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The impact of sodium-glucose cotransporter-2 inhibitors on the incidence, therapy, and outcomes of fournier gangrene: insights from a systematic review of case reports

Systematic Reviews volume 14, Article number: 25 (2025) Cite this article

Abstract

Background

The clinical characteristics, therapy, and outcome of Fournier Gangrene (FG) in patients using sodium-glucose cotransporter-2 inhibitors (SGLT2i) were examined in this systematic review.

Methods

Without a publication year restriction, we searched PubMed, ScienceDirect, and Cochrane. Additionally, we manually searched bibliographies using the terms "Fournier's gangrene" and "SGLT2 inhibitors." The requirements for inclusion were the English language case reports with specific patient data and FG patients with diabetes who were using SGLT2 medication. The risk of bias was analyzed utilizing the Joanna Briggs Institute checklists.

Results

A total of 78 studies were identified, and 14 of them were included in this review. The duration of SGLT2i use varied from 6 months to 6 years. The patients’ age varied from 34 to 72 years, with 10 studies including male participants only and patients with obesity. All studies have discontinued SGLT2i and replaced them with other anti-diabetic drugs. Therapy options included perianal ring block, insulin, rigid sigmoidoscopy, aggressive debridement, antibiotics, fluid resuscitation, incision, drainage, surgery, hyperbaric oxygen therapy, plastic surgery, and fasciocutaneous flaps. Seven studies reported patients discharged in the range of 9–51 days.

Conclusions

The incidence of FG following SGLT2i use is rare. Therapy was performed by replacing SGLT2i with other anti-diabetic drugs. The patient's outcome improved after treatment.

Peer Review reports

Background

Fournier Gangrene (FG) is an uncommon serious infection affecting the perineal and genital areas and is characterized by severe complications and a high mortality rate [1]. It exhibits gender disparity, with males being disproportionately afflicted at a ratio of 10:1. The annual prevalence increases to 1.6 cases per 100,000 males, and mortality rates range from 18 to 88%. Immunocompromised individuals with diabetes, obesity, or cancer are more vulnerable to FG [2].

The use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) is associated with the risk of FG, whereas one of the therapies for patients with diabetes is the use of SGLT2i. The European Society of Cardiology guidelines assigned a 1A recommendation for SGLT2i for heart failure patients regardless of diabetes status, which has been incorporated globally [3]. These drugs potentially contribute to glucose accumulation in the urine [4]. A meta-analysis found no risk of FG in patients on SGLT2i therapy, but the sample size was small. This indicates that more data is needed regarding SGLT2i and FG so that more accurate research is needed regarding the possibility of this relationship [5]. A study reported 10 cases showing the time to first therapy, ranging from 1 month to 6 years for the occurrence of adverse reactions. FG caused by SGLT2i, although the incidence is low, can be rapidly progressive and severe [6]. This risk raises a newly identified safety concern in patients on SGLT2i therapy. Prescribing physicians should be aware of the risk of FG and try to detect cases early [7].

The characteristics of FG patients taking SGLT2i are unknown. These characteristics are related to the risk of progression and therapy selection for patients. The association of predisposing factors may have contributed to the development of FG in this case and although the benefits of SGLT2i outweigh the risks, serious adverse events need to be reported [8].

The therapy of choice in patients with SGLT2i and FG cases is still questionable. There are differences in prescribing decisions for this agent, considering the benefits of other therapy [9]. If a patient taking an SGLT2i is suspected of having FG, it is recommended that the drug be immediately stopped and active therapy should be initiated to ensure clinical safety. Patients are advised to start combination therapy with broad-spectrum antibacterial drugs and surgical debridement. If the patient has diabetic ketoacidosis, insulin injections and aggressive fluid resuscitation are also required [6]. There may be differences in decision making that may provide therapy.

Better outcomes are found in multidisciplinary care so that the survival rate of FG continues to increase. However, multiple debridements often cause extensive skin damage. Therefore, clinicians still need to continue to explore better diagnosis, therapy, and care methods for FG [10]. In this systematic case review, we discuss FG's clinical characteristics, management, and outcomes in patients taking SGLT2i. The impact of this paper suggests that certain patient characteristics, such as the history of SGLT2i use and other demographic factors associated with increased risk of FG, should be considered so that prevention can be carried out in the hospital. The selection of suitable therapy can be adjusted, so that it can improve the patient's condition and prevent poor prognosis. In addition, this review explores the management of FG and diabetes following SGLT2i therapy discontinuation. The current condition of the patient after FG occurs causes changes in the therapy that the patient will experience to prevent a poor prognosis.

Methods

This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to provide accuracy and reliability in the reporting process [6].

Eligibility

A systematic search for case reports and case series of FG after SGLT2i therapy was performed. FG is defined as a fulminant form of infective necrotizing fasciitis of the perineal, genital, or perianal regions [11]. There was no publication limitation. Only studies with full-text articles and English language were included. Non-human subjects were excluded. All duplicates were removed before screening the titles and abstracts.

Search strategy and selection studies

A systematic search was carried out using the PubMed, Science Direct, and Cochrane databases on June 13, 2023. The search strategy included the keywords "Fournier’s gangrene" and "SGLT2 inhibitors." Due to the limited number of studies regarding patients with SGLT2i therapy who experience FG, additional relevant manual searches ('snowballing', i.e. checking reference lists to find additional studies) or 'grey literature', i.e. unpublished studies, were performed. The article titles and abstracts for eligible studies were independently scrutinized for full-text review.

Articles extraction

Relevant articles were independently screened for full-text review and data extraction. The extracted data included author and year of publication, country, age, gender, drug name, drug initiation, hemoglobin A1C (HbA1C) levels, body mass index (BMI), presenting signs and symptoms, medical history, complications, management, and follow-up results.

Quality assessment

The risk of bias in the selected studies was evaluated independently by three authors using the Joanna Briggs Institute (JBI) critical appraisal checklist for case reports and case series [12, 13]. This checklist evaluates the methodological quality of case reports based on specific criteria. The results of the bias assessment are presented as a checklist to indicate the presence or absence of potential bias instead of an accumulated score [12].

Statistical analysis

Because of the rarity of FG cases associated with SGLT2i therapy, the extracted data were analyzed descriptively using quantitative methods. Similar findings, such as clinical presentation, type of SGLT2i, and comorbidities, were grouped to evaluate their frequency.

Results

The search obtained 78 records, two of which were identical. After scrutinizing the titles and abstracts, 67 articles were eliminated, and 14 studies were incorporated into the systematic review following an in-depth examination of the full texts. The PRISMA flow diagram (Fig. 1) illustrates the selection process and the reasons for exclusion.

Fig. 1
figure 1

PRISMA flow diagram

Full size image

Quality assessment

All of the selected case reports were evaluated using the JBI checklist for case reports (Table 1). Although there is no definition of how to define the low risk of bias from the JBI checklist manual, the risk of bias in all case reports included in the review can be considered low since all criteria from the JBI checklist were fulfilled in each case report [12].

Table 1 Article quality assessment using Joanna Briggs Institute checklist
Full size table

Study characteristics

This systematic review included 14 case reports (Table 1) [14,15,16,17,18,19,20,21,22,23,24,25,26,27]. The case reports were published between 2016 and 2022. Five cases were reported in America [14, 15, 18,19,20] and 4 cases in Europe [21, 22, 25, 27], 3 cases in Asia [17, 23, 24], and 2 cases in Australia [16, 26].

Clinical characteristics

Clinical characteristics are presented in Table 2 in Appendix. The age of patients ranged from 34 to 72 years, with a median of 57 years. We found 10 articles describing cases in men; 8 studies reported patients with obesity, with a BMI exceeding 30 kg/m2; 5 studies reported hypertension; 3 patients were smokers and 1 was a former smoker. Common symptoms include pain, swelling, and redness in the genital area and groin. [14,15,16, 24]. One study reported painless discomfort for several days. After physical examination, a broad perineal abscess with 5 cm of necrotic tissue is a significant finding. [20]. In 4 cases, the patient may come with a toxic appearance accompanied by a fever. It is important to emphasize that our systematic review included 4 cases with systemic symptoms [14, 22, 25, 27]. Among these symptoms, pain and swelling of the scrotum are the most common complaints. HbA1C level was between 6.50% and 13.20%

History of SGLT2i medication

All cases confirmed the presence of FG and had a history of use of SGLT2i. The duration of SGLT2i therapy varies widely, ranging from 6 months to 6 years. Only 2 studies did not mention the duration of drug consumption [14, 15]. Currently, 3 different drugs in the SGLT2i class have been approved for sale on the market, namely Dapagliflozin, Empagliflozin, and Canagliflozin. The use of Dapagliflozin was reported in 7 cases [15, 17, 20, 22, 25,26,27], Empagliflozin in 5 cases [15, 16, 18, 23, 24] and Canagliflozin in 2 cases [19, 21]. Three cases used only SGLT2i, and the rest were in combination with other antidiabetic drugs.

Complication

Complications associated with FG indicate sepsis observed in 2 cases. Other cases are peripheral neuropathy, Hashimoto's hypothyroidism, horseshoe abscess and posterior communication of bilateral ischiorectal fossa, diabetic ketoacidosis, delirium, and derailed diabetes mellitus.

Management

Regarding disease management, all studies (14 studies) have discontinued certain SGLT2i and replaced them with other therapies. Two studies reported the resumption of therapy [24, 25], and 2 studies reported permanent discontinuation of SGLT2i therapy [22, 27]. The other 10 cases in their report only indicated drug discontinuation and did not report permanent or reintroduction of the drug. The therapies include aggressive debridement, antibiotics, fluid resuscitation, incisions, drainage, or insulin, rigid sigmoidoscopy, perianal ring block, surgery, hyperbaric oxygen therapy, plastic surgery, and faciocular flap. It should be noted that not all studies included in this review had complications [14, 18,19,20,21] (Table 3 in Appendix).

Outcome

The results of the therapy showed improvement. Seven cases reported patients discharged in the range of 9–51 days after receiving antibiotics and glucose control [15,16,17, 20,21,22,23,24, 26]. Three other cases reported progress in patient stability and wound healing [14]. A total of 4 cases did not report the results of the follow-up cases [18, 19, 25, 27].

Discussion

In this systematic review, we evaluated 14 case reports from various databases without setting a time limit, with details of 10 men and 4 women. Our findings showed that patients with FG caused by SGLT2i were aged between 32 and 72 years; however, it is important to note that there is an increasing risk of FG with increasing age [28]. Furthermore, our results are consistent with existing systematic reviews, which show that men are at higher risk of developing FG compared to women [2]. We identified ten case reports involving males, and a small number involving females. The most common risk factor identified in our systematic review was obesity, which was observed in nine cases. Existing systematic studies also highlight obesity as a significant risk factor, ranking second only to diabetes. Risk factors associated with FG can compromise the immune system, making it difficult to detect and treat infections. This results in bacterial growth and synergistic activity between aerobic and anaerobic bacteria. These molecules contribute to tissue damage and the spread of infection. The combined effects of platelet aggregation caused by aerobic bacteria, complement fixation caused by heparinase, and collagenase produced by anaerobic bacteria can result in microvascular thrombosis and skin necrosis. This may affect the management of FG patients undergoing SGLT2i therapy. Furthermore, impaired phagocytic activity in necrotic tissue may further facilitate the spread of infection [11].

The duration of SGLT2i prescriptions varies significantly, ranging from as little as ten days to as long as six years. In general, studies have shown that the average duration of SGLT2i use resulting in FG is approximately nine months, although there is considerable variation, with some cases lasting as little as five days and others lasting as long as 49 months [4]. There were 542 cases of FG identified in the FDA Adverse Event Reporting System (FAERS) database in patients receiving SGLT2i. Among all SGLT2 inhibitor therapies, empagliflozin was associated with the highest number of FG reports (232 in total), while empagliflozin plus metformin had the strongest association with FG events. Three new cases of FG caused by ertugliflozin were identified in 2019 [29].

In therapy, the selection of suitable therapy can be adjusted, so that it can improve the patient's condition and prevent sepsis. The use of therapy varies in the handling of FG cases in patients with SGLT2i. Management of FG requires urgent and aggressive intervention, including debridement of necrotic tissue and administration of broad-spectrum antibiotics. The Infectious Disease Society of America recommends empiric antimicrobial therapy that covers aerobic and anaerobic bacteria and includes methicillin-resistant Staphylococcus aureus (MRSA) [30]. Empirical antimicrobial therapy should consist of vancomycin or linezolid for MRSA combined with piperacillin-tazobactam, a carbapenem, or ceftriaxone, and metronidazole for broad-spectrum therapy. For cases of suspected streptococcal species, the use of penicillin combined with clindamycin is recommended [31]. Based on previous studies, sepsis contributed to the highest mortality rate associated with FG, reaching 76% (95% CI 63%–86%), followed by multiple organ failure at 66% (95% CI 37%–87%) [32]. Delayed diagnosis is often an underlying factor in the high mortality rate associated with sepsis [33]. Sepsis is the most common and most fatal complication observed. Sepsis is a possible complication of Fournier's gangrene, a rare but life-threatening infection that can occur in patients taking SGLT2i. If FG is suspected, discontinue the SGLT2i and immediately begin therapy with antibiotics and surgical wound cleansing [34]. Another study found sepsis to also be the most common complication of FG for SGLT2i users [7].

Most cases showed that the wounds healed gradually and improved after 31 days. Another study housed at the FDA identified 55 unique cases of FG in patients receiving SGLT2i between March 1, 2013, and January 31, 2019. All patients underwent surgical debridement and were critically ill. Three patients died [7]. Despite recent improvements in FG therapy, the mortality rate appears to have remained unchanged at 20% to 30%, according to earlier research. The prognosis is directly correlated with the time it takes to detect FG and the amount of time that passes before surgical debridement [10].

The association of predisposing factors may have contributed to the development of FG in this case, and although the benefits of SGLT2i outweigh the risks, serious adverse events need to be reported voluntarily to promptly intervene, verify association, and minimize the risk of bias [8]. With multidisciplinary cooperation and the improvement of medical level and postoperative nursing levels, the survival rate of FG continues to increase. However, multiple debridements often cause large-area skin damage, therefore, clinicians still need to continue to explore better diagnosis, therapy, and care methods for FG. Multidisciplinary collaborative diagnosis and therapy are essential in the management of FG [10]. Artificial intelligence systems are gaining significant attention in the healthcare domain as they have a significant impact. Artificial intelligence systems can improve healthcare institutions and help doctors make informed decisions [35].

Limitation

The findings from this systematic review cannot be generalized because it is a case report. This systematic review was limited in scope as it primarily focused on case reports with a small sample size without any randomized controlled trials. The inclusion of only a few cases may be attributed to the rarity of the disease, thus preventing us from conducting formal statistical analyses. Diabetes is not the only condition that makes FG worse.

Conclusion

The incidence of FG following SGLT2i use is rare. Therapy was performed by replacing SGLT2i with other anti-diabetic drugs. The patient's outcome improved after treatment. Most cases show that the wound heals gradually and improves after 31 days. Sepsis is the most common and fatal complication ever observed. Future studies with larger sample sizes must clarify the relationship between SGLT2i and FG in diabetes patients. This can be achieved by conducting large-scale multicenter pharmacovigilance studies, with participating centers in developed and developing countries. Additionally, the severity of FG and its impact (i.e. mortality) should also be assessed to gain more insight into the magnitude of the FG burden after SGLT2i.

Data availability

All data generated or analyzed during this study are included in this published.

article (and its supplementary information files).

Abbreviations

BMI:

Body Mass Index

FG:

Fournier Gangrene

JBI:

Joanna Briggs Institute

MRSA:

Methicillin-Resistant Staphylococcus aureus

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PROSPERO:

Prospective Register of Systematic Reviews

SGLT2i:

Sodium-Glucose Cotransporter-2 inhibitors

UTI:

Urinary Tract Infection

References

  1. Sorensen MD, Krieger JN. Fournier’s gangrene: epidemiology and outcomes in the general US population. Urol Int. 2016;97(3):249–59.

    Article  PubMed  Google Scholar 

  2. Chernyadyev SA, Ufimtseva MA, Vishnevskaya IF, Bochkarev YM, Ushakov AA, Beresneva TA, et al. Fournier’s gangrene: literature review and clinical cases. Urol Int. 2018;101(1):91–7.

    Article  PubMed  Google Scholar 

  3. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray KSA. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Hear J. 2021;42(36):3599–726.

    Article  CAS  Google Scholar 

  4. Chowdhury T, Gousy N, Bellamkonda A, Dutta J, Zaman CF, Zakia UB, Tasha T, Dutta P, Deb Roy P, Gomez AMMA. Fournier’s gangrene: a coexistence or consanguinity of SGLT-2 inhibitor therapy. Cureus. 2022;14(8):e27773.

    PubMed  PubMed Central  Google Scholar 

  5. Silverii GA, Dicembrini I, Monami MME. Fournier’s gangrene and sodium-glucose co-transporter-2 inhibitors: a meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2020;22(2):272–5.

    Article  CAS  PubMed  Google Scholar 

  6. Liu H. Case literature analysis of Fournier’s gangrene caused by sodium-glucose protein-2 inhibitors. Front Med. 2024;11(April):1–6.

    Google Scholar 

  7. Bersoff-Matcha SJ, Chamberlain C, Cao C, Kortepeter CCW. Fournier gangrene associated with sodium-glucose cotransporter-2 inhibitors: a review of spontaneous postmarketing cases. Ann Intern Med. 2019;170(11):764–9.

    Article  PubMed  Google Scholar 

  8. Suciu IM, Greluș A, Cozlac AR, Suciu BS, Stoica S, Luca S, et al. Fournier’s gangrene as an adverse event following treatment with sodium glucose cotransporter 2 inhibitors. Medicina. 2024;60(5):837.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Dave CV, Schneeweiss S, Patorno E. Association of sodium-glucose cotransporter 2 inhibitor treatment with risk of hospitalization for fournier gangrene among men. JAMA Intern Med. 2019;179(11):1587–90. https://doiorg.publicaciones.saludcastillayleon.es/10.1001/jamainternmed.2019.2813.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zhang KF, Shi CX, Chen SY, Wei W. Progress in multidisciplinary treatment of fournier’s gangrene. Infect Drug Resist. 2022;15:6869–80. https://www.tandfonline.com/doi/abs/10.2147/IDR.S390008.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Thwaini A, Khan A, Malik A, Cherian J, Barua J, Shergill I, et al. Fournier’s gangrene and its emergency management. Postgrad Med J. 2006;82(970):516–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu, R Currie M, Qureshi R, Mattis P, Lisy K MPF, et al. Checklist for Case Reports. Joanna Briggs Inst Crit Apprais tools. 2016:1–4. Available from: https://joannabriggs.org/ebp/critical_appraisal_tools%0Ahttps://jbi.global/critical-appraisal-tools%0Ahttp://joannabriggs.org/assets/docs/critical-appraisal-tools/JBI_Critical_Appraisal-Checklist_for_Case_Reports2017.pdf.

  13. Gagnier JJ, Kienle G, Altman DG, Moher D, Sox HRD. The CARE guidelines: consensus-based clinical case report guideline development. J Diet Suppl. 2013;10(4):381–90.

    Article  PubMed  Google Scholar 

  14. Jahir T, Hossain S, Bagum M, Saidi A, Risal RSM. A Rare but Life-Threatening Case of Fournier’s Gangrene Caused by Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitor, Empagliflozin. Cureus. 2022;14(9):e29264.

    PubMed  PubMed Central  Google Scholar 

  15. Vargo E, Leone G, Barat O, Yunker APN. A case of Fournier’s gangrene following a large-volume hydrocelectomy in a diabetic patient managed with SGLT-2 inhibitor therapy. Urol Case Rep. 2021;5(39): 101834.

    Article  Google Scholar 

  16. Kumar S, Costello AJCP. Fournier’s gangrene in a man on empagliflozin for treatment of Type 2 diabetes. Diabet Med. 2017;34(11):1646–8.

    Article  CAS  PubMed  Google Scholar 

  17. Onder CE, Gursoy K, Kuskonmaz SM, Kocer U, Culha C. Fournier’s gangrene in a patient on dapagliflozin treatment for type 2 diabetes. J Diabetes. 2019;11(5):348–50.

    Article  PubMed  Google Scholar 

  18. Elshimy G, Correa R, Alsayed MJS. Early presentation of a rare complication of sodium-glucose cotransporter-2 inhibitors 10 days after initiation: case report and literature review. Cureus. 2019;11(7):e5173.

    PubMed  PubMed Central  Google Scholar 

  19. Elbeddini A, Gallinger J, Davey M, Brassard S, Gazarin M, Plourde FAA. A case of fournier’s gangrene in a patient taking canagliflozin for the treatment of type II diabetes mellitus. Am J Case Rep. 2020;24(21):e920115.

    Google Scholar 

  20. Elbeddini A, Tayefehchamani Y, Davey M, Gallinger J, Hooda N, Aly A, Erickson DLS. Fournier’s gangrene with dapagliflozin in a rural hospital: a case report. BMJ Case Rep. 2021;14(2):e237784.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kasbawala K, Stamatiades GAMS. Fournier’s gangrene and diabetic ketoacidosis associated with sodium glucose co-transporter 2 (SGLT2) inhibitors: life-threatening complications. Am J Case Rep. 2020;21:e921536.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ellegård L, Prytz M. Fournier’s gangrene under SGLT-2 inhibitor therapy: a literature review and case report. Int J Surg Case Rep. 2020;77:692–4.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Vadi S, Ismail AKD. Fournier’s gangrene and diabetic ketoacidosis with lower-than-anticipated glucose levels associated with SGLT-2 inhibitor: a double trouble. Med J Armed Forces India. 2023;79(2):225–8.

    Article  PubMed  Google Scholar 

  24. Nagano Y, Yakame NK, Aoki H, Yamakawa TKN. Fournier’s gangrene in a patient with type 2 diabetes mellitus treated with empagliflozin: a case report. Drug Saf Case Rep. 2019;6(1):11.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Rodler S, Weig T, Finkenzeller C, Stief CSM. Fournier´s gangrene under sodium-glucose cotransporter 2 inhibitor therapy as a life-threatening adverse event: a case report and review of the literature. Cureus. 2019;26(9):e5778.

    Google Scholar 

  26. Cecilia-Chi W, Lim-Tio S. Fournier’s syndrome: a life-threatening complication of SGLT2 inhibition in poorly controlled diabetes mellitus. Joint Annual Scientific Meeting of the Australian Diabetes Educators Association (ADEA) and Australian Diabetes. Westmead: Westmead Hospital; 2016. https://ads-adea-2016.m.asnevents.com.au/schedule/session/9239/abstract/36604.

  27. Omer T, Dharan SS, Adler A. SGLT-2 inhibitor Dapagliflozin and Fournier’s gangrene A life-threatening severe adverse effect. Conference Paper Diabetes UK 2018. 2019. London: England. https://www.researchgate.net/publication/332211704_SGLT2_and_Fournier's_gangrene_-_a_life_threatening_adverse_effect.

  28. Joury A, Mahendra A, DA Alshehri M. Extensive necrotizing fasciitis from Fournier’s gangrene. Urol Case Rep. 2019;9(26):100943.

    Article  Google Scholar 

  29. Hu Y, Bai Z, Tang Y, Liu R, Zhao B, Gong J, et al. Fournier gangrene associated with sodium-glucose cotransporter-2 inhibitors: a pharmacovigilance study with data from the U.S. FDA adverse event reporting system. J Diabetes Res. 2020;2020:3695101.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sykes JE, Westropp JL. Bacterial Infections of the Genitourinary Tract. Canine and Feline Infectious Diseases. Chapter 89 Section 5. 2014. p. 871–885. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/B978-1-4377-0795-3.00089-2, https://pmc.ncbi.nlm.nih.gov/articles/PMC7151908/.

  31. Stevens DLBA. Necrotizing soft-tissue infections. N Engl J Med. 2017;377(23):2253–65.

    Article  PubMed  Google Scholar 

  32. El-Qushayri AE, Khalaf KM, Dahy A, Mahmoud AR, Benmelouka AY, Ghozy S, et al. Fournier’s gangrene mortality: a 17-year systematic review and meta-analysis. Int J Infect Dis. 2020;1(92):218–25. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.ijid.2019.12.030.

    Article  Google Scholar 

  33. Lupsa BC, Inzucchi SE. Use of SGLT2 inhibitors in type 2 diabetes: weighing the risks and benefits. Diabetologia. 2018;61(10):2118–25. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s00125-018-4663-6.

    Article  CAS  PubMed  Google Scholar 

  34. FDA. FDA warns about rare occurrences of a serious infection of the genital area with SGLT2 inhibitors for diabetes. 2024. Available from: https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-rare-occurrences-serious-infection-genital-area-sglt2-inhibitors-diabetes#:~:text=This adverse event is a,the bottom of this page.

  35. Omotunde H, Mouhamed M. The modern impact of artificial intelligence systems in healthcare: a concise analysis. Mesopotamian J Artif Intell Healthc. 2023;22(2023):66–70.

    Article  Google Scholar 

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Acknowledgements

All faculty members and urology residents of the Urology Residency Program at Universitas Airlangga’s Faculty of Medicine in Surabaya, East Java, Indonesia.

Funding

MJP received grants and honoraria from various pharmaceutical companies, all of which are fully unrelated to this research. Other authors have no relevant financial or non-financial interests to disclose.

Author information

Author notes

  1. Maarten J. Postma and Abdul Khairul Rizki Purba contributed equally as the last author.

Authors and Affiliations

  1. Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Yufi Aulia Azmi, Maarten J. Postma & Abdul Khairul Rizki Purba

  2. Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia

    Firas F. Alkaff, Maarten J. Postma & Abdul Khairul Rizki Purba

  3. Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Firas F. Alkaff

  4. Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Kevin Muliawan Soetanto

  5. Department of Urology, Faculty of Medicine Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

    Soetojo Wirjopranoto

  6. Institute of Science in Healthy Ageing & Healthcare (SHARE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Maarten J. Postma

  7. Department of Pharmacy, Unit of Pharmacotherapy, Epidemiology and Economics (PTE2), University of Groningen, Groningen, The Netherlands

    Maarten J. Postma

  8. Department of Economics, Econometrics and Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands

    Maarten J. Postma

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  1. Yufi Aulia Azmi
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Contributions

Yufi A Azmi: Project development, data collection, manuscript writing. Firas F Alkaff: Data analysis, manuscript writing. Soetojo Wirjopranoto: Data collection, manuscript editing. Kevin Muliawan Soetanto: Data analysis, manuscript editing. Maarten J Postma: Project development, manuscript editing. AKR Purba: Project development, manuscript editing.

Corresponding author

Correspondence to Abdul Khairul Rizki Purba.

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Appendix

Appendix

Table 2 Demographics, HbA1C, BMI, and comorbidities of patients in the included studies
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Table 3 Drug use, drug initiation, presenting signs and symptoms, complications, management, and follow-up results
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Azmi, Y.A., Alkaff, F.F., Soetanto, K.M. et al. The impact of sodium-glucose cotransporter-2 inhibitors on the incidence, therapy, and outcomes of fournier gangrene: insights from a systematic review of case reports. Syst Rev 14, 25 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13643-024-02746-3

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13643-024-02746-3

Keywords

Systematic Reviews

ISSN: 2046-4053