Comparison of Predebridement and Debridement Cultures in Predicting Postoperative Infections in Compound Fractures DC06-DC09
Dr. Krishnarao Arthi,
F9, G Block Divyavarshini, No. 7 Govindasamy St, Palavanthangal, Chennai-600114, Tamil Nadu, India.
Introduction: Compound fractures are fractures which communicate to the external environment through a wound, exposing the bone. Bacterial contamination is reported to occur in 60-70% of the cases which may be responsible for the infectious complications in these patients. This study has aimed to predict the appropriate time of culture, its frequency and the type of specimen to be processed for determining the microbial flora of the fracture wound which will help in instituting rational antibiotic treatment for the patient.
Aim: To compare predebridement and debridement cultures in causing postoperative infections in patients with compound fractures of long bones.
Materials and Methods: This was a prospective study conducted at Madras Medical College for a period of 6 months involving 100 samples consisting of sequential swabs and tissue specimens sent to the Microbiology laboratory for investigation.
Results: In the predebridement period, within 6 hours of injury, 15% of the cultures showed significant growth out of which Staphylococcus aureus was isolated in 53%. Among the debridement cultures 41% showed significant growth. Postoperative follow up was done for 6 weeks. Forty six percent of patients showed clinical signs of infection. Thirty nine percent of patients turned out to be culture positive confirming the presence of postoperative infection. It was noted that 53 percent of predebridement culture positive patients continued to have persistent infection in the postoperative period and 66% of the debridement culture positive patients developed postoperative infection. It was concluded that the sensitivity of predebridement cultures and debridement cultures were 21% and 69% respectively.
Conclusion: It is therefore recommended that debridement culture with a higher sensitivity will provide guidance regarding the choice of antimicrobial therapy.