Introduction: Fournier’s gangrene is a necrotizing infection of the external genitalia, perineal or perianal regions and is mainly seen in males. Its main risk factors include diabetes, chronic alcoholism, HIV and other immune-compromised states. Fournier’s gangrene has an aggressive course associated with a mortality rate of 20%−30%, making early diagnosis and management very important. The Fournier Gangrene Severity Index (FGSI) has been traditionally used to predict the severity and prognosis. More recently, simplified FGSI (sFGSI) has been proposed and is helpful. However, timely diagnosis, supportive medical management and complete surgical debridement are still the cornerstones of treatment. These must be complemented with early and timely re-look debridements and appropriate reconstruction to cover soft tissue defects. This literature review aims to look at recent relevant research regards risk factors and prognostic features of Fournier’s gangrene. Methods: A search was conducted on Google Scholar and PubMed databases for all articles related to Fournier’s Gangrene. These included clinical reviews, case reports, case series and retrospective studies. Reports or studies which were not published in English were not reviewed. Various reconstructive techniques to cover the defects have also been revisited. Results: Broad-spectrum antibiotics and urgent surgical debridement are the core management principles of Fournier’s gangrene. Repeat debridement after 24 h is also recommended. Adjunctive therapies such as hyperbaric oxygen and vacuum-assisted closure are supported in most aspects of recent literature. Expectedly, there is a lack of randomised controlled studies in such emergency surgical conditions, which limits the widespread use of newer therapies to patients unresponsive to conventional management. Conclusion: Fournier’s gangrene is a urological emergency with a high mortality rate. The aggressive nature of the infection necessitates early recognition and immediate surgical intervention. Negative pressure dressing and occasional hyperbaric oxygen as adjuncts should be used more routinely, especially if there is a delayed response to conventional treatment or in severe infections.

A contemporaneous narrative review of Fournier’s gangrene

Many widely used conventional antibiotics have failed to show clinical efficacy against Pseudomonas aeruginosa (P. aeruginosa) due to the strain's rising resistance to most clinically relevant antimicrobials. P. aeruginosa uses quorum sensing to regulate its virulence and biofilm development, which contributes to its pathogenicity and drug resistance. This mechanism is responsible for the resurgence and persistence of infections. Therefore, targeting the virulence and pathogenicity of P. aeruginosa through quorum sensing (QS) is regarded as a potential target for anti-infective therapy. However, a number of natural and synthetic compounds have been demonstrated to interfere with quorum sensing, resulting in potential antibacterial agents. In this review, we discuss the mechanisms of P. aeruginosa QS and recent advances in the development of quorum sensing inhibitors (both synthetic and natural) that have the potential to become effective antibiotics.

Multidrug-Resistant Bacteria Quorum-Sensing Inhibitors: a particular focus on Pseudomonas aeruginosa.

The prevention or control of bacterial infections requires continuous search for novel approaches among which bacterial quorum sensing inhibition is considered as a complementary antibacterial strategy. Quorum sensing, used by many different bacteria, functions through a cell-to-cell communication mechanism relying on chemical signals, referred to as autoinducers, such as N-acyl homoserine lactones (AHLs) which are the most common chemical signals in this system. Designing analogs of these autoinducers is one of the possible ways to interfere with quorum sensing. Since bioisosteres are powerful tools in medicinal chemistry, targeting analogs of AHLs or other signal molecules and mimics of known QS modulators built on amide bond bioisosteres is a relevant strategy in molecular design and synthetic routes. This review highlights the application of amide bond bioisosteric replacement in the design and synthesis of novel quorum sensing inhibitors. 

Amide bioisosteric replacement in the design and synthesis of quorum sensing modulators

Fournier's gangrene (FG) is a rare form of necrotizing soft tissue infection characterized by an acute, aggressive, and rapidly progressive course. In this case report, we describe advanced therapy combining critical care, surgery, pharmacotherapy, extended biochemical/cellular blood diagnostics, and post-discharge hyperbaric oxygen therapy rehabilitation. Such an intervention resulted in survival and improved health status and quality of life of the patient with FG and septic shock.

/pdf/advances-in-management-of-fourniers-gangrene-by-coupling-21zh2toe.pdf

Advances in Management of Fournier’s Gangrene by Coupling Intensive Hospital Treatment With Innovative Post-discharge Hyperbaric Oxygen Therapy Rehabilitation: A Case Report

Fournier’s gangrene ( FG ) is a necrotizing inflammation of the penis, scrotum and perineum subcutaneous tissues, that frequently spreads to the anterior abdominal wall and the upper surfaces of the thighs. Despite being an extremely rare disease, it has a very high mortality rate. It is one of the most difficult emergency conditions in urology. Infec¬tion is the most common cause of Fournier gangrene development. Men who have diabetes, use immunosuppressive therapy or abuse alcohol and steroids are especially vulnerable. Early detection and treatment are critical because the developing infection causes severe necrosis, septic shock and leads to death. Therefore, it is important to correctly diagnose the disease while still in the emergency department or emergency room. A review of the literature on diag¬nosis, therapy, and prognosis, as well as the role of Hospital Emergency Departments in the therapeutic process, was conducted in this review paper.

/pdf/fourniers-gangrene-a-life-threatening-urological-emergency-23w3kb0j.pdf

Fournier’s gangrene – a life threatening urological emergency

Identification of 3-nitrophenol ester derivatives as novel quorum-sensing inhibitors of Pseudomonas aeruginosa

Abstract Background Fournier’s gangrene (FG) is a rare life-threatening form of necrotizing fasciitis. The risk factors for septic shock in patients with FG are unclear. This study aimed to identify potential risk factors and develop a prediction model for septic shock in patients with FG. Methods This retrospective cohort study included patients who were treated for FG between May 2013 and May 2020 at the Sixth Affiliated Hospital, Sun Yat-sen University (Guangzhou, China). The patients were divided into a septic shock group and a non-septic shock group. An L1-penalized logistic regression model was used to detect the main effect of important factors and a penalized Quadratic Discriminant Analysis method was used to identify possible interaction effects between different factors. The selected main factors and interactions were used to obtain a logistic regression model based on the Bayesian information criterion. Results A total of 113 patients with FG were enrolled and allocated to the septic shock group (n = 24) or non-septic shock group (n = 89). The best model selected identified by backward logistic regression based on Bayesian information criterion selected temperature, platelets, total bilirubin (TBIL) level, and pneumatosis on pelvic computed tomography/magnetic resonance images as the main linear effect and Na+ × TBIL as the interaction effect. The area under the ROC curve of the probability of FG with septic shock by our model was 0.84 (95% confidence interval, 0.78–0.95). The Harrell's concordance index for the nomogram was 0.864 (95% confidence interval, 0.78–0.95). Conclusion We have developed a prediction model for evaluation of the risk of septic shock in patients with FG that could assist clinicians in identifying critically ill patients with FG and prevent them from reaching a crisis state.

/pdf/how-likely-is-septic-shock-to-develop-in-a-patient-with-qnqzwsej.pdf

How likely is septic shock to develop in a patient with Fournier's gangrene? A risk prediction model based on a 7-year retrospective study

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Identification of 3-nitrophenol ester derivatives as novel quorum-sensing inhibitors of Pseudomonas aeruginosa

How likely is septic shock to develop in a patient with Fournier's gangrene? A risk prediction model based on a 7-year retrospective study