Microbiological Profiles of Surgical Pad Cultures in Damage Control Surgery: Clinical Implications and Predictive Factors

<b><i>Purpose:</i></b> This study aimed to investigate the microbiological profiles of surgical pad cultures in patients undergoing damage control surgery (DCS) for abdominal trauma and to assess their association with clinical outcomes. <b><i>Patients and Methods:</i></b> A retrospective observational study was conducted on 122 patients who underwent DCS at a regional trauma center between January 2012 and December 2021. Patients were grouped according to the presence or absence of positive pad culture results. Microbiological data from surgical pad, abdominal, and wound cultures were analyzed. Clinical characteristics and postoperative infectious complications were compared between groups. Multi-variable logistic regression was performed to identify factors associated with infectious complications. <b><i>Results:</i></b> Pad cultures were positive in 71 patients (58.2%). The microbial distribution differed between sites: <i>Staphylococcus epidermidis</i> (20.3%) predominated in wound cultures, while <i>Enterococcus faecalis</i> was significantly more prevalent in abdominal cultures (20.0% vs. 4.3%, p = 0.006). Culture-positive patients had significantly higher rates of surgical site infection (42.1% vs. 20.2%, p = 0.018), intra-abdominal abscess (18.4% vs. 8.9%, p = 0.042), and pneumonia (15.2% vs. 7.8%, p = 0.038). In multi-variable analysis, positive pad culture (odds ratio [OR]: 3.49, 95% confidence interval [CI]: 1.52-8.01, p = 0.003) and red blood cell (RBC) transfusion ≥10 units (OR: 4.29, 95% CI: 1.89-9.74, p < 0.001) were independently associated with infectious complications. Culture positivity was not associated with mortality (p = 0.982). <b><i>Conclusion:</i></b> Surgical pad cultures obtained during DCS provide independent infection risk stratification beyond clinical and injury parameters. Positive cultures predict infectious complications but not mortality, suggesting specific utility for infection surveillance. Microbiological profiles differ by anatomical site, supporting site-specific antimicrobial approaches. These findings suggest potential utility of routine pad culture collection in DCS patients.