Fournier's gangrene

Updated May 21, 2025

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of Fournier's gangrene are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2025), the World Society of Emergency Surgery (WSES/AAST 2021), the Eastern Association for the Surgery of Trauma (EAST 2018), the Surgical Infection Society Europe (SIS-E/WSES 2018), and the Infectious Diseases Society of ...

Classification and risk stratification

Risk stratification: as per AAST/WSES 2021 guidelines, consider using Laboratory Risk Indicator for Necrotising Fasciitis score for an early diagnosis and Fournier's Gangrene Severity Index for prognosis and risk stratification of patients with suspected Fournier's gangrene.

Laboratory Risk Indicator for Necrotizing Fasciitis score (LRINEC score)

Calculator

When to use

C-reactive protein

< 15 mg/dL [150 mg/L]

≥ 15 mg/dL [150 mg/L]

White blood cell count

< 15,000/mcL

15,000-25,000/mcL

> 25,000/mcL

Hemoglobin

> 13.5 g/dL

11-13.5 g/dL

< 11

Sodium

≥ 135 mmol/L

< 135 mmol/L

Creatinine

≤ 1.6 mg/dL [141 mcmol/L]

> 1.6 mg/dL [141 mcmol/L]

Glucose

≤ 180 mg/dL [10 mmol/L]

> 180 mg/dL [10 mmol/L]

Calculation

Please enter all the required inputs.

The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is a clinical calculator used to assess the risk of necrotizing fasciitis, a severe type of soft tissue infection, in patients presenting with severe skin and soft tissue infections. The LRINEC score is calculated based on six laboratory values: C-reactive protein (CRP), white blood cell count (WBC), hemoglobin, sodium, creatinine, and glucose levels. This calculator is applicable to patients with severe skin and soft tissue infections where there is a suspicion of necrotizing fasciitis. The clinical utility of the LRINEC score is to aid in the early identification of necrotizing fasciitis, which is critical as this condition can rapidly progress and become life-threatening. The LRINEC score may not be applicable or accurate in patients with underlying conditions that can affect the laboratory values used in the score, such as chronic kidney disease (which can affect creatinine levels) or diabetes (which can affect glucose levels). It should also be noted that a low LRINEC score does not completely rule out necrotizing fasciitis, and clinical judgment should always be used in conjunction with this scoring system.

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Diagnostic investigations

Clinical examination: as per AAST/WSES 2021 guidelines, consider eliciting a focused medical history and performing a physical examination, including DRE, in patients with suspected Fournier's gangrene.

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Medical management

Hemodynamic support: as per SIS-E/WSES 2018 guidelines, initiate prompt appropriate hemodynamic support in patients with Fournier's gangrene.

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Surgical interventions

Surgical management, general principles

As per AAST/WSES 2021 guidelines:

Consider planning surgical management of early and delayed surgical sequelae in patients with Fournier's gangrene with a multidisciplinary and skilled team.

Consider using a multidisciplinary and tailored approach based upon the extent of perineal involvement, the degree of fecal contamination, and the possible presence of sphincter or urethral damage.

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Specific circumstances

Patients with urosepsis: as per EAU 2025 guidelines, use the qSOFA score to identify patients with potential sepsis.

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Quick Sequential Organ Failure Assessment (qSOFA score)

SBP ≤ 100 mmHg

Respiratory rate ≥ 22/min

Altered mental status

Criteria not met

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Follow-up and surveillance

Indications for surgical consultation: as per IDSA 2014 guidelines, obtain prompt surgical consultation for patients with aggressive infections associated with signs of systemic toxicity or suspicion of necrotizing fasciitis or gas gangrene.

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