The significance of perioperative cultures in open pediatric lower-extremity fractures.
The value of perioperative cultures in 86 open pediatric lower-extremity fractures was assessed. Thirteen infections were identified, for an incidence of 15%. The predebridement culture was positive in 63% of wounds, and the postdebridement culture was positive in 40%. In the 13 wounds with infection, the infecting pathogen was found among the organisms grown on positive predebridement cultures 29% of the time, and on 60% of post-debridement cultures. Neither culture was of value in predicting the identity of a potential subsequent infecting pathogen. There was no significant difference in the rate of infection for negative cultures versus positive cultures; however, a negative predebridement culture was associated with a 94% chance of avoiding infection, and a negative postdebridement culture correlated with a 79% probability that infection would not occur. A positive culture result was less useful, however, because the infection rate remained low in these instances. Predebridement cultures were highly sensitive (88%) in identifying wounds that developed infection; however, the false positive rate was high, resulting in a specificity of only 43%. Postdebridement cultures, although somewhat more specific (63%), lacked sensitivity (50%). Clearly the routine use of perioperative cultures in open pediatric lower-extremity fractures must be questioned. Further prospective study is needed to confirm the validity and general applicability of the results of this retrospective review.
Kreder
H J
HJ
Department of Orthopaedics, University of Washington, Harborview Medical Centre, Seattle 98104.
Armstrong
P
P
D001419:Bacteria / Q000302:isolation & purification*; D002648:Child; D003646:Debridement; D005597:Fractures, Open / Q000382:microbiology*; D006801:Humans; D007430:Intraoperative Care; D007869:Leg Injuries / Q000382:microbiology*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014946:Wound Infection / Q000382:microbiology