Bacterial tracheitis

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Background

  • Bacterial infection of tracheal epithelium
    • Often secondary infection after viral illness
    • S. Aureus most common, also strep spp, H. Influenza and anaerobes
  • Peak age is 3-5 years old
    • Occurs throughout childhood and adulthood

Clinical Features

  • Severely ill child, starts out as viral prodrome
    • Followed by inspiratory and expiratory stridor, respiratory distress, and copious purulent secretions
  • Difficult to differentiate from croup and epiglottis
    • Severe decompensation, high fever, purulent secretions help differentiate
    • May also have concomitant pneumonia
  • May have been treated with racemic epinephrine and steroids for croup, with no clinical improvement

Differential Diagnosis

Pediatric stridor

<6mo

>6mo

Evaluation

  • Clinical diagnosis
  • Gram stain with predominance of one organism, differentiating from colonization
  • XR neck may show subglottic narrowing with ragged tracheal epithelium
  • CXR may show concominant Pneumonia
  • Emergent bronchoscopy is diagnostic and therapeutic

Treatment

  • Intubation, emergent, usually necessary
  • Bronchoscopy to confirm diagnosis, rule out supraglottic pathology
  • Antibiotics[1]
    • Third generation cephalosporin (cefotaxime or ceftriaxone)
    • PLUS MRSA coverage, options below depending on prevalence of CA-MRSA
      • Clindamycin 40mg/kg/d IV divided q8hr
      • OR vancomycin 45mg/kg/d IV divided q8hr

Disposition

  • ICU admit
  • Often require prolong intubation, 4-5 days

See Also

References

  1. Bacterial Tracheitis - Treatment and Management. Medscape. http://emedicine.medscape.com/article/961647-treatment