Perioperative microbiological assessment in open fractures: a prospective comparative study of wound swab and tissue sample cultures

Background: Infection remains a major complication affecting the management and outcome of open fractures. The usefulness of perioperative microbiological cultures in predicting infection has been debated. Commonly used sampling techniques include wound swab (WS) culture and tissue sample (TS) culture. While previous studies have compared swab cultures at different stages of debridement, limited evidence exists comparing WS and TS cultures obtained both before and after debridement in acute open fractures. This study aimed to compare the effectiveness of WS and TS cultures in detecting bacterial contamination during the perioperative period of open fracture management. Methods: This prospective study included 83 patients presenting with open fractures. WS and TS cultures were obtained from all patients during both pre-debridement and post-debridement phases. The microbiological growth patterns from the two techniques were recorded and compared. The association between bacterial growth and factors such as fracture type, time to hospital presentation, and time to surgery was also analyzed. Postoperative infection rates were correlated with culture results. Results: TS cultures demonstrated significantly higher bacterial detection rates compared to WS cultures. Higher rates of bacterial contamination were observed in Gustilo-Anderson type III B fractures and in patients with delayed presentation to hospital and operating theatre. Post-debridement TS cultures showed higher sensitivity and specificity in predicting postoperative infections when compared with WS cultures. Conclusions: TS culture is a more reliable method than WS culture for detecting bacterial contamination in open fracture wounds. Post-debridement TS cultures are particularly effective in identifying patients at risk of postoperative infection and may aid in optimizing infection prevention strategies in open fracture management.