Bacterial tracheitis

Last updated: October 21, 2022

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Bacterial tracheitis is a condition characterized by profuse exudates and pseudomembranes due to severe bacterial infection of the trachea. It can occur as a primary bacterial infection or following a viral illness. The most common manifestation is stridor in young children. Bacterial tracheitis is similar to viral croup and epiglottitis; however, affected individuals typically have higher fevers, are ill-appearing, and have severe respiratory symptoms that do not respond to treatments (e.g., with nebulized epinephrine). Patients usually require immediate stabilization and airway management before proceeding to bronchoscopy for diagnostic confirmation and treatment. Additional treatment includes broad-spectrum antibiotics and ICU management. If left untreated, bacterial tracheitis may progress to complete airway obstruction, sepsis, and death.

This article only addresses bacterial tracheitis in patients with native airways; disease characteristics and management are different in patients with artificial airways.

  • Rare; primarily occurs children < 6 years of age [1]
  • > [1][2]
  • More common during the fall and winter [1]

Epidemiological data refers to the US, unless otherwise specified.

In contrast to croup, the symptoms of bacterial tracheitis do not improve with nebulized epinephrine. [6]

Approach [4][5][6]

Do not delay treatment to obtain diagnostic studies.

Immediate stabilization [7]

Most patients have severe airway compromise requiring intubation and intensive care management. [5][6]

Medical therapy [5][7]

Direct visualization [5][6]

Supportive studies [5]

The differential diagnoses listed here are not exhaustive.

We list the most important complications. The selection is not exhaustive.

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  3. Kuo CY, Parikh SR. Bacterial Tracheitis. Pediatr Rev. 2014; 35 (11): p.497-499. doi: 10.1542/pir.35.11.497 . | Open in Read by QxMD
  4. Al-Mutairi B, Kirk V. Bacterial tracheitis in children: Approach to diagnosis and treatment.. Paediatrics & child health. 2004; 9 (1): p.25-30. doi: 10.1093/pch/9.1.25 . | Open in Read by QxMD
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  6. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine 10th edition- Concepts and Clinical Practice E-Book. Elsevier Health Sciences ; 2022
  7. AAP Committee on Infectious Diseases. Red Book: 2021–2024 Report of the Committee on Infectious Diseases. American Academy of Pediatrics ; 2021 : p. 407-417
  8. Rybak MJ, Lomaestro BM, Rotschafer JC, et al. Vancomycin Therapeutic Guidelines: A Summary of Consensus Recommendations from the Infectious Diseases Society of America, the American Society of Health‐System Pharmacists, and the Society of Infectious Diseases Pharmacists. Clin Infect Dis. 2009; 49 (3): p.325-327. doi: 10.1086/600877 . | Open in Read by QxMD
  9. Miranda AD, Valdez TA, Pereira KD. Bacterial tracheitis: a varied entity.. Pediatr Emerg Care. 2011; 27 (10): p.950-3. doi: 10.1097/PEC.0b013e3182309d45 . | Open in Read by QxMD
  10. Perretta J. Neonatal and Pediatric Respiratory Care. F.A. Davis ; 2014
  11. DeBlasio D, Real FJ. Tracheitis. Pediatr Rev. 2020; 41 (9): p.495-497. doi: 10.1542/pir.2019-0181 . | Open in Read by QxMD
  12. Zoorob R, Sidani M, Murray J. Croup: an overview.. Am Fam Physician. 2011; 83 (9): p.1067-73.

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