[Obesity, diabetes mellitus, and gas gangrene: a major therapeutic challenge].
Soft tissue infections are uncommon but prognosis is severe (20 to 50%). Management consists in surgical debridement, antibiotic therapy against anaerobic and aerobic bacteria, and appropriate intensive care. When available, hyperbaric oxygen therapy is an integral part of the treatment. We report the case of 56-year-old female patient with diabetes (150 kg) was hospitalized in our unit a few days after surgical treatment of a buttocks abscess for clinical signs of peripheral gas gangrene. Surgical exploration showed necrotizing soft tissue infection with fasciitis. Adequate therapy using antibiotics, surgery daily and hyperbaric oxygen was given. Therapy had to be adapted to the patient's obesity. Outcome was good with recovery and few sequelae, allowing transfer to a medical ward.
Rouquette-Vincenti
I
I
Département d'Anesthésie-Réanimation, Paris, France.
Petitjeans
F
F
Villevieille
T
T
Szymczyszyn
P
P
Fangio
P
P
Baranger
B
B
Brinquin
L
L
D000038:Abscess / Q000601:surgery; D000583:Amikacin / Q000627:therapeutic use; D001004:Anus Diseases / Q000601:surgery; D002081:Buttocks; D002177:Candidiasis / Q000150:complications; D002442:Ceftazidime / Q000627:therapeutic use; D003125:Colostomy; D003131:Combined Modality Therapy; D003646:Debridement; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D004198:Disease Susceptibility; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005208:Fasciitis / Q000209:etiology; D005260:Female; D005738:Gas Gangrene / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D006931:Hyperbaric Oxygenation; D006973:Hypertension / Q000150:complications; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D012772:Shock, Septic / Q000209:etiology; D014640:Vancomycin / Q000627:therapeutic use
D008795:Metronidazole; D014640:Vancomycin; D000583:Amikacin; D002442:Ceftazidime