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Microorganisms and Antibiogram Patterns in Fournier's Gangrene: Contemporary Experience from a Single Tertiary Care Center.
J Urol. 2020 Jun 30 [Online ahead of print]JU

Abstract

PURPOSE

To evaluate the prevalent microorganisms, antibiotic sensitivity patterns, and associated outcomes in patients with Fournier's Gangrene (FG).

MATERIALS AND METHODS

A retrospective chart review of patients with FG was conducted between October 2011 and April 2018 at our institution. Univariate analysis was performed using independent t-test or Kruskal-Wallis H test for continuous variables and exact test for categorical variables.

RESULTS

Of the 143 patients included in this study, wound culture was available in 131 (92%) patients with a median number of 3 microorganisms per wound. The most commonly grown pathogens were Staphylococcus species (n= 66; 46%), Streptococcus species (n=53; 37%), Bacteroides species (n=34; 24%), Candida species (n=31, 22%), Escherichia coli (n=28; 20%), and Prevotella species (n=26, 18%). Most bacteria were sensitive to ampicillin-sulbactam, ceftriaxone, piperacillin-tazobactam, amikacin, and cefepime; and resistant to ampicillin, trimethoprim-sulfamethoxazole, levofloxacin, and clindamycin. Enterococcus faecalis and Streptococcus anginosus were resistant to vancomycin. The overall FG mortality rate was 14 (10%) patients. No association was noted between the type of infection and Fournier's gangrene severity index, length of hospital stay, or mortality.

CONCLUSIONS

At our institution, Candida is a prevalent pathogen in the wound culture of patients with FG. The resistance patterns for clindamycin and vancomycin are concerning. Addition of an antifungal agent to the empiric treatment should be considered based on clinical presentation.

Authors+Show Affiliations

The Ohio State University Wexner Medical Center, Department of Urology, Columbus, Ohio.The Ohio State University Wexner Medical Center, Department of Urology, Columbus, Ohio.The Ohio State University Wexner Medical Center, Department of Urology, Columbus, Ohio.The Ohio State University Wexner Medical Center, Department of Urology, Columbus, Ohio.The Ohio State University Wexner Medical Center, Department of Urology, Columbus, Ohio.The Ohio State University Wexner Medical Center, Department of Urology, Columbus, Ohio.The Ohio State University Wexner Medical Center, Department of Urology, Columbus, Ohio.The Ohio State University Wexner Medical Center, Department of Urology, Columbus, Ohio.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32602771

Citation

Castillejo Becerra, Clara M., et al. "Microorganisms and Antibiogram Patterns in Fournier's Gangrene: Contemporary Experience From a Single Tertiary Care Center." The Journal of Urology, 2020, pp. 101097JU0000000000001194.
Castillejo Becerra CM, Jaeger CD, Rose JR, et al. Microorganisms and Antibiogram Patterns in Fournier's Gangrene: Contemporary Experience from a Single Tertiary Care Center. J Urol. 2020.
Castillejo Becerra, C. M., Jaeger, C. D., Rose, J. R., Beecroft, N. J., Shah, N. C., Posid, T., Jenkins, L. C., & Baradaran, N. (2020). Microorganisms and Antibiogram Patterns in Fournier's Gangrene: Contemporary Experience from a Single Tertiary Care Center. The Journal of Urology, 101097JU0000000000001194. https://doi.org/10.1097/JU.0000000000001194
Castillejo Becerra CM, et al. Microorganisms and Antibiogram Patterns in Fournier's Gangrene: Contemporary Experience From a Single Tertiary Care Center. J Urol. 2020 Jun 30;101097JU0000000000001194. PubMed PMID: 32602771.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Microorganisms and Antibiogram Patterns in Fournier's Gangrene: Contemporary Experience from a Single Tertiary Care Center. AU - Castillejo Becerra,Clara M, AU - Jaeger,Christopher D, AU - Rose,Justin R, AU - Beecroft,Nicholas J, AU - Shah,Nayan C, AU - Posid,Tasha, AU - Jenkins,Lawrence C, AU - Baradaran,Nima, Y1 - 2020/06/30/ PY - 2020/7/1/entrez KW - Fournier gangrene KW - antibiotic resistance KW - candida KW - microbial KW - necrotizing fasciitis SP - 101097JU0000000000001194 EP - 101097JU0000000000001194 JF - The Journal of urology JO - J. Urol. N2 - PURPOSE: To evaluate the prevalent microorganisms, antibiotic sensitivity patterns, and associated outcomes in patients with Fournier's Gangrene (FG). MATERIALS AND METHODS: A retrospective chart review of patients with FG was conducted between October 2011 and April 2018 at our institution. Univariate analysis was performed using independent t-test or Kruskal-Wallis H test for continuous variables and exact test for categorical variables. RESULTS: Of the 143 patients included in this study, wound culture was available in 131 (92%) patients with a median number of 3 microorganisms per wound. The most commonly grown pathogens were Staphylococcus species (n= 66; 46%), Streptococcus species (n=53; 37%), Bacteroides species (n=34; 24%), Candida species (n=31, 22%), Escherichia coli (n=28; 20%), and Prevotella species (n=26, 18%). Most bacteria were sensitive to ampicillin-sulbactam, ceftriaxone, piperacillin-tazobactam, amikacin, and cefepime; and resistant to ampicillin, trimethoprim-sulfamethoxazole, levofloxacin, and clindamycin. Enterococcus faecalis and Streptococcus anginosus were resistant to vancomycin. The overall FG mortality rate was 14 (10%) patients. No association was noted between the type of infection and Fournier's gangrene severity index, length of hospital stay, or mortality. CONCLUSIONS: At our institution, Candida is a prevalent pathogen in the wound culture of patients with FG. The resistance patterns for clindamycin and vancomycin are concerning. Addition of an antifungal agent to the empiric treatment should be considered based on clinical presentation. SN - 1527-3792 UR - https://www.unboundmedicine.com/medline/citation/32602771/Microorganisms_and_Antibiogram_Patterns_in_Fournier's_Gangrene:_Contemporary_Experience_from_a_Single_Tertiary_Care_Center L2 - https://www.jurology.com/doi/10.1097/JU.0000000000001194?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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