Abstract

Aims and Objectives: To compare the bacterial flora of the lower respiratory tract during and after a week of tracheostomy. Study design: A clinical descriptive study of 21 months duration from Oct 2012 to June 2014. Study setting: Department of Otorhinolaryngology and Head and Neck Surgery. Kasturba Medical College Hospital, Mangalore and Government Wenlock Hospital, Mangalore, Manipal University. Materials and Methods: All patients on whom an open surgical tracheostomy was done was included. Patients with evidence of lower respiratory tract infection prior to tracheostomy were excluded. A total of two samples of tracheal aspirate were collectedusing a sterile suction catheter from each patient for the study; one during tracheostomy and the other seven days post tracheostomy. These sterile suction catheter tip were send for bacterial culture. Results: 130 patients were studied with ages ranging from 28-81 years with a mean age of 57.2 years. Commonest diagnosis in these patients was head and neck malignancy (73.1%) and the commonest indication for tracheostomy being upper airway obstruction (56.2%). The lower airways were found to be colonized in 5.4% of patients according to the culture done during tracheostomy; organisms isolated being Acenitobacterspps (3.4%) and KlebsiellaPneumoniae(1.5%), all of which were in patient who were previously intubated. Patients developed significantly more colonization post-tracheostomy (113/130) compared to culture done during tracheostomy (7/130). Post tracheostomy cultures taken on seventh post op day showed predominant growth of Gram Negative Bacilli particularly Pseudomonas aeruginosa(47.4%), Klebsiellapneumoniae (18.5%) and Acenitobacterspps (7.7%). Conclusions: Post-tracheostomy, lower respiratory tract, which is sterile in normal individuals gets colonized easily with bacteria post tracheostomy commonly by gram negative bacteriae like Pseudomonas aeruginosa and Klebsiellapneumoniae, Serial tracheal aspirate cultures have to be done to understand the nature of bacteria and treat the infections accordingly.

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