High mortality and clinical characteristics of Fournier’s gangrene: a 10-year retrospective study from an Indonesian tertiary hospital

INTRODUCTION: Fournier's gangrene (FG) is a rare but life-threatening necrotizing soft tissue infection with persistently high mortality. Data describing long-term clinical profiles and outcomes of FG in Indonesia remain limited. MATERIALS AND METHODS: A retrospective cohort study was conducted including all patients diagnosed with Fournier's gangrene at RSUD Dr. Saiful Anwar Malang between 2014 and 2024. Demographic characteristics, comorbidities, microbiological findings, Fournier's Gangrene Severity Index (FGSI), and outcomes were analyzed descriptively. Associations between age and comorbidity burden were evaluated using one-way ANOVA and chi-square tests. RESULTS: A total of 119 patients were included, with a mean age of 54.39 ± 12.11 years. Most patients were aged 56-65 years (37.81%). Renal impairment was the most frequently documented comorbidity (26.1%), while 33.6% of patients had no recorded comorbid conditions. Increasing age was significantly associated with greater comorbidity burden (p < 0.001). FGSI analysis was available in 44 patients and demonstrated very high mortality among patients with FGSI > 9 (95%). Mortality among patients with FGSI ≤ 9 also remained high (77.3%), suggesting limited prognostic discrimination in this cohort. Microbiological cultures were available in 33 patients, with Escherichia coli as the most common isolate (53.3%). Antibiotic sensitivity testing showed low sensitivity to meropenem (27.27%) and ciprofloxacin (21.21%). CONCLUSIONS: Fournier's gangrene in this tertiary center predominantly affected older patients and was associated with high mortality. Limited prognostic discrimination of FGSI and notable antimicrobial resistance patterns highlight the importance of early recognition and locally tailored management strategies.