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Bacterial Tracheitis

by John T. McBride, MD

Bacterial tracheitis is bacterial infection of the trachea.

Bacterial tracheitis is uncommon and can affect children of any age. Staphylococcus aureus and group A β-hemolytic streptococci are involved most frequently. Onset is acute and is characterized by respiratory stridor, high fever, and often copious purulent secretions. Rarely, bacterial tracheitis may develop as a complication of viral croup or endotracheal intubation. As in patients with epiglottitis, the child may have marked toxicity and respiratory distress that may progress rapidly and may require intubation.

Diagnosis is suspected clinically and can be confirmed by direct laryngoscopy, which reveals purulent secretions and inflammation in the subglottic area with a shaggy, purulent membrane or by lateral neck x-ray, which reveals subglottic narrowing that may be irregular as opposed to the symmetric tapering typical of croup.

Treatment in severe cases is the same as that of epiglottitis (see Epiglottitis); whenever possible, endotracheal intubation should be done in controlled circumstances by a clinician skilled in managing a pediatric airway (see Endotracheal tubes). Initial antibiotics should cover S. aureus and streptococcal species; cefuroxime or an equivalent IV preparation may be appropriate empirically unless methicillin-resistant staphylococcus is prevalent in the community, in which case vancomycin should be used. Therapy for critically ill children should be guided by a consultant knowledgeable in local susceptibility patterns. Once definitive microbial diagnosis is made, coverage is narrowed and continued for 10 days.

Complications include bronchopneumonia, sepsis, and retropharyngeal cellulitis or abscess. Subglottic stenosis secondary to prolonged intubation is uncommon. Most children treated appropriately recover without sequelae.

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