Nonclostridial gas gangrene. Report of 48 cases and review of the literature.

Gangrenous lesions accompanied by evidence of subcutaneous gas usually are diagnosed as "clostridial gas gangrene." The occurrence of nonclostridial gas gangrene has been infrequently reported and is thought to be relatively rare. Review of 278 admissions of diabetic patients with orthopedic vascular problems disclosed a 17% (48 patients) incidence of nonclostridial gas infections and a 3% (one patient) occurrence of clostridial gas gangrene. Clinical characteristics ranged from severe to benign toxicity. Appreciation of the causative organisms (usually mixed Gram-negative rod and enterococcus) of this syndrome is essential, especially in the diabetic patient, since appropriate antibiotic therapy and surgery can result in a low mortality (4%) and a high incidence (80%) of ambulatory, independent patients.