Brucato Maryellen P, Patel Krupa, Mgbako Obinna
Atlantic Health System, Morristown, NJ.
Foot and Ankle Specialists of New Jersey, Rahway, Westfield, and Union, NJ.
J Foot Ankle Surg. 2014 Mar-Apr;53(2):137-40. doi: 10.1053/j.jfas.2013.10.009. Epub 2013 Dec 15.
The Infectious Disease Society of America has defined gas gangrene as an infection caused by Clostridium species. However, in many clinical settings, soft tissue infections that produce subcutaneous gas have been diagnosed as gas gangrene without identification of the presence of Clostridium species. Instead, the diagnosis was based on clinical and radiographic findings. A chart review was performed of 25 consecutive patients treated at the Atlantic Health System for infections of the lower extremity that were diagnosed as gas gangrene. Wound cultures from the 25 patients grew 31 different species of bacteria. The most prevalent organism was Staphylococcus aureus, which accounted for 17 of 31 (54.84%) different organisms identified and 19.77% of 86 separate aerobic or anaerobic cultures. The most prevalent genus was Streptococcus, which accounted for 20 (64.52%) of the organisms identified and 23.26% of the cultures. The most prevalent anaerobic genus was Peptostreptococcus, which accounted for 8 (25.81%) of the organisms identified and 9.3% of the cultures. None of the cultures grew Clostridium species. These findings showed that gas-forming soft tissue infections of the lower extremity, commonly diagnosed as gas gangrene, are rarely caused by Clostridium species.
美国传染病学会将气性坏疽定义为由梭菌属引起的感染。然而，在许多临床环境中，产生皮下气肿的软组织感染在未确定梭菌属存在的情况下被诊断为气性坏疽。相反，诊断是基于临床和影像学检查结果。对大西洋医疗系统连续治疗的25例被诊断为气性坏疽的下肢感染患者进行了病历回顾。这25例患者的伤口培养出了31种不同的细菌。最常见的微生物是金黄色葡萄球菌，在鉴定出的31种（54.84%）不同微生物中占17种，在86次单独的需氧或厌氧培养中占19.77%。最常见的属是链球菌属，在所鉴定的微生物中占20种（64.52%），在培养物中占23.26%。最常见的厌氧属是消化链球菌属，在所鉴定的微生物中占8种（25.81%），在培养物中占9.3%。所有培养物中均未培养出梭菌属。这些发现表明，通常被诊断为气性坏疽的下肢产气软组织感染很少由梭菌属引起。
