title: Clinical Features of Non-clostridial Gas Gangrene and Risk Factors for In-hospital Mortality.
abstract: OBJECTIVE
  To examine the clinical features of patients with non-clostridial gas gangrene (NCGG) at our hospital and identify risk factors for in-hospital mortality.
  
  
  METHODS
  This study included 24 patients with NCGG who were hospitalized in our medical facility from April 2005 to March 2015. The clinical features of NCGG were reviewed, and the characteristics of 6 patients who died in hospital and 18 who survived were compared to investigate risk factors.
  
  
  RESULTS
  The median time from symptom onset to hospital arrival was 168 h. The causative agent was Klebsiella pneumoniae in 8.3% and mixed infection in 91.7%; 83.3% of patients had diabetes, and one patient had no obvious underlying disease. The site of infection was the neck in 4.2%, the thoracoabdominal wall and retroperitoneum in 12.5% each, the back in 33.3%, the buttocks in 25.0%, the perineum in 20.8%, and the extremities in 45.8%. Retroperitoneal infection, blood lactate ≥ 4.0 mmol/L, and Japanese Association for Acute Medicine disseminated intravascular coagulation (DIC) score ≥ 4 on emergency department (ED) arrival were significantly higher in non-survivors than in survivors.
  
  
  CONCLUSIONS
  NCGG tends to develop in patients with diabetes, and in-hospital mortality rates are still high. Retroperitoneal infection, hyperlactatemia, and DIC on ED arrival are risk factors for in-hospital mortality.
authors.affiliation: Department of Emergency and Critical Care Medicine, Tokai University of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan. kenken@is.icc.u-tokai.ac.jp.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Takazawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Otsuka
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: Sadaki
authors.initials: S
authors.lastname: Inokuchi
mesh_terms: D034861:Abdominal Wall; D000368:Aged; D001415:Back; D002081:Buttocks; D003920:Diabetes Mellitus; D004211:Disseminated Intravascular Coagulation; D005121:Extremities; D005260:Female; D005738:Gas Gangrene / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007711:Klebsiella pneumoniae / Q000472:pathogenicity; D007773:Lactates / Q000097:blood; D008297:Male; D008875:Middle Aged; D009333:Neck; D010502:Perineum; D012187:Retroperitoneal Space; D012307:Risk Factors; D012772:Shock, Septic; D035441:Thoracic Wall; D013997:Time Factors
chemical_list: D007773:Lactates