Chemotherapy in Gas Gangrene

Altemeier, William A.; Furste, Wesley; Culbertson, W. R.

doi:10.1001/archsurg.1947.01230080679004

Cited by 13 publications

(6 citation statements)

References 16 publications

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“…They demonstrated a significant deterioration in survival times when a regular intramuscular penicillin regime was initiated six hours after injury compared with immediately post-injury. 32 Owen-Smith and Matheson 10 showed that even with wound debridement at six hours, delaying antibiotics worsened survival in sheep with penetrating softtissue wounds contaminated with C. perfringens. Similarly, Mellor, Cooper and Bowyer 33 used a porcine penetrating injury model to show that when the start of a three-day course of benzylpenicillin was delayed from one to six hours after injury, it was ineffective in preventing infection.…”

Section: Discussionmentioning

confidence: 99%

Early antibiotics and debridement independently reduce infection in an open fracture model

Penn-Barwell

Murray

Wenke

2012

The Journal of Bone and Joint Surgery. British volume

100

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Most animal studies indicate that early irrigation and debridement reduce infection after an open fracture. Unfortunately, these studies often do not involve antibiotics. Clinical studies indicate that the timing of initial debridement does not affect the rate of infection but these studies are observational and fraught with confounding variables. The purpose of this study was to control these variables using an animal model incorporating systemic antibiotics and surgical treatment. We used a rat femur model with a defect which was contaminated with Staphylococcus aureus and treated with a three-day course of systemic cefazolin (5 mg/kg 12-hourly) and debridement and irrigation, both of which were initiated independently at two, six and 24 hour time points. After 14 days the bone and hardware were harvested for separate microbiological analysis. No animal that received antibiotics and surgery two hours after injury had detectable bacteria. When antibiotics were started at two hours, a delay in surgical treatment from two to six hours significantly increased the development of infection (p = 0.047). However, delaying surgery to 24 hours increase the rate of infection, but not significantly (p = 0.054). The timing of antibiotics had a more significant effect on the proportion of positive samples than earlier surgery. Delaying antibiotics to six or 24 hours had a profoundly detrimental effect on the infection rate regardless of the timing of surgery. These findings are consistent with the concept that bacteria progress from a vulnerable planktonic form to a treatment-resistant biofilm.

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Section: Discussionmentioning

confidence: 99%

Early antibiotics and debridement independently reduce infection in an open fracture model

Penn-Barwell

Murray

Wenke

2012

The Journal of Bone and Joint Surgery. British volume

100

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show abstract

“…2) Streptomycin. The experiments of Alteimeier, Furste, and Culbertson (29) indicate that streptomycin is of negligible value in the prophylaxis or treatment of gas gangrene.…”

Section: Subsequently Mcintosh and His Colleaguesmentioning

confidence: 99%

“…It has proved of great value in aborting experimental gas gangrene caused by all the commoner clostridia, particularly if given locally and within a short time after infection. If administered parenterally, considerably larger doses are required: if the drug is withheld for 2 hr or more its efficacy markedly and rapidly decreases (9,29,267,395,690,932). There is no evidence that penicillin has any neutralizing action in vitro against the toxins of C. perfringens (918), a fact that is borne out by the observation that when combined with antitoxin its efficacy in vivo is enhanced (459, 690, 756a).…”

Section: Subsequently Mcintosh and His Colleaguesmentioning

confidence: 99%

The Histotoxic Clostridial Infections of Man 12

Maclennan

1962

Bacteriological Reviews

259

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“…A state of severe septic shock with anuria occurred in 5 of the 42 patients. 6. The general appearance of the patient was also of some significance early in the course of the disease.…”

Section: A Variable Interval Existed Between In¬mentioning

confidence: 94%

“…Administration of polyvalent gas gangrene antitoxin before and after surgery, 50,000 units being given every 4 to 6 hours for 24 to 48 hours in patients with profound toxemia and hypotension. 6 …”

Section: A Variable Interval Existed Between In¬mentioning

confidence: 99%

Problems in the Diagnosis and Treatment of Gas Gangrene

Altemeier¹

1957

Arch Surg

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Chemotherapy in Gas Gangrene

Cited by 13 publications

References 16 publications

Early antibiotics and debridement independently reduce infection in an open fracture model

Early antibiotics and debridement independently reduce infection in an open fracture model

The Histotoxic Clostridial Infections of Man 12

Problems in the Diagnosis and Treatment of Gas Gangrene

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