Clinical Efficacy of Imipenem/Cilastatin for Treatment for Lower Respiratory Tract Infection of Neurosurgical Patients after Tracheotomy

OBJECTIVE To investigate the clinical curative effect of imipenem/cilastatin for pathogen from cranial neurosurgical patients with lower respiratory tract infection after tracheotomy to provide basis for treatment of such patients. METHODS Thirty-two cranial neurosurgical patients with lower respiratory tract infection after tracheotomy were enrolled in the study with original empiric therapy with imipenem/cilastatin. And the pathogenic bacteria in patient sputum from patients with lower respiratory tract infection after tracheotomy were strictly identified and analyzed by automatic microorganism analyzers. The clinical efficacy of Prepenem was identified after treatment. RESULTS The strain of bacterial species(48) and fungi(5) from 53 specimens were isolated. 15 Strains were infected by one kind of bacteria and 38 strains were infected by two kinds of bacteria. Among the pathogen,gram-negative bacilli were about 64.14% and Klebsiela pneumoniae(18.86%) was the most predominant. Gram-positive coccobacteria were about 26.42% and Staphylococcus aureus(13.21%) was the most predominant. Fungi were about 9.43% and Candida albicans(5.66%) was the most predominant. The drug sensitivity test showed that the ratio of drug resistance of bacteria isolated from sputum was high,but gram-negative bacilli were highly sensitive to imipenem,and its total clearance rate of all strains was 79.41%. 18 Patients(56.25%) were treated only by imipenem/cilastatin,8 patients(25.00%) were finished by combining with other antibiotics according to the drug sensitivity test. The total effective rate was 81.25%. the withdrawal rate of imipenem/cilastatin was only 18.75%. the total motality was only 6.25%. There was little severe adverse reaction during the therapy. CONCLUSION Gram-negative bacili are the main pathogenic bacteria in neurosurgical patients with lower respiratory tract infection after tracheotomy. because they were so highly sensitive to imipenem so imipenem canbe chose in the early days before the drug sensitivity test.