Clostridial Myonecrosis

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 absence of neutrophils and presence of gram-positive rods

• Anaerobic culture grows Clostridium spp

• Radiographic studies

  • May show gas within the soft tissues

  • However, this finding is neither sensitive nor specific

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