Medication
High doses of antibiotics, typically penicillin and clindamycin, are given, and all dead and infected tissue is removed surgically. About one of five people with gas gangrene in a limb requires amputation. Treatment in a high-pressure oxygen (hyperbaric oxygen) chamber may also be helpful, but such chambers are not always readily available.
Procedures
Hyperbaric oxygen therapy for gas gangrene generally lasts about 90 minutes. You may need two to three treatments daily. Other treatments for gangrene may include supportive care, including fluids, nutrients and pain medication to relieve your discomfort.
Therapy
Gas gangrene is a highly lethal infection of soft tissue, caused by Clostridium species, with Clostridium perfringens being the most common. This is synonymous with myonecrosis and is characterized by rapidly progressive gangrene of the injured tissue along with the production of foul-smelling gas.
What is the treatment for gas gangrene?
The total duration of the treatment at pressure is usually about 90 minutes with 10 minutes for descent and 10 minutes for the ascent. When treating gas gangrene the treatments start twice a day for the first 5 to 10 treatments, reducing to once daily treatments when stabilized.
How long does hyperbaric oxygen therapy for gas gangrene last?
What is Clostridium gangrene?
How long does it take to get rid of gangrene?
What is the best treatment for gas gangrene?
Treatment of Gas Gangrene If gas gangrene is suspected, treatment must begin immediately. High doses of antibiotics, typically penicillin and clindamycin, are given, and all dead and infected tissue is removed surgically.
What antibiotics are used to treat gas gangrene?
Antibiotic treatment should include gram-positive (penicillin or cephalosporin), gram-negative (aminoglycoside, third-generation cephalosporin, or ciprofloxacin), and anaerobic coverage (clindamycin or metronidazole).
How do you treat Clostridium perfringens?
Treatment of illness: There is no specific treatment or established cure for Clostridium perfringens toxins. Supportive care (intravenous fluids, medicine to control fever and pain) is the standard treatment.
What antibiotics treat Clostridium perfringens?
Any number of antibiotics can be used to remove Clostridium perfringens. Some choices include: ampicillin, amoxicillin, metronidazole, erythromycin, and tylosin. Tetracycline was formerly on the list but too much resistance has developed.
Does metronidazole treat gangrene?
In a mouse model of gas gangrene caused by Clostridium perfringens, clindamycin, metronidazole, rifampin, and tetracycline were all more efficacious than penicillin (P less than . 05).
Why does clindamycin treat gas gangrene?
In the presence of infections caused by GAS, both clindamycin and penicillin should be used. The addition of clindamycin suppresses toxin and cytokine production, and the use of penicillin provides coverage in the event of clindamycin resistance to GAS.
How does Clostridium perfringens cause gas gangrene?
Clostridium is found nearly everywhere. As the bacteria grow inside the body, it makes gas and harmful substances (toxins) that can damage body tissues, cells, and blood vessels. Gas gangrene develops suddenly. It usually occurs at the site of trauma or a recent surgical wound.
How do you get rid of Clostridium bacteria?
Antibiotics are the mainstay to treat C. difficile infection. Commonly used antibiotics include: Vancomycin (Vancocin HCL, Firvanq)
Is there a vaccine for Clostridium perfringens?
Currently there are no licensed vaccines suitable for use in humans which protect against either gas gangrene or epsilon-toxin. However, vaccines being developed for use in animals have the potential to be developed for use in humans.
Does vancomycin treat Clostridium perfringens?
Early studies have demonstrated in vitro susceptibility of C. perfringens strains to vancomycin [24]. However a more recent study has shown that vancomycin is not bactericidal against C. perfringens [25].
Does ciprofloxacin treat Clostridium perfringens?
In contrast, when the patient was treated with ciprofloxacin, not only C. perfringens, but also all coliforms including hemolytic strains of E. coli disappeared.
Is Clostridium perfringens sensitive to metronidazole?
Among C. perfringens strains, resistance to the drug choices such as penicillin as well as to alternatives of penicillin like metronidazole and clindamycin has also been observed.
How often do you need oxygen therapy for gas gangrene?
Patients with gas gangrene will need daily or repeated surgical debridement until the necrotizing infection is controlled, receive twice-daily hyperbaric oxygen therapy until tissue necrosis stops and signs of tissue recovery with granulation tissue formation occur. The patient will also need ongoing intensive care and may require hemodialysis for renal failure and extracorporeal membrane oxygenation (ECMO) for patients with severe adult respiratory distress syndrome (ARDS).[5]
What tests are done for gas gangrene?
Immediate workup of a patient with suspected gas gangrene includes: CBC, CMP, urinalysis, PT, APTT, blood and wound cultures. Additional blood tests such as ABG, lactic acid, and pre-calcitonin can be helpful in the evaluation of sepsis which is often present in gas gangrene. Common imaging studies include x-rays, CT scan of the infected body part, and ultrasound. These can be helpful in identifying the extent of the infection, abscess, and gas in the tissues. Extensive lab and imaging should not delay definitive surgical debridement of the necrotic tissue. A deep-wound aerobic and anaerobic culture at the time of the initial surgical debridement can help determine the causative organism and direct antibiotic therapy. [14]
What is gas gangrene?
Gas gangrene is synonymous with myonecrosis and is a highly lethal infection of deep soft tissue, caused by Clostridium species, with Clostridium perfringens being the most common. Clostridial myonecrosis historically was a common war wound infection with an incidence of 5%, but with improvement in wound care, antisepsis and the use of antibiotics, the incidence has fallen to 0.1% of war-related wound infections since the Vietnam war era. Puncture wounds and surgical wounds, especially GI surgeries done on the biliary tract or intestinal surgeries, are causes of clostridial infections due to inadvertent inoculation of the surgical wound with gut bacteria.[1][2]
Why is it important to diagnose gas gangrene early?
To enhance patient survival and reduce morbidity in gas gangrene, this diagnosis should be high on the differential if patient present with infection with signs of necrotic tissue, sepsis, or if gas is present in the tissue. It is important to diagnose early, consult surgery for emergent debridement, and transfer patients with gas gangrene to facilities that have the capability of taking care of such ill patients. They require coordinated care between surgery, intensive care, and hyperbaric oxygen/wound care. [23][24]
How does hyperbaric oxygen therapy work?
Hyperbaric oxygen therapy involves placing the patient in a pressurized chamber which can be mono-place (single patient) or multi-place (multiple patients treated at the same time). The mono-place chamber can only treat one patient at a time, and the attendant is outside of the chamber with specialized equipment and pumps to run IVs and even mechanical ventilation equipment through ports in the chamber door or wall. The disadvantage of this setup is that it limits the therapies available in the chamber and if the patient requires direct contact with the attendant, the chamber has to be depressurized, and the patient is taken out of the chamber. The multi-place chamber has the added benefit of being able to treat multiple patients at the same time, and the attendant is in the chamber with the patients allowing easier access to the patient for ventilator support, IV therapy, placement of a chest tube, or needle decompression of a pneumothorax. The treatment pressure for gas gangrene is 3 atmospheres absolute (ATA). The patient will have air brakes about every half hour to help reduce the risk of oxygen toxicity. These air brakes are usually 5 to 10 minutes in duration. The total duration of the treatment at pressure is usually about 90 minutes with 10 minutes for descent and 10 minutes for the ascent.
How to tell if you have gas gangrene?
Patients with gas gangrene (myonecrosis) present with signs of infection such as fever, chills, pain, and less superficial inflammation at the site of infection than one would expect given the deep penetrating nature of these infections. The condition of the patient can rapidly progress to sepsis and death if not treated aggressively. The wound discharge is often dishwater looking with a musty order. It can involve the vasculature that supplies large areas of infected tissue leading to necrosis of the subcutaneous fat down to the fascia and extends into the deeper muscle. If the nerves are damaged, the severity of the pain is less than expected for the extent of infection. The drainage from the necrotic tissue often has a dishwater appearance and musty order.
Which toxin breaks down the cell membrane?
Alpha toxin: Lecithinase (or phospholipase) that breaks down cell membrane resulting in cell death and tissue necrosis. This toxin is also hemolytic and cardiotoxic.
How to treat gangrene?
Gas gangrene is much easier to treat if caught early, but symptoms may not be visible until severe stages. One mode of treatment is antibiotic therapy. The most common antibiotics used are penicillin and clindamycin, and both are usually used simultaneously . There have also been recent studies conducted that protein synthesis inhibitors might be more effective ways of treatment than antibiotics. If doctors are able to block the synthesis of C. perfringens alpha toxin and perfringolysin O, they can reduce the amount of toxins inside the patient’s body and therefore lessen the effects of these toxins. People affected by gas gangrene are also usually affected by organ failure. They need intensive care due to necrosis affecting organs. Another mode of treatment is hyperbaric oxygen therapy, or HBO therapy . Although it has been used in the U.S. for gas gangrene treatment for a long time, it is controversial. The treatment involves administering 100% oxygen to patients for prolonged periods of time. Studies for this type of treatment on gas gangrene have reported that it inhibits alpha toxin production and makes the living and dead tissue more visible from each other. Therefore, this treatment is most likely better to use before surgery, excision, or amputation. There are however some risks like trauma resulting from pressure and oxygen toxicity. Ultimately, if gas gangrene of a patient cannot be treated with any of these methods, they will have to undergo surgery and/or amputation . The necrotic tissue must be cut off and physically removed so that it does not spread further in the body. If whole limbs are necrotic, they must be amputated. Removal of parts of the body is much better than letting the infection spread more and leading to death.
Why is Clostridium perfringens important?
The Clostridium perfringens A strain is of the most importance because it causes gas gangrene, or myonecrosis, in humans. Gangrene is the death of body tissue and usually seen in elderly people or diabetic people. Open wounds or trauma into deep tissue that become infected by bacteria also become gangrenous.
How Do These Toxins Help C. perfringens Persist and Spread in the Body?
Alpha Toxin and PFO Allow C. perfringens to Escape from Macrophages and the Immune System
What is the role of PFO in gangrene?
PFO was discovered to have an essential part in both cytotoxicity and escape of macrophages, therefore making it a crucial virulence factor of gas gangrene, helping the bacterium resist being killed by macrophages. In O’Brien and Melville’s experiment, they examined the role of PFO in the early stages of gas gangrene infection, at a time when the number of bacteria present was few relative to the number of phagocytic cells. They found that for the C. perfringens bacterium to persist in the host’s tissues, PFO was equally mandatory as the alpha toxin. This supports the crucial role PFO plays in the early stages of gas gangrene infection, where the ratio of bacterial cells to phagocytic cells is relatively low . Once the bacterium resists being killed by the macrophages and PMNs early into the infection, it is able to continue its spread deeper in the tissues. We can conclude that PFO is more crucial than the alpha toxin, although having both would be a bigger advantage in the spread of the infection than having just one toxin. PFO is the more important factor of cytotoxicity of the two .
What bacteria causes gas gangrene?
Awad and colleagues held an experiment where they infected mice with the wild type strain of C. perfringens bacteria that produced the typical symptoms of gas gangrene with thrombosis and vascular leukostasis. Then they infected another group of mice with a strain that was void of the genes that enabled production of alpha toxin and PFO. This group of mice showed very little symptoms of gas gangrene and little to no leukostasis in the blood vessels was seen. The leukocytes were able to travel to the infected tissues and fight the infection. They concluded from this experiment that both toxins are needed to work synergistically to allow the bacterium to evade the immune system and survive inside the host .
How many strains of Clostridium perfringens are there?
Clostridium perfringens is currently known to have five different strains, marked as: A, B, C, D, and E . The different strains are classified based on which toxins they produce: alpha toxin, beta toxin, epsilon toxin, and/or iota toxins . The Clostridium perfringens A strain is of the most importance because it causes gas gangrene, or myonecrosis, ...
What is gas gangrene?
Gas gangrene, or myonecrosis, is a form of gangrene and bacterial infection that produces toxins which lead to gas build up inside the tissues. The gas is produced through glucose fermentation, and is usually composed of 5.9% hydrogen, 3.4% carbon dioxide, 74.5% nitrogen, 16.1% oxygen . Gas gangrene is caused by a rod shaped, gram positive, ...
How to treat gangrene?
The faster you get treatment, the better your chance for recovery. Treatment for gangrene may involve medication, surgery or hyperbaric oxygen therapy — or a combination of these therapies — depending on the severity of your condition.
What to do if you have gangrene?
Depending on the severity of your symptoms, you may be told to go to the emergency room or to call 911 or your local emergency number for medical help.
How long does it take for gangrene to heal?
The treatment for gangrene generally lasts about 90 minutes. You may need two to three treatments every day until the infection clears.
How does hyperbaric oxygen therapy work?
Hyperbaric oxygen therapy is done inside a chamber pressurized with pure oxygen. You usually lie on a padded table that slides into a clear plastic tube. The pressure inside the chamber will slowly rise to about 2.5 times normal atmospheric pressure.
What is the procedure to remove gangrene?
Surgery for gangrene includes: Debridement. This type of surgery is done to remove the infected tissue and stop the infection from spreading. Your doctor may also perform surgery to repair any damaged or diseased blood vessels to restore blood flow to the infected area. Your doctor may prescribe certain antibiotics until the infection is cleared.
What tests are used to diagnose gangrene?
Tests used to help make a diagnosis of gangrene include: Blood tests. An abnormally high white blood cell count is usually a sign of infection. Your doctor might also order blood tests to look for the presence of specific bacteria or other germs. Fluid or tissue culture. Tests of the fluid from a blister on your skin may be examined ...
Can you get gangrene with an artificial limb?
In severe cases of gangrene, the infected body part — such as a toe, finger, arm or leg — may need to be surgically removed (amputated). You may later be fitted with an artificial limb (prosthesis).
What is the best treatment for gas gangrene?
Antibiotics. Surgery to remove all dead and infected tissue. If gas gangrene is suspected, treatment must begin immediately. High doses of antibiotics, typically penicillin and clindamycin, are given, and all dead and infected tissue is removed surgically.
What causes gas gangrene?
Causes of Gas Gangrene 1 Are deep and severe 2 Involve muscle 3 Are contaminated with dirt, decaying vegetable matter, or stool 4 Contain crushed or dead tissue
What causes gangrene in the body?
Such tissues have poor blood flow and thus low oxygen levels. Most clostridial soft-tissue infections, including gangrene, are caused by Clostridium perfringens. Clostridial soft-tissue infections usually develop hours or days after an injury but sometimes take several days to appear.
Why does gangrene happen?
Often, the infection blocks small blood vessels. As a result, the infected tissue dies, leading to gangrene. The dead tissue enables the clostridial infection to spread even faster. Gangrene is more likely to develop when muscle is infected than when only the skin is infected.
What is considered high risk gas gangrene?
High-risk injuries include wounds that. Rarely, gas gangrene occurs when there is no injury or surgery—usually in people with colon cancer, diverticulitis, or a disorder that reduces blood flow to the intestine or results in leaks through the wall of the intestine.
How do you know if you have gas gangrene?
Symptoms of Gas Gangrene. Gas gangrene causes severe pain in the infected area. Initially, the area is swollen and pale but eventually turns red, then bronze, and finally blackish green. The area is firm and tender to the touch. Large blisters often form.
What is the best way to check for gas bubbles in muscle tissue?
X-rays are taken to check for gas bubbles in muscle tissue, or computed tomography (CT) or magnetic resonance imaging (MRI) is done to check for areas of dead muscle tissue. These findings support the diagnosis. However, gas bubbles may also occur in other anaerobic infections.