Gas fire A48.0

Severe, life-threatening wound infection caused by clostridia in the absence of air Gas gangrene is classified as clostridial myonecrosis.

Notice!

Obligation to report illness and death!

Clostridium perfringens (80-90% of infections), C. novyi or C. septicum (together almost 20% of cases); rarely Clostridium histolyticum. Obligatory anaerobic spore formers.

Infection of wounds with extensive tissue ruptures and pocket-rich soft tissue injuries with toxin-forming anaerobes.

• Local: Painful, oedematous wound, blue-green to brownish skin colour, foul-smelling wound secretion; spontaneous or pressurised gas escape. Partly brittle, partly dissolving, gas-containing (x-ray) musculature.
• General: Physical deterioration: Intoxication, tachycardia, hypotension, agitation, haemolysis, anaemia, jaundice.

Gas formation in wounds during infections by pathogens such as E.coli, Bacteroides, Klebsiella, Proteus.

Myonecrosis, clostridial. Start therapy even on suspicion! Transfer to surgical intensive care.

Cave!

Risk of toxic cardiovascular failure, sepsis, anuric kidney failure! Immediate surgical revision with broad exposure, excision of necrotic tissue and open drainage! Hyperbaric oxygenation (controversial procedure!) after surgery.

Notice! Create aerobic wound conditions!

• High-dose antibiotics are first choice: benzylpenicillin (e.g. penicillin Grünenthal) 20-40 million IU/day distributed over 4-6 ED as a short infusion in combination with metronidazole (e.g. Clont), adults: 2-3 times 500 mg/day i.v., children: 20 mg/kg bw/day i.v. or p.o. distributed over 3 ED.
• Alternatively: cefotaxime (e.g. claforan) 2-3 times/day 2 g i.v. (max. 4 times/day 3 g) in combination with metronidazole (e.g. Clont), adults: 2-3 times/day 500 mg/day i.v., children: 20 mg/kg bw/day i.v. or p.o. distributed over 3 ED.
• In case of penicillin allergy: Imipenem (e.g. Zienam): adults: 3-4 times 0.5-1.0 g/day i.v., infants: 60 mg/kg bw/day distributed over 4 ED. Alternatively: erythromycin (erythrocin i.v.), adults 2 g/day i.v. in 4 ED, children 20-30 mg/kg bw/day i.v. in 4 ED. Alternatively linezolid (cyvoxide): adults 2 times/day 600 mg i.v.

Mortality: 30-50%.

Benzylpenicillin in high dosage: 5-20 million IU/day i.v. over 14 days.