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Fournier's gangrene at a tertiary health facility in northwestern Tanzania: a single centre experiences with 84 patients.

Chalya PL, Igenge JZ, Mabula JB, Simbila S - BMC Res Notes (2015)

Bottom Line: Bacterial culture results were obtained in only 46 (54.8%) patients.Systemic inflammatory response syndrome and diabetes mellitus were significantly associated with prolonged LOS (p < 0.001), whereas advancing age (>60 years), late presentation (>48 h), systemic inflammatory response syndrome on admission, diabetes mellitus, extension of infection to the abdominal wall, FG severity score >9 and HIV infection with CD4 count <200 μl/cells) were independent predictors of mortality (p < 0.001).Early recognition of infection associated with invasive and aggressive treatment is essential for attempting to reduce mortality rates associated with this disease in our setting.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania. drphillipoleo@yahoo.com.

ABSTRACT

Background: Fournier's gangrene (FG) is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia and perineum, leading to soft-tissue necrosis. Despite antibiotics and aggressive debridement, the mortality rate of FG remains high. This study describes our experiences in the management of FG and identifies prognostic factors.

Methods: This was a descriptive retrospective study of patients with FG treated at Bugando Medical Centre between November 2006 and April 2014.

Results: A total of 84 patients (M:F = 41:1) were studied. The median age was 34 years (range 15-76 years). The most common predisposing factor was diabetes mellitus (16.7%). Nine (11.3%) patients were HIV positive. Bacterial culture results were obtained in only 46 (54.8%) patients. Of these, 38(82.6%) had polymicrobial bacterial growth while 8 (17.4%) had monomicrobial bacterial growth. Escherichia coli (28.3%) were the most frequent bacterial organism isolated. All the microorganisms isolated showed high resistance to commonly used antibiotics except for Meropenem and imipenem, which were 100% sensitive each respectively. All patients were treated with a common approach of resuscitation, broad-spectrum antibiotics, and wide surgical excision. The median length of hospital stay (LOS) was 28 days and mortality rate was 28.6%. Systemic inflammatory response syndrome and diabetes mellitus were significantly associated with prolonged LOS (p < 0.001), whereas advancing age (>60 years), late presentation (>48 h), systemic inflammatory response syndrome on admission, diabetes mellitus, extension of infection to the abdominal wall, FG severity score >9 and HIV infection with CD4 count <200 μl/cells) were independent predictors of mortality (p < 0.001).

Conclusion: Fournier's gangrene remains a very severe disease with high mortality rates. Early recognition of infection associated with invasive and aggressive treatment is essential for attempting to reduce mortality rates associated with this disease in our setting.

No MeSH data available.


Related in: MedlinePlus

Distribution of patients according to the age group
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Fig1: Distribution of patients according to the age group

Mentions: A total of 88 patients were seen over a period of study with four patients excluded from the study on account of incomplete data, leaving 84 patients for the final analysis. There were 82 (97.6 %) males and 2 (2.4 %) females with a male to female ratio of 41: 1. The age of patients at presentation ranged from 15 to 76 years with a median of 34 years (+IQR of 32 to 41 years). The modal age group was 31–40 years accounting for 58.3 % of cases (Fig. 1). Most of patients, 68 (81.0 %) had either primary or no formal education and more than 80 % of them were unemployed. The majority of patients, 72 (85.7 %) came from the rural areas located a considerable distance from the study area and more than ninety percent of them had no identifiable health insurance.Fig. 1


Fournier's gangrene at a tertiary health facility in northwestern Tanzania: a single centre experiences with 84 patients.

Chalya PL, Igenge JZ, Mabula JB, Simbila S - BMC Res Notes (2015)

Distribution of patients according to the age group
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4584465&req=5

Fig1: Distribution of patients according to the age group
Mentions: A total of 88 patients were seen over a period of study with four patients excluded from the study on account of incomplete data, leaving 84 patients for the final analysis. There were 82 (97.6 %) males and 2 (2.4 %) females with a male to female ratio of 41: 1. The age of patients at presentation ranged from 15 to 76 years with a median of 34 years (+IQR of 32 to 41 years). The modal age group was 31–40 years accounting for 58.3 % of cases (Fig. 1). Most of patients, 68 (81.0 %) had either primary or no formal education and more than 80 % of them were unemployed. The majority of patients, 72 (85.7 %) came from the rural areas located a considerable distance from the study area and more than ninety percent of them had no identifiable health insurance.Fig. 1

Bottom Line: Bacterial culture results were obtained in only 46 (54.8%) patients.Systemic inflammatory response syndrome and diabetes mellitus were significantly associated with prolonged LOS (p < 0.001), whereas advancing age (>60 years), late presentation (>48 h), systemic inflammatory response syndrome on admission, diabetes mellitus, extension of infection to the abdominal wall, FG severity score >9 and HIV infection with CD4 count <200 μl/cells) were independent predictors of mortality (p < 0.001).Early recognition of infection associated with invasive and aggressive treatment is essential for attempting to reduce mortality rates associated with this disease in our setting.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania. drphillipoleo@yahoo.com.

ABSTRACT

Background: Fournier's gangrene (FG) is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia and perineum, leading to soft-tissue necrosis. Despite antibiotics and aggressive debridement, the mortality rate of FG remains high. This study describes our experiences in the management of FG and identifies prognostic factors.

Methods: This was a descriptive retrospective study of patients with FG treated at Bugando Medical Centre between November 2006 and April 2014.

Results: A total of 84 patients (M:F = 41:1) were studied. The median age was 34 years (range 15-76 years). The most common predisposing factor was diabetes mellitus (16.7%). Nine (11.3%) patients were HIV positive. Bacterial culture results were obtained in only 46 (54.8%) patients. Of these, 38(82.6%) had polymicrobial bacterial growth while 8 (17.4%) had monomicrobial bacterial growth. Escherichia coli (28.3%) were the most frequent bacterial organism isolated. All the microorganisms isolated showed high resistance to commonly used antibiotics except for Meropenem and imipenem, which were 100% sensitive each respectively. All patients were treated with a common approach of resuscitation, broad-spectrum antibiotics, and wide surgical excision. The median length of hospital stay (LOS) was 28 days and mortality rate was 28.6%. Systemic inflammatory response syndrome and diabetes mellitus were significantly associated with prolonged LOS (p < 0.001), whereas advancing age (>60 years), late presentation (>48 h), systemic inflammatory response syndrome on admission, diabetes mellitus, extension of infection to the abdominal wall, FG severity score >9 and HIV infection with CD4 count <200 μl/cells) were independent predictors of mortality (p < 0.001).

Conclusion: Fournier's gangrene remains a very severe disease with high mortality rates. Early recognition of infection associated with invasive and aggressive treatment is essential for attempting to reduce mortality rates associated with this disease in our setting.

No MeSH data available.


Related in: MedlinePlus