IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 18, Issue 3 Ser. 6 (March. 2019), PP 74-77 www.iosrjournals.org DOI: 10.9790/0853-1803067477 www.iosrjournals.org 74 | Page Microbes in Tracheostomy Aspirates of Head Injury Patients Bhavinder Kumar Arora, 1 Sangeeta Arora, 2 Monika Yadav 3 1 Professor, Department of Surgery Pt B D Sharma PGIMS Rohtak-124001 2,3 Resident, Department of Microbiology Faculty of Medicine and Health Sciences, SGT University, Budhera, Gurugram-122505 Corresponding Author: Dr Bhavinder Kumar Arora Abstract Background Tracheostomy is a life saving procedure in head injury patients with GCS less than 8. Tracheostomy exposes lower respiratory tract to exterior so leading to complication of brochopneumonia. Material and Methods This study was done to evaluate the microbiology of the tracheal aspirates of tracheostomised head injury patients. Results The bacteria isolated by culture of tracheal aspirates with their sensitivity of gram-negative bacilli are shown in table 1.Out of 50 patients 46 (92%) had growth of aerobic gram-negative bacilli particularly Pseudomonas aeruginosa 19(38%) and Klebsiella pneuminae (40%) while Methicillin resistant Staphylococcus aureus (MRSA) was present in 4 patients (8.0%). Conclusion This study enlists the microbes and sensitivity in secretions from the tracheostomy of head injury patients staying in general surgery ward in a short period of 7 days.From tracheal aspirate culture in head injury patients, Pseudomonas aeruginosa and Klebsiella pneumoniaewere the commonest isolates. Keywords: Tracheostomy, Tracheotomy, Tracheal stoma site infection, Tracheal aspirate, Microbes, Respiratory tract infection, --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 25-02-2019 Date of acceptance: 11-03-2019 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Tracheostomy is a lifesaving procedure in severe brain trauma. It bypasses the dead space and obstruction due to blood in pharynx. This also avoids the prolonged intubation particularly if assisted ventilation is required.Tracheostomy is required in these patients because of patient's inability to protect the airway and persistence of excessive secretions. For these excessive secretions in the tracheobronchial tree, tracheostomy provides a route with ease of suction. The tracheostomised patients with head injury are having a high risk of lower respiratory tract infection because the protective nasal barriers are removed and there is direct entry of microbes into tracheobronchial tree. The irritation by tracheostomy tube causes local inflammatory reaction and oedema leading to bacterial colonization.[1] To avoid the lower respiratory tract infection, careful hygiene of tracheostomy is recommended. Use sterile disposable suction catheters, gentle tracheal suction, bacteria free humidifiers, less visitors are recommended. [2]However, despite of high level of hygiene, exogenous colonization with or without subsequent infection is common.It is noted that the infection rates are lower after tracheostomy due to improved tracheobronchial toilet. This tracheal suction also inhibits microbial colonization thus avoiding complications.[3]Despite the fact that routine care is required for a substantial number of head injury patients with long term tracheostomy, surprisingly little published information is available regarding many aspects of prolong care, including assessment and management of suspected respiratory tract infections. Clinicians utilize tracheal-aspirate specimens to diagnose and treat lower respiratory tract infections. [4] Aim of Study The aim of this study was to evaluate the bacterial profile and antimicrobial sensitivity of respiratory secretions from tracheostomy in severe head injury trauma patients and to provide guidelines regarding use of antibiotics in treatment of lower respiratory infections.