Factors associated with Fournier's gangrene survival in a diverse urban community: a 15-year review

Objective: To assess risk factors, scoring systems, microbiology, and outcomes associated with Fournier's gangrene (FG) in a diverse urban community. Methods: A retrospective review of patients with FG medical data from 2007 to 2021 was performed. Means were compared via t-tests, associations via chi-square analysis, and survival probability via Kaplan–Meier analysis. Statistical findings were considered significant if P ≤ 0.05. Results: Of the 132 patients with FG, 14% died of FG, 47% were discharged home, and 39% were discharged to a nursing facility. Orchidectomies, thigh pouches, flap/graft wound closure, and immediate wound closure were performed in 9%, 12%, 22%, and 29% of cases, respectively. Escherichia coli, Bacteroides, Streptococcus, Enterococcus, and Candida were most frequently isolated. Candida and Proteus species were associated with lower survival probability, whereas Streptococcus and Staphylococcus species were associated with higher survival probability. Lower haemoglobin A1c was associated with orchidectomy and FG death, while higher A1c was associated with flap/graft use during wound closure. Compared to culture-concordant empiric antibiotics, culture-discordant empiric antibiotics were associated with longer hospital stay and worse outcomes. The Uludag Fournier's Gangrene Severity Index (UFGSI) was significantly associated with the most surgical and clinical outcomes of interest. Conclusions: The microbiome responsible for the FG disease process evolved with the emergence of fungal FG. Along with causative organisms, this study also highlights comorbid conditions that adversely affect patient outcomes, especially mental illness. We also note the relative superiority of the UFGSI compared to other scoring systems. There is a need to reassess empiric antibiotic selection and surgical management.