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Fournier’s Gangrene: A 10-Year Clinical Experience at a Tertiary Academic Medical Center
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Woo Seop Seong, Byeong Jin Kang, A Reum Kim, Kyung Hwan Kim, Hong Koo Ha
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Urogenit Tract Infect 2023;18(2):64-69. Published online August 31, 2023
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DOI: https://doi.org/10.14777/uti.2023.18.2.64
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 Abstract
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- Purpose: This retrospective study examined the factors influencing clinical outcomes and mortality in patients with Fournier's Gangrene (FG). The medical history, diagnostic procedures, treatment approaches, complications, and mortality factors associated with FG were analyzed.
Materials and Methods: This study retrospectively analyzed the medical records of 40 patients with FG treated over 10 years. The collected data included the patient demographics, comorbidities, vital signs, laboratory tests, Fournier’s Gangrene Severity Index (FGSI) scores, wound swab culture results, treatment approaches, and length of hospitalization.
Results: Among the patients with FG, diabetes mellitus and hypertension were the most common comorbidities. The hemodialysis dependence has been identified as a significant risk factor of mortality. In addition, septic shock and an FGSI >9 were associated with increased mortality. Escherichia coli was the most prevalent bacterium in wound swab cultures, and the presence of antibiotic-resistant bacteria was significantly higher in the non-survivors. Treatment involved broad-spectrum antibiotics, emergency surgical debridement, and subsequent adjustments based on culture results.
Conclusions: Early diagnosis and prompt initiation of treatment are essential for improving the outcomes of patients with FG. Hemodialysis dependency, septic shock, FGSI scores, and the presence of antibiotic-resistant bacteria are important factors associated with mortality in patients with FG. Further research will be needed to validate these findings and explore adjunctive therapies to enhance the patient outcomes and improve FG management.
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Treatment Modality of Prostatic Abscess according to Size: A Retrospective Study
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Gwon Kyeong Lee, Kyoung Ha Jang, Woo Seop Seong, Byeong Jin Kang, Kyung Hwan Kim, Hong Koo Ha
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Urogenit Tract Infect 2022;17(3):96-102. Published online December 31, 2022
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DOI: https://doi.org/10.14777/uti.2022.17.3.96
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Abstract
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- Purpose: This study aimed to determine the treatment modality for prostatic abscesses according to size.
Materials and Methods: Twenty-five patients diagnosed with prostatic abscesses were retrospectively reviewed. All patients were treated with intravenous empirical and appropriate antibiotics according to culture results. They were grouped according to the size of the prostate abscess based on computed tomography results (group A, with prostate abscess ≤2 cm, n=10; group B, with prostate abscess size >2 cm, n=15), and their treatment modality and outcomes were compared.
Results: The prostatic abscess sizes were 1.31±0.37 and 3.49±1.06 cm for groups A and B, respectively. Prostate-specific antigen, prostatic volume, and comorbidity were not significantly different (p>0.05), whereas pelvic pain was significantly different (p=0.028). There was no difference in the microorganisms isolated from urine and blood culture, empirical antibiotics, and broad-spectrum antibiotics between the two groups (p>0.05). More patients in group B underwent transurethral abscess deroofing than those in group A (p=0.040). Patients in group B had a more extended hospitalization period and intravenous antibiotics duration than those in group A (p=0.024 and p=0.013, respectively). Group B had more cases of septic shock, intensive care unit admission, and mortality events than group A (p=0.024, p=0.001, and p=0.061, respectively). However, prostatic abscess recurrence and urological chronic complication did not significantly differ (p>0.05).
Conclusions: Appropriate use of antibiotics is crucial. This study shows that the treatment of patients with prostatic abscess >2 cm is more difficult, but transurethral abscess deroofing can lower mortality, prostatic abscess recurrence, and urological chronic complications.
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Analysis of Uropathogens of Febrile Urinary Tract Infection in Infant and Relationship with Vesicoureteral Reflux
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Kyung Hwan Kim, Seung Hee Seo, Sang Don Lee, Jae Min Chung
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Urogenit Tract Infect 2018;13(3):58-65. Published online December 31, 2018
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DOI: https://doi.org/10.14777/uti.2018.13.3.58
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Abstract
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- Purpose: This study aimed to investigate the relationship between uropathogens of infants with febrile urinary tract infection (UTI) and vesicoureteral reflux (VUR).
Materials and Methods: We analyzed 308 infants hospitalized for febrile UTI between January 2010 and December 2015, and assessed the voiding cystourethrography (VCUG). The medical records, including clinical symptoms, laboratory findings, urinalysis, urine culture tests, ultrasound (US), dimercaptosuccinic acid scan, and VCUG, were retrospectively obtained. The incidences of VUR and high-grade VURs (III, IV, and V) were analyzed in 4 groups categorized by uropathogens and renal US findings.
Results: The mean age of 308 infants was 3.29±2.18 months. The male-to-female ratio was 3.46:1. In urine culture tests, 267 infants (86.69%) showed single bacterial uropathogen; Escherichia coli in 241 infants (78.25%) and non-E. coli uropathogens in 26 infants (8.44%). Multiple distinctive microorganisms were identified as causative uropathogens in 41 infants (13.31%). Abnormal findings of US and VCUG were identified in 216 and 64 patients, respectively. In 308 infants, the incidences of VUR and high-grade VUR were not different among the 4 groups. In 239 male infants, the incidences of high-grade VUR were higher in patients with non-E. coli single or multiple uropathogen and with abnormal US findings (p=0.042).
Conclusions: In male infants with non-E. coli uropathogen or multiple uropathogens and with abnormal US findings at febrile UTI, there was an increased chance of finding high-grade VURs on subsequent VCUG tests.
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