31 July 2026
: Case report 
Fournier Gangrene in an Immunocompetent Woman Following Minor Perineal Manipulation: A Case Report
Rare disease
Ali Bassi
ABEF 1,2*, Futoon Alsaleh BEF 1
DOI: 10.12659/AJCR.953136
Am J Case Rep 2026; 27:e953136
Table 1 Chronology, rationale, and modification of antimicrobial therapy during management of Fournier gangrene.
| Treatment phase | Antimicrobial regimen | Rationale | Duration/modification |
|---|---|---|---|
| Initial empiric therapy | Meropenem, clindamycin, and vancomycin | Broad-spectrum empirical coverage for suspected polymicrobial necrotizing infection, including gram-negative, anaerobic, and resistant gram-positive organisms | Initiated on admission |
| Early de-escalation | Discontinuation of clindamycin and vancomycin | Tissue cultures showed no methicillin-resistant or streptococcal species, and no clinically significant anaerobic growth was identified | After 48 hours |
| Targeted therapy | Meropenem continued | Tissue cultures identified extended-spectrum β-lactamase–producing , , and susceptible to carbapenems | Continued for 10 days |
| Culture-guided escalation | Addition of linezolid | Added following culture growth of resistant gram-positive organisms, including and coagulase-negative staphylococci | Administered for 14 days |
| Oral step-down therapy | Amoxicillin-clavulanate | Initiated after adequate surgical source control, sustained clinical improvement, and intermediate in vitro susceptibility, with close monitoring for relapse | Additional 14 days |