Fournier gangrene medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
===Medical Therapy | Fournier gangrene is a urological emergency requiring [[intravenous]] antibiotics and [[debridement]] (surgical removal) of [[necrotic]] (dead) tissue. Despite such measures, the mortality rate overall is 40%, but 78% if [[sepsis]] is already present at the time of initial hospital admission.<ref name="pmid16927060">{{cite journal| author=Yanar H, Taviloglu K, Ertekin C, Guloglu R, Zorba U, Cabioglu N et al.| title=Fournier's gangrene: risk factors and strategies for management. | journal=World J Surg | year= 2006 | volume= 30 | issue= 9 | pages= 1750-4 | pmid=16927060 | doi=10.1007/s00268-005-0777-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16927060}}</ref> The spread of gangrene is rapid at the rate of 2–3 cm/h, hence early diagnosis and emergency surgical treatment is important.<ref name="pmid1736475">{{cite journal| author=Paty R, Smith AD| title=Gangrene and Fournier's gangrene. | journal=Urol Clin North Am | year= 1992 | volume= 19 | issue= 1 | pages= 149-62 | pmid=1736475 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1736475 }}</ref> | ||
==Medical Therapy== | |||
Fournier gangrene is a urological emergency requiring [[intravenous]] antibiotics and [[debridement]] (surgical removal) of [[necrotic]] (dead) tissue. Despite such measures, the mortality rate overall is 40%, but 78% if [[sepsis]] is already present at the time of initial hospital admission.<ref name="pmid16927060">{{cite journal| author=Yanar H, Taviloglu K, Ertekin C, Guloglu R, Zorba U, Cabioglu N et al.| title=Fournier's gangrene: risk factors and strategies for management. | journal=World J Surg | year= 2006 | volume= 30 | issue= 9 | pages= 1750-4 | pmid=16927060 | doi=10.1007/s00268-005-0777-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16927060}}</ref> The spread of gangrene is rapid at the rate of 2–3 cm/h, hence early diagnosis and emergency surgical treatment is important.<ref name="pmid1736475">{{cite journal| author=Paty R, Smith AD| title=Gangrene and Fournier's gangrene. | journal=Urol Clin North Am | year= 1992 | volume= 19 | issue= 1 | pages= 149-62 | pmid=1736475 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1736475 }}</ref> | Fournier gangrene is a urological emergency requiring [[intravenous]] antibiotics and [[debridement]] (surgical removal) of [[necrotic]] (dead) tissue. Despite such measures, the mortality rate overall is 40%, but 78% if [[sepsis]] is already present at the time of initial hospital admission.<ref name="pmid16927060">{{cite journal| author=Yanar H, Taviloglu K, Ertekin C, Guloglu R, Zorba U, Cabioglu N et al.| title=Fournier's gangrene: risk factors and strategies for management. | journal=World J Surg | year= 2006 | volume= 30 | issue= 9 | pages= 1750-4 | pmid=16927060 | doi=10.1007/s00268-005-0777-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16927060}}</ref> The spread of gangrene is rapid at the rate of 2–3 cm/h, hence early diagnosis and emergency surgical treatment is important.<ref name="pmid1736475">{{cite journal| author=Paty R, Smith AD| title=Gangrene and Fournier's gangrene. | journal=Urol Clin North Am | year= 1992 | volume= 19 | issue= 1 | pages= 149-62 | pmid=1736475 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1736475 }}</ref> | ||
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==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Emergency mdicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
[[Category:Surgery]] | |||
[[Category:Orthopedics]] | |||
[[Category:Dermatology]] | |||
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Steven C. Campbell, M.D., Ph.D.; Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[1]; Jesus Rosario Hernandez, M.D. [2]
Overview
Fournier gangrene is a urological emergency requiring intravenous antibiotics and debridement (surgical removal) of necrotic (dead) tissue. Despite such measures, the mortality rate overall is 40%, but 78% if sepsis is already present at the time of initial hospital admission.[1] The spread of gangrene is rapid at the rate of 2–3 cm/h, hence early diagnosis and emergency surgical treatment is important.[2]
Medical Therapy
Fournier gangrene is a urological emergency requiring intravenous antibiotics and debridement (surgical removal) of necrotic (dead) tissue. Despite such measures, the mortality rate overall is 40%, but 78% if sepsis is already present at the time of initial hospital admission.[1] The spread of gangrene is rapid at the rate of 2–3 cm/h, hence early diagnosis and emergency surgical treatment is important.[2]
Antimicrobial Therapy
- Fournier gangrene[3]
- If caused by streptococcus species or clostridia
- Preferred regimen: Penicillin G
- Polymicrobial
-
- MRSA (methicillin resistant staphylococcus aureus) suspected
- Preferred regimen: vancomycin OR daptomycin
Nutritional Support
The metabolic demands of Fournier gangrene patients are similar to those of other major trauma or burns.[4] Nutritional support to replace lost proteins and fluids from large wounds and/or the result of shock is required from the first day of a patient's hospital admission.
Hyperbaric oxygen
- Delivery of 100% oxygen (hyperbaric) at two or three times the atmospheric pressure for 30 to 90 minutes with three to four treatments daily.[5]
- Hyperbaric oxygen inhibits infection and exotoxin release.[6]
- It enhances efficacy of antibiotics by increasing local oxygen tension in tissue and augment oxidative burst and killing ability of leukocytes.[7]
- These effects result in a reduced need for surgical debridement and improved morbidity and mortality in patients with necrotizing fasciitis.
Contraindications to hyperbaric oxygen are:[8][9]
- Pneumothorax
- Cisplatin (which decreases the production of superoxide dismutase which is protective against damaging effects of high partial O2 pressure)
- Doxorubicin therapy
Side effects of hyperbaric oxygen are:
- Barotrauma of the middle ear
- Seizures
- Loss of respiratory drive in hypercapnic patients (therefore, frequent periods of breathing in room air are interposed when patients are on HBOT)
- Vasoconstriction
IV γ-globulin
- Use of intravenous immune globulin is not FDA approved.
- If used, this treatment is restricted to critically ill patients with either staphylococcal or streptococcal infections.[10]
References
- ↑ 1.0 1.1 Yanar H, Taviloglu K, Ertekin C, Guloglu R, Zorba U, Cabioglu N; et al. (2006). "Fournier's gangrene: risk factors and strategies for management". World J Surg. 30 (9): 1750–4. doi:10.1007/s00268-005-0777-3. PMID 16927060.
- ↑ 2.0 2.1 Paty R, Smith AD (1992). "Gangrene and Fournier's gangrene". Urol Clin North Am. 19 (1): 149–62. PMID 1736475.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A (2014). "Current concepts in the management of necrotizing fasciitis". Front Surg. 1: 36. doi:10.3389/fsurg.2014.00036. PMC 4286984. PMID 25593960.
- ↑ Escobar SJ, Slade JB, Hunt TK, Cianci P (2005). "Adjuvant hyperbaric oxygen therapy (HBO2)for treatment of necrotizing fasciitis reduces mortality and amputation rate". Undersea Hyperb Med. 32 (6): 437–43. PMID 16509286.
- ↑ Korhonen K (2000). "Hyperbaric oxygen therapy in acute necrotizing infections with a special reference to the effects on tissue gas tensions". Ann Chir Gynaecol Suppl (214): 7–36. PMID 11199291.
- ↑ Hyperbaric oxygen therapy. http://onlinelibrary.wiley.com/doi/10.1080/110241500750008583/abstract (2016) Accessed on September 12, 2016
- ↑ Kindwall EP, Gottlieb LJ, Larson DL (1991). "Hyperbaric oxygen therapy in plastic surgery: a review article". Plast Reconstr Surg. 88 (5): 898–908. PMID 1924583.
- ↑ Capelli-Schellpfeffer M, Gerber GS (1999). "The use of hyperbaric oxygen in urology". J Urol. 162 (3 Pt 1): 647–54. PMID 10458334.
- ↑ Darabi K, Abdel-Wahab O, Dzik WH (2006). "Current usage of intravenous immune globulin and the rationale behind it: the Massachusetts General Hospital data and a review of the literature". Transfusion. 46 (5): 741–53. doi:10.1111/j.1537-2995.2006.00792.x. PMID 16686841.