title: Predebridement wound culture in open fractures does not predict postoperative wound infection: A pilot study.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Puducherry, India.
authors.forename: Reddy
authors.initials: R
authors.lastname: Lingaraj
authors.affiliation: Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
authors.forename: John Ashutosh
authors.initials: JA
authors.lastname: Santoshi
authors.affiliation: Department of Microbiology, Pondicherry Institute of Medical Sciences, Puducherry, India.
authors.forename: Sheela
authors.initials: S
authors.lastname: Devi
authors.affiliation: Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Puducherry, India.
authors.forename: Syed
authors.initials: S
authors.lastname: Najimudeen
authors.affiliation: Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Puducherry, India.
authors.forename: James J
authors.initials: JJ
authors.lastname: Gnanadoss
authors.affiliation: Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Puducherry, India.
authors.forename: Rengasamy
authors.initials: R
authors.lastname: Kanagasabai
authors.affiliation: Department of Microbiology, Pondicherry Institute of Medical Sciences, Puducherry, India.
authors.forename: Reba
authors.initials: R
authors.lastname: Kanungo
keywords: Culture; infection; initial; open fracture