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Key Features

  • Several terms have been used to classify these infections

    • Bacterial synergistic gangrene

    • Synergistic necrotizing cellulitis

    • Necrotizing fasciitis

    • Nonclostridial crepitant cellulitis

  • Usually occur

    • After trauma or surgery

    • With inadequate blood supply

    • In association with diabetes mellitus

  • Most common in areas contaminated by oral or fecal flora

  • All are mixed infections caused by aerobic and anaerobic organisms

  • Although there are some differences in microbiology among these infections, their differentiation on clinical grounds alone is difficult

Clinical Findings

  • There may be progressive tissue necrosis, evidence of gas in the tissues (crepitance) and a putrid odor

  • Pain out of proportion to the clinical findings

  • Hemodynamic instability and systemic toxicity may be present

Diagnosis

  • Surgical exploration

Treatment

  • Broad-spectrum antibiotics active against both anaerobes and gram-positive and gram-negative aerobes (eg, vancomycin plus piperacillin-tazobactam) should be instituted empirically and modified by culture results (Tables 30–4 and 30–5)

  • Require aggressive surgical débridement of necrotic tissue for cure

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