Fournier's Gangrene: Clinical Characteristics in the Elderly

Background: Fournier's gangrene is a rapidly progressing, life-threatening necrotizing soft tissue infection that affects the genitalia and perineum. The aim of this study was to analyze the clinical characteristics of elderly patients with Fournier's gangrene and compare them to those of younger patients with Fournier's gangrene. Methods: We conducted a retrospective study of patients diagnosed as having Fournier's gangrene from 1997 to 2012. Clinical data were compared between elderly (i.e., 65 years or older) and younger adult patients (i.e., younger than 65 years), and between patients who died and patients who survived. Results: Seventy-three cases of Fournier's gangrene were collected (with most from 69 males). There were 24 elderly patients and 50 younger adult patients. A larger percentage of elderly patients presented with shock (p = 0.015) and elderly patients had longer intensive care unit (ICU) stays (p = 0.014). The mortality rate was also higher in elderly patients, but the difference was not statistically significant (p = 0.176). Twelve patients of the 74 patients died. Patients who died had a higher Fournier's Gangrene Severity Score (p < 0.001) and longer ICU stay (p = 0.030), compared to patients who survived. Patients who died did not have more comorbidities, but a larger percentage of them presented with shock (p < 0.001). Conclusion: This study showed that the clinical characteristics of elderly Fournier's gangrene patients were not different from those of younger patients, and that elderly patients did not have more severe disease at presentation. However, a significant percentage of elderly patients presented with shock, and most patients who eventually died also had shock at presentation. We therefore suggest intensive monitoring of vital signs and adequate cardiovascular support, especially in the elderly. Copyright (C) 2014, Taiwan Society of Geriatric Emergency & Critical Care Medicine. Published by Elsevier Taiwan LLC. All rights reserved.