Defining the Standard of Care in Fournier's Gangrene-An Umbrella Review.

BACKGROUND AND

OBJECTIVE

Fournier's gangrene (FG) is a life-threatening bacterial infection. Unfortunately, outcomes have not improved in recent years mainly due to the fact that robust research is challenging in this very rare disease. Consequently, we conducted an umbrella review regarding the standard of care for FG to provide best evidence for clinicians and identify research gaps to plan high-quality studies.

METHODS

The recommendations provided in the Cochrane Handbook of Systematic Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. The full review protocol was pre-registered and is available at PROSPERO (CRD 42023489596).

KEY FINDINGS AND LIMITATIONS: The primary literature search yielded 3366 references. Finally, we were able to include seven systematic reviews including two meta-analyses. Up to 40% of patients may initially lack cutaneous signs, risking a diagnostic delay and progression to high-mortality disease. Diabetes mellitus emerged as the most prevalent comorbidity across the reviews (32-66%) and was most frequent among nonsurvivors. The management of FG is consistently described as a multimodal emergency, centered on three core interventions: early surgical debridement, empiric broad-spectrum antibiotics, and intensive supportive care. Adjunct interventions need further evaluation. Despite advances in multimodal care, FG carries high mortality and morbidity. There is only moderate confidence mainly due to the risk of bias from the individual studies being included in the reviews.

CONCLUSIONS AND CLINICAL IMPLICATIONS: Across the seven reviews, FG remains a life-threatening condition with substantial mortality. Further comprehensive research is needed desperately; a prospective registry might be suitable for managing this rare disease.

PATIENT SUMMARY: We conducted an umbrella review, a review including only systematic reviews and meta-analyses, about the standard of care for Fournier's gangrene (FG), which is a life-threatening and rare bacterial infection, and the clinical outcomes have not improved in recent years. In summary, FG is consistently described as a multimodal emergency, centered on three core interventions: early surgical debridement, empiric broad-spectrum antibiotics, and intensive supportive care; however, despite advances in care, FG is still associated with high mortality and morbidity. Consequently, further robust research is needed.