Bacterial tracheitis: A multi-centre perspective

Abstract

The published literature on bacterial tracheitis is limited. We report the first multi-centre study of bacterial tracheitis together with a concise review of the literature. We conducted a retrospective study of cases admitted during the period 1993-2007 to 3 tertiary paediatric centres in the United Kingdom and 1 in Australia. A total of 34 cases were identified. 31 patients (91%) required intubation. Complications included cardiorespiratory arrest in 1, ARDS in 1, hypotension in 10, toxic shock syndrome in 1 and renal failure in 1 patient(s). Staphylococcus aureus was the most commonly implicated bacterial organism, isolated from the respiratory tract in 55.8% of the cases overall. Other pathogens commonly isolated from the respiratory tract included Streptococcus pyogenes (5.9%), Streptococcus pneumoniae (11.8%) and Haemophilus influenzae (11.8%). Viral coinfection was identified in 9 (31%) of the 29 cases in whom immunofluorescence testing was performed (influenza A in 4 cases; parainfluenza 1 in 2 cases; parainfluenza 3 in 2 cases; adenovirus in 1 case). The combined experience from 4 major paediatric intensive care units suggests that bacterial tracheitis remains a rare condition with an estimated incidence of approximately 0.1/100,000 children per year. Short-term complications were common but long-term sequelae were rare. There were no fatal outcomes, which contrasts with the high historical mortality rates and likely reflects improvements in intensive care management.

Extracorporeal Membrane Oxygenation for Refractory Air Leak in a Child Presenting With Bacterial Tracheitis

“…Bacterial tracheitis is an uncommon condition, with an estimated annual incidence of 0.1 case/100,000 children. 3 Recognition of this serious disorder may be difficult, as many of the symptoms overlap with the much more common diagnosis of viral laryngotracheobronchitis (croup). As with our patient, the majority of children with bacterial tracheitis present with a viral prodrome, followed several days later by worsening stridor and increased work of breathing, likely representing bacterial superinfection after a viral illness.…”

“…3 Delayed recognition can lead to difficult airway management and cardiac arrest. Historically, mortality for bacterial tracheitis was as high as 40%, but currently, most children will make a full recovery, with a 3% estimated mortality rate.…”

“…Historically, mortality for bacterial tracheitis was as high as 40%, but currently, most children will make a full recovery, with a 3% estimated mortality rate. 3 Volutrauma, barotrauma, and air leak are substantial risks given the airway pressures necessary to overcome lower airway obstruction from tenacious secretions, edematous airways, and sloughing mucosa, leading to possible air-trapping caused by a ball-valve mechanism.…”

“…[1][2][3] Bacterial tracheitis is also associated with numerous complications, including ARDS, air leak syndromes, septic shock, and multiple organ dysfunction. [1][2][3] We describe the first reported case of bacterial tracheitis in a young child complicated by bilateral pneumothoraces and pneumomediastinum that was managed with extracorporeal membrane oxygenation (ECMO).…”

Stenotrophomonas Infection in a Patient with Glucose-6-Phosphate Dehydrogenase Deficiency

“…Bacterial tracheitis may have varied presentations and organisms. 8 Difficulty arises in therapeutic management of tracheitis, as organisms isolated from the tracheal aspirate may not be the causative organism of infection. In this case, the patient had had multiple previous positive respiratory cultures for P aeruginosa.…”