Fournier''s gangrene: non-clostridial gas gangrene of the perineum and diabetes mellitus.

Three successfully managed cases of Fournier's gangrene, all with diabetes, are reported. A simple bacteriological classification is offered and the importance of diabetes mellitus as a predisposing factor is stressed.     

1例气性坏疽病例报告

目的通过对医院收治的1例气性坏疽患者的诊疗及其医院感染防控效果观察,探讨此类疾病的院内感染防控路径。方法某男性患者阴囊肿胀伴破溃流脓半月余于2018年2月24日入院。结合案例的具体特点,依据现有法规,采取一系列有步骤的防控措施。结果患者因阴囊肿胀伴破溃流脓就诊,当地医院抗炎治疗,效果不明显,并逐渐出现皮肤苍白、紧张发亮,破溃流脓,局部呈黑紫色,出现液体水泡,流出恶臭味液体,局部组织失去弹性,急诊来我院,以阴囊气性坏疽收入院。入院后在腰麻下接受清创术,手术过程顺利。术后无菌操作下每日换药,阴囊部感染得到控制并逐渐好转。并于3月5日在某医院创伤中心会诊,3月8日在感染控制后接受阴囊部成形术,术后恢复好。结论阴囊气性坏疽在临床上极为罕见,因而针对性的医院感染防控措施缺乏现成的经验。医院各部门配合和无缝衔接,采取主动预防,措施得力,得以保证未出现院内感染的情况。由此可见,院内感染可防可控,对于此类罕发事件,不必恐慌和过度防护。采取合理、有效的感染控制措施,是控制医院感染、保障医疗安全的关键。     

Four cases of non-clostridial gas gangrene with diabetes mellitus

We report four cases of non-clostridial gas gangrene. All cases were associated with diabetes mellitus as the underlying disease. Case 1: a 60-year-old male developed an ulcerative lesion on the dorsum of his left foot. Peptostreptococcus asaccharolyticus, Citrobacter freundii and Staphyrococcus epidermidis were identified in culture from odoriferous pus. Case 2: a 81-year-old female developed a lesion on her vulva spreading to the right lower abdomen. Bacteroides bivius, Peptostreptococcus asaccharolyticus and Streptococcus faecalis were identified in culture of the odoriferous pus. Case 3: a 80-year-old male developed a swollen area with ulcer on the right foot. Bacteroides fragiris, Enterococcus faecalis, Proteus mirabilis, Enterococcus avium and Enterococcus faecalis were identified by culture. Case 4: a 52-year-old female developed swelling of her left groin. Enterococcus faecalis and Streptococcus anginosus were identified in culture from the odoriferous pus. In all patients, a radiological examination revealed the presence of subcutaneous gas in the lesion. Prognosis of non-clostridial gas gangrene is usually poor. These four patients, however, all survived. Once an infectious sign is seen in the diabetic patient, it is important to discover a gas figure by using the radiological examination (plain film or computed tomography). Earlier diagnosis and debridement are the most important for a better prognosis. Because workers with diabetes mellitus are now increasing in number, occupational physicians should always keep in mind that a serious infectious disease like non-clostridial gas gangrene can develop even from minor accidental trauma, and they should control the working environment in the workplace where accidents often happen.     

8例气性坏疽病人高压氧治疗效果分析

目的探讨高压氧治疗气性坏疽病人的疗效.方法回顾性研究我院2004年2月～2007年2月8例气性坏疽病人高压氧治疗后的情况.结果8例气性坏疽病人经外科治疗和高压氧综合治疗,全身症状均获改善,2例因伤情复杂需截肢(趾)外,其余6例均获痊愈.结论高压氧对气性坏疽病人有独特疗效,综合治疗可明显提高治愈率.     

糖尿病并发气性坏疽一例报道并文献复习

正大肠埃希菌是肠杆菌科中常见的细菌,为革兰阴性杆菌,能发酵多种糖类产酸、产气。本例患者为大肠埃希菌感染所致背部皮下软组织,脾脏后缘、左肾后方、左侧后腹部、盆腔及左下肢大量积气、积液,其临床表现为气性坏疽,在大肠埃希菌感染病例中实属罕见,故结合文献复习与大家分享,以提高对糖     

1例会阴、阴囊气性坏疽切开引流术的手术配合

气性坏疽（gas gangrene）是厌氧菌感染的一种,即由梭状芽孢杆菌所致的肌坏死或肌炎;主要表现为患部肿胀、产气,肌肉皮肤由红肿到发紫发黑,以致坏死,蔓延快、腐肉恶臭,极易引起严重毒血症,是创伤后最严重的并发症之一［1］。此类感染发展急剧,预后较差,死亡率高［2］。本院于2011年10月收治1例会阴、阴囊气性坏疽并行急诊切开引流术的患者,现将手术配合介绍如下。     

Fournier's gangrene

Fournier's gangrene is a rapidly progressive, necrotizing fasciitis of the perineal, genital or perianal regions. Despite increasing knowledge about aetiology, diagnostic procedures and treatment, the gangrene is still a destructive and potentially lethal disease. In two patients, men aged 54 and 63 years, Fournier's gangrene was diagnosed. The first one died of septic shock 12 hours after admission. Surgical débridement had been performed immediately. He had a latent promyelocytic leukaemia. The second patient recovered fully after extensive surgical and antimicrobial therapy. Fournier's gangrene appears to be caused by the synergistic pathogenic action of various individually non-pathogenic commensal bacteria. Virtually all patients have an underlying systemic disorder, mainly chronic alcoholism or diabetes mellitus. Immunosupression is a predisposing factor. The gangrene requires an aggressive approach, treatment being based on the combination of haemodynamic stabilisation, antibiotic triple therapy and radical surgical débridement.     

Management of gas gangrene in Hungary during 1979-1988 based on data from Public Health Centers

Authors present data on the therapy of 223 gas gangrene cases between 1979-1988, a ten years period, based on the reports of Public Health Stations in Hungary. Of the 223 patients 150 died, thus lethality was 67.3%. In lack of surgical intervention there was no chance of survive. Merely wound exposure resulted in a much higher fatality rate than necrectomy of the wound. Local hydrogen-hyperoxide treatment improved survival essentially. Specific antitoxin therapy did not influence the survival rate. The effect of a single antibiotic was poor; combined antibiotic treatment gave a significantly better result. As for combination, the most effective were erythromycin, the lincosamids and chloramphenicol. According to the data presented, it would be possible to reduce to the half the fatality rate of gas gangrene in Hungary.     

糖尿病合并下肢肺炎克雷伯菌气性坏疽1例

正气性坏疽是指由产气细菌引起且进展迅速的软组织感染,在早期报道中其病原体通常被特指为产气荚膜梭菌。然而随着大量文献报道,非产气荚膜梭菌导致的产气感染逐渐得到重视。本例患者为糖尿病合并下肢肺炎克雷伯菌气性坏疽,在肺炎克雷伯菌感染病例中相对少见。本文结合文献分析,以期提高对糖尿病合并非梭状菌气性坏疽的认识。