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Gas-Producing Infections in the Foot at a Large Academic Medical Center: A 10-Year Retrospective Review

  • John A. Martucci
    Correspondence
    Address correspondence to: John A. Martucci, DPM, AACFAS, Village Podiatry: An Upperline Health Company, 132 Riverstone Terrace, Suite 101, Canton, GA 30114.
    Affiliations
    Former Chief Resident, Podiatric Medicine and Surgery, Division of Podiatric Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Clinical Fellow, Harvard Medical School, Boston, MA
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  • Kevin Riemer
    Affiliations
    Clinical Instructor of Surgery, Harvard Medical School; Associate, Division of Podiatric Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
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Published:September 25, 2022DOI:https://doi.org/10.1053/j.jfas.2022.09.004

      Abstract

      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.

      Level of Clinical Evidence

      Keywords

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