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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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