[Anaerobic nonclostridial soft-tissue infection]

Over the period 1985 through 1994, observations are conducted on forty-eight patients, 35 men and 13 women, with age ranging from 11 to 56 years, presenting anaerobic non-spore-forming infection of the soft tissues (necrotizing fasciitis (3), postinjection nonclostridial myositis (7), crepitant cellulitis in diabetic gangrene (21), neck phlegmon (5), perineal phlegmon (9), and progressive bacterial synergistic gangrene against the background of chronic osteomyelitis (3). Infection development is characterized by local necrotic processes, intoxication, crepitations, fetor, fever, and in part of the patients--septic shock and DIC syndrome. The microbiological study shows presence of anaerobes, as mono- and polyinfection, aerobic-anaerobic associations, and gram-negative aerobes--in one patient alone. Invariably, the general condition is rather serious. Lethality amounting to 12.5 percent is ascribed to the late detection and unspecified and inadequate treatment protocol in the initial period of observation. The treatment is complex: incisions with successive many-staged necrectomies, antibiotics, metronidazole, hyperbaric oxygenation and hemadsorption. If several (2-3) of the aforementioned symptoms are present, evidence of anaerobic flora should be mandatory and purposefully seeked.