Gas-producing infections, such as clostridial and nonclostridial gas gangrene, crepitant cellulitis, and necrotizing fasciitis, are characterized in the literature by a variety of initial presentations, microbial burdens and surgical outcomes—ranging from debridement to amputation to death. The primary aim of this study was to identify the organisms cultured in gas-producing infections of the foot in patients that presented to a large academic medical center over a 10-year period. Our secondary aims were to report the prevalence of sepsis in this population upon presentation, and patient outcomes upon discharge. After a retrospective chart review of 207,534 procedures, 70 surgical cases met inclusion criteria. The most common organisms that grew in operating room cultures were Staphylococcus aureus, Group B Beta Streptococcus, and Enterococcus species. Just over half of the population presented with sepsis. After an average of 2 or more operations, 64% of patients underwent amputation. One death occurred. Gas-producing infections, or “gas gangrene,” are primarily polymicrobial infections, rarely due to Clostridium perfringens, that warrant surgical exploration for optimal outcomes.
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- Nonclostridial infection in the diabetic: review of the literature and report of three cases.Arch Intern Med. 1951; 88: 373-377
- Anaerobic streptococcal infections stimulating gas gangrene.Arch Surg. 1972; 104: 186-189
- Nonclostridial gas gangrene: report of 48 cases and review of literature.JAMA. 1975; 233: 958-963
- Necrotizing fasciitis: importance of roentgenographic studies for soft-tissue gas.JAMA. 1979; 241: 803-806
- Non-clostridial gas gangrene in the diabetic lower limb.Diabetolgia. 1977; 13: 373-376
- Treatment outcome of nonclostridial gas gangrene at a level 1 trauma center.J Orthop Trauma. 2002; 16: 12-17
- Early diagnosis of necrotizing fasciitis.Br J Surg. 2014; 101: e119-e125
- Gas gangrene and osteomyelitis of the foot in a diabetic patient treated with tea tree oil.Int J Emerg Med. 2011; 4: 1-4
- Diagnosis of gas gangrene: does a discrepancy exist between the published data and practice.J Foot Ankle Surg. 2014; 53: 137-140
- A comparison of necrotising fasciitis in diabetics and non-diabetics: a review of 127 patients.Bone Joint J. 2016; 98-B: 1563-1568
- Toxigenic clostridia.Clin Microbiol Rev. 1990; 3: 66-98
- Bone, joint, and necrotizing soft tissue infections.in: Baron S Medical Microbiology. 4. University of Texas Medical Branch at Galveston, Galveston, TX1996
- Diagnosis and management of skin and soft tissue infections in the intensive care unit: a review.Intens Care Med. 2016; 42: 1899-1911
- Practice guidelines for the diagnosis and management of skin and soft-tissue infections.Clin Infect Dis. 2005; 41: 1373-1406
- Interventions for treating gas gangrene (Review).Cochrane Database Systematic Rev. 2015; 12: 5-6
- Non clostridial gas infections in diabetes mellitus.Br Med J. 1960; 2: 566-568
- Bacteriologie des Septischen emphysemas.Prag Med Wochenschr. 1893; 18: 1-4
- Ueber die Gangrene Foudroyante.Sitzungsb Akad Wissensch, Math naturw Cl. 1899; 108: 145-163
- The unusual presence of gas from a puncture wound: a case report.J Foot Ankle Surg. 2018; 57: 785-789
- CDC Anaerobic Blood Agar [package insert].Anaerobe Systems, Morgan Hill, CA2017
- Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM consensus conference committee. American College of Chest Physicians/Society of Critical Care Medicine.Chest. 1992; 17: 1644-1655
- Transmetatarsal and minor amputation versus major leg amputation: 30-day readmissions, reamputations, and complications.J Foot Ankle Surg. 2020; 59: 484-490
- Infections in patients with diabetes mellitus.N Engl J Med. 1999; 341: 1906-1912
- Host factors predisposing to anaerobic infections.FEMS Immunol Med Microbiol. 1993; 6: 159-163
- Diabetic foot ulcers and their recurrence.N Engl J Med. 2017; 376: 2367-2375
- Bacterial infections of skin, soft tissue, and muscle.Mims’ Medical Microbiology. 5th ed. Elsevier Health Sciences, 2013
- Skin and soft tissue infections.Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Elsevier/Saunders, Philadelphia (PA)2015
- Pseudomonas exotoxin a: optimized by evolution for effective killing.Front Microbiol. 2015; 6: 963
Published online: September 25, 2022
Financial Disclosures: None reported.
Conflict of Interest: None reported.
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