Clostridial Gas Gangrene: A Review Of 48 Consecutive Cases

Summary

Gas gangrene (GG) is an acute necrosis of the muscle and/or subcutaneous tissue due to gas-forming microorganisms. The authors retrospectively review 48 consecutive cases of clostridial GG treated in an intensive care unit over a 17-year period (1969–1986). Surgery and trauma were the most frequent initiating factors (88 %) of clostridial GG. The diagnosis is clinical and based on a comparison of the local and systemic signs. Direct examination of the sweet-smelling discharge, revealing large Gram-positive bacilli, confirmed the clinical impression in about 75 % of the cases. The key to successful treatment of clostridial GG requires the judicious application of resuscitation measures (86 % of our eases), a correct antibiotherapy (penicillin G, 30 to 40 million units daily), surgery (fasciotomies, excisions limited to undoubtedly dead tissue) and hyperbaric oxygen (H.B.O.) therapy (83% of our patients), in order to break the vicious circle of progression of the disease. Sixteen of our 48 patients with clostridial GG died in hospital.