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Bacterial Tracheitis


Rajeev Bhatia

, MD, Phoenix Children's Hospital

Last full review/revision Jan 2022| Content last modified Jan 2022
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Bacterial tracheitis is bacterial infection of the trachea, typically causing dyspnea and stridor. Diagnosis is by direct laryngoscopy and imaging findings. Treatment is with airway control and IV antibiotics effective against Staphylococcus aureus and streptococcal species.

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 x-ray 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 x-ray, which reveals subglottic narrowing that may be irregular as opposed to the symmetric tapering typical of croup. 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

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.

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