Microbiological characteristics and real-world antibiotic therapy regimens in Fournier Gangrene: A systematic review

Microbiological characteristics and real-world antibiotic therapy regimens in Fournier Gangrene: A systematic review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Microbiological characteristics and real-world antibiotic therapy regimens in Fournier Gangrene: A systematic review Fabian Joel Aschwanden, Laura Wimmer, Charlotte Müssgens, Silvan Sigg, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8829364/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background and objective: Fournier’s gangrene is a rare (incidence ~ 1·6 per 100 000) but life-threatening necrotising infection of the perineum with high mortality (20–40%) despite antimicrobial therapy, prompt surgical debridement, and intensive care. Evidence on pathogens, resistance, and antibiotic management is largely derived from retrospective series. Our aim was to synthesize the microbiological spectrum and empiric regimens, and identified evidence gaps. Methods: We performed a systematic review following PRISMA and the Cochrane Handbook; the protocol was registered in PROSPERO (CRD42023489596). We included studies of adults with Fournier’s gangrene reporting microbiological findings and/or antibiotic therapy. Key findings and limitations: Across 88 studies (n = 4229), median length of stay was 24 days, mean symptom duration before admission was 7 days, and median mortality was 17%. Infections were polymicrobial in 66%. The most frequent isolates were Escherichia coli (30%), Streptococcus spp (11%), Pseudomonas aeruginosa (7%), and Staphylococcus aureus (6%); fungi accounted for 2%. Empiric regimens were heterogeneous (57 studies; n = 2958); ceftriaxone plus an aminoglycoside and metronidazole was most common (29%). Only 19% of patients received guideline-concordant therapy. Resistance data were available in seven studies and showed resistance to commonly used agents (23–64%). Conclusion and clinical implications: Empiric antimicrobial management is geographically variable, with low guideline adherence and clinically relevant resistance. Prospective, standardised studies with uniform sampling and reporting are needed to define locally adapted empiric strategies and improve alignment with contemporary recommendations. Patient Summary We reviewed 88 studies on Fournier’s gangrene, a rare but life-threatening infection. Most cases were caused by several bacteria at the same time, most often E. coli . Empiric antibiotic treatments varied widely, and many patients did not receive therapy recommended by guidelines. Resistance to common antibiotics was frequent.High-quality studies are needed to define the best treatments and improve patient outcomes. urological infections Fournier´s gangrene antibiotic therapy microbiology resistance Figures Figure 1 Figure 2 Figure 3 1. Introduction Fournier’s gangrene is a rare but life-threatening necrotising fasciitis of the perineal, genital, and perianal regions, with an estimated incidence of approximately 1.6 per 100 000 population. Common predisposing comorbidities include diabetes mellitus, obesity, cardiovascular disease, renal or hepatic impairment, malignancy, and alcohol misuse. It is characterised by a fulminant, rapidly progressive infection that tracks along fascial planes (including the Dartos, Colles’, and Scarpa’s fascia), leading to extensive soft-tissue necrosis, sepsis and septic shock. Despite antimicrobial therapy, prompt surgical debridement, and intensive care support, outcomes remain poor, with reported case-fatality rates ranging from 7.5% to 40% ( 1 – 3 ) Microbiologically, Fournier’s gangrene is typically polymicrobial, involving both aerobic and anaerobic bacteria, which is in contrast to classical, non-Fournier necrotizing fasciitis, which is more commonly monobacterial ( 4 ).Frequently isolated organisms include Escherichia coli , Streptococcus spp., Staphylococcus spp., and anaerobes such as Bacteroides fragilis ( 5 ). However, the current body of microbiological evidence is derived primarily from retrospective single-center case series or small cohorts, limiting generalizability. The management of Fournier’s gangrene is centered on three therapeutic cornerstones: hemodynamic resuscitation, urgent radical surgical debridement to reduce pathogen load, and empiric broad-spectrum antibiotic therapy. Contemporary international urological and infectious diseases guidelines recommend empiric regimens including carbapenems or piperacillin–tazobactam, frequently combined with clindamycin (Table 1 ). Notably, there is marked heterogeneity and variability among international guidelines regarding empiric antibiotic regimens and duration of therapy, and some major societies - including the American Urological Association (AUA) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) - do not provide specific recommendations ( 6 – 8 ). Table 1 Overview of the current guideline recommendations for antibiotic therapy and duration in Fournier’s gangrene . Antimicrobial Dosage Duration of antibiotic therapy EAU recommendations (2025) N/A Piperacillin-tazobactam plus 4.5 g q.i.d or t.i.d iv Vancomycin 15 mg/kg b.i.d Imipenem-cilastatin Standard dosage: 0.5 g iv q.i.d over 30 minutes, High dosage: 1 g iv q.i.d over 30 minutes Meropenem 1 g t.i.d iv Ertapenem 1 g o.d Gentamicin 6-7 mg/kg iv q.d Cefotaxime plus 2 g q.i.d iv Metronidazole or 500 mg q.i.d iv Clindamycin 600-900 mg t.i.d iv Cefotaxime plus 2 g q.i.d iv Fosfomycin plus 5 g t.i.d iv Metronidazole 500 mg q.i.d iv IDSA recommendations (2014) No necessity for further debridement, clinical improvement, afebrile for 48-72h Piperacillin-tazobactam plus 3.37 q.i.d or t.i.d iv Vancomycin 15 mg/kg b.i.d Imipenem-cilastatin 1g q.i.d or t.i.d iv Meropenem 1g b.i.d Ertapenem 1g o.d iv Cefotaxime plus 2g q.i.d iv Metronidazole or 500 mg q.i.d iv Clindamycin 600-900 mg t.i.d iv ESES/SIS-E Consensus (2018) "The initial empirical antibiotic regimen should comprise broad-spectrum drugs including anti-MRSA and anti-Gram-negative coverage" No necessity for further debridement, clinical improvement, afebrile for 48-72h AUA recommendations No recommendations provided ESCMID recommendations No recommendations provided iv = intravenous; b.i.d = twice daily; t.i.d = three times daily; q.i.d = four times daily, q.d = every day; o.d = once daily. EAU = European Association of Urology IDSA = Infectious Diseases Society of America AUA = American Association of Urology ESCMID = European Society of Clinical Microbiology and Infectious Diseases WSES/SIS-E = World Society of Emergency Surgery / Surgical Infection Society Europe Real-world prescribing practices and the actual microbiological spectrum underlying Fournier’s gangrene remain poorly characterized. Given the rarity of the disease, literature remains heavily weighted toward observational reports. Consequently, recommendations for empiric antibiotic therapy continue to rely largely on expert opinion or extrapolations from small case series. To address this gap, we conducted a systematic review to synthesize the published evidence on microbiological characteristics and real-world antibiotic therapy in Fournier’s gangrene. Hereby, we provide a comprehensive overview of pathogens, antimicrobial resistances, and empiric antibiotic regimens, thereby strengthening the evidence base for future clinical guidelines. Finally, we add an outlook for future studies aiming at investigating microbiological characteristics and antimicrobial therapy strategies in Fournier’s gangrene . 2. Methods 2.1 Literature search strategy This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines ( 9 ) and the recommendations provided in the Cochrane Handbook of systematic reviews ( 10 ) and was prospectively registered in the PROSPERO international prospective register of systematic reviews (registration ID: [CRD 42023489596]). We systematically searched PubMed/MEDLINE and the Cochrane Library. The search was conducted in May 2025. To provide the most comprehensive overview possible, no time restrictions regarding year of publication were applied. The detailed search strategy and MeSH terms are provided in the Supplementary Appendix ( Table S1 ). 2.2 Eligibility criteria We included studies reporting original clinical data on adult patients with Fournier’s gangrene that provided: 1) Microbiological results from wound, blood, urine, or other cultures, and/or 2) Antibiotic therapy data Eligible designs were retrospective or prospective cohorts, registry studies, and case series with ≥ 20 patients. We excluded single case reports, conference abstracts, non-clinical studies, and studies without extractable microbiological or antibiotic data. Only articles published in peer-reviewed English literature were considered. 2.3 Study selection Two reviewers (L.W. and F.A.) independently screened titles and abstracts. Full-text articles were retrieved for studies meeting eligibility criteria or in cases of uncertainty. Disagreements were resolved by a third reviewer (L.S.). 2.4 Data extraction Data was independently extracted by two reviewers (L.W. and F.A.) using a priori defined standardized template. Any discrepancies were resolved by a third reviewer (L.S.). The online platform Covidence ( https://www.covidence.org/ ; Veritas Health Innovation Ltd, Melbourne, Australia) was used for the screening and data extraction process. Extracted variables included study characteristics (such as study design, year of publication, geographic origin, sample size), patient demographics and comorbidities, microbiological findings (e.g. pathogen type, antimicrobial resistances), antibiotic therapy (e.g. applied regimens, duration of antibiotic therapy) and outcomes (e.g. mortality). 2.5 Study quality assessment Risk of bias assessment was performed for prospective studies, using the ROBINS-I V2 tool (Risk Of Bias In Non-randomized Studies of Interventions) ( 11 ). The assessment was performed by two independent review authors (L.W. and A.A.) and any disagreement was resolved by a third author (L. S.). Given the well-recognized susceptibility of retrospective observational case-series to bias, we did not undertake a formal risk-of-bias assessment for retrospective studies ( 12 ). 2.6 Evidence synthesis Despite considerable heterogeneity among study designs, patient populations, and outcome reporting, we conducted a quantitative synthesis of the results where appropriate. This pooling of data was undertaken primarily for descriptive purposes, as differences in study design and reporting standards limited formal comparative analysis. Summary statistics were calculated at the study level unweighted by sample size. The aggregated data are presented in tables or summary figures that illustrate the overall distribution of pathogens and the antibiotic strategies across the studies. 3. Results 3.1 Study selection The search yielded 3366 records; after deduplication 3136 remained. Following title/abstract screening, 156 full texts were reviewed; 88 studies were included. A PRISMA 2020 flow diagram is provided in Fig. 1 . 3.2 Quality assessment Risk of bias was evaluated for all prospective studies using the ROBINS-I V2 framework ( Supplementary Table S2 ). Overall risk ranged from moderate to critical across studies. Most studies were rated as having a serious or critical bias (83.3%), primarily because of confounding and selection biases related to non-randomized treatment allocation. Across all studies, the risk of bias related to classification of interventions and deviations from intended interventions was generally low. In contrast, measurement of outcomes and selective reporting were frequently judged as moderate, as outcome assessment was typically unblinded and few studies had pre-published protocols. A visual summary of the domain-level assessments is provided in Fig. 2 ( 13 ). 3.3 Study characteristics The 88 studies (1984–2024) enrolled 4229 patients (median sample size 40, (Interquartile range (IQR) [30–556]); 71.6% were male, the mean age was 53.9 years, (standard deviation (SD) 5.4). Most studies included retrospective cohorts (94%), while only 6% were prospective studies. The included studies were conducted across North and Central America, Europe, Africa, Asia, and the Middle East. Most patients originated from the Middle East, Asia, and Africa, which together accounted for 73.6% of the study population (Fig. 3 ). European cohorts contributed 14.8% of patients, North American studies 10.0%, and Central American studies 1.5%. Across the included studies, the median Fournier’s Gangrene Severity Index was 6.2 (IQR [5.7–6.9]), the median mortality was 17% (IQR [9.3–22.0]), the median hospital length of stay was 23.7 days (IQR [17.0–32.8]) and the mean duration of symptoms prior to admission was 6.7 days (SD 2.7). An overview of the main study characteristics is presented in Table 2 . Table 2 Overview and characteristics of all included studies (n = 88) Author Year Country Sample size (n) mean age (y) Polymicrobial infection (% of cohort) Sterile infections (% of cohort) Fungal infections (% of cohort) Most frequent pathogen Total duration of antibiotic therapy (days) Administered antibiotic regimen Antibiotic resistances Mean length of stay (days) Mortality rate (%) Kundan ( 40 ) 2024 India 156 E. coli Amoxiclav & Metronidazol 8,6 Hong ( 27 ) 2024 Korea 35 57,9 100 2,9 E. coli 22.9% multi drug resistant bacteria 45,3 17,0 Wirjopranoto ( 41 ) 2024 Indonesia 123 52,0 30,2 10,6 4,9 E. coli 12,0 17,9 You ( 42 ) 2024 China 46 21,7 E. coli 17,0 6,5 He ( 21 ) 2023 China 36 48,5 2,8 E. coli Carbapenem & Vancomycin Gram negative bacilli resistance to 3rd generation cephalosporins 35%, all Staphylococcus haemolyticus methicillin resistant 44,0 Al-Kohlany ( 43 ) 2023 Yemen 26 65,8 Ceftriaxone & Metronidazol 5,4 35,0 Mahmood ( 44 ) 2023 Egypt 30 59,6 E. coli . Broad spectrum antibiotics 19,7 0,0 Ucaner ( 45 ) 2023 Turkey 24 E. coli Piperacillin/Tazobactam Meropenem 0,0 Tuncer ( 46 ) 2023 Turkey 66 57,9 16,7 E. coli 22,5 19,7 Vilela ( 47 ) 2023 Portugal 32 S. aureus Shiratori ( 48 ) 2023 Japan 36 E. coli 19,4 Topuz 2022 Turkey 36 56,4 E. coli Piperacillin/Tazobactam Ciprofloxacin & Metronidazol Ceftriaxone & Metronidazol Meropenem Ertapenem Imipenem 12,5 0,0 Wirjopranoto ( 49 ) 2022 Indonesia 135 9,6 6,7 K. pneumoniae P. aeroginosa Ceftriaxone Metronidazol 13,0 17,0 Tutino ( 50 ) 2022 Italy 23 62,7 42,9 4,4 E. coli 26,0 13,1 Itaimi ( 51 ) 2022 Tunesia 35 46,0 P. aeroginosa 10,0 23,0 Nisbet ( 18 ) 2022 USA 26 47,8 7,7 15,4 Streptococcus spp. Staphylococcus spp. 11,0 Bensardi ( 52 ) 2021 Morocco 84 49,0 Broad spectrum antibiotics 13,0 7,1 Gul ( 53 ) 2021 Turkey 22 56,9 50 E. coli 25,8 27,3 Agwu ( 54 ) 2020 Nigeria 47 42,7 E. coli Ceftriaxone & Aminoglycoside & Metronidazol 34,1 17,0 Castillejo Becerra ( 26 ) 2020 USA 143 87,6 21,7 Staphylococcus spp. Piperacillin/Tazobactam & Clindamycin Carbapenem & Vancomycin Most pathogens had resistance to commonly used antibiotics such as ampicillin, trimethoprim-sulfamethoxazole, clindamycin and levofloxacin. 10,0 Lin ( 55 ) 2019 China 60 53,0 2,9 E. coli 15,7 Ceftriaxone & Aminoglycoside & Metronidazol 1,7 Ahmed ( 56 ) 2019 Pakistan 44 54,9 E. coli Ceftriaxone & Metronidazol 11,6 Garg ( 57 ) 2019 India 72 56,3 E. coli 12,7 8,3 Wetterauer ( 5 ) 2018 Switzerland 20 90,0 18 Carbapenem & Clindamycin 15,0 Elsaket ( 15 ) 2018 South Africa 44 51,0 Co-Amoxiclav & Metronidazol & Gentamicin Co-Amoxiclav 26,0 11,4 Sockkalingam ( 58 ) 2018 India 34 50,0 79,4 K. pneumoniae Ceftriaxone & Aminoglycoside & Metronidazol 11,4 Meki ( 59 ) 2018 Zimbabwe 51 47,0 Broad spectrum antibiotics 15,0 27,0 Ghodoussipour ( 60 ) 2018 USA 54 54,3 75,9 0,00 37,5 5,6 Hahn ( 61 ) 2018 South Korea 41 54,4 24,1 29,27 Ceftriaxone & Aminoglycoside & Metronidazol 47,0 22,0 Yücel ( 62 ) 2017 Turkey 25 54,3 E. coli Broad spectrum antibiotics 21,4 4,0 Yilmazlar ( 25 ) 2017 Turkey 50 58,5 79,2 4,00 12,0 Ceftriaxone & Aminoglycoside & Metronidazol The highest bacterial resistance was observed against ampicillin-sulbactam (64%), followed by ciprofloxacin and levofloxacin (44%) and cefazolin (42%) (74%). 22,0 26,0 Ioannidis ( 63 ) 2017 Greece 24 58,9 100 E. coli Bacteroides spp. 16 Piperacillin/Tazobactam Ceftriaxone Carbapenem Quinolones 27,0 20,8 Hong ( 64 ) 2017 South Korea 20 61,8 10,00 E. coli 25,0 Taken ( 65 ) 2016 Turkey 65 25,0 E. coli PenicillinG & Aminoglycoside & Metronidazol 9,2 12,3 Doluoğlu ( 66 ) 2016 Turkey 39 54,7 20,5 E. coli Ceftriaxone & Metronidazol 21,0 Kincius ( 17 ) 2016 Lithuania 41 59,4 21,9 E. coli Ceftriaxone & Metronidazol 10,0 22,0 Chalya ( 22 ) 2015 Tanzania 84 82,6 E. coli Ceftriaxone & Aminoglycoside & Metronidazol Most of pathogens had multiple resistant to almost all tested antibiotics, except for meropenem and imipenem, which were 10 % sensitive. 28,0 28,6 Bozkurt ( 67 ) 2015 Turkey 33 57,6 37,0 18,2 E. coli Ceftriaxone & Metronidazol Ciprofloxacin & Metronidazol 9,1 Oguz ( 68 ) 2015 Turkey 43 52,0 E. coli Ceftriaxone & Metronidazol 21,9 14,0 Tarchouli ( 69 ) 2015 Morocco 72 51,0 84,1 17,0 Polistena ( 70 ) 2014 Italy 23 68 Broad spectrum antibiotics 0,0 Avakoudjo ( 71 ) 2014 Bein Republic 72 52,0 E. coli Broad spectrum antibiotics 72,0 10,0 Yilmazlar ( 72 ) 2014 Turkey 120 8,3 2,5 E. coli Ceftriaxone & Metronidazol 14,5 20,8 Eskitaşcıoğlu ( 73 ) 2014 Turkey 80 53,5 18,9 E. coli 34,8 3,8 Aliyu ( 16 ) 2013 Nigeria 38 37,8 81,8 13,2 Ceftriaxone & Metronidazol 28,0 15,8 Benjellounel ( 74 ) 2013 Morocco 50 48,0 E. coli Ceftriaxone & Aminoglycoside & Metronidazol 21,0 24,0 Katib ( 75 ) 2013 Saudi Arabia 20 56,0 Piperacillin/Tazobactam & Clindamycin 22,3 0,0 Sarvestani ( 76 ) 2013 Iran 28 44,6 E. coli Ceftriaxone & Aminoglycoside & Metronidazol 17,2 35,7 Akilov ( 24 ) 2013 Canada 28 46,7 Staphylococcus spp. Broad spectrum antibiotics 3 patients with MRSA bacteremia. 24,4 0,0 Verma ( 77 ) 2012 India 95 46,0 52,6 0,0 E. coli 23,0 27,0 Aridogan ( 78 ) 2012 Turkey 71 61,3 80,3 18,3 E. coli Ceftriaxone & Aminoglycoside & Metronidazol 27,4 29,6 Wang ( 79 ) 2012 China 24 48,8 E. coli Broad spectrum antibiotics 40,6 20,8 Altarax 2012 Switzerland Coratia Slovenia 41 62,0 83,8 Streptococcus spp. Broad spectrum antibiotics 37,0 Martinschek ( 80 ) 2012 Germany 55 100 C. perfiringens Broad spectrum antibiotics 16,4 Ugwumba ( 81 ) 2012 Nigeria 28 48,3 E. coli Ceftriaxone & Aminoglycoside & Metronidazol 37,1 3,6 Simsek ( 23 ) 2011 Turkey 20 52,2 20,0 E. coli Ceftriaxone & Metronidazol 1 case of MRSA 20,0 Koukouras ( 82 ) 2011 Germany 45 50,0 E. coli Broad spectrum antibiotics 15,7 15,6 García Marín ( 83 ) 2011 Spain 34 E. coli Piperacillin/Tazobactam Ciprofloxacin & Metronidazol Meropenem Meropenem & Vancomycin Imipenem PenicillinG & Aminoglycoside & Metronidazol Penicillin & Gentamicin & Clindamycin 29,0 Chen ( 84 ) 2010 Taiwan 31 53.6 68 16 Broad spectrum antibiotics 12 Chen ( 85 ) 2010 Taiwan 41 57,2 75,8 E. coli Broad spectrum antibiotics 19,5 Czymek ( 86 ) 2010 Germany 38 57,7 100 E. coli 62,1 21,1 Luján ( 87 ) 2010 Spain 51 33,0 16,0 Martinez-Rodriguez ( 88 ) 2009 Spain 20 57,0 E. coli 39,0 20,0 Ullah ( 89 ) 2009 Pakistan 60 47,0 100 Ceftriaxone & Metronidazol 31,0 7,0 Czymek ( 90 ) 2009 Germany 35 57,7 87,5 8,6 E. coli 65,3 20,0 Czymek ( 91 ) 2009 Germany 33 86,7 9,1 E. coli 18,2 Saffle ( 92 ) 2008 USA 30 54,3 13 Broad spectrum antibiotics 25,3 16,6 Ghnnam ( 93 ) 2008 Egypt 74 51,0 64,9 E. coli Ceftriaxone & Aminoglycoside & Metronidazol 9,2 21,6 Rajput ( 94 ) 2008 India 30 57,0 Bacteroides spp. Penicillin & Metronidazol 26,6 Bhatnagar ( 95 ) 2008 India 110 100 E. coli 19,3 12,8 Kabay ( 96 ) 2008 Turkey 72 61,4 Ceftriaxone & Aminoglycoside & Metronidazol PenicillinG & Aminoglycoside & Metronidazol 27,0 40,3 Cakmak ( 97 ) 2008 Turkey 65 50,8 29,0 4,6 E. coli Ceftriaxone & Metronidazol 24,4 27,7 Ersay ( 98 ) 2007 Turkey 70 46,2 Streptococcus spp. Ceftriaxone & Aminoglycoside & Metronidazol 21,9 22,8 Basoglu ( 99 ) 2007 Turkey 45 54,0 Ceftriaxone & Aminoglycoside & Metronidazol 32,0 8,9 Ferreira ( 100 ) 2007 Portugal 43 56,6 82,9 6,9 S. aureus 73,6 2,3 Tahmaz ( 101 ) 2006 Turkey 33 53,9 33,4 E. coli PenicillinG & Aminoglycoside & Metronidazol 21,7 9,1 Ayan ( 102 ) 2005 Turkey 41 57,3 E. coli 39,0 22,0 Jeong ( 103 ) 2005 Korea 40 55,3 41,2 E. coli 28,0 Korkut ( 104 ) 2003 Turkey 45 54,6 28,9 Ceftriaxone & Aminoglycoside & Metronidazol 12,0 20,0 Atakan ( 105 ) 2002 Turkey 21 50,3 100 E. coli Broad spectrum antibiotics 43,0 19,0 Norton ( 106 ) 2002 USA 33 51,5 100 15,2 Bacteroides spp. 21,1 9,0 Villanueva-Sáenz ( 107 ) 2002 Mexico 28 57,8 76 10,7 E. coli Ceftriaxone & Aminoglycoside & Metronidazol Imipenem 19,0 35,6 Dahm ( 19 ) 2000 USA 50 56,3 26,0 22,4 Corman ( 108 ) 1999 USA 23 51,7 E. coli 4,0 Aşci ( 109 ) 1998 Turkey 34 55,0 E.Coli 30,0 14,7 Hollabaugh ( 110 ) 1998 USA 26 57,0 95,8 7,7 E.Coli 21,0 23,0 Hejase ( 111 ) 1996 Mexico / USA 38 54,0 100 5,3 Ceftriaxone & Aminoglycoside & Metronidazol 17,0 3,0 Spirnak ( 112 ) 1984 USA 20 54,6 100 E. coli Broad spectrum antibiotics 73,0 45,0 3.4 Microbiology Microbiological data were reported in 80 studies, providing microbiological results for 1,883 patients. Among these, 66% of infections were polymicrobial, while 34% were monomicrobial. Sterile wound cultures were documented in 4% of cases, and fungal pathogens were isolated in 2%, with Candida albicans accounting for 49.3% of all fungal isolates. Bacterial pathogens predominated (97.9%). Escherichia coli was the most frequently reported organism, identified in 30.7% of cases, followed by Streptococcus spp. (10.9%), Pseudomonas aeruginosa (6.8%), Bacteroides spp. (6.7%), and Staphylococcus aureus (6.3%). Other Gram-negative organisms included Klebsiella spp. (4.0%), Klebsiella pneumoniae (3.3%), Acinetobacter spp. (3%) and Proteus spp. (2.9%). Other Gram-positive organisms were Enterococcus spp. (4.1%) and Coagulase-negative staphylococci (5.1%). Less common isolates included Clostridium perfringens (1.3%), Corynebacterium spp. (0.4%), Lactobacillus spp. (0.4%), Morganella morganii (0.3%), and Streptococcus pyogenes (0.2%). Among pathogen classes, Gram-negative bacteria accounted for 59.6% of isolates, Gram-positive bacteria for 32.1%, fungi, negative microbiological cultures and not further specified bacteria for the remaining 8.3%. An overview of the distribution of pathogens is provided in Fig. 4 A. The specimen source of the isolated pathogens was rarely specified. Only five studies explicitly reported wound cultures, in which Staphylococcus aureus (63.8%), Acinetobacter spp. (12.5%), and Escherichia coli (12.5%) were the most frequently identified organisms. Less common isolates included Streptococcus pyogenes (10.0%) and Proteus mirabilis (1.3%)( 14 – 18 ). Bacteremia was documented in four studies, with Escherichia coli (50.0%) as the predominant isolate, followed by Klebsiella spp . (25.0%) and Pseudomonas aeruginosa (25.0%) ( 14 , 18 – 20 ). Two studies reported positive urine cultures; however, only Elsaket et al. provided detailed pathogen distribution. In their cohort of 44 patients, 79.6% had positive urine cultures, with Escherichia coli isolated in 63.6% and Proteus mirabilis in 15.9% of cases( 15 ). 3.5 Antimicrobial regimens Fifty-seven studies, including a total of 2,958 patients, reported empiric antimicrobial therapy regimens. No study reported targeted therapy regimens. Considerable heterogeneity was observed in empiric antibiotic choice, although broad-spectrum combinations predominated. A total of 22 different regimens were reported. The most frequently reported regimen was a combination of ceftriaxone plus an aminoglycoside and metronidazole, administered in 861 patients (29.1%). Other common regimens included ceftriaxone with metronidazole (18.1%) and broad-spectrum antibiotic combinations (17.8%) which were not further specified by the authors. Carbapenem containing regimens were also widely used, particularly carbapenem combined with vancomycin (6.1%) or carbapenem with clindamycin (0.6%). Piperacillin–tazobactam, either alone (1.7%) or combined with clindamycin (5.5%), was reported in several cohorts. Less frequently described regimens included penicillin-based combinations such as penicillin plus metronidazole (1%); penicillin G with aminoglycoside and metronidazole (5.8%), and fluoroquinolone-based therapy such as ciprofloxacin with metronidazole (1.5%). Use of single-agent therapies was uncommon, with only sporadic reports of meropenem (0.5%), imipenem (0.6%), or ertapenem (0.1%) as monotherapy. The distribution of reported antibiotic regimens across the included studies is illustrated in Fig. 4 B. A comprehensive table displaying the isolated pathogens and administered antibiotic therapies, and their frequency can be found in the supplementary materials ( Table S3 ). 3.5.1 Duration of antimicrobial therapies The duration of antibiotic therapy was specified in only four studies, with a reported median duration of 15.8 days (IQR 15.0–16.4). None of the studies distinguished between intravenous and oral treatment duration. 3.5.2 Adherence to guideline recommendations Assessment of adherence to guideline-concordant therapy was available for all 22 reported antimicrobial regimens. Overall, only 4 regimens (18.7%) were consistent with recommendations issued by the European Association of Urology (EAU) or the Infectious Diseases Society of America (IDSA). These included carbapenem monotherapy, either ertapenem or meropenem, and the combination of ceftriaxone with metronidazole. Most patients (81,3%) were treated with regimens that did not meet the above-mentioned guideline recommendations. It should be noted, however, that regimens reported only as ‘broad-spectrum antibiotics’ (17.8%) were not classified as guideline-adherent, as the specific agents used were not specified. Upon exclusion of these non-specified broad-spectrum regimens from the analysis, 77.2% of patients remained treated with therapies not concordant with current guideline recommendations. 3.6 Resistance patterns Only seven studies reported antimicrobial resistance patterns and their findings highlighted notable resistance among isolated pathogens. Specifically, He et al.( 21 ) found that 35% of Gram-negative bacilli were resistant to third-generation cephalosporins, and all Staphylococcus haemolyticus isolates were methicillin-resistant. Chalya et al. ( 22 ) observed that most pathogens had multiple resistances, with 100% susceptibility only to meropenem and imipenem. Simsek et al. ( 23 ) documented a single case of methicillin-resistant Staphylococcus aureus (MRSA) among 20 patients, while Akilov et al. ( 24 ) reported three MRSA cases in a series of 28 patients. Yilmazlar et al. ( 25 ) reported high resistance rates to common antibiotics, including 64% of the pooled isolates resistant to ampicillin-sulbactam, 44% to ciprofloxacin and levofloxacin, and 42% to cefazolin. Castillejo et al. ( 26 ) similarly noted that 13 of 23 isolates were resistant to at least one antibiotic, most frequently ampicillin, trimethoprim-sulfamethoxazole, clindamycin, and levofloxacin. Finally, Hong et al. ( 27 ) reported that 22.9% of isolates were multidrug resistant, although no further details were provided. 4 Discussion This systematic review provides a comprehensive overview of real-world antimicrobial regimens and microbiology in Fournier’s gangrene. We synthesized data from 88 studies across four continents, encompassing 4,257 patients. Our analysis confirms that Fournier’s gangrene is usually a polymicrobial infection. About 66% of cases had polymicrobial cultures, typically involving a mix of aerobic and anaerobic bacteria from skin, genitourinary, or colorectal sources. This finding is in line with classic teachings that Fournier’s gangrene is synergistic necrotizing fasciitis caused by multiple organisms ( 28 ). Escherichia coli was the most common organism identified, accounting for 31% of all isolates in wound cultures. Other frequently isolated aerobes included streptococcal species (~ 11% of cases ), Staphylococcus aureus (~ 7%), Pseudomonas aeruginosa (~ 7%), and Enterobacteriaceae such as Klebsiella spp. and Proteus . Notably, our review found Candida (fungal) isolates in 2% of cases. While fungi accounted for only a small fraction of isolates, their presence in a few cases highlights that clinicians should remain vigilant – if an Fournier’s gangrene patient fails to improve on broad antibacterial therapy, an undetected fungal co-infection or resistant organism could be contributors ( 28 ). The fact that one-third of infections were monomicrobial in culture is notable. In some instances, a single pathogen can drive Fournier’s gangrene. MRSA-only cases of Fournier’s gangrene have been documented in the literature as an emerging phenomenon ( 29 ). However, monomicrobial culture results can also arise from prior antibiotic administration or suboptimal culture techniques that miss fastidious co-pathogens. Only a limited number of studies provided detailed information on the specimen source of isolated pathogens; for example, positive blood cultures were reported in just five studies. Given the high mortality of Fournier’s gangrene and the central role of sepsis as the leading cause of death, bloodstream infections would be expected to be more frequently documented ( 30 ). It is therefore likely that the low reported rates of positive blood cultures may not reflect the true incidence but are attributable to inconsistent reporting and, in some settings, the absence of blood culture testing owing to limited resources or restrictive testing practices, particularly in low- and middle-income countries ( 31 ). To address this gap, more rigorous and standardized reporting is needed. With this regard, tools such as the Microbiology Investigation Criteria for Reporting Objectively (MICRO) checklist may facilitate improved quality and consistency in the reporting of microbiological findings ( 32 ). Despite these restrictions, the microbiology data in this review echo longstanding recommendations: empiric therapy must target all likely organisms. In practical terms, that means coverage for enteric Gram-negatives, Gram-positive skin flora and anaerobes from GI or perineal sources. Empiric antibiotic regimens were very heterogeneous, reflecting both the breadth of organisms involved, the evolution of treatment paradigms over time and epidemiological characteristics. In our compiled data (57 studies reporting regimens for 2958 patients), combination therapy was the norm. The most frequently documented regimen was a triple-drug combination of ceftriaxone + an aminoglycoside + metronidazole, used in about 29% of patients. Eighteen percent received ceftriaxone + metronidazole without an aminoglycoside – a regimen that covers many Gram-negatives and anaerobes but lacks P. aeruginosa and methicillin-resistent S. aureus coverage. Carbapenems were also frequently utilized, often in combination with other agents. Notably, about 6% of patients received a carbapenem combined with vancomycin. This regimen is very broad, effectively covering Gram-negatives (including most ESBL-producers), anaerobes, and MRSA. The use of single-agent therapy was distinctly uncommon – only isolated reports of monotherapy with meropenem, imipenem, or ertapenem (< 1% each) were found. This might underscore the widespread clinical perception that no single antibiotic is usually sufficient for Fournier’s gangrene. Even in the few monotherapy cases, the agents used (carbapenems) were ones with a very broad spectrum. When comparing the reported regimens with the treatment guidelines most used in urological practice, it becomes evident that adherence to guideline-recommended therapy is limited in published clinical practice. Indeed, only 4 out of 22 distinct antibiotic regimens reported (18%) were consistent with the current guideline recommendations. However, it is important to note that many of the included studies were retrospective and some pre-dated the latest guidelines, which could partly explain this gap. Moreover, 73.6% of the included patients were from the Middle East, Africa, and Asia, and may have been treated according to local antimicrobial stewardship recommendations that may not be publicly available. These regimens are likely informed by regional epidemiological characteristics and resistance patterns, whereas the guidelines used to assess adherence are based primarily on Western epidemiology ( 33 ). Additionally, in resource-limited settings, clinicians may have used what was readily available rather than boradspectrum agents. This is particularly relevant as the majority of included studies originated from low and middle-income countries, where access to newer antimicrobial therapies may be constrained ( 34 , 35 ). Also, in these countries resources for proper microbiological assessment may be limited. Finally, besides epidemiologic and economic factors, the choice of antibiotic therapy may also be influenced by patient-specific factors, such as drug allergies, potential drug-drug interactions, etc. Non-guideline regimens may translate to worse outcomes if key pathogens are missed, however the heterogeneity and lack of data did not allow an according analysis. Antibiotic resistance in Fournier’s gangrene pathogens is an important finding in this review. Although only seven studies reported resistance patterns, their results consistently highlight the threat of drug-resistant organisms. For example, one series noted that 35% of Gram-negative bacilli in Fournier’s gangrene were resistant to third-generation cephalosporins, and all Staphylococcus haemolyticus isolates were methicillin-resistant. These results align with other reports, indicating an increasing rate of multidrug-resistant pathogens in Fournier’s gangrene ranging from 11 to 22% ( 29 , 33 , 36 ). Given global trends in antimicrobial resistance, it is reasonable to expect resistance patterns in Fournier’s gangrene to rise further in the coming years, and clinicians should (i) rigorously test and screen for antimicrobial resistance and (ii) maintain heightened vigilance when selecting empiric regimens and, whenever possible, base therapy on local resistance data ( 37 ). Only four studies specified treatment duration, with a median of 15.8 days. Guidelines do not provide a firm recommendation on duration specific to Fournier’s gangrene, instead suggesting that antibiotics be continued until source control is achieved and the patient is stable ( 6 , 7 ). The lack of more robust data on optimal duration represents an evidence gap – prolonged courses are often used due to the catastrophic nature of inadequately treated necrotizing infection, but it remains unclear if long courses confer additional benefit once the source is controlled. However, unnecessarily extended therapy may increase the risk of antimicrobial resistance, side effects and risk for Clostridial infection, underscoring the need for future studies to define the optimal duration of antibiotic treatment ( 38 ). This review has several important limitations. First, many included studies were observational and their retrospective nature makes them prone to selection bias and confounding and the few prospective studies were at moderate to critical risk of bias. Second, there was significant heterogeneity among studies in terms of patient populations, settings, and data reported. Additionally, some studies only vaguely described their antibiotic regimens (e.g. “broad-spectrum antibiotics”), which made it difficult to assess guideline adherence or compare efficacy. Third, geographical clustering with a predominance of low- to middle income countries (73.6% of included patients) may influence aggregate outcomes and patterns. Fourth, the time span covered by the included studies (1984–2024) is another source of variability. Over 40 years, there have been substantial changes in medical practice, including the advent of new antibiotics and antimicrobial resistance has also generally increased over time. However, despite increasing antimicrobial resistance over time, reported mortality has declined over the past decades ( 2 , 39 ). Because we included studies from a wide range of years and regions, the aggregate results may not reflect any single healthcare system. These limitations suggest caution in interpreting the pooled results of our study and highlight the need for more prospective, standardized research on Fournier’s gangrene to guide evidence-based practice. 5 Conclusion Fournier’s gangrene is a predominantly polymicrobial infection with E. coli as the leading pathogen, yet antimicrobial regimens reported in the literature were heterogeneous and largely not guideline concordant. Resistance to commonly used antibiotics was frequent. Future prospective, standardized studies are needed to define optimal antimicrobial strategies, incorporate harmonized sampling protocols to improve comparability of microbiological data, and align practice more closely with guideline recommendations. These strategies should also account for local epidemiology and geographic variation in pathogen distribution and resistance patterns, to inform appropriate empiric regimens and subsequent de-escalation. Declarations Declarations Ethics approval and consent to participate: Not applicable. This study is a systematic review of published aggregate data and involved no direct human participants or identifiable individual-level information; therefore, ethics committee/IRB approval and informed consent were not required under national regulations and institutional policies. Supplementary Table 1 Detailed PubMed search strategy (MeSH terms and free-text keywords) used to identify studies. 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Dis Colon Rectum 46(5):649–652 Atakan IH, Kaplan M, Kaya E, Aktoz T, Inci O (2002) A life-threatening infection: Fournier’s gangrene. Int Urol Nephrol 34(3):387–392 Norton KS, Johnson LW, Perry T, Perry KH, Sehon JK, Zibari GB (2002) Management of Fournier’s Gangrene: An Eleven Year Retrospective Analysis of Early Recognition, Diagnosis, and Treatment. Am Surg 68(8):709–713 Villanueva-Sáenz E, Martínez Hernández-Magro P, Valdés Ovalle M, Montes Vega J, Alvarez-Tostado FJF (2002) Experience in management of Fournier’s gangrene. Tech Coloproctol 6(1):5–10 discussion 11 Corman, Moody A (1999) Fournier’s gangrene in a modern surgical setting: improved survival with aggressive management. BJU Int 84(1):85–88 Aşci R, Sarikaya S, Büyükalpelli R, Yilmaz AF, Yildiz S (1998) Fournier’s gangrene: risk assessment and enzymatic debridement with lyophilized collagenase application. Eur Urol 34(5):411–418 Hollabaugh RS Jr, Dmochowski RR, Hickerson WL, Cox CE (1998) Fournier’s gangrene: therapeutic impact of hyperbaric oxygen. Plast Reconstr Surg 101(1):94–100 Hejase MJ, Simonin JE, Bihrle R, Coogan CL (1996) Genital fournier’s gangrene: experience with 38 patients. Urology 47(5):734–739 Patrick Spirnak J, Resnick MI, Hampel N, Persky L (1984) Fournier’s Gangrene: Report of 20 Patients. J Urol 131(2):289–291 Additional Declarations No competing interests reported. Supplementary Files SupplementaryTables.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 06 May, 2026 Reviews received at journal 11 Apr, 2026 Reviewers agreed at journal 09 Mar, 2026 Reviewers invited by journal 16 Feb, 2026 Editor assigned by journal 12 Feb, 2026 Submission checks completed at journal 12 Feb, 2026 First submitted to journal 09 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8829364","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":593548913,"identity":"a78da498-0fd9-4a3f-b9e1-ee4f385d303b","order_by":0,"name":"Fabian Joel Aschwanden","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDElEQVRIie2PsUoDQRCG5xBMs8F2t4j3CnsE7giJ5FXuEExz5hVcCEwa00cs8gprF7tdFrS59HekMb0RLEMu4Io2opuktNivGIYfPv4ZAI/nH9IQBNTXSj7HiY1GIhB25Q6FqF8K0YcV+KnQ7IDSWGi1mUMYjhdPdDPvnidshWxaQ5i4FDJM9aSASBbDKzYpBu3OfYbsASF6FH8rfci5aiIEkpK4bKLJ5NIqKwEpV46Ws1eudwj92ZTE1Q7Njaw0spd6j0JzbmxLJkoSL21LyssAmTzdp7ylpoX0UhZ5sm3hwD6VjTp3SCPpPOzavK+xdzEbF+1ojd2QPxtd3da90NXyDT0i8Xg8Hs/xfAAfrGGRN1PbogAAAABJRU5ErkJggg==","orcid":"","institution":"University Teaching and Research Hospital of the University of Lucerne","correspondingAuthor":true,"prefix":"","firstName":"Fabian","middleName":"Joel","lastName":"Aschwanden","suffix":""},{"id":593548917,"identity":"0d0ecb07-ffa9-49d7-b298-771361440ae6","order_by":1,"name":"Laura Wimmer","email":"","orcid":"","institution":"University Hospital 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Lucerne","correspondingAuthor":false,"prefix":"","firstName":"Sonja","middleName":"","lastName":"Bertschy","suffix":""},{"id":593548942,"identity":"178bcebc-f40e-4390-b41e-813b0f705e33","order_by":8,"name":"Adrian Egli","email":"","orcid":"","institution":"University of Zurich","correspondingAuthor":false,"prefix":"","firstName":"Adrian","middleName":"","lastName":"Egli","suffix":""},{"id":593548948,"identity":"afe471a1-443b-4e01-9a81-412e0e675438","order_by":9,"name":"Christian Daniel Fankhauser","email":"","orcid":"","institution":"University Teaching and Research Hospital of the University of Lucerne","correspondingAuthor":false,"prefix":"","firstName":"Christian","middleName":"Daniel","lastName":"Fankhauser","suffix":""},{"id":593548951,"identity":"f55b8f80-07d0-4d49-b303-6631fe767766","order_by":10,"name":"Laila Schneidewind","email":"","orcid":"","institution":"University Hospital Bern, Inselspital, University of Bern","correspondingAuthor":false,"prefix":"","firstName":"Laila","middleName":"","lastName":"Schneidewind","suffix":""}],"badges":[],"createdAt":"2026-02-09 10:53:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8829364/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8829364/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103166051,"identity":"5d3cf643-dd62-4964-9fb3-6bd4f2b599ef","added_by":"auto","created_at":"2026-02-22 12:36:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1363944,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flow diagram\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8829364/v1/95e6029b58e160766d7cce49.png"},{"id":103504369,"identity":"a1d7f22b-fcab-41bf-a605-bd171d0f6152","added_by":"auto","created_at":"2026-02-26 13:19:32","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":344470,"visible":true,"origin":"","legend":"\u003cp\u003eRisk of bias assessment of included prospective studies using the ROBINS-I V2 tool.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8829364/v1/ffcc21fde03f27a7b82439a0.png"},{"id":103504605,"identity":"fe91c947-f736-4725-9730-11803beaa3f2","added_by":"auto","created_at":"2026-02-26 13:20:43","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":74529,"visible":true,"origin":"","legend":"\u003cp\u003eGeographic origin of included studies; bubble size represents the number of patients per country , and color denotes region (yellow = North America; blue = Central America; violet = Africa; dark green = Europe; green = Middle East; dark blue = Asia)\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8829364/v1/e897a8a2cdf89f61409dfbc8.png"},{"id":103509046,"identity":"36e87c99-bcf6-4bcc-bb07-6920938418c0","added_by":"auto","created_at":"2026-02-26 13:56:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3611699,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8829364/v1/69308b6b-e4a2-48fb-836e-5ff61bf1d2ed.pdf"},{"id":103166049,"identity":"5dcb2dd9-7859-4cb3-ae1a-c097f85202d1","added_by":"auto","created_at":"2026-02-22 12:36:35","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":89810,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTables.docx","url":"https://assets-eu.researchsquare.com/files/rs-8829364/v1/4843f729e87085bb321844bc.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Microbiological characteristics and real-world antibiotic therapy regimens in Fournier Gangrene: A systematic review","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eFournier\u0026rsquo;s gangrene is a rare but life-threatening necrotising fasciitis of the perineal, genital, and perianal regions, with an estimated incidence of approximately 1.6 per 100 000 population. Common predisposing comorbidities include diabetes mellitus, obesity, cardiovascular disease, renal or hepatic impairment, malignancy, and alcohol misuse. It is characterised by a fulminant, rapidly progressive infection that tracks along fascial planes (including the Dartos, Colles\u0026rsquo;, and Scarpa\u0026rsquo;s fascia), leading to extensive soft-tissue necrosis, sepsis and septic shock. Despite antimicrobial therapy, prompt surgical debridement, and intensive care support, outcomes remain poor, with reported case-fatality rates ranging from 7.5% to 40% (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003eMicrobiologically, Fournier\u0026rsquo;s gangrene is typically polymicrobial, involving both aerobic and anaerobic bacteria, which is in contrast to classical, non-Fournier necrotizing fasciitis, which is more commonly monobacterial (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e).Frequently isolated organisms include \u003cem\u003eEscherichia coli\u003c/em\u003e, \u003cem\u003eStreptococcus\u003c/em\u003e spp., \u003cem\u003eStaphylococcus\u003c/em\u003e spp., and anaerobes such as \u003cem\u003eBacteroides fragilis\u003c/em\u003e (\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e). However, the current body of microbiological evidence is derived primarily from retrospective single-center case series or small cohorts, limiting generalizability.\u003c/p\u003e\n\u003cp\u003eThe management of Fournier\u0026rsquo;s gangrene is centered on three therapeutic cornerstones: hemodynamic resuscitation, urgent radical surgical debridement to reduce pathogen load, and empiric broad-spectrum antibiotic therapy. Contemporary international urological and infectious diseases guidelines recommend empiric regimens including carbapenems or piperacillin\u0026ndash;tazobactam, frequently combined with clindamycin (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Notably, there is marked heterogeneity and variability among international guidelines regarding empiric antibiotic regimens and duration of therapy, and some major societies - including the American Urological Association (AUA) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) - do not provide specific recommendations (\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eOverview of the current guideline recommendations for antibiotic therapy and duration in Fournier\u0026rsquo;s gangrene .\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003e\u003cstrong\u003eAntimicrobial\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e\u003cstrong\u003eDosage\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\n\u003cp\u003e\u003cstrong\u003eDuration of antibiotic therapy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eEAU recommendations (2025)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003ePiperacillin-tazobactam plus\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e4.5 g q.i.d or t.i.d iv\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eVancomycin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e15 mg/kg b.i.d\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eImipenem-cilastatin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003eStandard dosage: 0.5 g iv q.i.d over 30 minutes, High dosage: 1 g iv q.i.d over 30 minutes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eMeropenem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e1 g t.i.d iv\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eErtapenem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e1 g o.d\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eGentamicin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e6-7 mg/kg iv q.d\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eCefotaxime plus\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e2 g q.i.d iv\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eMetronidazole or\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e500 mg q.i.d iv\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eClindamycin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e600-900 mg t.i.d iv\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eCefotaxime plus\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e2 g q.i.d iv\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eFosfomycin plus\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e5 g t.i.d iv\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eMetronidazole\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e500 mg q.i.d iv\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eIDSA recommendations (2014)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\n\u003cp\u003eNo necessity for further debridement, clinical improvement, afebrile for 48-72h\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003ePiperacillin-tazobactam plus\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e3.37 q.i.d or t.i.d iv\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eVancomycin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e15 mg/kg b.i.d\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eImipenem-cilastatin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e1g q.i.d or t.i.d iv\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eMeropenem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e1g b.i.d\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eErtapenem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e1g o.d iv\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eCefotaxime plus\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e2g q.i.d iv\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eMetronidazole or\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e500 mg q.i.d iv\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eClindamycin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e600-900 mg t.i.d iv\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eESES/SIS-E Consensus (2018)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"399\"\u003e\n\u003cp\u003e\u003cem\u003e\"The initial empirical antibiotic regimen should comprise broad-spectrum drugs including anti-MRSA and anti-Gram-negative coverage\"\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\n\u003cp\u003eNo necessity for further debridement, clinical improvement, afebrile for 48-72h\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eAUA recommendations\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eNo recommendations provided\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eESCMID recommendations\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"199\"\u003e\n\u003cp\u003eNo recommendations provided\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"200\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"147\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable width=\"592\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"592\"\u003e\n\u003cp\u003e\u003cem\u003eiv = intravenous; b.i.d = twice daily; t.i.d = three times daily; q.i.d = four times daily, q.d = every day; o.d = once daily.\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"592\"\u003e\n\u003cp\u003e\u003cem\u003eEAU = European Association of Urology\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIDSA = Infectious Diseases Society of America\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAUA = American Association of Urology\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eESCMID = European Society of Clinical Microbiology and Infectious Diseases \u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"592\"\u003e\n\u003cp\u003e\u003cem\u003eWSES/SIS-E = World Society of Emergency Surgery / Surgical Infection Society Europe \u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eReal-world prescribing practices and the actual microbiological spectrum underlying Fournier\u0026rsquo;s gangrene remain poorly characterized. Given the rarity of the disease, literature remains heavily weighted toward observational reports. Consequently, recommendations for empiric antibiotic therapy continue to rely largely on expert opinion or extrapolations from small case series. To address this gap, we conducted a systematic review to synthesize the published evidence on microbiological characteristics and real-world antibiotic therapy in Fournier\u0026rsquo;s gangrene. Hereby, we provide a comprehensive overview of pathogens, antimicrobial resistances, and empiric antibiotic regimens, thereby strengthening the evidence base for future clinical guidelines. Finally, we add an outlook for future studies aiming at investigating microbiological characteristics and antimicrobial therapy strategies in Fournier\u0026rsquo;s gangrene .\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003e2.1 Literature search strategy\u003c/h2\u003e\n\u003cp\u003eThis systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines (\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e) and the recommendations provided in the Cochrane Handbook of systematic reviews (\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e) and was prospectively registered in the PROSPERO international prospective register of systematic reviews (registration ID: [CRD 42023489596]). We systematically searched PubMed/MEDLINE and the Cochrane Library. The search was conducted in May 2025. To provide the most comprehensive overview possible, no time restrictions regarding year of publication were applied. The detailed search strategy and MeSH terms are provided in the Supplementary Appendix (\u003cstrong\u003eTable S1\u003c/strong\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003e2.2 Eligibility criteria\u003c/h2\u003e\n\u003cp\u003eWe included studies reporting original clinical data on adult patients with Fournier\u0026rsquo;s gangrene that provided:\u003c/p\u003e\n\u003cp\u003e1) Microbiological results from wound, blood, urine, or other cultures, and/or\u003c/p\u003e\n\u003cp\u003e2) Antibiotic therapy data\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eEligible designs were retrospective or prospective cohorts, registry studies, and case series with \u0026ge;\u0026thinsp;20 patients. We excluded single case reports, conference abstracts, non-clinical studies, and studies without extractable microbiological or antibiotic data. Only articles published in peer-reviewed English literature were considered.\u003c/p\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003e2.3 Study selection\u003c/h2\u003e\n\u003cp\u003eTwo reviewers (L.W. and F.A.) independently screened titles and abstracts. Full-text articles were retrieved for studies meeting eligibility criteria or in cases of uncertainty. Disagreements were resolved by a third reviewer (L.S.).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003e2.4 Data extraction\u003c/h2\u003e\n\u003cp\u003eData was independently extracted by two reviewers (L.W. and F.A.) using a priori defined standardized template. Any discrepancies were resolved by a third reviewer (L.S.). The online platform Covidence (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.covidence.org/\u003c/span\u003e\u003c/span\u003e; Veritas Health Innovation Ltd, Melbourne, Australia) was used for the screening and data extraction process. Extracted variables included study characteristics (such as study design, year of publication, geographic origin, sample size), patient demographics and comorbidities, microbiological findings (e.g. pathogen type, antimicrobial resistances), antibiotic therapy (e.g. applied regimens, duration of antibiotic therapy) and outcomes (e.g. mortality).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003ch2\u003e2.5 Study quality assessment\u003c/h2\u003e\n\u003cp\u003eRisk of bias assessment was performed for prospective studies, using the ROBINS-I V2 tool (Risk Of Bias In Non-randomized Studies of Interventions) (\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e). The assessment was performed by two independent review authors (L.W. and A.A.) and any disagreement was resolved by a third author (L. S.). Given the well-recognized susceptibility of retrospective observational case-series to bias, we did not undertake a formal risk-of-bias assessment for retrospective studies (\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003e2.6 Evidence synthesis\u003c/h2\u003e\n\u003cp\u003eDespite considerable heterogeneity among study designs, patient populations, and outcome reporting, we conducted a quantitative synthesis of the results where appropriate. This pooling of data was undertaken primarily for descriptive purposes, as differences in study design and reporting standards limited formal comparative analysis. Summary statistics were calculated at the study level unweighted by sample size. The aggregated data are presented in tables or summary figures that illustrate the overall distribution of pathogens and the antibiotic strategies across the studies.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003e3.1 Study selection\u003c/h2\u003e\n\u003cp\u003eThe search yielded 3366 records; after deduplication 3136 remained. Following title/abstract screening, 156 full texts were reviewed; 88 studies were included. A PRISMA 2020 flow diagram is provided in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003e3.2 Quality assessment\u003c/h2\u003e\n\u003cp\u003eRisk of bias was evaluated for all prospective studies using the ROBINS-I V2 framework (\u003cstrong\u003eSupplementary Table S2\u003c/strong\u003e). Overall risk ranged from moderate to critical across studies. Most studies were rated as having a serious or critical bias (83.3%), primarily because of confounding and selection biases related to non-randomized treatment allocation. Across all studies, the risk of bias related to classification of interventions and deviations from intended interventions was generally low. In contrast, measurement of outcomes and selective reporting were frequently judged as moderate, as outcome assessment was typically unblinded and few studies had pre-published protocols. A visual summary of the domain-level assessments is provided in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e (\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n\u003ch2\u003e3.3 Study characteristics\u003c/h2\u003e\n\u003cp\u003eThe 88 studies (1984\u0026ndash;2024) enrolled 4229 patients (median sample size 40, (Interquartile range (IQR) [30\u0026ndash;556]); 71.6% were male, the mean age was 53.9 years, (standard deviation (SD) 5.4). Most studies included retrospective cohorts (94%), while only 6% were prospective studies. The included studies were conducted across North and Central America, Europe, Africa, Asia, and the Middle East. Most patients originated from the Middle East, Asia, and Africa, which together accounted for 73.6% of the study population (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). European cohorts contributed 14.8% of patients, North American studies 10.0%, and Central American studies 1.5%. Across the included studies, the median Fournier\u0026rsquo;s Gangrene Severity Index was 6.2 (IQR [5.7\u0026ndash;6.9]), the median mortality was 17% (IQR [9.3\u0026ndash;22.0]), the median hospital length of stay was 23.7 days (IQR [17.0\u0026ndash;32.8]) and the mean duration of symptoms prior to admission was 6.7 days (SD 2.7). An overview of the main study characteristics is presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eOverview and characteristics of all included studies (n\u0026thinsp;=\u0026thinsp;88)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAuthor\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eYear\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCountry\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSample size (n)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003emean age (y)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePolymicrobial infection (% of cohort)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSterile infections\u003c/p\u003e\n\u003cp\u003e(% of cohort)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFungal infections\u003c/p\u003e\n\u003cp\u003e(% of cohort)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMost frequent pathogen\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal duration of antibiotic therapy (days)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAdministered antibiotic regimen\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAntibiotic resistances\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean length of stay\u003c/p\u003e\n\u003cp\u003e(days)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMortality rate\u003c/p\u003e\n\u003cp\u003e(%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eKundan (\u003cspan class=\"CitationRef\"\u003e40\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2024\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIndia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e156\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAmoxiclav \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8,6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHong (\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2024\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eKorea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22.9% multi drug resistant bacteria\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e45,3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e17,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWirjopranoto (\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2024\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIndonesia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e123\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e52,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e30,2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10,6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e17,9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYou (\u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2024\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChina\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21,7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e17,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6,5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHe (\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChina\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e48,5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2,8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCarbapenem \u0026amp; Vancomycin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGram negative bacilli resistance to 3rd generation cephalosporins 35%, all \u003cem\u003eStaphylococcus haemolyticus\u003c/em\u003e methicillin resistant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e44,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAl-Kohlany (\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYemen\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65,8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5,4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMahmood (\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEgypt\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e59,6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBroad spectrum antibiotics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19,7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUcaner (\u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePiperacillin/Tazobactam\u003c/p\u003e\n\u003cp\u003eMeropenem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTuncer (\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e16,7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e22,5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19,7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVilela (\u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePortugal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eS. aureus\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eShiratori (\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eJapan\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19,4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTopuz\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56,4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePiperacillin/Tazobactam\u003c/p\u003e\n\u003cp\u003eCiprofloxacin \u0026amp; Metronidazol\u003c/p\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Metronidazol\u003c/p\u003e\n\u003cp\u003eMeropenem\u003c/p\u003e\n\u003cp\u003eErtapenem\u003c/p\u003e\n\u003cp\u003eImipenem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12,5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWirjopranoto (\u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIndonesia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e135\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9,6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6,7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eK. pneumoniae\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eP. aeroginosa\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone\u003c/p\u003e\n\u003cp\u003eMetronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e17,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTutino (\u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eItaly\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62,7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e42,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4,4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13,1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eItaimi (\u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTunesia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP. aeroginosa\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e23,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNisbet (\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUSA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47,8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7,7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15,4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eStreptococcus\u003c/em\u003e spp.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStaphylococcus\u003c/em\u003e spp.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBensardi (\u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2021\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMorocco\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBroad spectrum antibiotics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7,1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGul (\u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2021\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e25,8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e27,3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAgwu (\u003cspan class=\"CitationRef\"\u003e54\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2020\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNigeria\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42,7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e34,1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e17,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCastillejo Becerra (\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2020\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUSA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e143\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e87,6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21,7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eStaphylococcus\u003c/em\u003e spp.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePiperacillin/Tazobactam \u0026amp; Clindamycin\u003c/p\u003e\n\u003cp\u003eCarbapenem \u0026amp; Vancomycin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMost\u003c/p\u003e\n\u003cp\u003epathogens had resistance to commonly used antibiotics\u003c/p\u003e\n\u003cp\u003esuch as ampicillin, trimethoprim-sulfamethoxazole,\u003c/p\u003e\n\u003cp\u003eclindamycin and levofloxacin.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLin (\u003cspan class=\"CitationRef\"\u003e55\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2019\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChina\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15,7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAhmed (\u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2019\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePakistan\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11,6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGarg (\u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2019\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIndia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56,3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12,7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8,3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWetterauer (\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2018\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSwitzerland\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e90,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCarbapenem \u0026amp; Clindamycin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eElsaket (\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2018\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSouth Africa\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCo-Amoxiclav \u0026amp; Metronidazol \u0026amp; Gentamicin\u003c/p\u003e\n\u003cp\u003eCo-Amoxiclav\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11,4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSockkalingam (\u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2018\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIndia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e79,4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eK. pneumoniae\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11,4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMeki (\u003cspan class=\"CitationRef\"\u003e59\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2018\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eZimbabwe\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBroad spectrum antibiotics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e27,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGhodoussipour (\u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2018\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUSA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54,3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e37,5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5,6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHahn (\u003cspan class=\"CitationRef\"\u003e61\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2018\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSouth Korea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54,4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24,1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e29,27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e47,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e22,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eY\u0026uuml;cel (\u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2017\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54,3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBroad spectrum antibiotics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21,4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYilmazlar (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2017\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58,5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e79,2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eThe highest bacterial resistance was observed against ampicillin-sulbactam (64%), followed by\u003c/p\u003e\n\u003cp\u003eciprofloxacin and levofloxacin (44%) and cefazolin (42%)\u003c/p\u003e\n\u003cp\u003e(74%).\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e22,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIoannidis (\u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2017\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGreece\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBacteroides\u003c/em\u003e spp.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePiperacillin/Tazobactam\u003c/p\u003e\n\u003cp\u003eCeftriaxone\u003c/p\u003e\n\u003cp\u003eCarbapenem\u003c/p\u003e\n\u003cp\u003eQuinolones\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e27,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20,8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHong (\u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2017\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSouth Korea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e61,8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e25,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTaken (\u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2016\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e25,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePenicillinG \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9,2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12,3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDoluoğlu (\u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2016\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54,7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20,5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eKincius (\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2016\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLithuania\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e59,4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e22,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChalya (\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2015\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTanzania\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e82,6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMost of pathogens had multiple\u003c/p\u003e\n\u003cp\u003eresistant to almost all tested antibiotics, except for\u003c/p\u003e\n\u003cp\u003emeropenem and imipenem, which were 10 % sensitive.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28,6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBozkurt (\u003cspan class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2015\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57,6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e37,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18,2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Metronidazol\u003c/p\u003e\n\u003cp\u003eCiprofloxacin \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9,1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOguz (\u003cspan class=\"CitationRef\"\u003e68\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2015\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e52,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTarchouli (\u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2015\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMorocco\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e84,1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e17,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePolistena (\u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2014\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eItaly\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBroad spectrum antibiotics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAvakoudjo (\u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2014\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBein Republic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e52,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBroad spectrum antibiotics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e72,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYilmazlar (\u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2014\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e120\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8,3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2,5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14,5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20,8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEskitaşcıoğlu (\u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2014\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53,5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e34,8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3,8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAliyu (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNigeria\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37,8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e81,8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13,2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15,8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBenjellounel (\u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMorocco\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eKatib (\u003cspan class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSaudi Arabia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePiperacillin/Tazobactam \u0026amp; Clindamycin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e22,3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSarvestani (\u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIran\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44,6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e17,2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35,7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAkilov (\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCanada\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46,7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eStaphylococcus\u003c/em\u003e spp.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBroad spectrum antibiotics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 patients with MRSA bacteremia.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24,4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVerma (\u003cspan class=\"CitationRef\"\u003e77\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2012\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIndia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e95\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e52,6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e23,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e27,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAridogan (\u003cspan class=\"CitationRef\"\u003e78\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2012\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e71\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e61,3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e80,3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18,3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e27,4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e29,6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWang (\u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2012\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChina\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48,8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBroad spectrum antibiotics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e40,6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20,8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAltarax\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2012\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSwitzerland\u003c/p\u003e\n\u003cp\u003eCoratia\u003c/p\u003e\n\u003cp\u003eSlovenia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e83,8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eStreptococcus\u003c/em\u003e spp.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBroad spectrum antibiotics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e37,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMartinschek (\u003cspan class=\"CitationRef\"\u003e80\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2012\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGermany\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eC. perfiringens\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBroad spectrum antibiotics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e16,4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUgwumba (\u003cspan class=\"CitationRef\"\u003e81\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2012\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNigeria\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48,3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e37,1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3,6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSimsek (\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2011\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e52,2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 case of MRSA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eKoukouras (\u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2011\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGermany\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBroad spectrum antibiotics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15,7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15,6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGarc\u0026iacute;a Mar\u0026iacute;n (\u003cspan class=\"CitationRef\"\u003e83\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2011\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSpain\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePiperacillin/Tazobactam\u003c/p\u003e\n\u003cp\u003eCiprofloxacin \u0026amp; Metronidazol\u003c/p\u003e\n\u003cp\u003eMeropenem\u003c/p\u003e\n\u003cp\u003eMeropenem \u0026amp; Vancomycin\u003c/p\u003e\n\u003cp\u003eImipenem\u003c/p\u003e\n\u003cp\u003ePenicillinG \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003cp\u003ePenicillin \u0026amp; Gentamicin \u0026amp; Clindamycin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e29,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChen (\u003cspan class=\"CitationRef\"\u003e84\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTaiwan\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBroad spectrum antibiotics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChen (\u003cspan class=\"CitationRef\"\u003e85\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTaiwan\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57,2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75,8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBroad spectrum antibiotics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19,5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCzymek (\u003cspan class=\"CitationRef\"\u003e86\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGermany\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57,7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e62,1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21,1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLuj\u0026aacute;n (\u003cspan class=\"CitationRef\"\u003e87\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSpain\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e33,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e16,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMartinez-Rodriguez (\u003cspan class=\"CitationRef\"\u003e88\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSpain\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e39,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUllah (\u003cspan class=\"CitationRef\"\u003e89\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePakistan\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e31,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCzymek (\u003cspan class=\"CitationRef\"\u003e90\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGermany\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57,7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e87,5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8,6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e65,3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCzymek (\u003cspan class=\"CitationRef\"\u003e91\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGermany\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e86,7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9,1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18,2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSaffle (\u003cspan class=\"CitationRef\"\u003e92\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2008\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUSA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54,3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBroad spectrum antibiotics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e25,3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e16,6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGhnnam (\u003cspan class=\"CitationRef\"\u003e93\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2008\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEgypt\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e64,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9,2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21,6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRajput (\u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2008\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIndia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eBacteroides\u003c/em\u003e spp.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePenicillin \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26,6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBhatnagar (\u003cspan class=\"CitationRef\"\u003e95\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2008\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIndia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e110\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19,3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12,8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eKabay (\u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2008\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e61,4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003cp\u003ePenicillinG \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e27,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e40,3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCakmak (\u003cspan class=\"CitationRef\"\u003e97\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2008\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50,8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e29,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4,6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24,4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e27,7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eErsay (\u003cspan class=\"CitationRef\"\u003e98\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2007\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46,2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eStreptococcus\u003c/em\u003e spp.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e22,8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBasoglu (\u003cspan class=\"CitationRef\"\u003e99\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2007\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e32,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8,9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFerreira (\u003cspan class=\"CitationRef\"\u003e100\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2007\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePortugal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56,6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e82,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eS. aureus\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e73,6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2,3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTahmaz (\u003cspan class=\"CitationRef\"\u003e101\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2006\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e33,4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePenicillinG \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21,7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9,1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAyan (\u003cspan class=\"CitationRef\"\u003e102\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2005\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57,3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e39,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e22,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eJeong (\u003cspan class=\"CitationRef\"\u003e103\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2005\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eKorea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55,3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e41,2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eKorkut (\u003cspan class=\"CitationRef\"\u003e104\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2003\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54,6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAtakan (\u003cspan class=\"CitationRef\"\u003e105\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50,3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBroad spectrum antibiotics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e43,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNorton (\u003cspan class=\"CitationRef\"\u003e106\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUSA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51,5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15,2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eBacteroides\u003c/em\u003e spp.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21,1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVillanueva-S\u0026aacute;enz (\u003cspan class=\"CitationRef\"\u003e107\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMexico\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57,8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10,7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003cp\u003eImipenem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35,6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDahm (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUSA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56,3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e22,4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCorman (\u003cspan class=\"CitationRef\"\u003e108\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1999\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUSA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51,7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAşci (\u003cspan class=\"CitationRef\"\u003e109\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1998\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTurkey\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eE.Coli\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e30,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14,7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHollabaugh (\u003cspan class=\"CitationRef\"\u003e110\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1998\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUSA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e95,8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7,7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eE.Coli\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e23,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHejase (\u003cspan class=\"CitationRef\"\u003e111\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1996\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMexico / USA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5,3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCeftriaxone \u0026amp; Aminoglycoside \u0026amp; Metronidazol\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e17,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSpirnak (\u003cspan class=\"CitationRef\"\u003e112\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1984\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUSA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54,6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBroad spectrum antibiotics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e73,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e45,0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n\u003ch2\u003e3.4 Microbiology\u003c/h2\u003e\n\u003cp\u003eMicrobiological data were reported in 80 studies, providing microbiological results for 1,883 patients. Among these, 66% of infections were polymicrobial, while 34% were monomicrobial. Sterile wound cultures were documented in 4% of cases, and fungal pathogens were isolated in 2%, with \u003cem\u003eCandida albicans\u003c/em\u003e accounting for 49.3% of all fungal isolates.\u003c/p\u003e\n\u003cp\u003eBacterial pathogens predominated (97.9%). \u003cem\u003eEscherichia coli\u003c/em\u003e was the most frequently reported organism, identified in 30.7% of cases, followed by \u003cem\u003eStreptococcus\u003c/em\u003e spp. (10.9%), \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (6.8%), \u003cem\u003eBacteroides\u003c/em\u003e spp. (6.7%), and \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (6.3%). Other Gram-negative organisms included \u003cem\u003eKlebsiella spp.\u003c/em\u003e (4.0%), \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e (3.3%), \u003cem\u003eAcinetobacter\u003c/em\u003e spp. (3%) and \u003cem\u003eProteus\u003c/em\u003e spp. (2.9%). Other Gram-positive organisms were \u003cem\u003eEnterococcus\u003c/em\u003e spp. (4.1%) and Coagulase-negative staphylococci (5.1%). Less common isolates included \u003cem\u003eClostridium perfringens\u003c/em\u003e (1.3%), \u003cem\u003eCorynebacterium\u003c/em\u003e spp. (0.4%), \u003cem\u003eLactobacillus\u003c/em\u003e spp. (0.4%), \u003cem\u003eMorganella morganii\u003c/em\u003e (0.3%), and \u003cem\u003eStreptococcus pyogenes\u003c/em\u003e (0.2%).\u003c/p\u003e\n\u003cp\u003eAmong pathogen classes, Gram-negative bacteria accounted for 59.6% of isolates, Gram-positive bacteria for 32.1%, fungi, negative microbiological cultures and not further specified bacteria for the remaining 8.3%. An overview of the distribution of pathogens is provided in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003eA.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe specimen source of the isolated pathogens was rarely specified. Only five studies explicitly reported wound cultures, in which \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (63.8%), \u003cem\u003eAcinetobacter spp.\u003c/em\u003e (12.5%), and \u003cem\u003eEscherichia coli\u003c/em\u003e (12.5%) were the most frequently identified organisms. Less common isolates included \u003cem\u003eStreptococcus pyogenes\u003c/em\u003e (10.0%) and \u003cem\u003eProteus mirabilis\u003c/em\u003e (1.3%)(\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e). Bacteremia was documented in four studies, with \u003cem\u003eEscherichia coli\u003c/em\u003e (50.0%) as the predominant isolate, followed by \u003cem\u003eKlebsiella spp\u003c/em\u003e. (25.0%) and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (25.0%) (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e). Two studies reported positive urine cultures; however, only Elsaket et al. provided detailed pathogen distribution. In their cohort of 44 patients, 79.6% had positive urine cultures, with \u003cem\u003eEscherichia coli\u003c/em\u003e isolated in 63.6% and \u003cem\u003eProteus mirabilis\u003c/em\u003e in 15.9% of cases(\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n\u003ch2\u003e3.5 Antimicrobial regimens\u003c/h2\u003e\n\u003cp\u003eFifty-seven studies, including a total of 2,958 patients, reported empiric antimicrobial therapy regimens. No study reported targeted therapy regimens. Considerable heterogeneity was observed in empiric antibiotic choice, although broad-spectrum combinations predominated. A total of 22 different regimens were reported. The most frequently reported regimen was a combination of ceftriaxone plus an aminoglycoside and metronidazole, administered in 861 patients (29.1%). Other common regimens included ceftriaxone with metronidazole (18.1%) and broad-spectrum antibiotic combinations (17.8%) which were not further specified by the authors. Carbapenem containing regimens were also widely used, particularly carbapenem combined with vancomycin (6.1%) or carbapenem with clindamycin (0.6%). Piperacillin\u0026ndash;tazobactam, either alone (1.7%) or combined with clindamycin (5.5%), was reported in several cohorts. Less frequently described regimens included penicillin-based combinations such as penicillin plus metronidazole (1%); penicillin G with aminoglycoside and metronidazole (5.8%), and fluoroquinolone-based therapy such as ciprofloxacin with metronidazole (1.5%). Use of single-agent therapies was uncommon, with only sporadic reports of meropenem (0.5%), imipenem (0.6%), or ertapenem (0.1%) as monotherapy. The distribution of reported antibiotic regimens across the included studies is illustrated in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003eB.\u003c/p\u003e\n\u003cp\u003eA comprehensive table displaying the isolated pathogens and administered antibiotic therapies, and their frequency can be found in the supplementary materials (\u003cstrong\u003eTable S3\u003c/strong\u003e).\u003c/p\u003e\n\u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\n\u003ch2\u003e3.5.1 Duration of antimicrobial therapies\u003c/h2\u003e\n\u003cp\u003eThe duration of antibiotic therapy was specified in only four studies, with a reported median duration of 15.8 days (IQR 15.0\u0026ndash;16.4). None of the studies distinguished between intravenous and oral treatment duration.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\n\u003ch2\u003e3.5.2 Adherence to guideline recommendations\u003c/h2\u003e\n\u003cp\u003eAssessment of adherence to guideline-concordant therapy was available for all 22 reported antimicrobial regimens. Overall, only 4 regimens (18.7%) were consistent with recommendations issued by the European Association of Urology (EAU) or the Infectious Diseases Society of America (IDSA). These included carbapenem monotherapy, either ertapenem or meropenem, and the combination of ceftriaxone with metronidazole. Most patients (81,3%) were treated with regimens that did not meet the above-mentioned guideline recommendations. It should be noted, however, that regimens reported only as \u0026lsquo;broad-spectrum antibiotics\u0026rsquo; (17.8%) were not classified as guideline-adherent, as the specific agents used were not specified. Upon exclusion of these non-specified broad-spectrum regimens from the analysis, 77.2% of patients remained treated with therapies not concordant with current guideline recommendations.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n\u003ch2\u003e3.6 Resistance patterns\u003c/h2\u003e\n\u003cp\u003eOnly seven studies reported antimicrobial resistance patterns and their findings highlighted notable resistance among isolated pathogens. Specifically, He et al.(\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e) found that 35% of Gram-negative bacilli were resistant to third-generation cephalosporins, and all \u003cem\u003eStaphylococcus haemolyticus\u003c/em\u003e isolates were methicillin-resistant. Chalya et al. (\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e) observed that most pathogens had multiple resistances, with 100% susceptibility only to meropenem and imipenem. Simsek et al. (\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e) documented a single case of methicillin-resistant \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (MRSA) among 20 patients, while Akilov et al. (\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e) reported three MRSA cases in a series of 28 patients. Yilmazlar et al. (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e) reported high resistance rates to common antibiotics, including 64% of the pooled isolates resistant to ampicillin-sulbactam, 44% to ciprofloxacin and levofloxacin, and 42% to cefazolin. Castillejo et al. (\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e) similarly noted that 13 of 23 isolates were resistant to at least one antibiotic, most frequently ampicillin, trimethoprim-sulfamethoxazole, clindamycin, and levofloxacin. Finally, Hong et al. (\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e) reported that 22.9% of isolates were multidrug resistant, although no further details were provided.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThis systematic review provides a comprehensive overview of real-world antimicrobial regimens and microbiology in Fournier\u0026rsquo;s gangrene.\u003c/p\u003e \u003cp\u003eWe synthesized data from 88 studies across four continents, encompassing 4,257 patients. Our analysis confirms that Fournier\u0026rsquo;s gangrene is usually a polymicrobial infection. About 66% of cases had polymicrobial cultures, typically involving a mix of aerobic and anaerobic bacteria from skin, genitourinary, or colorectal sources. This finding is in line with classic teachings that Fournier\u0026rsquo;s gangrene is synergistic necrotizing fasciitis caused by multiple organisms (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). \u003cem\u003eEscherichia coli\u003c/em\u003e was the most common organism identified, accounting for 31% of all isolates in wound cultures. Other frequently isolated aerobes included streptococcal species (~\u0026thinsp;11% of cases\u003cem\u003e), Staphylococcus aureus\u003c/em\u003e (~\u0026thinsp;7%), \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (~\u0026thinsp;7%), and \u003cem\u003eEnterobacteriaceae\u003c/em\u003e such as \u003cem\u003eKlebsiella spp.\u003c/em\u003e and \u003cem\u003eProteus\u003c/em\u003e. Notably, our review found \u003cem\u003eCandida\u003c/em\u003e (fungal) isolates in 2% of cases. While fungi accounted for only a small fraction of isolates, their presence in a few cases highlights that clinicians should remain vigilant \u0026ndash; if an Fournier\u0026rsquo;s gangrene patient fails to improve on broad antibacterial therapy, an undetected fungal co-infection or resistant organism could be contributors (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The fact that one-third of infections were monomicrobial in culture is notable. In some instances, a single pathogen can drive Fournier\u0026rsquo;s gangrene. MRSA-only cases of Fournier\u0026rsquo;s gangrene have been documented in the literature as an emerging phenomenon (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). However, monomicrobial culture results can also arise from prior antibiotic administration or suboptimal culture techniques that miss fastidious co-pathogens.\u003c/p\u003e \u003cp\u003e Only a limited number of studies provided detailed information on the specimen source of isolated pathogens; for example, positive blood cultures were reported in just five studies. Given the high mortality of Fournier\u0026rsquo;s gangrene and the central role of sepsis as the leading cause of death, bloodstream infections would be expected to be more frequently documented (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). It is therefore likely that the low reported rates of positive blood cultures may not reflect the true incidence but are attributable to inconsistent reporting and, in some settings, the absence of blood culture testing owing to limited resources or restrictive testing practices, particularly in low- and middle-income countries (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). To address this gap, more rigorous and standardized reporting is needed. With this regard, tools such as the Microbiology Investigation Criteria for Reporting Objectively (MICRO) checklist may facilitate improved quality and consistency in the reporting of microbiological findings (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite these restrictions, the microbiology data in this review echo longstanding recommendations: empiric therapy must target all likely organisms. In practical terms, that means coverage for enteric Gram-negatives, Gram-positive skin flora and anaerobes from GI or perineal sources.\u003c/p\u003e \u003cp\u003eEmpiric antibiotic regimens were very heterogeneous, reflecting both the breadth of organisms involved, the evolution of treatment paradigms over time and epidemiological characteristics. In our compiled data (57 studies reporting regimens for 2958 patients), combination therapy was the norm. The most frequently documented regimen was a triple-drug combination of ceftriaxone\u0026thinsp;+\u0026thinsp;an aminoglycoside\u0026thinsp;+\u0026thinsp;metronidazole, used in about 29% of patients. Eighteen percent received ceftriaxone\u0026thinsp;+\u0026thinsp;metronidazole without an aminoglycoside \u0026ndash; a regimen that covers many Gram-negatives and anaerobes but lacks \u003cem\u003eP. aeruginosa\u003c/em\u003e and methicillin-resistent \u003cem\u003eS. aureus\u003c/em\u003e coverage. Carbapenems were also frequently utilized, often in combination with other agents. Notably, about 6% of patients received a carbapenem combined with vancomycin. This regimen is very broad, effectively covering Gram-negatives (including most ESBL-producers), anaerobes, and MRSA. The use of single-agent therapy was distinctly uncommon \u0026ndash; only isolated reports of monotherapy with meropenem, imipenem, or ertapenem (\u0026lt;\u0026thinsp;1% each) were found. This might underscore the widespread clinical perception that no single antibiotic is usually sufficient for Fournier\u0026rsquo;s gangrene. Even in the few monotherapy cases, the agents used (carbapenems) were ones with a very broad spectrum.\u003c/p\u003e \u003cp\u003e When comparing the reported regimens with the treatment guidelines most used in urological practice, it becomes evident that adherence to guideline-recommended therapy is limited in published clinical practice. Indeed, only 4 out of 22 distinct antibiotic regimens reported (18%) were consistent with the current guideline recommendations. However, it is important to note that many of the included studies were retrospective and some pre-dated the latest guidelines, which could partly explain this gap. Moreover, 73.6% of the included patients were from the Middle East, Africa, and Asia, and may have been treated according to local antimicrobial stewardship recommendations that may not be publicly available. These regimens are likely informed by regional epidemiological characteristics and resistance patterns, whereas the guidelines used to assess adherence are based primarily on Western epidemiology (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Additionally, in resource-limited settings, clinicians may have used what was readily available rather than boradspectrum agents. This is particularly relevant as the majority of included studies originated from low and middle-income countries, where access to newer antimicrobial therapies may be constrained (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Also, in these countries resources for proper microbiological assessment may be limited. Finally, besides epidemiologic and economic factors, the choice of antibiotic therapy may also be influenced by patient-specific factors, such as drug allergies, potential drug-drug interactions, etc. Non-guideline regimens may translate to worse outcomes if key pathogens are missed, however the heterogeneity and lack of data did not allow an according analysis.\u003c/p\u003e \u003cp\u003eAntibiotic resistance in Fournier\u0026rsquo;s gangrene pathogens is an important finding in this review. Although only seven studies reported resistance patterns, their results consistently highlight the threat of drug-resistant organisms. For example, one series noted that 35% of Gram-negative bacilli in Fournier\u0026rsquo;s gangrene were resistant to third-generation cephalosporins, and all \u003cem\u003eStaphylococcus haemolyticus\u003c/em\u003e isolates were methicillin-resistant. These results align with other reports, indicating an increasing rate of multidrug-resistant pathogens in Fournier\u0026rsquo;s gangrene ranging from 11 to 22% (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Given global trends in antimicrobial resistance, it is reasonable to expect resistance patterns in Fournier\u0026rsquo;s gangrene to rise further in the coming years, and clinicians should (i) rigorously test and screen for antimicrobial resistance and (ii) maintain heightened vigilance when selecting empiric regimens and, whenever possible, base therapy on local resistance data (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOnly four studies specified treatment duration, with a median of 15.8 days. Guidelines do not provide a firm recommendation on duration specific to Fournier\u0026rsquo;s gangrene, instead suggesting that antibiotics be continued until source control is achieved and the patient is stable (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The lack of more robust data on optimal duration represents an evidence gap \u0026ndash; prolonged courses are often used due to the catastrophic nature of inadequately treated necrotizing infection, but it remains unclear if long courses confer additional benefit once the source is controlled. However, unnecessarily extended therapy may increase the risk of antimicrobial resistance, side effects and risk for Clostridial infection, underscoring the need for future studies to define the optimal duration of antibiotic treatment (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis review has several important limitations. First, many included studies were observational and their retrospective nature makes them prone to selection bias and confounding and the few prospective studies were at moderate to critical risk of bias. Second, there was significant heterogeneity among studies in terms of patient populations, settings, and data reported. Additionally, some studies only vaguely described their antibiotic regimens (e.g. \u0026ldquo;broad-spectrum antibiotics\u0026rdquo;), which made it difficult to assess guideline adherence or compare efficacy. Third, geographical clustering with a predominance of low- to middle income countries (73.6% of included patients) may influence aggregate outcomes and patterns. Fourth, the time span covered by the included studies (1984\u0026ndash;2024) is another source of variability. Over 40 years, there have been substantial changes in medical practice, including the advent of new antibiotics and antimicrobial resistance has also generally increased over time. However, despite increasing antimicrobial resistance over time, reported mortality has declined over the past decades (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Because we included studies from a wide range of years and regions, the aggregate results may not reflect any single healthcare system. These limitations suggest caution in interpreting the pooled results of our study and highlight the need for more prospective, standardized research on Fournier\u0026rsquo;s gangrene to guide evidence-based practice.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003e Fournier\u0026rsquo;s gangrene is a predominantly polymicrobial infection with E. coli as the leading pathogen, yet antimicrobial regimens reported in the literature were heterogeneous and largely not guideline concordant. Resistance to commonly used antibiotics was frequent. Future prospective, standardized studies are needed to define optimal antimicrobial strategies, incorporate harmonized sampling protocols to improve comparability of microbiological data, and align practice more closely with guideline recommendations. These strategies should also account for local epidemiology and geographic variation in pathogen distribution and resistance patterns, to inform appropriate empiric regimens and subsequent de-escalation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eDeclarations\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e \u003cp\u003eNot applicable. This study is a systematic review of published aggregate data and involved no direct human participants or identifiable individual-level information; therefore, ethics committee/IRB approval and informed consent were not required under national regulations and institutional policies.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eSupplementary Table\u0026nbsp;1\u003c/h2\u003e \u003cp\u003eDetailed PubMed search strategy (MeSH terms and free-text keywords) used to identify studies.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eSupplementary Table S2\u003c/h2\u003e \u003cp\u003eRisk of Bias Assessment (ROBINS-I V2)\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eNo funding was received for this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eFA, CF, and LS conceived and designed the study. FA, LW, CM, and SS acquired the data. FA, AA, and LS performed the analysis and interpreted the data. FA and LS drafted the manuscript. CF, SB, AM, and AE critically revised the manuscript for important intellectual content. BK performed the statistical analysis. AM and CF provided administrative, technical, or material support. CF and LS supervised the work. All authors reviewed and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRadcliffe RS, Khan MA (2020) Mortality associated with Fournier\u0026rsquo;s gangrene remains unchanged over 25 years. BJU Int 125(4):610\u0026ndash;616\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSorensen MD, Krieger JN, Rivara FP, Broghammer JA, Klein MB, Mack CD et al (2009) Fournier\u0026rsquo;s Gangrene: Population Based Epidemiology and Outcomes. 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N Z Med J 121(1275):46\u0026ndash;56\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKabay S, Yucel M, Yaylak F, Algin MC, Hacioglu A, Kabay B et al (2008) The clinical features of Fournier\u0026rsquo;s gangrene and the predictivity of the Fournier\u0026rsquo;s Gangrene Severity Index on the outcomes. Int Urol Nephrol 40(4):997\u0026ndash;1004\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCakmak A, Gen\u0026ccedil; V, Akyol C, Kayaoğlu HA, Hazinedaroğlu SM (2008) Fournier\u0026rsquo;s gangrene: is it scrotal gangrene? Adv Ther 25(10):1065\u0026ndash;1074\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErsay A, Yilmaz G, Akgun Y, Celik Y (2007) Factors affecting mortality of Fournier\u0026rsquo;s gangrene: review of 70 patients. ANZ J Surg 77(1\u0026ndash;2):43\u0026ndash;48\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBasoglu M, Ozbey I, Atamanalp SS, Yildirgan MI, Aydinli B, Polat O et al (2007) Management of Fournier\u0026rsquo;s gangrene: review of 45 cases. Surg Today 37(7):558\u0026ndash;563\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerreira PC, Reis JC, Amarante JM, Silva \u0026Aacute;C, Pinho CJ, Oliveira IC et al (2007) Fournier\u0026rsquo;s gangrene: a review of 43 reconstructive cases. Plast Reconstr Surg 119(1):175\u0026ndash;184\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTahmaz L, Erdemir F, Kibar Y, Cosar A, Yalc\u0026yacute;n O (2006) Fournier\u0026rsquo;s gangrene: Report of thirty-three cases and a review of the literature. Int J Urol 13(7):960\u0026ndash;967\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAyan F, Sunamak O, Paksoy SM, Polat SS, As A, Sakoglu N et al (2005) Fournier\u0026rsquo;s gangrene: a retrospective clinical study on forty-one patients. ANZ J Surg 75(12):1055\u0026ndash;1058\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJeong HJ, Park SC, Seo IY, Rim JS (2005) Prognostic factors in Fournier gangrene. Int J Urol 12(12):1041\u0026ndash;1044\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKorkut M, İ\u0026ccedil;\u0026ouml;z G, Dayanga\u0026ccedil; M, Akg\u0026uuml;n E, Yeniay L, Erdoğan \u0026Ouml; et al (2003) Outcome Analysis in Patients With Fournier\u0026rsquo;s Gangrene: Report of 45 Cases. Dis Colon Rectum 46(5):649\u0026ndash;652\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAtakan IH, Kaplan M, Kaya E, Aktoz T, Inci O (2002) A life-threatening infection: Fournier\u0026rsquo;s gangrene. Int Urol Nephrol 34(3):387\u0026ndash;392\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNorton KS, Johnson LW, Perry T, Perry KH, Sehon JK, Zibari GB (2002) Management of Fournier\u0026rsquo;s Gangrene: An Eleven Year Retrospective Analysis of Early Recognition, Diagnosis, and Treatment. Am Surg 68(8):709\u0026ndash;713\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVillanueva-S\u0026aacute;enz E, Mart\u0026iacute;nez Hern\u0026aacute;ndez-Magro P, Vald\u0026eacute;s Ovalle M, Montes Vega J, Alvarez-Tostado FJF (2002) Experience in management of Fournier\u0026rsquo;s gangrene. Tech Coloproctol 6(1):5\u0026ndash;10 discussion 11\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorman, Moody A (1999) Fournier\u0026rsquo;s gangrene in a modern surgical setting: improved survival with aggressive management. BJU Int 84(1):85\u0026ndash;88\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAşci R, Sarikaya S, B\u0026uuml;y\u0026uuml;kalpelli R, Yilmaz AF, Yildiz S (1998) Fournier\u0026rsquo;s gangrene: risk assessment and enzymatic debridement with lyophilized collagenase application. Eur Urol 34(5):411\u0026ndash;418\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHollabaugh RS Jr, Dmochowski RR, Hickerson WL, Cox CE (1998) Fournier\u0026rsquo;s gangrene: therapeutic impact of hyperbaric oxygen. Plast Reconstr Surg 101(1):94\u0026ndash;100\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHejase MJ, Simonin JE, Bihrle R, Coogan CL (1996) Genital fournier\u0026rsquo;s gangrene: experience with 38 patients. Urology 47(5):734\u0026ndash;739\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatrick Spirnak J, Resnick MI, Hampel N, Persky L (1984) Fournier\u0026rsquo;s Gangrene: Report of 20 Patients. J Urol 131(2):289\u0026ndash;291\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjur","sideBox":"Learn more about [World Journal of Urology](https://link.springer.com/journal/345)","snPcode":"345","submissionUrl":"https://submission.nature.com/new-submission/345/3","title":"World Journal of Urology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"urological infections, Fournier´s gangrene, antibiotic therapy, microbiology, resistance","lastPublishedDoi":"10.21203/rs.3.rs-8829364/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8829364/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground and objective:\u003c/h2\u003e \u003cp\u003eFournier\u0026rsquo;s gangrene is a rare (incidence\u0026thinsp;~\u0026thinsp;1\u0026middot;6 per 100 000) but life-threatening necrotising infection of the perineum with high mortality (20\u0026ndash;40%) despite antimicrobial therapy, prompt surgical debridement, and intensive care. Evidence on pathogens, resistance, and antibiotic management is largely derived from retrospective series. Our aim was to synthesize the microbiological spectrum and empiric regimens, and identified evidence gaps.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003e We performed a systematic review following PRISMA and the Cochrane Handbook; the protocol was registered in PROSPERO (CRD42023489596). We included studies of adults with Fournier\u0026rsquo;s gangrene reporting microbiological findings and/or antibiotic therapy.\u003c/p\u003e\u003ch2\u003eKey findings and limitations:\u003c/h2\u003e \u003cp\u003eAcross 88 studies (n\u0026thinsp;=\u0026thinsp;4229), median length of stay was 24 days, mean symptom duration before admission was 7 days, and median mortality was 17%. Infections were polymicrobial in 66%. The most frequent isolates were Escherichia coli (30%), Streptococcus spp (11%), Pseudomonas aeruginosa (7%), and Staphylococcus aureus (6%); fungi accounted for 2%. Empiric regimens were heterogeneous (57 studies; n\u0026thinsp;=\u0026thinsp;2958); ceftriaxone plus an aminoglycoside and metronidazole was most common (29%). Only 19% of patients received guideline-concordant therapy. Resistance data were available in seven studies and showed resistance to commonly used agents (23\u0026ndash;64%).\u003c/p\u003e\u003ch2\u003eConclusion and clinical implications:\u003c/h2\u003e \u003cp\u003e Empiric antimicrobial management is geographically variable, with low guideline adherence and clinically relevant resistance. Prospective, standardised studies with uniform sampling and reporting are needed to define locally adapted empiric strategies and improve alignment with contemporary recommendations.\u003c/p\u003e\u003ch2\u003ePatient Summary\u003c/h2\u003e \u003cp\u003eWe reviewed 88 studies on Fournier\u0026rsquo;s gangrene, a rare but life-threatening infection. Most cases were caused by several bacteria at the same time, most often \u003cem\u003eE. coli\u003c/em\u003e. Empiric antibiotic treatments varied widely, and many patients did not receive therapy recommended by guidelines. Resistance to common antibiotics was frequent.High-quality studies are needed to define the best treatments and improve patient outcomes.\u003c/p\u003e","manuscriptTitle":"Microbiological characteristics and real-world antibiotic therapy regimens in Fournier Gangrene: A systematic review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-22 12:36:30","doi":"10.21203/rs.3.rs-8829364/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-06T12:46:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-11T20:40:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"228073730467614992645115535571888091696","date":"2026-03-10T02:51:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-16T12:14:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-13T02:10:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-12T17:22:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"World Journal of Urology","date":"2026-02-09T10:20:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjur","sideBox":"Learn more about [World Journal of Urology](https://link.springer.com/journal/345)","snPcode":"345","submissionUrl":"https://submission.nature.com/new-submission/345/3","title":"World Journal of Urology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"c37cb669-4c8b-4c18-bb1d-935423535792","owner":[],"postedDate":"February 22nd, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-06T12:46:43+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-19T11:53:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-22 12:36:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8829364","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8829364","identity":"rs-8829364","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}