背景:Fournier坏疽(FG)是一种累及会阴的坏死性筋膜炎,肛周,和生殖器结构,死亡率极高。为了帮助早期发现高危患者,我们旨在系统回顾与FG死亡率相关的因素.患者和方法:在PubMed中进行搜索,Embase和Scopus。在我们的审查中,至少需要五名患者,这是为了排除样本量极小的研究,如病例报告和小病例系列,与大规模研究相比,相关性最小。患者特征,致病微生物,感染的解剖区域,合并症的存在,严重性评分,FG的原因,提取并发症并进行比较,以确定与死亡率相关的因素.结果:共纳入57项研究。在3,646名研究参与者中,FG的死亡率为20.41%。非幸存者的平均年龄为61.27岁。男性死亡人数更多,然而,女性死亡率较高。糖尿病是死者中最常见的合并症,但死亡率最高的是HIV患者(54.17%)。不同抗生素药物的死亡率差异不大。关于致病生物,真菌感染的死亡率最高(68.18%),导致死亡的最常见微生物是大肠杆菌.结论:女性性别,合并症,解剖分布,脓毒症的发展,和真菌感染都增加了死亡风险。早期识别危险因素,和提供适当的治疗对于降低FG高危患者的死亡率至关重要。
Background: Fournier gangrene (FG) is a form of necrotizing fasciitis involving the perineal, peri-anal, and genital structures, and has exceptionally high mortality rates. To help in early detection of high-risk patients, we aimed to systematically
review factors associated with mortality from FG. Patients and Methods: Searches were conducted in PubMed, Embase and Scopus. In our
review, a minimum of five patients were required and this was to exclude studies with exceedingly small sample sizes, such as case reports and small case series, with minimal relevance in comparison to larger scale studies. Patient characteristics, causative
microbes, anatomic areas of infection, presence of comorbidities, severity scores, causes of FG, and complications were extracted and compared to identify factors related to mortality. Results: A total of 57 studies were included in the
review. Across 3,646 study participants, the mortality rate of FG was 20.41%. The mean age of non-survivors was 61.27 years. There were more total male deaths, however, the mortality rate was higher in females. Diabetes mellitus was the most common comorbidity in those who died, but the highest mortality rate was seen in HIV patients (54.17%). Mortality rates did not differ widely among antibiotic agents. Regarding causative organisms, fungal infections had the highest rates of mortality (68.18%) and the most common microbe leading to death was Escherichia coli. Conclusions: Female gender, comorbidities, anatomic distribution, development of sepsis, and fungal infection all increased risk for mortality. Early identification of risk factors, and provision of appropriate treatment are crucial in reducing mortality rates of high-risk patients with FG.