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3. Sorensen M, Kriegar J. Fournier’s gangrene: epidemiology and outcomes in


the general US population. Urol Int. 2016;97(3):249-259. 4. Sen H, Bayrak O, Erturhan S, Borazan E, Koc MN. Is hemoglobin A1c level effective in predicting the prognosis of Fournier gangrene? Urol Ann.

Which of the following is the cornerstone of mortality reduction in Fournier gangrene?

2016;8(3):343-347. 5. Eke N. Fournier’s gangrene: a review of 1726 cases. Br J Surg. 2000;87(6):718-728. 6. Yim SU, Kim SW, Ahn JH, et al. Neutrophil to lymphocyte and platelet to


lymphocyte ratios are more effective than the Fournier’s gangrene sever-

■ Early surgical intervention ■ An interdisciplinary approach ■ Appropriate antibiotic coverage

ity index for predicting poor prognosis in Fournier’s gangrene. Surg Infect


(Larchmt). 2016;17(2):217-223. 26.03%


7. Norton KS, Johnson L, Perry T, Perry K, Sehon J, Zibari G. Management of Fournier’s gangrene: an eleven year retrospective analysis of early recognition, diagnosis, and treatment. Am Surg. 2002;68(8):709-713.

■ Glycemic control

8. Anaya DA, Dellinger EP. Necrotizing soft-tissue infection diagnosis and management. Clin Infect. Dis. 2007;44(5):705-710. 9. Thwaini A, Khan A, Malik A, et al. Fournier’s gangrene and its emergency

For more polls, visit

management. Postgrad Med J. 2006;82(970):516-519. 10. Smith GL, Bunker C, Dinneen M. Fournier’s gangrene. Br J Urol. 1998;81(3):347-355. 11. Chennamsetty A, Khourdaji I, Burks F, Killinger KA. Contemporary diagno-

is associated with high likelihood of mortality, and a score <9 is associated with a greater likelihood of survival.4,9,13,15

sis and management of Fournier’s gangrene. Ther Adv Urol. 2015;7(4):203-215. 12. Saber A, Bajwa TM. A simplified prognostic scoring system for Fournier’s gangrene. Urol Nephrol Open Access. 2014;1(3):00018.


13. Wróblewska M, Kuzaka B, Borkowski T, Kuzaka P, Kawecki D,

Although rare, FG may be associated with significant risk for morbidity and mortality especially if recognition and treatment are delayed, which is common due to ambiguous history and physical examination findings. Although risks can be reduced significantly with preventive health management of key comorbid conditions, namely those associated with immunodeficiency, disease cannot always be prevented. If FG develops despite these preventive efforts, prompt identification and management, including early antibiotic administration and surgical intervention, are the foundations of mortality reduction and require a high index of suspicion on the part of the examiner. ■

Radziszewski P. Fournier’s gangrene–current concepts. Pol J Microbiol. 2014;63(3):267-273. 14. Zaba R, Grzybowski A, Prokop J, Zaba Z, Zaba C. Fournier’s gangrene: historical survey, current status, and case description. Med Sci Monit. 2009;15(2):CS34-CS39. 15. Chia L, Crum-Cianflone NF. Emergence of multi-drug resistant organisms (MDROs) causing Fournier’s gangrene. J Infect. 2018;76(1):38-43. 16. Levenson RB, Singh A, Novelline R. Fournier gangrene: role of imaging. Radiographics. 2008;28:519-528. 17. Sharif HS, Clark D, Aabed M, et al. MR imaging of thoracic and abdominal wall infection: comparison with other imaging procedures. AJR Am J Roentgenol. 1990;154:989-995. 18. Verma S, Sayana A, Kala S, Rai S. Evaluation of the utility of the Fournier’s

Mara Kohls, MPAS, PA-C, is a physician assistant with Qualified Emergency Specialists, Inc. and the Department of Emergency Medicine of the University of Cincinnati in Cincinnati, Ohio. Christopher M. Howell, DSc, MSc, MPAS, PA-C, MBA, FAAPA, is an associate professor at Kettering College in Kettering, Ohio, and practices in Indiana and Ohio in addiction and emergency medicine.

gangrene severity index in the management of Fournier’s gangrene in North India: a multicentre retrospective study. J Cutan Aesthet Surg. 2012;5(4):273-276. 19. Jeong HJ, Park SC, Seo IY, Rim JS. Prognostic factors in Fournier gangrene. Int J Urol. 2005;12:1041-1044. 20. Nisbet AA, Thompson I. Impact of diabetes mellitus on the presentation and outcomes of Fournier’s gangrene. Urology. 2002;60(5):775-779.


21. Ersoz F, Sari S, Arikan S, et al. Factors affecting mortality in Fournier’s gan-

1. Tarchouli M, Bounaim A, Essarghini M, et al. Analysis of prognostic factors

grene: experience with fifty-two patients. Singapore Med J. 2012;53:537-540.

affecting mortality in Fournier’s gangrene: a study of 72 cases. Can Urol Assoc J.

22. Lin TY, Ou CH, Tzai TS, et al. Validation and simplification of Fournier’s


gangrene severity index. Int J Urol. 2014;21(7):696-701.

2. Faria SN, Helman A. Deep tissue infection of the perineum: case report and

23. Taviloglu K, Yanar H. Necrotizing fasciitis: strategies for diagnosis and

literature review of Fournier gangrene. Can Fam Physician. 2016;62(5):405-407.

management. World J Emerg Surg. 2007;2:19. • THE CLINICAL ADVISOR • JUNE 2019 29

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June 2019 Clinical Advisor  

June 2019 Clinical Advisor