Clostridial Myonecrosis

Key Features

• A life-threatening muscle infection produced by any one of several clostridia, such as

  • Clostridium perfringens

  • Clostridium ramosum

  • Clostridium bifermentans

  • Clostridium histolyticum

  • Clostridium novyi

• Trauma and injection drug use are common predisposing conditions

• Sudden onset of pain and edema in a contaminated wound

• Prostration and systemic toxicity

• Presence of gas in infected tissue

Clinical Findings

• Hypotension and tachycardia

• Painful, edematous wound with surrounding pale skin

• Foul-smelling brown, blood-tinged discharge

Diagnosis

• Brown to blood-tinged watery exudate, with skin discoloration of surrounding area

• Gas in the tissue by palpation or radiograph

• Gram-positive rods in culture or smear of exudate

• Toxins produced in devitalized tissues under anaerobic conditions result in

  • Shock

  • Hemolysis

  • Myonecrosis

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