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antibiotic resistance

Founier’s Gangrene: A Rare Life Threatening Story

Teaser: 

1William J. Watson, MSc, MD, CCFP, FCFP, 2D'Arcy Little MD CCFP FCFP FRCPC,

1Staff Physician (Retired), Honorary Consultant, Family Medicine, St. Michael’s Hospital, Associate Professor Emeritus, Department of Family and Community Medicine and the Dalla Lana School of Public Health, University of Toronto. 2Medical Director, Journal of Current Clinical Care and www.healthplexus.net Radiologist, Orillia Soldiers’ Memorial Hospital, Assistant Professor, Department of Medical Imaging cross-appointed to Department of Family and Community Medicine, University of Toronto, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Abstract:
A 45-year-old diabetic male developed Fournier’s gangrene requiring emergency surgery. His infectious disease specialist noted his rapid recovery was partly attributable to preserved antibiotic susceptibility from years of judicious prescribing by his family physician who avoided unnecessary antibiotics. This case highlights antibiotic stewardship’s critical role in maintaining treatment effectiveness for life-threatening infections.

Key Words: Fournier’s gangrene, antibiotic stewardship, necrotizing fasciitis, antibiotic resistance.
Fournier’s gangrene is a rapidly progressive necrotizing infection of the genitals and perineum with 40-50% mortality requiring emergency surgical debridement and broad-spectrum antibiotics.
The patient’s preserved antibiotic susceptibility, resulting from years of avoided unnecessary antibiotic use, contributed to his rapid recovery from this life-threatening infection.
CT imaging is the preferred diagnostic modality, detecting subcutaneous emphysema in soft tissues, though clinical diagnosis should never delay urgent surgical intervention.
Risk factors include diabetes mellitus, immunocompromise, alcohol misuse, and SGLT-2 inhibitor use, with early recognition being crucial to reducing mortality.
Time is tissue: Fournier’s gangrene progresses at 2-3 cm per hour—immediate surgical debridement is lifesaving and should never be delayed for imaging when clinical diagnosis is evident.
Antibiotic stewardship saves lives: Preserving antibiotic effectiveness through judicious prescribing for minor viral infections maintains therapeutic options for critical infections requiring immediate broad-spectrum coverage.
High index of suspicion: Scrotal or perineal pain with systemic toxicity (fever, tachycardia, hypotension) in diabetic or immunocompromised patients warrants urgent evaluation—systemic signs may be disproportionate to local findings.
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Related Terms: Radiology, Fournier’s gangrene, antibiotic stewardship, necrotizing fasciitis, antibiotic resistance
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Prescribing Antibiotics to Patients with Acne

Prescribing Antibiotics to Patients with Acne

Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.

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Teaser: 

Shannon Humphrey, MD, FRCPC, FAAD, Clinical Assistant Professor, Director of Continuing Medical Education, Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.

Abstract
The pathogenesis of acne is tied to Propionibacterium acnes (P. acnes), an anaerobic bacteria. There has been a dramatic rise in resistance to antibiotics that are usually prescribed to treat acne. Given resistance to antibiotic therapy can occur in more pathogenic bacteria than P. acnes, and the fact that a rise in pathogenic P. acnes has been reported, the development of antibiotic resistance in acne is a public health matter globally. Clinical practice guidelines are aiming to curb the further development of antibiotic resistance without detracting from effective management of both inflammatory and non-inflammatory acne.
Key Words: acne vulgaris, antibiotic resistance, benzoyl peroxide, anti-inflammatory, sub-antimicrobial dosing.

Related Terms: Dermatology, Acne Vulgaris, antibiotic resistance, acne vulgaris, benzoyl peroxide, anti-inflammatory, sub-antimicrobial dosing