and 20% as a spontaneous infection.

• #3 Gangrene epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Gangrene_epidemiology_and_demographics

  Ischemic or dry gangrene is commonly associated with peripheral artery disease (PAD). The most advanced stage of PAD is critical limb ischemia/ chronic limb-threatening ischemia, and it has an incidence rate of 1% in the United States. […] Periperhal artery disease of the lower extremities has a prevalence rate of 200 million, with up to 10% of them have critical limb ischemia/ chronic limb-threatening ischemia. […] Gas gangrene is a rare condition, with an annual record of 1000 cases in the United States, 50% of which are due to traumatic injuries, 30% due to post-operative complications, and the remaining part is attributed to infections.

• #4 Gangrene | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/24944

  Ischemic/dry gangrene occurs as tissue loss most commonly seen with progressive peripheral artery disease (PAD). Critical limb ischemia/chronic limb-threatening ischemia (CLI/CLTI) is the most advanced stage of peripheral artery disease, with an incidence of 1% of the United States population over 50 years old and up to twice that over 70 years old. Lower extremity peripheral artery disease itself affects more than 200 million people worldwide, and up to 10% of people with PAD have CLI/CLTI. Over five years, between 5-10% of patients with asymptomatic PAD or minimal symptoms with intermittent claudication, may progress to CLI/CLTI. […] Gas gangrene typically occurs after trauma, with anaerobic bacteria’s introduction into a previously protected tissue space. Gas gangrene has been identified after traffic accidents, crush injuries, gunshot wounds, and postoperative complications related to infection. Non-traumatic gas gangrene has also been documented from hematogenous spread, and multiple case studies have demonstrated an association with a metastatic gut malignancy. Similarly, other necrotizing soft tissue infections typically have a defined entry point due to trauma or postoperative surgical site complications. Gas gangrene is relatively rare, with approximately 1000 cases per year in the United States; 50% are attributed to traumatic injuries, 30% to postoperative complications, and 20% as a spontaneous infection.

• #5 Gas gangrene – Wikipedia

  https://en.wikipedia.org/wiki/Gas_gangrene

  Gas gangrene (also known as clostridial myonecrosis) is a bacterial infection that produces tissue gas in gangrene. This deadly form of gangrene usually is caused by Clostridium perfringens bacteria. About 1,000 cases of gas gangrene are reported yearly in the United States. […] In the United States, the incidence of myonecrosis is only about 1,000 cases per year. […] During World War I and World War II, Clostridial myonecrosis was found in 5% of wounds, but with improvement in wound care, antisepsis and the use of antibiotics, the incidence had fallen to 0.1% of war-related wound infections by the Vietnam War. […] With the best of care including early recognition, surgical care, antibiotic treatment, and hyperbaric oxygen therapy the mortality rate is 20-30% and can be as low as 5-10%. If untreated, the disease has a 100% fatality rate.

• #6 Clostridial Gas Gangrene: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/214992-overview

  Approximately 1000 cases of clostridial gas gangrene are reported per year. […] Although no published data exist, prevalence is most likely higher in countries other than the United States because of lack of access to health care in other parts of the world. […] If properly treated, the overall mortality rate is 20% to 30%. If untreated, the process is 100% fatal. […] Spontaneous cases carry a mortality rate of 67% to 100%. […] With trunk involvement, the mortality rate is higher (60%) than the mortality rate associated with involvement of the extremities, which carries a better prognosis. […] A longer incubation period, presence of significant comorbidities, and development of shock increase the risk for mortality.

• #7 Epidemiology ,control and management of gas gangrene | PPT

  https://www.slideshare.net/slideshow/epidemiology-control-and-management-of-gas-gangrene/251094296

  Gas gangrene also known as clostridial myonecrosis and is a bacterial infection that produces tissue gas in gangrene. This deadly form of gangrene usually caused by clostridium perfeingens bacteria. Gangrene is a condition that arise when a considerable mass of body tissue dies (necrosis) this may occur after any injury, infection or in people suffering from any chronic health problem affecting blood circulation. It can affect any part of the body but typically starts in the toes, feet, fingers and hand (the extremities). […] Epidemiology Clostriduim species are found in soil, especially soil used for animal husbandry. In medical facilities, it thrives when unhygienic circumstances prevail, In the United States, the incidence of myonecrosis is only about 1000 cases per year. During world war l and World war ll clostridial myonecrosis was found in 5% of wounds, but with improvement in wound care, antisepsis and the use of antibiotics, the incidence had fallen to 0.1% of war related wound infections by the Vietnam war.

• #7 Epidemiology ,control and management of gas gangrene | PPT

  https://www.slideshare.net/slideshow/epidemiology-control-and-management-of-gas-gangrene/251094296

  With the best of care including early recognition, surgical care, antibiotics treatment, and hyperbaric oxygen therapy the mortality rate is 20-30 % and can be as low as 5-10%. If untreated, the disease has a 100% fatality rate. […] Gangrene is caused when a body part loses its blood supply due to an injury or an underlying disease. The conditions most commonly responsible for causing gangrene are as follows: Diabetes Blood vessel disease such as arteriosclerosis causing hardening of the arteries, in arms or legs. Suppressed immune system (for example, from HIV or chemotherapy) surgery Due to infection or ischemia, such as by the bacteria Clostridium perfringens or by thrombosis (a blocked blood vessel). […] The symptoms of Gas gangrene are as follows: Feeling of heaviness followed by severe pain. In most cases of gas gangrene, pressing skin near the affected area will produce a crackling sound caused by a build-up of gas; producing the feeling of crushing fine tinfoil.

• #8 Fournier’s Gangrene: Population Based Epidemiology and Outcomes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3042351/

  Case series have shown a Fourniers gangrene mortality rate of 20% to 40% with an incidence of as high as 88% in some studies. […] Because to our knowledge there are no population based data, we used a national database to investigate the epidemiology of Fourniers gangrene. […] The overall incidence was 1.6/100,000 males, which peaked in males who were 50 to 79 years old (3.3/100,000) with the highest rate in the South (1.9/100,000). […] The overall case fatality rate was 7.5%. […] Patients with Fourniers gangrene are rarely treated at most hospitals. […] The population based mortality rate of 7.5% was substantially lower than that reported in case series from tertiary care centers. […] Fourniers gangrene is a rare but serious necrotizing soft tissue infection. […] The incidence of Fourniers gangrene was 1.6 cases per 100,000. […] The contemporary population based case fatality rate of 7.5% is lower than that previously reported in tertiary referral series in the literature.

• #9 Fournier’s gangrene: population-based epidemiology and outcomes | Publisso

  https://books.publisso.de/en/publisso_gold/publishing/books/overview/52/46

  Most hospitals rarely care for Fourniers gangrene patients. The population-based mortality rate (7.5%) was substantially lower than case series from tertiary care centers. Hospitals that treated more Fourniers gangrene patients had lower mortality rates supporting the rationale for regionalized care for patients with this rare disease. […] We used a large population-based database to better understand the epidemiology and outcomes of Fourniers gangrene. Our initial goals were to determine the incidence, patient characteristics, and hospital experience with Fourniers gangrene. […] The overall incidence was 1.6 Fourniers gangrene cases per 100,000 males annually. The incidence peaked and remained steady after age 50 at 3.3 cases per 100,000 males. […] The incidence of Fourniers gangrene was highest in the South and the lowest in the West and Midwest US. Fourniers gangrene incidence increased 0.2 per 100,000 males for each 1% increase in the regional prevalence of diabetes.

• #9 Fournier’s gangrene: population-based epidemiology and outcomes | Publisso

  https://books.publisso.de/en/publisso_gold/publishing/books/overview/52/46

  These population-based epidemiological studies provide a broader perspective than previous studies of Fourniers gangrene. The major advantage of our population-based approach was the ability to identify a large number of Fourniers gangrene cases managed at multiple centers, including tertiary care referral hospitals and non-referral hospitals, limiting case-selection and publication biases. […] We confirmed that Fourniers gangrene is indeed rare, representing less than 0.02% of hospital admissions in the US with an overall incidence of 1.6 cases per 100,000 males per year.

• #10 Fournier gangrene epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Fournier_gangrene_epidemiology_and_demographics

  The overall incidence of Fournier gangrene annually is 1.6 cases per 100,000 males. The incidence peaked and remained steady after age 50 at 3.3 cases per 100,000 males. […] Fournier gangrene affects individuals of all ages but more commonly affects individuals older than 50 years of age. […] Men are more commonly affected with Fournier gangrene than women, with a male:female ratio of 10:1. […] The mortality rate of Fournier gangrene is between 20% to 80%. Higher mortality rates are found in diabetics, alcoholics and those with colorectal sources of infection. […] The incidence of Fournier gangrene increased 0.2 per 100,000 males for each 1% increase in the regional prevalence of diabetes. […] The incidence rate was highest in the southern U.S. and lowest in the western and mid-western U.S. […] Mortality rate decreases with early aggressive treatment.

• #11 Fournier Gangrene: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2028899-overview

  The frequency of Fournier gangrene has not likely changed appreciably. Rather, the apparent increase in the number of cases in the literature most likely results from increased reporting. […] No seasonal variation occurs. Fournier gangrene is not indigenous to any region of the world, although the largest clinical series originate from the African continent. […] The typical patient with Fournier gangrene is an elderly man in his sixth or seventh decade of life with comorbid diseases. The male-to-female ratio is approximately 10:1. The lower incidence in females may reflect better drainage of the perineal region through vaginal secretions. […] Men who have sex with men may be at higher risk, especially for infections caused by community-associated methicillin-resistant Staphylococcus aureus (MRSA). […] Most reported cases occur in patients aged 30-60 years. A literature review found only 56 pediatric cases, with 66% of those in infants younger than 3 months.

• #11 Fournier Gangrene: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2028899-overview

  Fournier gangrene is relatively uncommon, but the exact incidence of the disease is unknown. In a review of Fournier gangrene in 1992, Paty et al calculated that approximately 500 cases of the infection had been reported in the literature since Fournier’s 1883 report, yielding a rate of 1 case in 7500 persons. A retrospective case review revealed 1726 cases documented in the literature from 1950-1999, with an average of 97 cases per year reported from 1989-1998. A review of National Inpatient Sample data from 2004-2012 identified a total of 9249 patients with Fournier gangrene. […] A review using the US State Inpatient Database in 2009 estimated that among 25.8 million hospital admissions from 2001 and 2004, Fournier gangrene constituted only 0.02% of hospital admissions. In this same database, 66% of the hospitals reported no patients with Fournier gangrene, and among high volume centers, the admission frequency was only 1 patient every few months.

• #12 Fournier Gangrene | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688603/all/Fournier_Gangrene?q=Anemia

  Fournier gangrene is a urologic emergency with a high rate of morbidity and mortality if not diagnosed and managed promptly. […] The majority of patients are between 50 and 79 years of age, but it can occur at all ages. […] Incidence 1.6 in 100,000. […] 0.02% of hospitalized patients.

• #13 Combating the Insidious Enemy: Epidemiology, Pathophysiology, and Treatment of Clostridial Gas Gangrene | SpringerLink

  https://link.springer.com/10.1007%2F978-94-007-5869-8_36

  Clostridial gas gangrene is a life-threatening condition having dreaded features like myonecrosis, gas production, and sepsis and is usually caused by Clostridium perfringens which exists in the soil and as part of the gastrointestinal flora of humans. […] The disease is a noncommunicable one and the infection generally occurs in traumatic wounds with soil contamination and surgery involving the bowel; nonetheless, a spontaneous gangrene is also reported. […] Common characteristics of inciting events include contamination of the site with Clostridium sp. and devitalization of tissue. […] Areas with low oxygen concentration are ideal for these infections; anaerobic conditions impel Clostridium sp. to convert itself from spore to the vegetative form which produces toxins, say -toxin and -toxin which in a row are responsible for tissue damage and systemic manifestations. […] For managing the infected patients, an early diagnosis is crucial. […] Delays in doing so increase tissue loss and mortality which are directly proportional to time of intervention.

• #14 Combating the Insidious Enemy: Epidemiology, Pathophysiology, and Treatment of Clostridial Gas Gangrene | SpringerLink

  https://link.springer.com/10.1007/978-94-007-5869-8_36

  Clostridial gas gangrene is a life-threatening condition having dreaded features like myonecrosis, gas production, and sepsis and is usually caused by Clostridium perfringens which exists in the soil and as part of the gastrointestinal flora of humans. […] The disease is a noncommunicable one and the infection generally occurs in traumatic wounds with soil contamination and surgery involving the bowel; nonetheless, a spontaneous gangrene is also reported. […] Areas with low oxygen concentration are ideal for these infections; anaerobic conditions impel Clostridium sp. to convert itself from spore to the vegetative form which produces toxins, say -toxin and -toxin which in a row are responsible for tissue damage and systemic manifestations. […] For managing the infected patients, an early diagnosis is crucial. […] Delays in doing so increase tissue loss and mortality which are directly proportional to time of intervention.

• #15 Fournier Gangrene | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/21939

  Known risk factors for Fournier gangrene include: Atherosclerosis, Chemotherapy, Chronic alcohol abuse, Chronic steroid use, Colorectal malignancy, Diabetes, Drug abuse, HIV infection, Immunosuppression, Inflammatory bowel disease, Leukemia, Liver failure and cirrhosis, Male gender, Malnutrition, Neurogenic bladder, Obesity, Perianal abscess, Peripheral vascular disease, Prostate cancer, Recent trauma or surgery, Rectal fistula, Renal failure, Significant cardiac disease, Spinal cord injury, Urethral strictures, Use of SGLT2 inhibitors. […] Despite worldwide advances in sepsis treatment, the mortality rate for Fournier gangrene has remained stable at approximately 40%. […] Delayed diagnosis and treatment significantly contribute to this high mortality rate, with delays increasing the death rate to 88%. […] Time to surgical intervention is the most critical factor influencing mortality, as early surgery can reduce the death rate by half.

• #15 Fournier Gangrene | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/21939

  Fournier gangrene is a rare infection, accounting for less than 0.02% of all hospital admissions. […] This condition has a strong male predilection, with a male-to-female ratio of 10:1, although women tend to experience higher morbidity and mortality rates. […] The incidence in males is 1.6 cases per 100,000 men. […] Fournier gangrene most commonly affects men aged 50 to 79, with an incidence of 3.3 cases per 100,000 men. […] The southeastern United States has the highest reported rate of Fournier gangrene at 1.9 cases per 100,000 population. […] These frequencies appear relatively constant among patients in the United States and worldwide. […] Although less common in females, women tend to present with more severe illness. […] They are twice as likely to require mechanical ventilation and dialysis, have a longer average hospital stay, and experience a higher fatality rate compared to male patients.

• #16 Fournier gangrene | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/fournier-gangrene?lang=us

  Fournier gangrene is typically seen in men with diabetes mellitus, aged 50-70 years. […] Although historically women were rarely affected, the incidence appears to be increasing and is particularly associated with morbid obesity. […] Other predisposing factors include end-stage renal and/or liver failure, hypertension, immunosuppression, obesity (BMI 30), alcohol use, smoking, debility, HIV, and diabetes. […] It is considered a urological emergency with a poor prognosis due to its high mortality rate (ranging ~15-50%). […] Imaging should be used judiciously, and must not allow the delay of potentially life-saving definitive treatment. […] Critical findings to assess and report is extension of disease into deeper tissues such as intraperitoneal involvement or extension into space of Retzius, as these will alter therapy and require a laparotomy.

• #17 Fournier Gangrene Microbiology and Risk Factors

  https://www.gavinpublishers.com/article/view/fournier-gangrene-microbiology-and-risk-factors

  Fournier gangrene, a form of necrotizing fasciitis, is an emergent urological condition that affects the perineal, anal, scrotal and genital superficial and deep tissues. […] The purpose of this study is to provide a contemporaneous report on the polymicrobial organisms associated with Fournier Gangrene in the region of Queensland, Australia and the potential risk factors associated with this condition. […] Fourniers Gangrene is a rapidly progressing, life-threatening soft tissue infection that predominantly affects the genital, perineal, and lower abdominal regions. […] It is characterized by the necrosis of tissues due to a synergistic infection caused by a mix of aerobic and anaerobic microorganisms. […] Fourniers Gangrene tends to occur in patients with various predisposing factors, particularly those that compromise the immune system or alter the integrity of the skin and mucous membranes.

• #18 Fournier Gangrene: Causes, Symptoms, Treatment, Prevention

  https://www.webmd.com/diabetes/what-is-fourniers-gangrene

  The disease is very rare. About 1.6 per 100,000 men and many fewer women or children get it each year. One study that looked at 10.7 million hospitalized men and boys found 2,238 cases of Fourniers gangrene. The same study found just 49 cases in more than 15 million hospitalized women and girls. […] Its not clear how often people who get Fourniers gangrene die from it. Some studies say the death rate could be as low as 7.5 %; most studies put the rate at 20% to 40%. […] Fournier’s gangrene is most common in people who have a weak immune system or other health problems. You’re more likely to get Fourniers gangrene if you have: […] The FDA has reported cases in people with type 2 diabetes who were taking certain drugs to lower their blood sugar. These drugs are called SGLT2 inhibitors and include medications such as canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance), and ertugliflozin (Steglatro).

• #18 Fournier Gangrene: Causes, Symptoms, Treatment, Prevention

  https://www.webmd.com/diabetes/what-is-fourniers-gangrene

  If Fourniers gangrene isn’t stopped in the earliest stages, you can get serious complications. […] You’re more likely to survive Fourniers gangrene than to die from it. But after the crisis, you might have some lingering problems. […] There are some steps you can take to lower your chances of getting Fourniers gangrene: […] Fourniers gangrene is a life-threatening infection. It usually starts with redness, swelling, and pain around your genitals or anus. If you have possible signs, its very important to see a doctor right away. Early treatment can save your life.

• #19 FDA warns about rare occurrences of a serious infection of the genital area with SGLT2 inhibitors for diabetes | FDA

  https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-rare-occurrences-serious-infection-genital-area-sglt2-inhibitors-diabetes

  Cases of a rare but serious infection of the genitals and areas around them have been reported with the class of type 2 diabetes medicines called sodium-glucose cotransporter-2 (SGLT2) inhibitors. This serious condition, called necrotizing fasciitis of the perineum or Fourniers gangrene, can progress quickly and must be treated immediately because it can cause severe damage to the tissues around the genital area. […] Overall published literature about the incidence of Fourniers gangrene in men and women is very limited. Publications using the U.S. State Inpatient Database (SID) from 593 civilian hospitals of 13 states in 2001 and 21 states in 2004 reported that Fourniers gangrene occurs in 1.6 out of 100,000 males annually in the U.S., with the highest incidence occurring in males 50-79 years (3.3 out of 100,000).

• #20 Fournier’s gangrene: population-based epidemiology and outcomes | Publisso

  https://series.publisso.de/en/publisso_gold/publishing/books/overview/52/46

  These population-based epidemiological studies provide a broader perspective than previous studies of Fourniers gangrene. The major advantage of our population-based approach was the ability to identify a large number of Fourniers gangrene cases managed at multiple centers, including tertiary care referral hospitals and non-referral hospitals, limiting case-selection and publication biases. […] Overall mortality was 7.5% in our population-based study. This was substantially lower than rates reported in the literature. The highest mortality was reported in 1972 by Stone and Martin (88% mortality among 33 patients). […] Increased patient age (aOR 4.0 to 15.0, p0.0001) proved the strongest independent predictor of mortality. Patients in hospitals that treated more Fourniers gangrene cases had 42 to 84% lower mortality (p0.0001) than hospitals treating only 1 case per year. […] Teaching hospitals cared for the majority of Fourniers gangrene cases while 30% of non-teaching hospitals treated patients with Fourniers gangrene.

• #20 Fournier’s gangrene: population-based epidemiology and outcomes | Publisso

  https://series.publisso.de/en/publisso_gold/publishing/books/overview/52/46

  Most hospitals rarely care for Fourniers gangrene patients. The population-based mortality rate (7.5%) was substantially lower than case series from tertiary care centers. Hospitals that treated more Fourniers gangrene patients had lower mortality rates supporting the rationale for regionalized care for patients with this rare disease. […] We used a large population-based database to better understand the epidemiology and outcomes of Fourniers gangrene. Our initial goals were to determine the incidence, patient characteristics, and hospital experience with Fourniers gangrene. […] The overall incidence was 1.6 Fourniers gangrene cases per 100,000 males annually. The incidence peaked and remained steady after age 50 at 3.3 cases per 100,000 males. […] The incidence of Fourniers gangrene was highest in the South and the lowest in the West and Midwest US. Fourniers gangrene incidence increased 0.2 per 100,000 males for each 1% increase in the regional prevalence of diabetes.

• #21 SciELO Brazil – Profile of patients with Fournier’s gangrene and their clinical evolution Profile of patients with Fournier’s gangrene and their clinical evolution

  https://www.scielo.br/j/rcbc/a/n4v55NFwyZm5nzvtmcjmrTy/

  Fourniers Gangrene (FG) is a severe infectious disease of soft tissues, of fast progression, that affects the genital region and adjacent areas, characterized by intense tissue destruction, involving the subcutaneous and the fascia. […] It displays high mortality rates, ranging from 13 to 30.8% in Brazil. […] FG is a necrotizing fasciitis that originates in the perineal region and can extend to the abdominal and thoracic wall. […] In Brazil, the disease has a high prevalence in the male gender (10:1), but can also affect women and children. […] In this study, the mean hospitalization time was over 19 days and 22.5% of the patients died. There was a strong correlation between sepsis on admission and mortality. […] These data suggest the need for improvements in the emergency services, for the early diagnosis and treatment of the disease and to reduce its morbidity and mortality.

• #22 Fournier’s Gangrene in the Turkish Population: A Two-Decade Analysis – Turkish Journal of Colorectal Disease

  https://turkishjcrd.com/articles/doi/tjcd.galenos.2023.2023-7-2

  Aim: The nature and rarity of Fourniers gangrene (FG) limit the conducting of clinical studies with large patient populations. The present study aims to determine FG risk factors and predictors of mortality among the Turkish population using published data. […] The reported overall mortality rates for FG vary between 0% and 88%. However, studies published during the last three decades report a mortality rate ranging from 20% to 40%. […] It was shown that FG is still associated with a significant mortality rate (17.39%) and that the female gender, anorectal origin, CRF, and fecal diversion may be associated with a poor outcome. […] The median mortality rate was 17.39% in the present study; this rate is comparable with that reported in Ekes study (16%) but higher than those in the studies published in North America. However, the authors determined a higher mortality rate in the first decade (2000-2010) than in the second decade (2010-2020). […] The cutaneous origin may be associated with better outcomes, and female gender, CRF, and the need for fecal diversion may be associated with a poor prognosis.

• #23 Fournier’s gangrene mortality: A 17-year systematic review and meta-analysis – Rowan University

  http://primo.rowan.edu/discovery/fulldisplay/cdi_doaj_primary_oai_doaj_org_article_ff120bb7b40f48678b23a3eae9d28a59/01ROWU_INST:ROWAN

  Fournier Gangrene – epidemiology […] To provide better management of Fournier’s gangrene, mortality-associated comorbidities and common etiologies were identified. A systematic search was conducted using 12 databases, followed by meticulous screening to select relevant articles. Meta-analysis and meta-regression (for possible cofounders) were both done for all possible outcomes. Out of 1186 reports screened, 38 studies were finally included in the systematic review and meta-analysis. A higher risk of mortality was detected in patients with diabetes, heart disease, renal failure, and kidney disease, with risk ratios (RR) and 95% confidence intervals (95% CI) of 0.72 (0.59–0.89), 0.39 (0.24–0.62), 0.41 (0.27–0.63), and 0.34 (95% CI 0.16–0.73), respectively. However, there was no association between mortality rates and comorbid hypertension, lung disease, liver disease, or malignant disease (p > 0.05). The highest mortality rates were due to sepsis (76%) and multiple organ failure (66%), followed by respiratory (19.4%), renal (18%), cardiovascular (15.7%), and hepatic (5%) mortality. Modifications to the Fournier’s Gangrene Severity Index (FGSI) are recommended, in order to include comorbidities as an important prognostic tool for FG mortality. Close monitoring of the patients, with special interest given to the main causes of mortality, is an essential element of the management process.

• #24 Fournier’s gangrene: outcome analysis and prognostic factors

  http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612018000300008

  Fournier’s gangrene is an infective necrotising fasciitis of the external genitalia and perineum associated with significant morbidity and mortality. The identification of prognostic factors remains critical to improve outcomes. […] The disease related hospital mortality was 27% (14/51). […] Fournier’s gangrene remains a fatal condition with a hospital mortality of 27%. Prognostic factors for non survival include an advanced age, a urogenital source of infection, abdominal involvement, severe sepsis and renal dysfunction. […] The worldwide mortality rate has remained high with an average mortality of 20 -30% despite advances in treatment over the years. […] The mortality due to Fournier’s gangrene varies worldwide with a range from 3% to 45%. […] In this prospective study of 51 patients, the hospital based mortality among patients admitted with a clinical diagnosis of Fournier’s gangrene was found to be 27%.

• #25 Progress in Multidisciplinary Treatment of Fournier’s Gangrene | IDR

  https://www.dovepress.com/progress-in-multidisciplinary-treatment-of-fourniers-gangrene-peer-reviewed-fulltext-article-IDR

  There are many factors significantly related to the prognosis of FG patients, including early diagnosis, waiting period to surgery and comorbidity. […] A retrospective study found that the mortality will rise when the time for making a definitive diagnosis exceeds 136 minutes in the emergency department. […] Goh et al found that as the waiting period before debridement after admission increased from 24 hours to 48 hours, the survival rate decreased from 93.2% to 75.2%. […] Fournier’s gangrene severity index(FGSI), including body temperature, respiratory rate, heart rate and serum sodium, was used to predict the prognosis of FG patients. […] Although several studies support different thresholds, most studies have demonstrated that higher FGSI scores are helpful to identify high-risk patients and indicate poor prognosis.

• #25 Progress in Multidisciplinary Treatment of Fournier’s Gangrene | IDR

  https://www.dovepress.com/progress-in-multidisciplinary-treatment-of-fourniers-gangrene-peer-reviewed-fulltext-article-IDR

  Based on the correlation between each univariate and the length of stay, Ghodoussipour et al finally chose age and eight laboratory indicators to constitute a multivariable model, namely Combined Urology and Plastics Index (CUPI), for predicting the length of stay. […] CUPI is a supplement to the existing prognosis prediction model, high CUPI score being useful to detect high-risk FG patients and urge multidisciplinary participation, which can shorten LOS and improve the prognosis. […] The management of FG often requires multidisciplinary participation. […] Early and decisive surgical debridement and empirical application of broad-spectrum antibiotics can greatly improve the prognosis of patients. […] Due to multi-disciplinary cooperation, the improvement of medical level and postoperative nursing level, the survival rate of FG has been continuously improved.

• #25 Progress in Multidisciplinary Treatment of Fournier’s Gangrene | IDR

  https://www.dovepress.com/progress-in-multidisciplinary-treatment-of-fourniers-gangrene-peer-reviewed-fulltext-article-IDR

  Recent studies showed that the female incidence rate is increasing, the proportion of female patients was as high as 23% and 55% in the two recent case studies. […] However, with the increase of the average age of the population and the number of patients receiving immunosuppressive therapy or infected with human immunodeficiency virus (HIV), the incidence of FG incidence rate has increased in some areas. […] A study systematic reviewed 6152 cases published from 1993 to 2018, and found that the case mortality was between 042% respectively, and the total mortality was 19.8%, which did not seem to have improved significantly over the twenty-five years. […] However, a recent study found that the mean mortality of FG patients from 2000 to 2021 was 7.5%, which has decreased compared with previous years.

• #26 Fournier’s Gangrene: Epidemiology and Outcomes in the General US Population. | EBSCOhost

  https://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=00421138&AN=118815317&h=m%2B2yiQFIAEU9JtSyPXGmEBDrDpUROkQMC4T1xj1OjP%2FW2XZMh9xLhy6efnLponxK4w8yqnXnyf0%2BNQuyPSBjow%3D%3D&crl=f

  Fournier’s Gangrene: Epidemiology and Outcomes in the General US Population. […] Purpose: Case series reported 20-40% mortality rates for patients with Fournier’s gangrene with some series as high as 88%. […] We identified and analyzed inpatients with Fournier’s gangrene who had a surgical debridement or died in the US State Inpatient Databases. […] Overall, the incidence was 1.6 cases per 100,000 males and case fatality was 7.5%. […] Teaching hospitals had higher mortality (adjusted OR 1.9) due primarily to more acutely ill patients. […] Hospitals treating more than 1 Fournier’s gangrene case per year had an adjusted 42-84% lower mortality (p < 0.0001). [...] The population-based mortality rate (7.5%) was substantially lower than the case series from tertiary care centers. [...] Hospitals that treated more number of Fournier's gangrene patients had lower mortality rates, thereby supporting the rationale that regionalized care worked well for patients with this rare disease.

• #27 Fournier’s gangrene: a modern analysis of predictors of outcomes – Sparenborg – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/24666/html

  Fourniers gangrene (FG) is a rapidly progressing necrotizing fasciitis that carries a significant morbidity and mortality. […] Epidemiologic data was collected for patients and used to calculate an FGSI score. […] The FGSI score predicts a greater likelihood of more surgical interventions, longer hospitalization period, sepsis, complications and mortality within this patient population. […] The mortality rate of 5% is much less than the historically reported 20-30% and may reflect improved understanding and care of this aggressive disease. […] The FGSI is a scoring system that consists of 9 lab parameters and vital signs, measured at presentation, each assigned a score from 0 to 4 based on deviation from the normal range. […] The FGSI score is the most widely used prognostic tool in the management of FG.

• #27 Fournier’s gangrene: a modern analysis of predictors of outcomes – Sparenborg – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/24666/html

  The mortality rate reported in this study is in line with these recent publications suggesting improved outcomes for FG patients compared to the higher mortality rates often cited in textbooks. […] FGSI score was significantly associated with patient mortality, and length of hospital stay. This scoring tool holds utility in stratifying risks and outcomes.

• #28 Prognostic factors and clinical outcomes in Fournier’s Gangrene: a retrospective study of 35 patients | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-09900-1

  Coagulation dysfunction and multidrug resistant bacterial infection were identified as independent negative prognostic factors, highlighting the need for prompt monitoring and proactive strategies against Fourniers gangrene. […] Fourniers gangrene is associated with a high mortality rate, necessitating prompt diagnosis and robust treatment. […] Therefore, understanding the factors related to adverse prognoses and mortality is crucial, as it can enhance survival rates, making the research of prognostic indicators significantly important. […] The markedly higher initial SOFA score in the non-survivor group underscores its potential utility as an early predictor of poor outcomes in patients with Fourniers gangrene. […] This highlights the critical need for promptly assessing organ dysfunction upon patient presentation and implementing swift interventions to address any identified organ dysfunction.

• #28 Prognostic factors and clinical outcomes in Fournier’s Gangrene: a retrospective study of 35 patients | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-09900-1

  Our study suggests that coagulation dysfunction with reduced platelet count, as a prognostic factor for Fourniers gangrene, is an independent negative prognostic factor for survival. […] The significantly higher prevalence of coagulation dysfunction in the non-survivor group compared to that in the survivor group demonstrates its association with adverse clinical outcomes. […] These findings suggest the importance of monitoring coagulation abnormalities in patients with Fourniers gangrene. […] In one notable study of 40 patients with Fourniers gangrene, MDR bacterial infections were reported in 25% of the patients, with a significantly higher rate of MDR bacterial infection in the non-survivor group. […] Similarly, our study detected MDR bacterial infections in 22.9% of the patients, revealing a significant association between MDR bacterial infections and in-hospital mortality.

• #28 Prognostic factors and clinical outcomes in Fournier’s Gangrene: a retrospective study of 35 patients | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-09900-1

  Our study highlights the intricate nature of Fourniers gangrene and emphasizes the pivotal role of the initial SOFA score in predicting clinical outcomes. […] Notably, coagulation dysfunction and MDR bacterial infections are independent negative prognostic factors, highlighting the importance of prompt monitoring and proactive strategies.

• #29

  https://journals.lww.com/dcrjournal/abstract/2000/43090/fournier_s_gangrene__changing_face_of_the_disease.24.aspx

  Our experience with ten cases of Fournier’s gangrene prompted us to review the related literature to highlight the current status of the disease. […] The epidemiologic features of our patients were similar to those reported in other recent studies. Mortality rate was 20 percent. Currently, the disease affects both genders and a wide range of ages, has a more insidious onset than in the past, and is not idiopathic. Associated systemic disorders (diabetes, alcoholism, and immunosuppression) are common. Perianal infection is the commonest cause and is associated with more moribund features. […] The epidemiology of Fournier’s gangrene is changing from its original description. Population aging worldwide as a result of improving health care and therefore the increasing prevalence of associated medical disorders may explain these changes. These factors may also explain the consistently high mortality rate during more recent years, masking any survival benefits from improved medical care. Better understanding of the pathophysiology has reduced the ratio of idiopathic cases to a minimum.

• #30 Patient-reported outcomes and health-related quality of life in male long-term survivors of Fournier’s gangrene :: Cambridge Media Journals

  https://journals.cambridgemedia.com.au/jwm/volume-23-number-3/patient-reported-outcomes-and-health-related-quality-life-male-long-term-survivors-fourniers-gangrene

  In long-term survivors of FG, the wound situation has a deeply negative impact on HRQoL. […] The wound situation has a deeply negative impact on HRQoL, especially in the physical domains. […] Further research is essential to ensure the quality of care. One initial approach could be the development of a disease-specific validated quality of life questionnaire for FG patients, especially addressing the wound situation and physical impairment.

• #30 Patient-reported outcomes and health-related quality of life in male long-term survivors of Fournier’s gangrene :: Cambridge Media Journals

  https://journals.cambridgemedia.com.au/jwm/volume-23-number-3/patient-reported-outcomes-and-health-related-quality-life-male-long-term-survivors-fourniers-gangrene

  Objectives To describe patient-reported outcomes and health-related quality of life (HRQoL) in male long-term survivors of Fourniers gangrene (FG). […] The incidence of FG is 1.6 cases per 100,000 male patients in the United States. […] The prognosis, survival and outcome of FG has not improved in recent years, despite more intensive critical-care therapy for these patients. […] Key points for the successful treatment of FG are immediate surgical debridement, accompanied by forced antibiotic therapy and, usually, intensive medical management. […] Improving survival is only one aspect of this severe disease. Other areas of concern are the long-term situation of FG patients, including the wound situation, quality of life and general health status. […] Suijker et al. performed a retrospective cohort study on quality of life in patients surviving necrotising soft tissue infection and found statistically significant decreased scores on the Short Health Form 36 questionnaire for the domains of physical functioning, role physical functioning and general health, in comparison to the Dutch reference population.

• #31 Fournier Gangrene: Description of 37 Cases and Analysis of Associated Health Care Costs | Actas Dermo-Sifiliográficas

  https://www.actasdermo.org/es-fournier-gangrene-description-37-cases-articulo-S1578219012000558

  The mortality rate of Fournier gangrene can be as high as 67%, despite new techniques applied in the ICU, extensive debridement, wound care, and broad-spectrum antibiotics. […] Fournier gangrene is a urological emergency with high mortality (20%30%) despite early and appropriate treatment. There is no consensus on predictors of the disease. In most cases, the anorectal or genitourinary area is affected. When involvement of these sites occurs with underlying systemic diseases, such as diabetes mellitus and chronic alcoholism, susceptibility to polymicrobial infection increases. Although its incidence is low, Fournier gangrene generates high health care costs; therefore, primary and secondary preventive measures should be applied to correct the risk factors associated with the primary infection.

• #31 Fournier Gangrene: Description of 37 Cases and Analysis of Associated Health Care Costs | Actas Dermo-Sifiliográficas

  https://www.actasdermo.org/es-fournier-gangrene-description-37-cases-articulo-S1578219012000558

  Fournier gangrene is a urological emergency associated with a high mortality. It is a necrotizing fasciitis caused by polymicrobial infection originating in the anorectal or genitourinary area. The aim of this study was to analyze the epidemiological and clinical characteristics of Fournier gangrene along with the variables that influence disease course and mortality in patients treated in our department. […] Fournier gangrene is associated with high mortality despite appropriate early treatment. Although the condition is infrequent, the high associated health care costs suggest that primary and secondary prevention measures should be implemented. […] Fournier gangrene is usually considered a polymicrobial infection, although not all the microorganisms involved are necessarily detected in culture. Both aerobes and anaerobes are almost always present, although anaerobes are isolated less frequently.

• #32 Fournier Gangrene: Description of 37 Cases and Analysis of Associated Health Care Costs | Actas Dermo-Sifiliográficas

  https://actasdermo.org/es-fournier-gangrene-description-37-cases-articulo-S1578219012000558

  Fournier gangrene is a urological emergency associated with a high mortality. It is a necrotizing fasciitis caused by polymicrobial infection originating in the anorectal or genitourinary area. The aim of this study was to analyze the epidemiological and clinical characteristics of Fournier gangrene along with the variables that influence disease course and mortality in patients treated in our department. […] Fournier gangrene is associated with high mortality despite appropriate early treatment. Although the condition is infrequent, the high associated health care costs suggest that primary and secondary prevention measures should be implemented. […] Fournier gangrene is a urological emergency with high mortality (20%30%) despite early and appropriate treatment. There is no consensus on predictors of the disease. In most cases, the anorectal or genitourinary area is affected. When involvement of these sites occurs with underlying systemic diseases, such as diabetes mellitus and chronic alcoholism, susceptibility to polymicrobial infection increases. Although its incidence is low, Fournier gangrene generates high health care costs; therefore, primary and secondary preventive measures should be applied to correct the risk factors associated with the primary infection.

• #33 Update on Fournier’s Gangrene Pathophysiology and Treatment – American Urological Association

  https://auanews.net/issues/articles/2022/january-2022/update-on-fourniers-gangrene-pathophysiology-and-treatment

  Fournier’s gangrene (FG) is a necrotizing soft tissue infection of the perineal, genital or anorectal region. […] Despite modern surgical and antimicrobial management, mortality has been reported to be 7.5% in the United States. […] Delays in diagnosis likely contribute to this degree of mortality. […] Patients diagnosed with FG presented with symptomatically similar diagnoses on average 12 days prior to formal diagnosis, representing an opportunity for an earlier diagnosis. […] Currently, there are no formal guidelines by the AUA for the management of this condition. […] FG requires decisive surgical management, careful antimicrobial coverage and often reconstruction to support patients through this challenging infection. […] Delays in diagnosis are common, and a thorough physical exam is necessary to reduce these delays when patients present with related complaints. […] Currently, there are no formal guidelines by the AUA for the management of this condition, and development of these guidelines may be helpful for consistent urological management in the future.

• #34 A Review of Clinical Manifestations of Gangrene in Western Uganda | IntechOpen

  https://www.intechopen.com/chapters/43947

  Gangrene is described as the necrosis or death of soft tissue due to obstructed circulation, usually followed by decomposition and putrefaction (Vitin 2011). […] It is a serious and potentially life-threatening medical condition that has significant economic burden worldwide [Hall et al., (2011)]. […] The prevalence and incidence of gangrene are difficult to establish [Vivek, 2011] because some patients may die from gangrene and its complications without visiting healthcare facilities, especially among poor rural dwellers with few or no healthcare facilities. […] The prognosis of gangrene is highly dependent on early detection of its clinical manifestations, diagnosis and institution of appropriate treatment. […] Early detection of clinical manifestations of gangrene remains a challenge to healthcare providers due to limited resources.

• #34 A Review of Clinical Manifestations of Gangrene in Western Uganda | IntechOpen

  https://www.intechopen.com/chapters/43947

  This study has shown that the prevalence of gangrene remains unknown in our community. […] Since the clinical manifestations of deep tissue gangrene may be vague, clinicians are encouraged to have a high index of suspicion in all patients that have risk factors for developing gangrene at any clinician-patient consultation to promote early detection and institution of appropriate preventive and curative measures.

• #35 Fournier gangrene | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/fournier-gangrene?embed_domain=hackmd.io%25252525252F%252525252540yIPUAFeCSL2JsU8smR5nJQ%25252525252Fbnjhjgjghjghjghfavicon.icoradiopaedia-icon-144.pngfavicon.icofavicon.ico&lang=us

  Fournier gangrene is typically seen in men with diabetes mellitus, aged 50-70 years. […] Although historically women were rarely affected, the incidence appears to be increasing and is particularly associated with morbid obesity. […] Other predisposing factors include end-stage renal and/or liver failure, hypertension, immunosuppression, obesity (BMI 30), alcohol use, smoking, debility, HIV, and diabetes. […] It is considered a urological emergency with a poor prognosis due to its high mortality rate (ranging ~15-50%). […] Imaging should be used judiciously, and must not allow the delay of potentially life-saving definitive treatment. […] Critical findings to assess and report is extension of disease into deeper tissues such as intraperitoneal involvement or extension into space of Retzius, as these will alter therapy and require a laparotomy. […] Given the time-critical nature of this disease, contacting the treating clinician immediately is of paramount importance.

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