Lauerman Margaret Hedgecock, Kolesnik Olga, Sethuraman Kinjal, Rabinowitz Ronald, Joshi Manjari, Clark Emily, Stein Deborah, Scalea Thomas, Henry Sharon
From the Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland.
J Trauma Acute Care Surg. 2017 Sep;83(3):443-448. doi: 10.1097/TA.0000000000001562.
Antibiotic management of Fournier's gangrene (FG) is without evidence-based guidelines and is based on expert opinion. The effect of duration of antibiotic therapy on outcomes in FG is unknown.
A retrospective review was performed of FG patients from 2012 to 2015 at a single institution. Patients were managed by our institutional practice of complete primary wound closure as possible, with antibiotic duration according to physician judgment. Patients were stratified into multiple durations of antibiotic administration.
Overall, 168 patients with FG were included. When examining multiple stratifications of antibiotic therapy of 7 days or less, 8 days to 10 days, 11 days to 14 days, or 15 days or more of antibiotics, there was no significant difference in mortality (p = 0.11), primary closure (p = 0.75), surgical site infection (SSI) (p = 0.52), or Clostridium difficile infection (p = 0.63). There were no cases of recurrent FG in any antibiotic stratification. Mortality was not increased (p = 1.00) and ability to achieve primary closure was not decreased (p = 0.08) with initial antibiotic therapy exclusive of cultured organisms.
Shorter antibiotic courses for patients in whom source control is obtained and initial antibiotic selection exclusive of many resistant organisms were not associated with worse outcomes in FG.
Therapeutic, level IV.
福尼尔坏疽（FG）的抗生素管理缺乏循证指南，基于专家意见。抗生素治疗持续时间对FG患者预后的影响尚不清楚。
对2012年至2015年在一家机构就诊的FG患者进行回顾性研究。患者按照我们机构尽可能进行一期伤口完全闭合的常规处理，并根据医生判断确定抗生素使用时间。将患者按抗生素使用的不同持续时间分层。
共纳入168例FG患者。在检查抗生素治疗持续时间为7天及以下、8至10天、11至14天或15天及以上的多种分层时，死亡率（p = 0.11）、一期闭合率（p = 0.75）、手术部位感染（SSI）（p = 0.52）或艰难梭菌感染（p = 0.63）均无显著差异。在任何抗生素分层中均无FG复发病例。不考虑培养出的微生物而仅进行初始抗生素治疗时，死亡率未增加（p = 1.00），且实现一期闭合的能力未降低（p = 0.08）。
对于已实现源控制且初始抗生素选择不包括许多耐药菌的患者，较短疗程的抗生素治疗与FG患者较差的预后无关。
治疗性研究，IV级。
