Prognostic Aspects, Survival Rate, and Predisposing Risk Factors in Patients with Fournier’s Gangrene and Necrotizing Soft Tissue Infections: Evaluation of Clinical Outcome of 55 Patients
| Autor: | H. Gerngroß, A Martinschek, Christoph Sparwasser, B Evers, L. Lampl, R Schmidt |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Critical Care Urology Necrosis Risk Factors Intensive care Humans Medicine Prospective Studies Prospective cohort study Survival rate Aged Aged 80 and over Gangrene Hyperbaric Oxygenation Coinfection business.industry Soft Tissue Infections Mortality rate Hemodynamics Middle Aged medicine.disease Anti-Bacterial Agents Perineum Surgery Survival Rate Treatment Outcome medicine.anatomical_structure Debridement Abdomen Female business Fournier Gangrene Gas gangrene |
| Zdroj: | Urologia Internationalis. 89:173-179 |
| ISSN: | 1423-0399 0042-1138 |
| Popis: | Objective: To determine predisposing or prognostic factors and mortality rates of patients with Fournier’s gangrene compared to other necrotizing soft tissue infections (NSTI). Material and Methods: Data of 55 intensive care patients (1981–2010) with NSTI were evaluated. Data were collected prospectively. Results: 43.4% of the patients were in septic condition and 27.3% were hemodynamically unstable. Half of the patients showed predisposing factors (52.7%). The lower extremity (63.2%), abdomen (30.9%), and perineum (14.5%) were most affected. Polymicrobial infections were frequent (65.5%, mean 2.8, range: 1–4). The mortality rate was 16.4% (n = 9). An increase was shown for diabetes mellitus (20%), cardiac insufficiency (22.3%), septic condition at presentation (33.3%), abdominal affection (47.1%), and hemodynamic instability (46.7%). Comparing survivors and nonsurvivors, statistical significance was seen with age (p < 0.001), septic condition at admission (p < 0.001), hemodynamic instability (p < 0.001), low blood pressure (p < 0.001), and abdominal affection (p < 0.001). In laboratory findings, an increase of creatine kinase (p < 0.001) and lactate (p < 0.001) and a decrease of antithrombin III (p < 0.007) and the Quick value (p < 0.01) proved to be significant. Conclusion: Patients with Fournier’s gangrene do not differ in all aspects from those with other NSTI. Successful treatment consists of immediate surgical debridement, broad-spectrum antibiotic treatment, and critical care management. Supportive hyperbaric oxygen therapy should be considered. |
| Databáze: | OpenAIRE |
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