Anaerobic Infections, Skin & Soft Tissue

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

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

Surgical exploration

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