Chalya Phillipo L, Igenge John Z, Mabula Joseph B, Simbila Samson
Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
Department of Urology, Bugando Medical Centre, Mwanza, Tanzania.
BMC Res Notes. 2015 Sep 28;8:481. doi: 10.1186/s13104-015-1493-1.
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.
This was a descriptive retrospective study of patients with FG treated at Bugando Medical Centre between November 2006 and April 2014.
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).
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.
福尼尔坏疽（FG）是一种罕见的、进展迅速的外生殖器和会阴坏死性筋膜炎，可导致软组织坏死。尽管使用了抗生素并进行了积极的清创术，但FG的死亡率仍然很高。本研究描述了我们在FG治疗方面的经验，并确定了预后因素。
这是一项对2006年11月至2014年4月在布甘多医疗中心接受治疗的FG患者进行的描述性回顾性研究。
共研究了84例患者（男:女 = 41:1）。中位年龄为34岁（范围15 - 76岁）。最常见的诱发因素是糖尿病（16.7%）。9例（11.3%）患者HIV呈阳性。仅46例（54.8%）患者获得了细菌培养结果。其中，38例（82.6%）有多种细菌生长，8例（17.4%）有单一细菌生长。大肠埃希菌（28.3%）是最常分离出的细菌。除美罗培南和亚胺培南分别100%敏感外，所有分离出的微生物对常用抗生素均表现出高度耐药性。所有患者均采用复苏、广谱抗生素和广泛手术切除的常规方法进行治疗。中位住院时间（LOS）为28天，死亡率为28.6%。全身炎症反应综合征和糖尿病与住院时间延长显著相关（p < 0.001），而高龄（>60岁）、就诊延迟（>48小时）、入院时全身炎症反应综合征、糖尿病、感染扩展至腹壁、FG严重程度评分>9以及CD4细胞计数<200 μl/细胞的HIV感染是死亡的独立预测因素（p < 0.001）。
福尼尔坏疽仍然是一种非常严重的疾病，死亡率很高。早期识别感染并进行侵入性和积极的治疗对于在我们的环境中试图降低与该疾病相关的死亡率至关重要。
