Pressure sores significantly increase the risk of developing a Fournier's gangrene in patients with spinal cord injury

• Published in: Spinal cord 2011-11, Vol.49 (11), p.1143-1146
• Main Authors: Backhaus, M, Citak, M, Tilkorn, D-J, Meindl, R, Schildhauer, T A, Fehmer, T
• Format: Article
• Language: English
• Subjects: 631/378/1687/1825; 692/499; 692/699/2768; 692/700/139; Adult; Aged; Anatomy; Bacterial Infections - epidemiology; Bacterial Infections - mortality; Bacterial Infections - surgery; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Cerebrospinal fluid. Meninges. Spinal cord; Comorbidity; Critical Care - statistics & numerical data; Debridement; Fournier Gangrene - epidemiology; Fournier Gangrene - mortality; Fournier Gangrene - surgery; Human Physiology; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurochemistry; Neurology; Neuropsychology; Neurosciences; original-article; Paraplegia - epidemiology; Paraplegia - mortality; Pressure Ulcer - epidemiology; Pressure Ulcer - mortality; Quadriplegia - epidemiology; Quadriplegia - mortality; Retrospective Studies; Risk Factors; Spinal Cord Injuries - epidemiology; Spinal Cord Injuries - mortality; Traumas. Diseases due to physical agents; Young Adult
• ISSN: 1362-4393; 1476-5624
• DOI: 10.1038/sc.2011.75

Study design: Retrospective chart review. Objectives: The aim of our study was to evaluate the mortality rate and further specific risk factors for Fournier's gangrene in patients with spinal cord injury (SCI). Setting: Division of Spinal Cord Injury, BG-University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, Germany. Methods: All patients with a SCI and a Fournier's gangrene treated in our hospital were enrolled in this study. Following parameters were taken form patients medical records: age, type of SCI, cause of Fournier's gangrene, number of surgical debridements, length of hospital and intensive care unit stay, co morbidity factors and mortality rate. In addition, laboratory parameter including the laboratory risk indicator for necrotizing fasciitis (LRINEC) score and microbiological findings were analyzed. Clinical diagnosis was made via histological examination. Results: A total of 16 male patients (15 paraplegic and one tetraplegic) were included in the study. In 81% of all cases, the origin of Fournier's gangrene was a pressure sore. The median LRINEC score on admission was 6.5. In the vast majority of cases, a polybacterial infection was found. No patient died during the hospital stay. The mean number of surgical debridements before soft tissue closure was 1.9 and after a mean time interval of 39.1 days wound closure was performed in all patients. Conclusions: Pressure sores significantly increase the risk of developing Fournier's gangrene in patients with SCI. We reported the results of our patients to increase awareness among physicians and training staff working with patients with a SCI in order to expedite the diagnosis.