Fournier Gangrene

Description

• Fournier gangrene is a life-threatening necrotizing skin infection of the genitals and/or perineum.
• Urologic emergency requiring antibiotics and emergent surgical débridement

ALERT
Fournier gangrene is a urologic emergency with a high rate of morbidity and mortality if not diagnosed and managed promptly.

Epidemiology

• 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

• Etiology
  • Often polymicrobial (83%)
  • Common organisms include
    • Bacteroides (43.9%)
    • Escherichia coli (36.6%)
    • Prevotella (34.1%)
  • Other organisms isolated include Staphylococcus, Streptococcus, Candida.
• Pathophysiology
  • 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.

Risk Factors

• Alcohol abuse
• Diabetes
• 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

General Prevention

• Routine hygiene
• Modification of risk factors

Commonly Associated Conditions

• Perirectal abscess
• Urethral strictures
• Testicular infections (epididymitis, orchitis)
• Skin infections (hidradenitis, folliculitis, cellulitis)
• Sepsis