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The significance of perioperative cultures in open pediatric lower-extremity fractures
1Department of Orthopaedics, University of Washington, Harborview Medical Centre, Seattle 98104.
Insights
Perioperative cultures in pediatric open lower-extremity fractures have questionable value. Negative cultures showed a high probability of avoiding infection, but positive results were less predictive of actual infection development.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Pediatric Medicine
Background:
- Open pediatric lower-extremity fractures are susceptible to infection.
- Perioperative cultures are often used to guide treatment, but their utility in this specific population is debated.
Purpose of the Study:
- To assess the diagnostic value of perioperative cultures (pre- and post-debridement) in predicting infection following open pediatric lower-extremity fractures.
Main Methods:
- Retrospective review of 86 pediatric patients with open lower-extremity fractures.
- Analysis of predebridement and postdebridement wound culture results.
- Correlation of culture results with subsequent infection development.
Main Results:
- An infection incidence of 15% was observed.
- Predebridement cultures were positive in 63% and postdebridement in 40% of wounds.
- Positive cultures identified the infecting pathogen in only 29% (pre) and 60% (post) of infected wounds.
- Negative predebridement cultures predicted no infection with 94% accuracy; negative postdebridement cultures predicted no infection with 79% accuracy.
- Predebridement cultures had high sensitivity (88%) but low specificity (43%); postdebridement cultures had lower sensitivity (50%) but better specificity (63%).
Conclusions:
- Routine perioperative cultures in open pediatric lower-extremity fractures may not be consistently valuable for predicting infection.
- Negative cultures appear more reliable in ruling out infection than positive cultures are in confirming it.
- Further prospective studies are needed to validate these findings and determine the general applicability of perioperative cultures in this context.
Abstract:
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.