Presentation and Management Outcome of Fournier's Gangrene:A Two-Centre Study
Keywords:
Fournier's gangrene, Necrotizing fasciitis, HIV, Debridement, Fournier's Gangrene Severity IndexAbstract
Fournier's gangrene (FG) is a rapidly progressive and life-threatening necrotizing fasciitis of the perineum, genitalia, and perianal region. It carries a high mortality rate in resource-limited settings, where delayed presentation and inadequate healthcare infrastructure compound management challenges.The aim of this study is to determine the clinical presentation, management patterns, and predictors of mortality among patients with Fournier's gangrene managed at two tertiary centres in Nigeria. This was a retrospective review of medical records of all patients managed for Fournier's gangrene over five years at two tertiary referral centres in Nigeria was conducted. Data on sociodemographic profile, clinical presentation, Fournier's Gangrene Severity Index (FGSI), management, and outcomes were extracted and analyzed. Descriptive statistics were used for continuous variables; Fisher's exact test compared categorical variables between survivors and non-survivors; and logistic regression analysis was used to evaluate predictors of mortality. Thirteen patients (all male) were managed during the study period, with a mean age of 47.9 ± 12.9 years (range 28-76 years). The scrotal region was the commonest site of involvement (46.2%). Diabetes mellitus and smoking were each present in 46.2% of cases. HIV seropositivity was documented in 15.4%. All patients underwent aggressive surgical debridement (mean 4.9 ± 1.8 procedures) combined with broad-spectrum antibiotics. The predominant organisms isolated were Escherichia coli and Staphylococcus aureus (each 46.2%), with polymicrobial infection in 38.5%. Two patients (15.4%) died. HIV seropositivity was the only variable significantly associated with mortality (p = 0.002). Fournier's gangrene in our environment predominantly affects middle-aged men, with diabetes mellitus and smoking as key predisposing factors. HIV seropositivity was a significant predictor of mortality. Early aggressive surgical debridement, targeted antibiotic therapy, and HIV screening on admission are essential to improving survival outcomes.
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