Fournier Gangrene

Fournier Gangrene is a topic covered in the 5-Minute Clinical Consult.

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Basics

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

Incidence
  • The majority of patients are between 50 and 79 years of age, but it can occur at all ages.
  • Male > female 10:1
  • 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

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