Risk Factors of Bacteremia and Mortality in Fournier's Gangrene

福尼爾氏壞疽菌血症及死亡的風險因子

謝宇軒(Yu-Hsuan Hsieh) ； 薛榮華(Jung-Hua Hsueh) ； 林政達(Cheng-Ta Lin) ； 劉文忠(Wen-Chung Liu) ； 楊國強(Kuo-Chung Yang) ； 何彥儀(Yen-Yi Ho) ； 陳逸軒(I-Hsuan Chen) ； 陳理維(Lee-Wei Chen)

《臺灣整形外科醫學會雜誌》 28卷2期 (2019/06) Pp. 96-106

摘要

Background: Fournier's gangrene is a disease with high mortality. Progressive tissue necrosis over perineum with toxic signs is observed in patients with Fournier's gangrene. Many studies discussed about the severity of Fournier gangrene and the microbiology of pathogens from wound culture. Mixed infection was usually found in wound culture. However, not all pathogens identified in wound culture were true pathogens. In contrast, blood culture was more reliable for antibiotic adjustment. In addition, the risk factors of bacteremia and mortality in Fournier's gangrene were not well established, and the outcome of bacteremia from different pathogens remains unclear. Aim and objectives: We tried to identified the risk factor of bacteremia and mortality in the patients of Fournier's gangrene. The pathogens found in blood culture were reviewed. The outcomes of different pathogens identified in blood cultures were compared. Materials and Methods: We identified the patients of Fournier's gangrene using keyword ＂Fournier's gangrene＂ in our electronic medical system from 2001 to 2015. Their age, sex, body mass index, underlying disease, disease origin, pathogen of bacteremia, and outcome were reviewed. The risk factors of bacteremia and mortality were analyzed by univariate and multivariate analysis using SPSS version 22.0 software (IBM Corp., Armonk, NY). Significant risk factors in univariate analysis were included into a multivariate analysis for final result. A P value ＜ 0.05 was considered as significant. Results: Bedridden state and cutaneous origin had significant higher risk of bacteremia. Hollow organ perforation related Fournier's gangrene and bacteremia especially gramnegative and anaerobic pathogens related had significant higher risk of mortality. Age, Sex, body mass index, and underlying disease were not significant factors of mortality and bacteremia. Conclusions: Critical care should always be applied to patients with Fournier's gangrene presenting with bedridden state, cutaneous origin, hollow organ perforation origin, and bacteremia especially gram-negative and anaerobic pathogens.

關鍵字

Fournier's gangrene ； bacteremia ； outcome

並列摘要

背景：福尼爾氏壞疽是一個高死亡率的疾病，在這類的病人可以觀察到會陰部組織持續壞死及毒性病容。許多研究討論傷口培養的細菌結果及如何去評估福尼爾氏壞疽的嚴重度。病人傷口的細菌培養通常是一個混合性的感染。然而並非所有傷口培養出來的細菌都是真正的病源菌。相對而言，血液細菌培養的結果對我們調整抗生素是較可靠的。此外，福爾氏壞疽併發菌血症及死亡的風險因子目前還沒有確立，而不同病原菌造成菌血症的預後差異目前也不清楚。目的及目標：我們嘗試去找到福尼爾氏壞疽病人併發菌血症及死亡的風險因子。血液培養裡培養出的病原菌將被回顧，並比較不同病原菌造成的菌血症的預後。材料及方法：我們從醫院的電子病歷用關鍵字「福尼爾氏壞疽」做搜尋，收集了2001年至2015年的病人。病人的年紀、性別、身體質量指數、固有疾病、疾病源頭、菌血症的病原菌，及預後被回顧。菌血症及死亡的風險因子用SPSS統計軟體做單變量及多變量分析，在單變量分析顯著的因子將會納入多變量分析作運算。P值小於0.05被認為是有顯著差異。結果：臥床的病人及皮膚來源的疾病有顯著較高菌血症的機率。中空器官穿孔造成的福尼爾氏壞疽和菌血症會顯著增加死亡率，尤其是革蘭氏陰性菌及厭氧菌造成的菌血症。年齡、性別、身體質量指數，和固有疾病並不會顯著增加菌血症及死亡率。結論：臥床、皮膚來源、中空器官穿孔來源，及菌血症的福尼爾氏病人更加需要重症照護，尤其是革蘭氏陰性菌及厭氧菌造成的菌血症。