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Clostridial myonecrosis ('gas gangrene') during cephalosporin prophylaxis
Abstract:
Four cases of clostridial myonecrosis that developed in open fractures were treated with surgical debridement and with intravenous cephalosporins as antibiotic prophylaxis. All patients recovered following amputation of the involved extremity, and treatment with high-dose penicillin in three cases, and erythromycin plus high-dose cephalothin in the fourth. This complication was not seen in patients with similar injuries that were managed surgically but used other antibiotics, usually penicillin, as prophylaxis. In vitro susceptibility tests of clostridia to cephalothin were performed; the results demonstrated that nearly 50% of clostridia tested were resistant to cephalothin.
Insights
Clostridial myonecrosis in open fractures may occur with cephalosporin prophylaxis. Alternative antibiotics like penicillin are recommended to prevent this severe complication. Further susceptibility testing is advised.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Microbiology
Background:
- Open fractures present a high risk for serious infections, including clostridial myonecrosis.
- Antibiotic prophylaxis is standard practice to prevent surgical site infections in orthopedic trauma.
Observation:
- Four cases of clostridial myonecrosis developed in patients with open fractures who received intravenous cephalosporins for antibiotic prophylaxis.
- These patients ultimately required amputation and further antibiotic treatment.
Findings:
- Clostridial myonecrosis was not observed in similar open fracture cases managed with different prophylactic antibiotics, primarily penicillin.
- In vitro testing revealed that approximately 50% of tested clostridial strains exhibited resistance to cephalothin.
Implications:
- Cephalosporins may be ineffective or even contribute to the development of clostridial myonecrosis in open fractures.
- Current antibiotic prophylaxis protocols for open fractures should be reviewed, considering the potential for cephalosporin resistance in clostridial species.
- Penicillin or other effective antibiotics should be prioritized for prophylaxis in open fracture management.