Clinical and Microbiological Spectrum of Clostridial Myonecrosis from a Tertiary Care Centre
Sukanya Sudhaharan, Kanne Padmaja, Padmasri Chavali and Vijay Dharma Teja
Journal Title:Acta Scientific Microbiology
Introduction:Infections due to Clostridium spp is most often seen in traumatic injuries, surgery, malignancy and underlying im-munocompromised conditions. Gas gangrene, the clinical manifestation of Clostridium spp is a diffuse necrotizing infection of deep soft tissues. The infection can develop rapidly following any trauma that compromises the blood supply and is characterized by high mortality. Early Identification of the signs and symptoms in these patients would help in the management and reduce mortality as-sociated with this infection. In this review we presented a series of cases with infection due to Clostridium spp after trauma
Materials and Methods:Twelve cases of Clostridium perfringens infections were analysed from our Institute prospectively during the period of 2012 - 2019 (duration of 8 years). The tissue samples from the cases were subjected to direct Gram stain and further inoculated aerobically on Chromogenic agar and 5% sheep blood agar. Anaerobic inoculation was done on 5% sheep blood agar and incubated into anaerobic pouch
Results: The median age of the patients were 31 years. All the patients were males. The patients had sustained injury due to road traffic accident (RTA). 5/12 patients had Grade 3 compound fracture of leg, 1/12 patient had injury extending up to thigh, 5/12 pa-tients had crush injury of lower limb, 1/12 patient had crush injury of upper limb.Escherichia coli was the predominant aerobic organism isolated in 7/12 of the patients. The patients were treated surgically with below knee amputation in 10/12, below elbow amputation in 1/12, above knee amputation in 1/12 of patients. All the patients were treated with intravenous penicillin G10 U/day. Eleven patients were discharged in stable condition with advise to follow up. The patient with above knee amputation succumbed to the infection in spite of the treatment.
Conclusion:From this study we conclude that early clinical suspicion and microbiological diagnosis helps in the proper management of the patients. Careful and adequate treatment along with antibiotics and all other supportive treatments should be instituted im-mediately will avoid further deterioration and reduce the mortality in these patients