Zakaur Rab Siddiqui, Ejaz Ahmed, Niazud Din, Khaleequz Zaman.
Antimicrobial sensitivity of lower respiratory tract infections in tracheostomised severe head injury patients.
Ann Pak Inst Med Sci Jan ;7(2):52-6.

Objective: To evaluate the bacteriology of lower respiratory tract infections and antimicrobial sensitivity following tracheostomy in a head injury unit. Study Design: Descriptive study. Place and Duration: Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad from January 2006 to December 2006 Materials and Methods: The patients with severe head injury (with a GCS of less than 8) were first admitted to the 10-bedded head injury unit followed by tracheostomy. The two indications of tracheostomy included patient\'s inability to protect the airway due to deep coma, requiring intubation for more than a week and persistence of excessive secretions. A total of 50 patients of either gender with severe head injury and undergoing tracheostomy and having clinical features of infection were included in the study. Tracheal secretions were taken in cases where the lower airway secretions were turbid or the patient was having unexplained fever with chest x-ray showing consolidation and sent for culture and sensitivity. Specimens for culture and sensitivity were collected using a catheter which passes through the tracheostomy tube into the trachea and analyzed at a single microbiological laboratory. All samples were incubated for 24 hours at 37oC for obtaining aerobic growths. Microbes were identified by their by their colonial morphology and characteristic biochemical tests (using API-20E ). Results: Out of 50 patients 41 patients (82%) had shown growth during the culture, mainly aerobic gram negative bacilli (AGNB), in 38 patients (76.0%), particularly Pseudomonas aeruginosa(32%) and Klebsiella pneumonia(28%), while Methicillin Resistant Staphylococcus aureus (MRSA) was present in 3 patients (6.0 %).The highest mean resistance among GNB of tracheal aspirates was noted to amoxiciclav (augmentin) and cefaclor (100%). The lowest mean resistance of tracheal aspirate isolates was to piperacillin+tazobactam(7.7%) followed by imipenum (20.6), cefoperazone+sulbactum (23.7%) and amikacin (26.3%). MRSA showed 100% sensitivity to vancomycin as well as fusidic acid. Conclusion: GNB were the predominant isolates of LRT infections with AGNB, Klebsiella pneumonia and Pseudomonas aeruginosa as the commonest isolates. Patients in severe head injury unit with altered consciousness and on prior injudicious antimicrobial therapy are at high risk for contracting lower respiratory tract infections due to resistant AGNB.

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