Neue Aspekte zur Fournierschen Gangrän – Ein Rapid Review

Zusammenfassung

Die Fourniersche Gangrän (FG) ist eine sporadische, lebensbedrohliche, nekrotisierende Infektion des Perineums, der Perinealregion und des äußeren Genitales. Aus der Literatur gibt es einige Hinweise darauf, dass die Prognose der Erkrankung in den letzten Jahren nicht wesentlich verbessert werden konnte. Daher wurde eine schnelle Evidenzanalyse mittels Literaturrecherche in MEDLINE aus den aktuellen Publikationen des Jahres 2020 durchgeführt, um mittels neuer Aspekte zu ermöglichen, die Versorgungssituation der betroffenen Patienten zu verbessern und weitere Forschungsvorhaben ideal zu planen. Insgesamt konnten für dieses Review 18 Publikationen berücksichtigt werden. Bei 15 dieser Arbeiten handelt es sich um Orginalarbeiten sowie 3 systematische Reviews. Bez. der Orginalarbeiten handelt es sich um 12 retrospektive Fallserien, 2 epidemiologische und eine prospektive Studie. 2 der systematischen Reviews inkludieren ebenfalls eine Metaanalyse. Die Mehrzahl der Autoren dieser Publikationen kommt unter anderem zu der Schlussfolgerung, dass die FG weiterhin eine ernsthafte Erkrankung mit teils inakzeptablen Mortalitätsraten für die moderne Medizin ist und es in der Therapie weiterhin Optimierungsbedarf gibt. Weiterhin wurden neue Risikofaktoren identifiziert, die mit einer erhöhten Mortalität bei FG Patienten assoziiert sind. Es handelt sich um eine Dyslipoproteinämie, Diabetes mellitus, Herzerkrankungen und akutes sowie chronisches Nierenversagen. 4 der inkludierten Arbeiten untersuchten den Zusammenhang des Auftretens von FG und der Einnahme oraler Antidiabetika, SGLT2- sowie DPP4-Hemmern. Keine Studie konnte dabei einen signifikanten Zusammenhang nachweisen, insbesondere eine Metaanalyse mit 84 Studien nicht. Vielversprechende Konzepte für die Wundbehandlung sind die hyperbare Oxygenierung (HBO), der vakuum-assistierte Wundverschluss und Wundkonditionierung mittels Larven. Zusammenfassend ist die FG ein seltenes, aber immer noch potenziell vital bedrohliches Krankheitsbild. Die Prognose konnte in den letzten Jahren nicht verbessert werden. Daher ist eine weitere Therapieoptimierung dringend erforderlich. Dies kann nur durch weitere Studien erreicht werden. Aufgrund der Seltenheit der Erkrankung sehen wir die Möglichkeit dies mit einer nationalen Registerstudie zu erreichen. Zusätzlich können aus dem Register Risikostratefizierungen erarbeitet werden, welche Patienten z. B. von einer Therapie in einem Zentrum oder bestimmten Wundkonditionierungen profitieren.

Abstract

Fournierʼs gangrene (FG) is a sporadic, life-threatening, necrotising infection affecting the perineum, perineal region and genitals. Published literature provides hints that the outcome of this disease has failed to improve in recent years. We have therefore performed a rapid evidence synthesis by searching the database MEDLINE. The literature from 2020 was studied to identify new aspects to improve the care of FG patients and plan further therapeutic research. 18 publications were chosen for this review, 15 of these were original research and three systematic reviews. 12 were retrospective case series, 2 epidemiological studies, with one prospective clinical study, one systematic review and 2 systematic reviews, together with a meta-analysis. Most of the authors of the studies concluded that FG is still a severe disease with unacceptable mortality rates, so that there is urgent need for therapy improvement. New risk factors for higher mortality in FG have been identified in these studies, namely dyslipoproteinemia, diabetes mellitus, heart disease, as well as both acute and chronic kidney failure. Furthermore, 4 of the included studies investigated the association of SGLT2- and DDP4-inhibitors, which are drugs used in diabetes mellitus, and the incidence of FG. No studies reported a significant association between these drugs and FG, especially not a meta-analysis with 84 included studies. New promising concepts for wound conditioning are hyperbaric oxygenation (HBO), vacuum-assisted wound closure (VAC) and Maggot therapy (blowfly larvae). In summary, FG is still a severe disease, the prognosis has not improved in recent years and so there is an urgent need for improved therapy. This could only be achieved with further research in FG. In our opinion and due to the rarity of FG, this would be possible with a national registry study. For example, it might be possible to calculate risk stratification from this registry to identify patients who would benefit from treatment in a centre or with special wound conditioning.

Schlüsselwörter

Urologische Infektionen - Sepsis - Fourniersches Gangrän

Keywords

urinary tract infections - sepsis - Fournier´s gangrene

Publication History

Article published online:
21 April 2021

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