Fournier gangrene in a tertiary surgical center: patterns of microbiology, antibiotic resistance, and risk stratification.

BACKGROUND

Fournier gangrene is a rapidly progressive and life-threatening soft-tissue infection originating in the perineal and genital regions, spreading quickly along fascial planes. Early identification of causative pathogens and their antimicrobial susceptibility is essential to guide empirical therapy and improve outcomes.

METHODS

This retrospective study was conducted at a tertiary academic medical center. Among 59 surgically treated patients, 30 with complete clinical and microbiological data and available wound cultures were included. Demographic characteristics, microbiological profiles, and antimicrobial susceptibility patterns were analyzed.

RESULTS

The mean age was 59.2 years (range 45-84), and 56.7% were male. Nearly half of the patients were aged 50-59 years (46.7%). Wound cultures revealed monomicrobial growth in 50.0%, polymicrobial in 26.7%, and no growth in 23.3%. Escherichia coli was the leading pathogen (56.3%), followed by Klebsiella pneumoniae (9.4%), while anaerobes were rarely isolated. Resistance rates were 41.4% among Gram-positives and 38.3% among Gram-negatives. Amikacin (100%) and carbapenems (>80%) showed the highest susceptibility, whereas fluoroquinolones and aminopenicillins exhibited resistance exceeding 40%.

CONCLUSION

E. coli was the predominant organism in Fournier gangrene, accompanied by substantial resistance to commonly used antibiotics. Aminoglycosides and carbapenems remain the most reliable empirical choices. Although most patients presented with low FGSI scores, the presence of resistant isolates highlights the need for region-specific antibiotic stewardship and ongoing surveillance.