Gas gangrene and NSTI

Q: Gram stain with gram-positive rods is the hallmark of? (select one) 

 A) Clostridial myonecrosis (gas gangrene) 
B) Necrotizing soft tissue infections (NSTI) 


 Answer: A 

The early clinical distinction between NSTI and gas gangrene is very important as it may salvage the life or the limb. Clinically, they are hard to distinguish as they both are associated with gas in the tissues. Early gram stain can be very helpful. Gram stain in gas gangrene by default usually demonstrates gram-positive rods, while NSTI is polymicrobial. Gas gangrene requires early attention towards amputation to save the life, whereas early right antibiotics can salvage both limbs as well as life in NSTI.

#surgicalcriticalcare
#infectiousdisease


References:

1. Stevens DL, Bryant AE. Necrotizing Soft-Tissue Infections. N Engl J Med 2017; 377:2253.

2. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis 2014; 59:147. 

3. Jerrold B. Leikin; Frank P. Paloucek, eds. (2008), "Clostridium perfringens Poisoning", Poisoning and Toxicology Handbook (4th ed.), Informa, pp. 892–893