View source for Bacterial tracheitis

==Background==
[[File:Blausen 0865 TracheaAnatomy.png|thumb|Tracheal anatomy.]]
[[File:Cross section of a trachea and esophagus.png|thumb|Cross section of a trachea and esophagus anatomy.]]
*Bacterial infection of tracheal epithelium 
**Often secondary infection after [[viral syndrome|viral illness]] 
**[[S. Aureus]] most common, also [[strep]] species, [[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 [[epiglottitis]] 
**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 DDX}}

==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 concomitant [[pneumonia]]
*Emergent bronchoscopy is diagnostic and therapeutic

==Management==
*[[Intubation]], emergent, usually necessary 
*Bronchoscopy to confirm diagnosis, rule out supraglottic pathology 
*Antibiotics<ref>Bacterial Tracheitis - Treatment and Management. Medscape. http://emedicine.medscape.com/article/961647-treatment</ref>
**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==
*Admit to ICU 
*Often require prolonged intubation (4-5 days)

==Complications==
*[[Toxic shock syndrome]]
*[[Septic shock]]
*[[Renal failure]]
*Postintubation [[pulmonary edema]]
*[[ARDS]]
*Residual [[subglottic stenosis]]

==See Also==
*[[Stridor (Peds)]]
*[[Stridor]]

==External Links==
*[https://www.merckmanuals.com/professional/pediatrics/respiratory-disorders-in-young-children/bacterial-tracheitis Merck Manual - Bacterial Tracheitis]
*[http://www.emdocs.net/tracheitis-in-children-a-2018-update/ emDocs - Tracheitis in Children]

==References==
<references/>

[[Category:Pediatrics]]
[[Category:ID]]
[[Category:Pulmonary]]