Prognostic Factors of Fournier's Gangrene in the Elderly: Experiences of a Medical Center in Southern Taiwan

Abstract

Background: Prognoses of Fournier's gangrene in the elderly are rarely discussed. This study aims to investigate the clinical characteristics and prognosis of Fournier's gangrene in a series of elderly patients in Taiwan. Methods: The medical records of 90 patients with Fournier's gangrene were reviewed between January 01, 1995 and December 31, 2009. Univariate and logistic regression analyses were used to analyze the data. Results: Among 90 patients (83 males and 7 females) with a mean age of 76.4 years, 78.9% were alive and 21.1% died. The mean duration of hospitalization was 32.14 days. Diabetes mellitus (50%) was the leading predisposing factor. Escherichia coli, Klebsiella pneumoniae, and Proteus spp. were the three most common isolated pathogens. In total, 296 operations and 244 debridements were performed. Significant variables related to mortality in the univariate analysis were a serum albumin level of < 2.5, sepsis, infection with Proteus spp., polymicrobial wound infection, bacteremia, acute renal failure, septic shock, and respiratory failure requiring intubation. The logistic regression analysis showed that the mortality rate in patients with individual factors, including polymicrobial wound infection, fewer operations (< 3), acute renal failure, and respiratory failure requiring intubation, was higher than that in those without those factors. Conclusion: The core principles to manage Fournier's gangrene in geriatric patients are early diagnoses, aggressive resuscitations, use of broad-spectrum antibiotics, and prompt and repeated surgical intervention. Medical teams can save their lives by applying aggressive treatment with longer hospitalization.

Keywords

• elderly
• Fournier's gangrene
• prognosis