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Review
. 2015 Dec 3;2015(12):CD010577.
doi: 10.1002/14651858.CD010577.pub2.

Interventions for treating gas gangrene

Zhirong Yang  1 , Jing Hu, Yanji Qu, Feng Sun, Xisheng Leng, Hang Li, Siyan Zhan
Affiliations
Review

Interventions for treating gas gangrene

Zhirong Yang et al. Cochrane Database Syst Rev. .

Abstract

Background: Gas gangrene is a rapidly progressive and severe disease that results from bacterial infection, usually as the result of an injury; it has a high incidence of amputation and a poor prognosis. It requires early diagnosis and comprehensive treatments, which may involve immediate wound debridement, antibiotic treatment, hyperbaric oxygen therapy, Chinese herbal medicine, systemic support, and other interventions. The efficacy and safety of many of the available therapies have not been confirmed.

Objectives: To evaluate the efficacy and safety of potential interventions in the treatment of gas gangrene compared with alternative interventions or no interventions.

Search methods: In March 2015 we searched: The Cochrane Wounds Group Specialized Register, The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL, Science Citation Index, the China Biological Medicine Database (CBM-disc), the China National Knowledge Infrastructure (CNKI), and the Chinese scientific periodical database of VIP INFORMATION (VIP) for relevant trials. We also searched reference lists of all identified trials and relevant reviews and four trials registries for eligible research. There were no restrictions with respect to language, date of publication or study setting.

Selection criteria: We selected randomized controlled trials (RCTs) and quasi-RCTs that compared one treatment for gas gangrene with another treatment, or with no treatment.

Data collection and analysis: Independently, two review authors selected potentially eligible studies by reviewing their titles, abstracts and full-texts. The two review authors extracted data using a pre-designed extraction form and assessed the risk of bias of each included study. Any disagreement in this process was solved by the third reviewer via consensus. We could not perform a meta-analysis due to the small number of studies included in the review and the substantial clinical heterogeneity between them, so we produced a narrative review instead.

Main results: We included two RCTs with a total of 90 participants. Both RCTs assessed the effect of interventions on the 'cure rate' of gas gangrene; 'cure rate' was defined differently in each study, and differently to the way we defined it in this review.One trial compared the addition of Chinese herbs to standard treatment (debridement and antibiotic treatment; 26 participants) against standard treatment alone (20 participants). At the end of the trial the estimated risk ratio (RR) of 3.08 (95% confidence intervals (CI) 1.00 to 9.46) favoured Chinese herbs. The other trial compared standard treatment (debridement and antibiotic treatment) plus topical hyperbaric oxygen therapy (HBOT; 21 participants) with standard treatment plus systemic HBOT (23 participants). There was no evidence of difference between the two groups; RR of 1.10 (95% CI 0.25 to 4.84). For both comparisons the GRADE assessment was very low quality evidence due to risk of bias and imprecision so further trials are needed to confirm these results.Neither trial reported on this review's primary outcomes of quality of life, and amputation and death due to gas gangrene, or on adverse events. Trials that addressed other therapies such as immediate debridement, antibiotic treatment, systemic support, and other possible treatments were not available.

Authors' conclusions: Re-analysis of the cure rate based on the definition used in our review did not show beneficial effects of additional use of Chinese herbs or topical HBOT on treating gas gangrene. The absence of robust evidence meant we could not determine which interventions are safe and effective for treating gas gangrene. Further rigorous RCTs with appropriate randomisation, allocation concealment and blinding, which focus on cornerstone treatments and the most important clinical outcomes, are required to provide useful evidence in this area.

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Conflict of interest statement

Zhirong Yang: none known. Jing Hu: none known. Yanji Qu: none known. Feng Sun: none known. Xisheng Leng: none known. Hang Li: none known. Siyan Zhan: none known.

Figures

1
1
Study flow diagram
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
4
4
Forest plot of comparison: 1 Additional Chinese herbs versus no additional Chinese herbs, outcome: 1.1 Cure rate.
5
5
Forest plot of comparison: 2 Additional topical HBOT versus additional systemic HBOT, outcome: 2.1 Cure rate.
1.1
1.1. Analysis
Comparison 1 Additional Chinese herbs versus no additional Chinese herbs, Outcome 1 Cure rate.
2.1
2.1. Analysis
Comparison 2 Additional topical HBOT versus additional systemic HBOT, Outcome 1 Cure rate.
See this image and copyright information in PMC

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  • doi: 10.1002/14651858.CD010577

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References

References to studies included in this review

Hou 2010 {published data only}
    1. Hou J, Guo Y, Xu Z. Efficacy of complex treatments for gas gangrene [in Chinese]. Chinese Journal of Misdiagnostics 2010;10(33):8095.
Li 2001 {published data only}
    1. Li Y, Ma Z, Cao Y. Effect of localized hyperbaric oxygenation on gas gangrene [in Chinese]. Modern Diagnosis and Treatment 2001;12(4):229‐30.

References to studies excluded from this review

Luo 1987 {published data only}
    1. Luo M. Heat‐clearing and detoxifying treatment for severe wounds infection in 30 cases [in Chinese]. Journal of Chinese Physician 1987;7:19‐20.
Ma 2008 {published data only}
    1. Ma Y, Qiao X, Liu H, Yang Q. Hyperbaric oxygen therapy for patients with gas gangrene [in Chinese]. Journal of Nurses Training 2008;14:1307‐8.
Mou 1985 {published data only}
    1. Mou R, Li S, Wei L. Hyperbaric oxygen therapy for gas gangrene due to war injuries: an analysis of 15 cases [in Chinese]. People's Military Surgeon 1985;9:22‐3.
Raman 2006 {published data only}
    1. Raman G, Kupelnick B, Chew P, Lau J. A horizon scan: uses of hyperbaric oxygen therapy. Health Technology Assessment Database 2006:1‐47. - PubMed
Rao 1994 {published data only}
    1. Rao G. Surgery and hyperbaric oxygen therapy for experimental gas gangrene [in Chinese]. Journal of Navy Medicine 1994;15(1):46.
Zhang 1988 {published data only}
    1. Zhang H. Comparisons of the effects of clindamycin, rifampicin, tetracycline, metronidazole and penicillin on experimental gas gangrene [in Chinese]. World Notes on Antibiotics 1988;1:75.

References to ongoing studies

NCT02111161 {published data only}
    1. Immunoglobulin for necrotizing soft tissue infections: a randomised controlled trial. http://ClinicalTrials.gov/show/NCT02111161 (accessed October 2015).

Additional references

Altemeier 1971
    1. Altemeier WA, Fullen WD. Prevention and treatment of gas gangrene. JAMA 1971;217(6):806‐13. - PubMed
Anderson 2007
    1. Anderson DM, Novak PD, Keith J, Elliott MA. Dorland's Illustrated Medical Dictionary. 1st Edition. Saunders, 2007.
Bartlett 2007
    1. Bartlett JG. Clostridial infections. In: Goldman L, Schafer AI editor(s). Cecil Medicine. 23. Philadelphia: Saunders Elsevier, 2007:2201‐7.
Bessman 1975
    1. Bessman AN, Wagner W. Nonclostridial gas gangrene. Report of 48 cases and review of the literature. JAMA 1975;233(9):958‐63. - PubMed
Brook 2008
    1. Brook I. Microbiology and management of soft tissue and muscle infections. International Journal of Surgery 2008;6(4):328‐38. - PubMed
Brown 1974
    1. Brown PW, Kinman PB. Gas gangrene in a metropolitan community. Journal of Bone and Joint Surgery 1974;56(7):1445‐51. - PubMed
Brown 1994
    1. Brown DR, Davis NL, Lepawsky M, Cunningham J, Kortbeek J. A multicenter review of the treatment of major truncal necrotizing infections with and without hyperbaric oxygen therapy. American Journal of Surgery 1994;167(5):485‐9. - PubMed
Chen 2011
    1. Chen E, Deng L, Liu Z, Zhu X, Chen X, Tang H. Management of gas gangrene in Wenchuan earthquake victims. Journal of Huazhong University of Science and Technology‐Medical Sciences 2011;31(1):83‐7. - PubMed
De 2003
    1. De A, Varaiya A, Mathur M, Bhesania A. Bacteriological studies of gas gangrene and related infections. Indian Journal of Medical Microbiology 2003;21(3):202‐4. - PubMed
Demello 1973
    1. Demello FJ, Haglin JJ, Hitchcock CR. Comparative study of experimental Clostridium perfringens infection in dogs treated with antibiotics, surgery, and hyperbaric oxygen. Surgery 1973;73(6):936‐41. - PubMed
Folstad 2004
    1. Folstad SG. Soft tissue infections. In: Tintinalli JE, Stapczynski JS, Ma OJ, Cline D, Cydulka RK, Meckler GD editor(s). Emergency Medicine: A Comprehensive Study Guide. 6th Edition. New York: McGraw Hill, 2004:976‐87.
George 2009
    1. George ME, Rueth NM, Skarda DE, Chipman JG, Quickel RR, Beilman GJ. Hyperbaric oxygen does not improve outcome in patients with necrotizing soft tissue infection. Surgical Infections 2009;10(1):21‐8. - PubMed
Gerding 2011
    1. Gerding DN, Johnson S. Clostridial infections. In: Goldman L, Schafer AI editor(s). Goldman's Cecil Medicine. 24. Philadelphia: Saunders Elsevier, 2011:e304‐1‐7.
Hart 1983
    1. Hart GB, Lamb RC, Strauss MB. Gas gangrene: I. A collective review. Journal of Trauma 1983;23(11):991‐1000. - PubMed
Hart 1990
    1. Hart GB, Strauss MB. Gas gangrene ‐ clostridial myonecrosis: a review. Journal of Hyperbaric Medicine 1990;5(2):125‐44.
Headley 2003
    1. Headley AJ. Necrotizing soft tissue infections: a primary care review [2003]. American Family Physician 2003;68(2):323‐8. - PubMed
Higgins 2011
    1. Higgins JPT, Altman DG, Sterne JAC, on behalf of the Cochrane Statistical Methods Group and the Cochrane Bias Methods Group. Chapter 8: Assessing risk of bias in included studies. In: Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hirn 1993
    1. Hirn M. Hyperbaric oxygen in the treatment of gas gangrene and perineal necrotizing fasciitis. A clinical and experimental study. The European Journal of Surgery. Supplement 1993;570:1‐36. - PubMed
Holland 1975
    1. Holland JA, Hill GB, Wolfe WG, Osterhout S, Saltzman HA, Brown IW Jr. Experimental and clinical experience with hyperbaric oxygen in the treatment of clostridial myonecrosis. Surgery 1975;77(1):75‐85. - PubMed
Hu 2015
    1. Hu N, Wu XH, Liu R, Yang SH, Huang W, Jiang DM, et al. Novel application of vacuum sealing drainage with continuous irrigation of potassium permanganate for managing infective wounds of gas gangrene. Journal of Huazhong University of Science and Technology‐Medical Sciences 2015;35(4):563‐568. - PubMed
Kaye 1967
    1. Kaye D. Effect of hyperbaric oxygen on Clostridia in vitro and in vivo. Proceedings of the Society for Experimental Biology and Medicine 1967;124:360‐6. - PubMed
Korhonen 1999
    1. Korhonen K, Klossner J, Hirn M, Niinikoski J. Management of clostridial gas gangrene and the role of hyperbaric oxygen. Annales Chirurgiae et Gynaecologiae 1999;88(2):139‐42. - PubMed
Laflin 1976
    1. Laflin MJ, Tobey RE, Reves JG. Anesthetic considerations in patients with gas gangrene. Anesthesia and Analgesia 1976;55(2):247‐52. - PubMed
Leach 1998
    1. Leach RM, Rees PJ, Wilmshurst P. ABC of oxygen: hyperbaric oxygen therapy. BMJ 1998;317(7166):1140‐3. - PMC - PubMed
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J, on behalf of the Cochrane Information Retrieval Methods Group. Chapter 6: Searching for studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Lehnhardt 2008
    1. Lehnhardt M, Homann HH, Daigeler A, Hauser J, Palka P, Steinau HU. Major and lethal complications of liposuction: a review of 72 cases in Germany between 1998 and 2002. Plastic and Reconstructive Surgery 2008;121(6):396e‐403e. - PubMed
Leung 1981
    1. Leung FW, Serota AI, Mulligan ME, George WL, Finegold SM. Nontraumatic clostridial myonecrosis: an infectious disease emergency. Annals of Emergency Medicine 1981;10:312‐4. - PubMed
Liu 2011
    1. Liu G, Liu X, Liu X. Thorough debridement plus HuaFuShengJiDingTongSan for severe gas gangrene: report of 20 cases [in Chinese]. Journal of External Therapy of Traditional Chinese Medicine 2011;20(4):22‐3.
Ma 1991
    1. Ma Y, Gu Y. Injuries with gas gangrene: analysis of 20 cases [in Chinese]. Chinese Journal of Traditional Medical Traumatology and Orthopedics 1991;3:20‐3.
Marrie 1981
    1. Marrie TJ, Haldane EV, Swantee CA, Kerr EA. Susceptibility of anaerobic bacteria to nine antimicrobial agents and demonstration of decreased susceptibility of Clostridium perfringens to penicillin. Antimicrobial Agents and Chemotherapy 1981;19(1):51‐5. - PMC - PubMed
McGuigan 2002
    1. McGuigan CC, Penrice GM, Gruer L, Ahmed S, Goldberg D, Black M, et al. Lethal outbreak of infection with Clostridium novyi type A and other spore‐forming organisms in Scottish injecting drug users. Journal of Medical Microbiology 2002;51(11):971‐7. - PubMed
Melville 2006
    1. Melville S. Clostridia: diarrheal disease, tissue infection, botulism, and tetanus. In: Engleberg NC, DiRita V, Dermody T editor(s). Schaechter's Mechanisms of Microbial Disease. 5th Edition. Philadelphia: Lippincott Williams & Wilkins, 2012:235‐41.
Morgan 1971
    1. Morgan A, Morain W, Eraklis A. Gas gangrene of the abdominal wall: management after extensive debridement. Annals of Surgery 1971;173(4):617‐22. - PMC - PubMed
Oda 2008
    1. Oda M, Kihara A, Yoshioka H, Saito Y, Watanabe N, Uoo K, et al. Effect of erythromycin on biological activities induced by clostridium perfringens alpha‐toxin. Journal of Pharmacology and Experimental Therapeutics 2008;327(3):934‐40. - PubMed
Pu 2008
    1. Pu D, Qiao F, Zhang W, Zeng Z, Tan C, Yin W, et al. Control analysis of hospital cross infections of 67 cases of doubtful gas gangrene from the earthquake disaster area [in Chinese]. Chinese Journal of Evidence‐based Medicine 2008;8(8):620‐2.
RevMan 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Rotter 1974
    1. Rotter M, Mittermayer H, Kundi M, Gruber H. Experimental investigations in guinea pigs on the therapy of gas gangrene with ozone. A preliminary report [in German]. Wiener Klinische Wochenschrift 1974;86(24):776‐8. - PubMed
Saunders 2003
    1. Saunders PJ. Hyperbaric oxygen therapy in the management of carbon monoxide poisoning, osteoradionecrosis, burns, skin grafts, and crush injury. International Journal of Technology Assessment in Health Care 2003;19(3):521‐5. - PubMed
Schwartz 1978
    1. Schwartz AA. Infectious disease emergencies: the clostridial syndromes. Therapy of clostridial myonecrosis. Western Journal of Medicine 1978;129(2):118‐20. - PMC - PubMed
Shupak 1984
    1. Shupak A, Halpern P, Ziser A, Melamed Y. Hyperbaric oxygen therapy for gas gangrene casualties in the Lebanon War, 1982. Israel Journal of Medical Sciences 1984;20(4):323‐6. - PubMed
SIGN 2015
    1. Scottish Intercollegiate Guidelines Network (SIGN). Search filters. http://www.sign.ac.uk/methodology/filters.html#random (accessed 23 November 2015).
Soh 2012
    1. Soh CR, Pietrobon R, Freiberger JJ, Chew ST, Rajgor D, Gandhi M, et al. Hyperbaric oxygen therapy in necrotising soft tissue infections: a study of patients in the United States Nationwide Inpatient Sample. Intensive Care Medicine 2012;38(7):1143‐51. - PubMed
Stanek 1976
    1. Stanek VG, Mittermayer H, Rotter M, Gruber H. Further experimental investigations on the therapy of gas gangrene with ozone and oxygen [in German]. Wiener Klinische Wochenschrift 1976;88(4):141‐4. - PubMed
Stevens 1987a
    1. Stevens DL, Maier KA, Laine BM, Mitten JE. Comparison of clindamycin, rifampin, tetracycline, metronidazole, and penicillin for efficacy in prevention of experimental gas gangrene due to Clostridium perfringens. Journal of Infectious Diseases 1987;155(2):220‐8. - PubMed
Stevens 1987b
    1. Stevens DL, Maier KA, Mitten JE. Effect of antibiotics on toxin production and viability of Clostridium perfringens. Antimicrobial Agents and Chemotherapy 1987;31(2):213‐8. - PMC - PubMed
Stevens 1988
    1. Stevens DL, Troyer BE, Merrick DT, Mitten JE, Olson RD. Lethal effects and cardiovascular effects of purified alpha‐ and theta‐toxins from Clostridium perfringens. Journal of Infectious Diseases 1988;157:272‐9. - PubMed
Stevens 1990
    1. Stevens DL, Musher DM, Watson DA, Eddy H, Hamill RJ, Gyorkey F, et al. Spontaneous, nontraumatic gangrene due to Clostridium septicum. Review of Infectious Disease 1990;12(2):286‐96. - PubMed
Stevens 1993
    1. Stevens DL, Bryant AE, Adams K, Mader JT. Evaluation of therapy with hyperbaric oxygen for experimental infection with Clostridium perfringens. Clinical Infectious Diseases 1993;17(2):231‐7. - PubMed
Stevens 2005
    1. Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ, et al. Practice guidelines for the diagnosis and management of skin and soft‐tissue infections. Clinical Infectious Diseases 2005;41(10):1373‐406. - PubMed
Tang 1982
    1. Tang R. Integreted traditional Chinese and western treatment for 11 patients with severe gas gangrene [in Chinese]. Yunnan Journal of Traditional Chinese Medicine and Materia Medica 1982;3:1‐3,8,51‐2.
Tibbles 1996
    1. Tibbles PM, Edelsberg JS. Hyperbaric‐oxygen therapy. New England Journal of Medicine 1996;334(25):1642‐8. - PubMed
Titball 2005
    1. Titball RW. Gas gangrene: an open and closed case. Microbiology 2005;151:2821‐8. - PubMed
Trott 2005
    1. Trott AT. Skin and soft‐tissue infections. In: Harwood‐Nuss A, Sharieff GQ, Wolfson AB editor(s). Clinical Practice of Emergency Medicine. 4th Edition. Philadelphia: Lippincott Williams & Wilkins, 2005:715‐7.
Wang 2003
    1. Wang C, Schwaitzberg S, Berliner E, Zarin DA, Lau J. Hyperbaric oxygen for treating wounds: a systematic review of the literature. Archives of Surgery 2003;138(3):272‐9. - PubMed
Wang 2010
    1. Wang Y, Hao P, Lu B, Yu H, Huang W, Hou H, et al. Causes of infection after earthquake, China, 2008. Emerging Infectious Diseases 2010;16(6):974‐5. - PMC - PubMed
Xiao 2008
    1. Xiao G. Sporiferous Anaerobic Infection [in Chinese]. In: Wu Z, Wu Z, Zheng S, An H, Wang J editor(s). Surgery. 7. Beijing: People's Medical Publishing House, 2008:162‐4.
Yu 1986
    1. Yu M. Combination of traditional Chinese and western medicine for treating gas gangrene in 4 cases [in Chinese]. Chinese Journal of Integrated Traditional and Western Medicine 1986;4:189.
Zhao 2004
    1. Zhao M. Traditional Chinese and western medicine treatment and care for gas gangrene [in Chinese]. Journal of Sichuan of Traditional Medicine 2004;22(9):73‐4.

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