TY - JOUR
T1 - The microbiological profile of patients with Fournier's gangrene: A retrospective multi-institutional cohort study
AU - Cipriani, Chiara
AU - Iacovelli, Valerio
AU - Sandri, Marco
AU - Bertolo, Riccardo
AU - Maiorino, Francesco
AU - Antonucci, Francesco
AU - Micali, Salvatore
AU - Rocco, Bernardo
AU - Puliatti, Stefano
AU - Ferrarese, Paolo
AU - Benedetto, Giuseppe
AU - Minervini, Andrea
AU - Cocci, Andrea
AU - Pastore, Antonio Luigi
AU - Al Salhi, Yazan
AU - Antonelli, Alessandro
AU - Morena, Tonino
AU - VOLPE, Alessandro
AU - Poletti, Filippo
AU - Celia, Antonio
AU - Zeccolini, Guglielmo
AU - Leonardo, Costantino
AU - Proietti, Flavia
AU - Finazzi Agrò, Enrico
AU - Bove, Pierluigi
PY - 2021/1/1
Y1 - 2021/1/1
N2 - Objectives: To evaluate the role of the microbiological profile and of disease-related factors in the management of patients affected with Fournier's gangrene (FG).Patients and methods: Data regarding patients admitted for FG at nine Italian Hospitals (March 2007-June 2018) were collected. Patients were stratified according to the number of microorganisms documented: Group A - one microorganism; Group B - two microorganisms; Group C - more than three microorganisms. Baseline blood tests, dedicated scoring systems, predisposing risk factors, disease's features, management and post-operative course were analyzed. UpSet technique for visualizing set intersections in a matrix layout and Cuzick's nonparametric test for trend across ordered groups were used.Results: Eighty-one patients were available for the analysis: 18 included in Group A, 32 in Group B, 31 in Group C. The most common microorganism isolated was Escherichia coli. In Group B-C, Escherichia coli was often associated to Enterococcus faecalis, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Statistically significant positive association was highlighted among the number of pathogens (Group A vs B vs C) and serum C-reactive Protein (p < 0.001), procalcitonin (p = 0.02) and creatinine (p = 0.03). Scoring systems were associated with the number of microorganisms detected (p < 0.02). A significant association between the number of microorganisms and the use of VAC therapy and need of a fecal diversion was found (p < 0.02). The number of microorganisms was positively associated with the length of stay (LOS) (p = 0.02). Ten weeks after initial debridement, wound closure was achieved in 11 (91.7%), 22 (84.6%) and 20 (80%) patients in Group A, B, and C, respectively, with no differences in overall survival.Conclusion: Polymicrobial infections in FG are positively associated with inflammatory scores, the need for fecal diversion and the LOS. This results may help the counseling and the clinical management of this rare niche of patients.
AB - Objectives: To evaluate the role of the microbiological profile and of disease-related factors in the management of patients affected with Fournier's gangrene (FG).Patients and methods: Data regarding patients admitted for FG at nine Italian Hospitals (March 2007-June 2018) were collected. Patients were stratified according to the number of microorganisms documented: Group A - one microorganism; Group B - two microorganisms; Group C - more than three microorganisms. Baseline blood tests, dedicated scoring systems, predisposing risk factors, disease's features, management and post-operative course were analyzed. UpSet technique for visualizing set intersections in a matrix layout and Cuzick's nonparametric test for trend across ordered groups were used.Results: Eighty-one patients were available for the analysis: 18 included in Group A, 32 in Group B, 31 in Group C. The most common microorganism isolated was Escherichia coli. In Group B-C, Escherichia coli was often associated to Enterococcus faecalis, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Statistically significant positive association was highlighted among the number of pathogens (Group A vs B vs C) and serum C-reactive Protein (p < 0.001), procalcitonin (p = 0.02) and creatinine (p = 0.03). Scoring systems were associated with the number of microorganisms detected (p < 0.02). A significant association between the number of microorganisms and the use of VAC therapy and need of a fecal diversion was found (p < 0.02). The number of microorganisms was positively associated with the length of stay (LOS) (p = 0.02). Ten weeks after initial debridement, wound closure was achieved in 11 (91.7%), 22 (84.6%) and 20 (80%) patients in Group A, B, and C, respectively, with no differences in overall survival.Conclusion: Polymicrobial infections in FG are positively associated with inflammatory scores, the need for fecal diversion and the LOS. This results may help the counseling and the clinical management of this rare niche of patients.
KW - Fournier’s gangrene
KW - bacteria
KW - microbiology
KW - necrotizing fasciitis
KW - urological infections
KW - Fournier’s gangrene
KW - bacteria
KW - microbiology
KW - necrotizing fasciitis
KW - urological infections
UR - https://iris.uniupo.it/handle/11579/128310
U2 - 10.1177/03915603211018441
DO - 10.1177/03915603211018441
M3 - Article
SN - 0391-5603
SP - 3915603211018441
JO - Urologia
JF - Urologia
ER -