Quantitative wound cultures in upper extremity trauma

In a prospective study, 64 traumatic wounds to the hand and forearm were examined for infection by quantitative smear (Gram stain) and culture to determine whether significant wound contamination had occurred and to help in making the decisions regarding use of antibiotics and immediate or delayed closure. Sepsis developed in 23 of the 64 patients. The smears, available in 25 to 30 minutes, gave correct indications regarding development or absence of sepsis in 54 patients (84%); and the cultures, available in 24 to 36 hours, did so in 57 (89%). Prophylactic treatment with antibiotics in 36 patients was deemed unnecessary or inappropriate in 24 (smear and culture both negative, or organisms resistant to the agent). Quantitative smears and cultures, undertaken immediately by the techniques used in this study, are of practical value in management of traumatic wounds to the hand and forearm.