Treatment outcome of nonclostridial gas gangrene at a Level 1 trauma center.
OBJECTIVE
To evaluate the results of treatment of nonclostridial gas gangrene at a Level 1 trauma center.


METHODS
Retrospective.


METHODS
Level 1 trauma center.


METHODS
Seven patients with nonclostridial gas gangrene were studied. The average age of all patients at the time of admission was 40.3 years (range 14 to 67 years).


RESULTS
Three of seven patients had posttraumatic infection, and the remaining four were strongly associated with underlying diseases: diabetes mellitus in three and paraplegia as the result of a spinal cord injury in two. The time of symptom onset was clearly defined in four cases, and the average interval between symptom onset and transfer to our hospitals was six days (range 2 to 10 days). Surgical debridement was performed immediately on admission in six patients (86 percent). A triple antibiotic regimen consisting of penicillin, gentamicin, and clindamycin was used initially in all patients. In three patients, hyperbaric oxygen therapy was also used. The overall mortality rate was 42.9 percent (three of seven patients). In these patients, the interval from onset of symptom to transfer to our hospital was ten days in one patient, which was longer than average, and was not accurately known in the other two patients.


CONCLUSIONS
Nonclostridial gas gangrene is extremely rare but life-threatening. The greatest pitfall for the emergency department physician is failure to suspect it clinically. Aggressive treatment, including surgical debridement and intravenous antibiotics with or without hyperbaric oxygen therapy, must be initiated immediately to minimize morbidity and mortality.
Takahira
Naonobu
N
Department of Traumatology and Critical Care Medicine, Kitasato University School of Medicine, Kitasato, Sagamihara, Japan.
Shindo
Masateru
M
Tanaka
Keiji
K
Soma
Kazui
K
Ohwada
Takashi
T
Itoman
Moritoshi
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000379:methods*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003013:Clostridium / Q000302:isolation & purification; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D004188:Disarticulation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005738:Gas Gangrene / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality / Q000628:therapy*; D006621:Hip Joint / Q000601:surgery; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D007866:Leg; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D014193:Trauma Centers
D000900:Anti-Bacterial Agents