Bacteriological profile of endotracheal tube aspirates in head injury patients admitted in Neurosurgical Intensive Care Unit: a cross-sectional study from a tertiary care hospital of Central Nepal

Background and objectives: Many head injury patients have reduced consciousness, are prone to aspiration of oral secretions and likely develop pneumonia. The organisms causing such infection and their antibiotic susceptibility will vary from patient to patient. The aim of this study was to identify the common organisms which cause respiratory tract infection in Neurosurgical Intensive Care Unit, investigate their antibiotic susceptibility, and try to prepare a common antibiotic formulation which can be started empirically. We also intended to find out the antibiotic resistance of these different types of bacteria. Subjects and methods: We conducted a retrospective cross-sectional study for a period from January to June 2018 in patients who were admitted with head injury in Neurosurgical Intensive Care Unit. All those having endotracheal tubes for assisting respiration for ≥ 3 days were included in the study. Endotracheal tube aspirate was obtained on the 3rd day of admission. We recorded age, sex, Glasgow Coma Scale score at the time of admission, the respiratory pathogen isolated, and its antibiotic susceptibility and resistance as identified by bacterial culture. Statistical analysis of data was done to find out if there was any age or sex-wise distribution of the organism and to which antibiotic most of the organisms responded. This study was approved by the Institutional Review Committee of The College of Medical Sciences - Teaching Hospital, Bharatpur on November 28, 2017. Results: The types of bacteria isolated from endotracheal tube aspirate were Acinetobacter baumanii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli and Enterobacter species. Among all the antibiotics which were tested for sensitivity, Meropenem was the only one that was found to be consistently sensitive to all the above bacterial species. Conclusion: If we are encountering a respiratory tract infection in an intubated head injury patient, Meropenem is a potential antibiotic which can be the empirical drug of choice till the final culture and sensitivity are reported.