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Background: Microbiology of open fracture wounds is constantly changing. A clear understanding of the bacterial flora that could be expected is needed in order to administer a rational and effective antibiotic treatment for open fractures. The role and efficacy of primary bacterial cultures in management of open fractures is also debatable and needs further evaluation. Methods: One hundred patients with one hundred and seven open fractures of long bones were studied prospectively, from March 1st 2001 till February 28th 2002. Wound swabs were obtained at pre-debridement, intra-operative, post debridement, 1st dressing/after 24hrs intervals, subsequently every week and sent for cultures. The infecting organism, its antibiotic susceptibility and its correlation between cultures at different stages was noted. Results: An infection rate of 43.9% was noted. Most of the initial wound cultures, showed growth of Gram-negative organisms (76%), commonest being Pseudomonas (36%) and Acinitobacter(20.7%). However, majority of infections after 2nd week were caused by Gram-positive organisms. Staphylococcus aureus (93.5%) was the predominant Gram-positive organism. None of the organisms grown on admission and pre-debridemet cultures eventually caused infection; however, 28% of cases with negative cultures eventually got infected. Post debridement cultures were positive in none. Among the cultures obtained at 1st dressing 40% of organisms grown eventually caused infection whereas 60% showed growth with different organism. Conclusions: A shift in the bacterial flora occurs in compound fracture wounds from Gram-negative to Gram-positive organisms after the 2nd week. Cultures obtained at admission, predebridment, posted brid ment and at 1st dressing or after 24hrs are not reliable indicators of subsequent wound infection.

Study of microbilogical flora and role of primary bacterial cultures in management of open fractures of long bones