What is the incidence of Fournier's gangrene in patients with Solid Organ Transplants (SOTs)?

From the Guidelines

The incidence of Fournier's gangrene in patients with Solid Organ Transplants (SOTs) is not directly reported in the provided evidence, but we can infer that immunocompromised individuals, such as those with SOTs, are at a higher risk of developing various infections and complications, including potentially Fournier's gangrene, due to their compromised immune status 1.

Incidence of Infections in Immunocompromised Individuals

• The risk of herpes zoster (HZ) and related complications is increased in immunocompromised adults, with an incidence rate of HZ ranging from 9 to 95 cases per 1000 person-years (PY) in the US 1.
• Patients with hematopoietic stem cell transplantation (HSCT) have the highest incidence estimates, followed by those with hematologic malignancies, solid organ transplantation (SOT), and solid cancers 1.
• The incidence of HZ also increases with age within different immunocompromised populations, except for people living with HIV (PLWH) 1.

Considerations for Fournier's Gangrene in SOT Patients

• Fournier's gangrene is a rapidly progressing necrotizing fasciitis affecting the genital, perineal, and perianal regions, typically caused by polymicrobial infections in immunocompromised individuals or following trauma or surgical procedures in the genital/perineal region.
• While the provided evidence does not directly report the incidence of Fournier's gangrene in SOT patients, it is essential to consider the increased risk of infections and complications in immunocompromised individuals, such as those with SOTs, and take necessary precautions to prevent and manage potential infections 1.

From the Research

Incidence of Fournier's Gangrene in SOT Patients

• There is limited information available on the incidence of Fournier's gangrene specifically in patients with Solid Organ Transplants (SOTs) 2.
• However, it is known that immunocompromised patients, including those with SOTs, are at a higher risk of developing Fournier's gangrene due to their weakened immune system 3, 4.
• A case study reported a patient who developed Fournier's gangrene after liver transplantation, highlighting the need for extra caution in patients on immunosuppressants 2.

Risk Factors and Mortality Rates

• Fournier's gangrene has a high mortality rate, ranging from 20-40% 4, 5, 6.
• Risk factors for developing Fournier's gangrene include diabetes, HIV, alcoholism, and other immune-compromised states 3, 4, 6.
• Advanced age, renal failure, extension of infection to the abdominal wall, septic shock, and need for postoperative mechanical ventilation are also prognostic factors of mortality 5.

Treatment and Management

• Immediate broad-spectrum antibiotic therapy and urgent surgical debridement are the core managerial principles of Fournier's gangrene 4.
• Hyperbaric oxygen therapy may be used as an adjuvant to conventional therapy to optimize infected tissue oxygenation and reduce mortality rates 2, 6.