Bacterial tracheitis is uncommon and can affect children of any age. Staphylococcus aureus Staphylococcal Infections Staphylococci are gram-positive aerobic organisms. Staphylococcus aureus is the most pathogenic; it typically causes skin infections and sometimes pneumonia, endocarditis, and osteomyelitis... read more and group A beta-hemolytic streptococci Streptococcal Infections Streptococci are gram-positive aerobic organisms that cause many disorders, including pharyngitis, pneumonia, wound and skin infections, sepsis, and endocarditis. Symptoms vary with the organ... read more are involved most frequently.
Symptoms and Signs of Bacterial Tracheitis
Most children have symptoms of viral respiratory infection for 1 to 3 days before the onset of severe symptoms of stridor Stridor Stridor is a high-pitched, predominantly inspiratory sound. It is most commonly associated with acute disorders, such as foreign body aspiration, but can be due to more chronic disorders, such... read more and dyspnea Dyspnea Dyspnea is unpleasant or uncomfortable breathing. It is experienced and described differently by patients depending on the cause. Although dyspnea is a relatively common problem, the pathophysiology... read more . In a few children, onset is acute and is characterized by respiratory stridor, high fever, and often copious purulent secretions. Rarely, bacterial tracheitis develops as a complication of viral croup Croup Croup is acute inflammation of the upper and lower respiratory tracts most commonly caused by parainfluenza virus type 1 infection. It is characterized by a brassy, barking cough and inspiratory... read more or endotracheal intubation Tracheal Intubation Most patients requiring an artificial airway can be managed with tracheal intubation, which can be Orotracheal (tube inserted through the mouth) Nasotracheal (tube inserted through the nose)... read more . As in patients with epiglottitis Epiglottitis Epiglottitis is a rapidly progressive bacterial infection of the epiglottis and surrounding tissues that may lead to sudden respiratory obstruction and death. Symptoms include severe sore throat... read more , children with bacterial tracheitis may have marked toxicity and respiratory distress that may progress rapidly and may require intubation.
Complications of bacterial tracheitis include hypotension, cardiorespiratory arrest, bronchopneumonia, and sepsis. Subglottic stenosis secondary to prolonged intubation is uncommon. Most children treated appropriately recover without sequelae.
Diagnosis of Bacterial Tracheitis
Direct laryngoscopy
Characteristic radiographic findings
Diagnosis of bacterial tracheitis 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 radiograph, which reveals subglottic narrowing that may be irregular as opposed to the symmetric tapering (steeple sign) typical of croup Croup Croup is acute inflammation of the upper and lower respiratory tracts most commonly caused by parainfluenza virus type 1 infection. It is characterized by a brassy, barking cough and inspiratory... read more . Direct laryngoscopy should be done in controlled circumstances where an artificial airway can be rapidly established if necessary.
Treatment of Bacterial Tracheitis
Adequate airway ensured
Antibiotics effective against S. aureus and streptococcal species
Treatment of bacterial tracheitis in severe cases is the same as that for epiglottitis Treatment Epiglottitis is a rapidly progressive bacterial infection of the epiglottis and surrounding tissues that may lead to sudden respiratory obstruction and death. Symptoms include severe sore throat... read more ; whenever possible, endotracheal intubation Tracheal Intubation Most patients requiring an artificial airway can be managed with tracheal intubation, which can be Orotracheal (tube inserted through the mouth) Nasotracheal (tube inserted through the nose)... read more should be done in controlled circumstances by a clinician skilled in managing a pediatric airway (1 Treatment reference Bacterial tracheitis is bacterial infection of the trachea, typically causing dyspnea and stridor. Diagnosis is by direct laryngoscopy in a controlled setting and imaging findings. Treatment... read more ).
Initial antibiotics should cover S. aureus, including methicillin-resistant S. aureus (MRSA), and streptococcal species; IV vancomycin and ceftriaxone may be appropriate empirically. Ceftaroline, as monotherapy, is a reasonable alternative to this combination regimen. 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.
Treatment reference
1. Tebruegge M, Pantazidou A, Thorburn K, et al: Bacterial tracheitis: a multi-centre perspective. Scand J Infect Dis 41(8):548-557, 2009. doi: 10.1080/00365540902913478
Key Points
Bacterial tracheitis, although uncommon, can affect children of any age.
Most children have symptoms of respiratory infection for 1 to 3 days before developing stridor and dyspnea.
Clinical suspicion of bacterial tracheitis can be confirmed with a lateral neck radiograph or direct laryngoscopy; however, direct laryngoscopy should be done in controlled circumstances where an artificial airway can be rapidly established if necessary.
Severe bacterial tracheitis should be treated as for epiglottis, with adequate airway ensured.
Give initial antibiotics effective against S. aureus and streptococcal species, but narrow coverage once the specific pathogen is identified.
Drugs Mentioned In This Article
Drug Name | Select Trade |
---|---|
vancomycin |
FIRVANQ, Vancocin, Vancocin Powder, VANCOSOL |
ceftriaxone |
Ceftri-IM , Ceftrisol Plus, Rocephin |
ceftaroline |
Teflaro |