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- Fournier gangrene is a life-threatening necrotizing skin infection of the genitals and/or perineum.
- Urologic emergency requiring antibiotics and emergent surgical débridement
Fournier gangrene is a urologic emergency with a high rate of morbidity and mortality if not diagnosed and managed promptly.
- The majority of patients are between 50 and 79 years of age but it can occur at all ages.
- Male > female10:1
- White (52.3%)
- Most patients have >2 comorbidities.
- Incidence 1.6 in 100,000
- 0.02% of hospitalized patients
Etiology and Pathophysiology
- Often polymicrobial (83%)
- Common organisms include
- Bacteroides (43.9%)
- Escherichia coli (36.6%)
- Prevotella (34.1%)
- Other organisms isolated include Staphylococcus, Streptococcus, Candida.
- Infection, typically polymicrobial, occurs in the genitals or perineum.
- Develops into a synergistic necrotizing fasciitis
- Leads to thrombosis of adjacent subcutaneous vessels resulting in gangrene
- Left untreated, it progresses to sepsis and death.
- Alcohol abuse
- Extremes of age <10 years old or >50 years old
- IV drug abuse
- Recent genital or perineal trauma or infection
- Recent penile, perineal, or perirectal surgery
- Immunocompromised state
- Chronic renal failure
- Chronic liver disease
- Peripheral vascular disease
- Routine hygiene
- Modification of risk factors
Commonly Associated Conditions
- Perirectal abscess
- Urethral strictures
- Testicular infections (epididymitis, orchitis)
- Skin infections (hidradenitis, folliculitis, cellulitis)