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Bacterial tracheitis
From WikEM
Contents
Background
- Bacterial infection of tracheal epithelium
- Often secondary infection after 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 epiglottis
- May have been treated with racemic epinephrine and steroids for croup, with no clinical improvement
Differential Diagnosis
Pediatric stridor
<6mo
- Laryngotracheomalacia
- Vocal cord paralysis (weak cry)
- Subglottic stenosis (previous intubation)
- Airway hemangioma (usually regresses by age 5)
- Vascular ring/sling
>6mo
- Croup
- Epiglottitis
- Bacterial tracheitis
- Foreign body (sudden onset)
- Retropharyngeal abscess (muffled voice, fever)
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
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
- ↑ Bacterial Tracheitis - Treatment and Management. Medscape. http://emedicine.medscape.com/article/961647-treatment
