Methods: A retrospective study of Fournier’s gangrene from 2006 to 2015 at a large academic hospital was conducted. Cases were identified using ICD codes (ICD-9: 608.83, V13.89; ICD-10: N49.3, Z87.438), and a review of medical and pathology records was performed to confirm each case. Data collected included socio-demographics, medical conditions, bacterial pathogens and their resistance patterns, treatments, and outcome. Descriptive and univariate statistics were performed.
Results: A total of 59 cases were evaluated with an incidence of 31.8 cases per 100,000 admissions over the study period. Mean age was 56 years (range 18-91), 71% were male, and 45% white. Diabetes was noted among 26 (44%) with a mean A1c of 9.6%. Other risk factors included: overweight/obesity (61%), immunocompromised state (34%), and substance use (32%). A causative organism was identified in all but 2 cases; 12 patients (21%) had a MDRO with MRSA being the most common pathogen (n=8, 14% of all cases), followed by ESBL E. coli (n=3) and MDRO Acinetobacter (n=1). MRSA was the sole pathogen in five (63%) of the eight cases involving this organism. Among those with an aerobic Gram-negative rod (GNR) isolated, 31% were fluoroquinolone-resistant. An MDRO infection was significantly associated with an immunocompromised state (OR 5.5, p=0.01) and chronic wounds (OR 7.0, p=0.02). Overall, 30% of all cases had an adverse outcome (15% died and an additional 15% had loss of an organ). Those with MDRO were more likely to experience an adverse outcome (42% vs. 28%), although this was not statistically significant (p=0.48); of note most (83%) MDRO cases were treated with an initial antibiotic with efficacy against the MDRO.
Conclusion: This report suggests a much higher incidence of Fournier’s gangrene than previously described and highlights the emergence of MDROs as an important cause of these infections including MRSA and drug-resistant GNRs. Antibiotics should be chosen with broad-spectrum, anti-MDRO activity given the high morbidity and mortality associated with these infections.