Bacterial tracheitis: an unusual pathogen

Bacterial tracheitis: a therapeutic approach

OBJECTIVES/HYPOTHESIS

tracheitis is an acute, infectious, potentially life-threatening condition of the pediatric airway. Historically, patients have often required urgent invasive airway support, and have been treated with broad-spectrum antibiotics, often combined with direct laryngoscopy and bronchoscopy.

STUDY DESIGN

Retrospective chart review.

METHODS

Six patients between the ages of 10 months and 16 years were treated at Children's Hospital, Boston, Massachusetts, for bacterial tracheitis between January 2009 and March 2009. All patients underwent urgent direct laryngoscopy and bronchoscopy for debridement of mucopurulent debris and tissue culture. Broad-spectrum intravenous antibiotics were administered, and patients were kept on acute cardiopulmonary monitoring for 48 to 72 hours, after which time the airway was re-evaluated by direct laryngoscopy and bronchoscopy in five of the patients, and by fiberoptic nasolaryngoscopy in one patient. All of the patients were transitioned to oral antibiotic therapy for 10 to 14 days after discharge.

RESULTS

Following debridement, all of the patients did well with aggressive medical management. None of the patients required urgent intubation, although one patient was kept on ventilator support for 48 hours until disease resolution was confirmed. No patients required tracheotomy, and there were no cardiopulmonary arrests. The mean hospital length of stay was 4.8 days (range, 3-8 days).

CONCLUSIONS

This study highlights the importance of early disease identification and urgent surgical intervention in the management of bacterial tracheitis. It also demonstrates an approach with the potential to improve patient outcomes from this dangerous condition.

Infraglottic and bronchial infections

Concerns over infraglottic and bronchial infections have been a source of anxiety and lost sleep for many children, parents, and physicians. The annual incidence of lower respiratory tract infections in children younger than 6 years old exceeds 5 million in the United States. Despite the frequency of these infections, the often common and nonspecific clinical symptomatology, variable severity, and changing epidemiology over time all have contributed to our understanding and misunderstanding of these disorders.

The old and new of acute laryngotracheal infections

Laryngotracheal infections in childhood frequently result in airway obstruction, the major symptom of which is stridor. The primary aims of management are to establish a diagnosis rapidly and to maintain or secure the child's airway. Medical treatment and airway stabilization measures vary for the three most prevalent laryngotracheal infections--supraglottitis, laryngotracheitis, and bacterial tracheitis--as well as for older and newer infectious airway entities.