Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 33-05: Clostridial Diseases + Key Features Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ Hypotension and tachycardia Painful, edematous wound with surrounding pale skin Foul-smelling brown, blood-tinged discharge + Diagnosis Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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