Fournier's Gangrene: Incidence, Risk Factors, and Adverse Outcomes

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Fournier’s gangrene is an uncommon but often devastating infection.
Fournier’s gangrene is an uncommon but often devastating infection.

This article is part of Infectious Disease Advisor's in-depth coverage of IDWeek 2017™, which took place in San Diego, CA. Our staff will be reporting on the latest treatment advancements and research initiatives for skin infections. Check back regularly for highlights from IDWeek 2017.

According to recent research presented at IDWeek 2017, held October 4-8 in San Diego, California, Fournier's gangrene was shown to be associated with multidrug-resistant (MDR) organisms and resulted in death or loss of an organ in 30% of affected patients.

In a retrospective analysis at a large academic hospital, cases of Fournier's gangrene between 2006 and 2015 were identified using ICD codes. Cases were confirmed by a review of medical pathology records. The characteristics of the infections and affected patients were evaluated with descriptive and univariate statistics.

The researchers identified 59 cases of Fourier's gangrene (mean age 56; 71% men; 45% white) with an incidence of 31.8 cases per 100,000 admissions. The researchers noted that this incidence was higher than that previously reported in the literature. Risk factors for infection included diabetes (44%; mean hemoglobin A1c 9.6%), overweight/obesity (61%), immunocompromised state (34%), and substance use (32%).

Of cases with identified causative pathogens, 21% were MDR organisms: methicillin-resistant Staphylococcus aureus (14%), extended-spectrum beta-lactamase Escherichia coli (5%), and MDR Acinetobacter (2%). Fluoroquinolone-resistant strains were identified in 31% of cases with aerobic Gram-negative rod bacteria.

MDR infections were significantly correlated with immunocompromised states (odds ratio [OR] 5.5; P =.01) and chronic wounds (OR 7.0; P =.02).

Adverse outcomes included death (15%) and loss of an organ (15%). Cases involving MDR organisms were more likely to have adverse outcomes (42% vs 28%; P =.48). The researchers noted that most MDR infections were treated with an antibiotic with documented efficacy against MDR organisms.

The researchers concluded that "the emergence of [MDR organisms is] an important cause of [acute bacterial skin and skin structure infections] including [methicillin-resistant S aureus] and drug-resistant [Gram-negative rod bacteria]. Antibiotics should be chosen with broad-spectrum, anti-[MDR organism] activity given the high morbidity and mortality associated with these infections."


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Reference

Chai L, Crum-Cianflone N. Emergence of multi-drug resistant organisms (MDROs) causing Fournier's gangrene. Presented at: IDWeek 2017; October 4-8, 2017; San Diego, California. Poster 262.

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