Reddy Lingaraj1, John Ashutosh Santoshi2, Sheela Devi3, Syed Najimudeen1, James J Gnanadoss1, Rengasamy Kanagasabai1, Reba Kanungo3
1Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Puducherry, India.
2Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
3Department of Microbiology, Pondicherry Institute of Medical Sciences, Puducherry, India.
Background: There is confusion in the current literature regarding the value of obtaining predebridement wound cultures in the management of open fractures with several studies reporting contrasting results. We undertook a pilot study to determine the initial bacterial flora of open fractures in our environment and determine the correlation between subsequent wound infection if any, and the initial bacterial flora. Materials and Methods: Initial/predebridement wound swabs were obtained for 32 patients with open fractures. Patients underwent a debridement of the open wound and preliminary stabilization of fracture in the operating room within 24 h. Postdebridement wound cultures were obtained at 48 h and repeated subsequently, if indicated, during the follow-up period. The antibiotic therapy was modified based on the culture reports. Results: Initial wound swab culture showed bacterial contamination in 18 patients (56%); 14 patients (44%) developed an infection in the immediate postoperative period or during follow-up. Age, gender, co-morbid medical condition, delay in presentation, and grade of open fracture were not found to be predictors of postoperative infection. No patient had an infection with the same organism, which was present in the initial culture. Conclusion: The findings of this study suggest that the initial flora are not the infecting organisms in the open fracture wounds, and predebridement wound cultures have no value in predicting postdebridement wound infection.
Keywords: Culture, infection, initial, open fracture.