Abstract: OBJECTIVE To analyze the pathogenic bacteria distribution and the drug resistance of lower respiratory tract infection in patients with severe traumatic brain injury (sTBI) after tracheotomy, so as to provide an objective basis for the scheming of reasonable anti infection treatment and clinical treatment strategy. METHODS A total of 528 cases of patients with sTBI after tracheotomy from Jun. 2011 to Jun. 2016 were selected as the research subjects. The incidence, the pathogenic bacteria distribution and the drug resistance of lower respiratory tract infection of the included patients were analyzed and studied. RESULTS Totally 327 cases were complicated with lower respiratory tract infection, and the infection rate was 61.9%. A total of 647 strains of pathogenic bacteria were isolated, and the gram-negative bacteria, gram-positive bacteria, and fungi accounted for 78.5%, 20.1% and 1.4%, respectively. The proportions of Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii and Staphylococcus aureus were the highest, accounting for 30%, 21.8%, 19% and 18.5%, respectively. In the gram-negative bacteria isolated, the resistant rates of Pseudomonas aeruginosa to gentamicin, aztreonam, and ceftazidime were higher, which were more than 60.0%. The resistant rates of K. pneumoniae to piperacillin, ceftizoxime, and cefotaxime were higher, which were more than 80.0%. The resistant rates of A.baumannii to all tested antimicrobial drugs were more than 50%, among them, the resistant rates to ceftizoxime, ceftazidime, and cefuroxime reached 100.0%, and the resistant rates of ampicillin, and ampicillin/sulbactam were higher, which were more than 90.0%. In the strains of S. aureus, 87 strains were methicillin-resistant S. aureus (MRSA) strains, with the detection rate of 72.5%. The resistant rates of MRSA strains to cefazolin, oxacillin, and penicillin G reached 100.0%, and to levofloxacin, gentamicin, erythromycin, and clindamycin were more than 75%. Totally 33 strains were methicillin-sensitive Staphylococcus aureus (MSSA) strains, accounting for 27.5%. The resistant rate of such strains to penicillin G was higher, which was 93.9%, while the resistant rates to other antimicrobial drugs were lower. CONCLUSION The pathogenic bacteria distribution and the drug resistance of lower respiratory tract infection in the patients with sTBI after tracheotomy have certain features. The susceptible antimicrobial drugs should be employed reasonably according to the etiological characteristics in order to improve the success rate of treatment and the prognosis of patients.