Significance of Hyperbaric Oxygenation in the Treatment of Fournier's Gangrene: A Comparative Study

Urol Int. 2018;101(4):467-471. doi: 10.1159/000493898. Epub 2018 Oct 16.

Abstract

Introduction: Hyperbaric oxygenation (HBO), in addition to anti-infective and surgical therapy, seems to be a key treatment point for Fournier's gangrene. The aim of this study was to investigate the influence of HBO therapy on the outcome and prognosis of Fournier's gangrene.

Patients and methods: In the present multicenter, retrospective observational study, we evaluated the data of approximately 62 patients diagnosed with Fournier's gangrene between 2007 and 2017. For comparison, 2 groups were distinguished: patients without HBO therapy (group A, n = 45) and patients with HBO therapy (group B, n = 17). The analysis included sex, age, comorbidities, clinical symptoms, laboratory and microbiological data, debridement frequency, wound dressing, antibiotic use, outcome and prognosis. The statistical analysis was performed with GraphPad Prism 7® (GraphPad Software, Inc., La Jolla, USA).

Results: Demographic data showed no significant differences. The laboratory parameters C-reactive protein and urea were significantly higher in group B (group B: 301.7 vs. 140.6 mg/dL; group A: 124.8 vs. 54.7 mg/dL). Sepsis criteria were fulfilled in 77.8 and 100% of the patients in groups A and B respectively. Treatment in the intensive care unit (ICU) was therefore indicated in 69% of the patients in group A and 100% of the patients in group B. The mean ICU stay was 9 and 32 days for patients in groups A and B respectively. The wound debridement frequency and hospitalization stay were significantly greater in group B (13 vs. 5 debridement and 40 vs. 22 days). Initial antibiosis was test validated in 80% of the patients in group A and 76.5% of the patients in group B. Mortality was 0% in group B and 4.4% in the group A.

Conclusion: The positive influence of HBO on the treatment of Fournier's gangrene can be estimated only from the available data. Despite poorer baseline findings with comparable risk factors, mortality was 0% in the HBO group. The analysis of a larger patient cohort is desirable to increase the significance of the results.

Keywords: Fournier’s gangrene; Hyperbaric oxygenation; Necrotizing fasciitis; Necrotomy; Soft tissue infection.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • C-Reactive Protein / metabolism
  • Debridement*
  • Female
  • Fournier Gangrene / diagnosis
  • Fournier Gangrene / therapy*
  • Humans
  • Hyperbaric Oxygenation*
  • Intensive Care Units
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Urea / metabolism

Substances

  • Anti-Bacterial Agents
  • Urea
  • C-Reactive Protein