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.
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. 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 , the child 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 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 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.
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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