Microbiological aspects of Fournier's gangrene

Abstract

Background: Fournier's gangrene (FG) is a devastating disease that is characterized by necrotizing fasciitis of the perineal, genital, or perianal region. Broad-spectrum antibiotics are the key component of its treatment. However, there is paucity of data regarding the optimal empirical antibiotherapy for FG.

Materials and methods: Data from patients who underwent surgery for FG between January 2007 and December 2012 were retrieved from a prospectively collected departmental FG database. Demographics, clinical characteristics, causative pathogens and drug susceptibility/resistance were evaluated.

Results: Fifty patients with a median age of 58.5 (22-83) years were included. The perianal origin (58%) was most commonly affected. A positive growth was found in specimen cultures of 48 (96%) patients. The median number of bacterial strains that grew in the cultures was 3 (0-10). Amikacin was the antibiotic with the highest frequency of sensitivity (74%), while the highest resistance was observed against ampicillin-sulbactam (64%). Escherichia coli was the most common microorganism (72%). Acinetobacter baumannii and Klebsiella pneumonia were significantly more common in patients who required mechanical ventilation. The mortality rate was 26%. An Uludag Fournier's Gangrene Severity Index (UFGSI) score of >9.5 and ventilatory support requirement were factors associated with an increased rate of mortality. Acinetobacter baumannii was the only microorganism which was associated with an increased mortality rate.

Conclusion: Causative pathogens in FG appeared to be shifting; thus, empirical antibiotic treatment for this disease should be modified. We recommend 3rd-generation cephalosporin, metronidazole and amikacin for empirical therapy.

Keywords: Empiric antimicrobial therapy; Microbial; Necrotizing fasciitis.