Bacterial tracheitis – tremendously rare, but truly important: A systematic review

Abstract

Bacterial tracheitis is a rare, but potentially life-threatening infection, which predominately affects children. The existing literature on this condition is relatively limited. Objective: To provide a comprehensive review of the published literature on bacterial tracheitis by systematically summarizing epidemiological, radiological, clinical and microbiological aspects of the disease combined with a discussion of potential mechanisms involved in the pathogenesis and recommendations for the management of suspected cases. Methods: Search of multiple databases including Medline/PubMed, the Web of Science, EMBASE, the Cochrane database, Scopus and CINAHL. All original reports in English with four or more cases of bacterial tracheitis were included, with the exception of one paper, which provided insufficient detail. All relevant publications were searched for further references. Results: Nineteen publications were identified, which included a combined total of 300 patients. The male-to-female ratio was 1.3:1. The majority (72%) of patients required intubation or tracheostomy. While short-term complications including hypotension, pulmonary edema and pneumothorax were not uncommon, long-term sequelae were rare. Fatality rates varied considerably between reports (range 0-40%). The most common reported causative organisms were Staphylococcus aureus (41%), Haemophilus influenzae (18%), Streptococcus pneumoniae (15%), Moraxella catarrhalis (13%) and Streptococcus pyogenes (9%). Other bacterial organisms were relatively uncommon (< 3%). Conclusions: Bacterial tracheitis remains a potentially fatal infection. However, in contrast to the high mortality rates documented in some of the earlier publications, fatal outcomes in recent reports were overall relatively rare. Active management, including timely intubation, is vital to prevent complete upper airway obstruction and consequent respiratory arrest. Based on the data presented, initial antibiotic therapy should consist of broad-spectrum coverage, including an appropriate anti-staphylococcal agent, with a view to optimizing antibiotic therapy once culture and susceptibility results become available.

Demographic Characteristics of Children Diagnosed with Bacterial Tracheitis

“…The clinical course of patients in this study was consistent with recently published reports suggesting a spectrum in the severity of disease. 1-3,6-11 Patients diagnosed and treated for bacterial tracheitis at our institution were more likely to be privately insured, and white. Further study of bacterial tracheitis should focus on the spectrum of severity and a broader analysis of patient demographics over a larger geographic area.…”

“…Clinically, the presentation, bacteriology, clinical course, and outcomes found in this series were consistent with previous literature on pediatric bacterial tracheitis. [1][2][3][4][5][6][7][8][9][10][11] Along with clinical outcomes, we examined the demographic characteristics of patients with a diagnosis of bacterial tracheitis, and found that children diagnosed with bacterial tracheitis were more likely to be privately insured than a control group. This suggests that children of higher SES are more likely to be diagnosed and treated for bacterial tracheitis.…”

“…4,5 In recent years, the patient population and clinical course of bacterial tracheitis has changed, with a less severe subset of the disease described, as well as a shift in incidence to patients 5 to 10 years old. 3,[6][7][8][9][10] Overall morbidity has also decreased, perhaps due to a high index of suspicion and earlier diagnosis. 9,11 While the clinical course of BT has been well studied, existing literature on the demographic characteristics of patients with bacterial tracheitis is quite limited, particularly in regard to socioeconomic status (SES).…”

Nebulized Gentamicin as an Alternative to Nebulized Tobramycin for Tracheitis in Pediatric Patients

“…The studies that define the optimal treatment of bacterial tracheitis within the pediatric population are limited. 15 In addition, the optimal treatment duration with nebulized antibiotics also remains unclear. For the treatment with systemic therapies, studies recommend 10-to 14-day treatment courses.…”