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For further information, see CMDT Part 33-05: Clostridial Diseases

Key Features

  • Sudden onset of pain and edema in wound

  • Systemic toxicity

  • Presence of gas in infected tissue

  • Gram-positive rods on Gram stain or culture

Clinical Findings

  • Hypotension and tachycardia

  • Painful, edematous wound with surrounding pale skin

  • Foul-smelling brown, blood-tinged discharge

Diagnosis

  • Gram stain shows paucity of white blood cells and gram-positive rods

  • Anaerobic culture grows Clostridium spp

Treatment

  • Surgical débridement with radical excision as necessary

  • Penicillin, 2 million units every 3 hours intravenously (other antimicrobials active against anaerobes are also effective)

  • Clindamycin

    • May decrease the production of bacterial toxin

    • Some experts recommend adding clindamycin, 600–900 mg every 8 hours intravenously, to penicillin

  • Anecdotally, hyperbaric oxygen may be beneficial in conjunction with surgery and antimicrobial therapy

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