Fournier gangrene is considered a disease with a high mortality rate [6]. Predisposing factors affecting the course of the disease are an important key factor in the progression of the disease, and identifying those elements can prevent the fulminant course of the disease and can lower the mortality rate of such disease.

All of the patients in the current study were men. An earlier study discovered a male/female ratio of 5.2/1 [9]. Males were found to be ten times more likely than females to contract the disease [10]. According to some studies, this significant difference is due to the drainage system of the female pelvic anatomy as women perineal region may better drain through vaginal secretions [10, 11]. The male predominance is consistent with previous findings reported in other studies [11, 12]. However, it was found that female patients with FG have greater BMI but similar clinical presentation, microbiologic characteristics and mortality rate compared to men [13].

The mean length of hospital stay (LHS) of studied patients in the present study was 54.56 ± 54.57 days. This LHS is longer than that observed in a previous study, where the average length of hospital stay was 13 days [14].

The average age of the patients studied was 59.23 11.19 years, with no relationship between age and LHS. This age range is consistent with previous research, which found an age range of 30–60 years [15]. Another study found that the majority of cases were between the ages of 50 and 60 [16]. Ghnnam [17] conducted a study in Egypt and found that the average age of patients at diagnosis was 51 years (21–72 years). Other studies [18, 19] reported an older age at presentation.

A study performed by Eksi et al., 2022, found a mean age of 55.1 ± 7.6 years and that age had no effect on LHS [9]. The same nonsignificant relationship between patient age and LHS was observed in other studies [20].

A multicenter study found that patients over 60 years of age were at risk for prolonged hospitalization, and the length of hospital stay was found to be proportional to an increase in the number of comorbidities [21]. In a study of 80 patients, Eksi et al. [9] discovered that age and gender had no effect on the length of hospital stay, which is consistent with the current findings.

The most common comorbidity among the patients studied was diabetes (88%), and the most common risk factor was uncontrolled diabetes (76%). Diabetes has been identified as a risk factor in 32–66% of FG cases but has been shown to have no effect on outcomes or mortality [22, 23].

Diabetes mellitus was the most commonly reported comorbid disease associated with this pathology, consistent with other studies [24,25,26]. Diabetes mellitus is estimated to affect 50 to 70% of Fournier’s gangrene patients by some authors [24, 26]. Diabetes mellitus has been identified as a risk factor for Fournier’s gangrene, with a more progressive and fatal outcome due to decreased phagocytic and intracellular bactericidal activity, as well as neutrophil dysfunction [25].

In the current study, a nonsignificant relationship was discovered between comorbidities as risk factors and LHS. A previous study found that the most common comorbidity in FG was diabetes, but no significant correlation could be found between diabetes and any other comorbidity and LHS [9]. However, in a previous study [27]. The presence of DM and HT, as well as the number of comorbidities, increased the length of hospital stay. In the Chalya et al. study [28], advanced age (> 60 years) and diabetes were associated with prolonged LHS.

Longer LHS (> 50 days) in the current study was significantly higher among patients who were alive. However, other studies found a significant difference between LOS and mortality rates [29,30,31].

This study found that the mean length of hospital stay (LHS) among studied patients was 54.56 ± 54.57 days. Shorter LHS was observed in previous studies [27, 32]. However, previous studies revealed that the reported length of hospital stay ranges from 2 to 276 days [20].

Morbidity and prolonged hospitalization remain significant issues because patients are frequently in their forties and fifties and have comorbidities. Multiple debridement procedures, reconstructive surgeries, diverting stoma procedures, and related complications are common in these cases, and hospitalization can last up to 9 months [27]. Several bacterial organisms, both aerobes and anaerobes, have been identified as agents that work together to cause the disease [33].

In the current study, 24% of patients had a polymicrobial infection, and the most common organism revealed in the culture analysis was E. coli (52%). Jiménez-Pacheco et al. discovered polymicrobial infection in 59.5% of cases [32].

Most experts believe that the polymicrobial nature of Fournier gangrene is needed to create the synergy of enzyme production that promotes the infection’s rapid multiplication and spread [34,35,36]. Our study’s microbiological results are consistent with the literature, with Escherichia coli being the most common organism [33]. Chalya et al. discovered that E. coli (28.3%) was the most common bacterial organism isolated [28].

The current study discovered a nonsignificant relationship between the site of skin debridement and LHS. Previous studies [37] discovered the same thing. At the same time, a retrospective study conducted in Turkey between 2013 and 2018 found no significant correlation between the Fournier Gangrene Severity Index (FGSI) and either the duration of hospital stay or the frequency of surgical debridement [38].

Treatment is based on early and extensive debridement to remove infected and necrotic tissue, hemodynamic stabilization, and broad spectrum antibiotics, according to the literature [39, 40].

The antibiotic regimen varies according to the center and antibiotic resistance in the geographic area where the microorganisms are isolated. Recent research suggests beginning empirical therapy with third-generation cephalosporins for gram-negative agents and metronidazole for anaerobes, with the possibility of adding aminoglycosides [39, 41].

Shorter LHS (50 days) was found to be significantly associated with receiving a compatible initial antibiotic and imipenem or combined vancomycin and meropenem as alternative antibiotics after incompatibility. When FG is diagnosed, broad-spectrum parental antibiotic therapy is administered empirically and then tailored based on culture results. Antibiotics must be effective against staphylococcal, streptococcal, and gram-negative bacteria, coliforms, Pseudomonas, Bacteroides, and Clostridium [42]. Empirical triple antibiotic therapy consists of a broad-spectrum penicillin or third-generation cephalosporin, an aminoglycoside (e.g., gentamicin), and metronidazole or clindamycin [13, 42].

Early diagnosis, broad-spectrum antimicrobial treatment, and prompt surgical debridement are the recommended treatments for Fournier’s gangrene [35, 42].

This study found a long mean LHS among studied patients. Longer LHS (> 50 days) was associated with patients who did not receive a compatible initial antibiotic, whereas shorter LHS was associated with patients who received imipenem or combined vancomycin and meropenem as alternative antibiotics after incompatibility. Patients who had reconstruction had significantly longer LHS and a higher mean temperature. Patients with FG had a long LHS. Knowing the values that predict LHS allows for patient-centered treatment and may be useful in predicting more radical treatments or the need for additional treatment in high-risk patients. Future multicenter prospective studies that include larger samples are needed to assess the needed variables and the predictors of long LHS.

A limitation of the present study was the small sample size. The retrospective single centre nature was another limitation that hinders the generalization of the study results. Another limitation was not using the Fournier Gangrene Severity Index (FGSI).