Bacterial tracheitis: Difference between revisions
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*Bacterial infection of tracheal epithelium | *Bacterial infection of tracheal epithelium | ||
**Often secondary infection after viral illness | **Often secondary infection after viral illness | ||
**S. Aureus most common, also strep | **[[S. Aureus]] most common, also [[strep]] species, [[H. Influenza]] and anaerobes | ||
*Peak age is 3-5 years old | *Peak age is 3-5 years old | ||
**Occurs throughout childhood and adulthood | **Occurs throughout childhood and adulthood | ||
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==Clinical Features== | ==Clinical Features== | ||
*Severely ill child, starts out as viral prodrome | *Severely ill child, starts out as viral prodrome | ||
**Followed by inspiratory and expiratory stridor, respiratory distress, and copious purulent secretions | **Followed by inspiratory and expiratory [[stridor]], [[respiratory distress]], and copious purulent secretions | ||
*Difficult to differentiate from croup and epiglottis | *Difficult to differentiate from [[croup]] and [[epiglottis]] | ||
**Severe decompensation, high fever, purulent secretions help differentiate | **Severe decompensation, high [[fever]], purulent secretions help differentiate | ||
**May also have concomitant pneumonia | **May also have concomitant [[pneumonia]] | ||
*May have been treated with racemic epinephrine and steroids for croup, with no clinical improvement | *May have been treated with racemic epinephrine and steroids for croup, with no clinical improvement | ||
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*Gram stain with predominance of one organism, differentiating from colonization | *Gram stain with predominance of one organism, differentiating from colonization | ||
*XR neck may show subglottic narrowing with ragged tracheal epithelium | *XR neck may show subglottic narrowing with ragged tracheal epithelium | ||
*[[CXR]] may show | *[[CXR]] may show concomitant [[pneumonia]] | ||
*Emergent bronchoscopy is diagnostic and therapeutic | *Emergent bronchoscopy is diagnostic and therapeutic | ||
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*Bronchoscopy to confirm diagnosis, rule out supraglottic pathology | *Bronchoscopy to confirm diagnosis, rule out supraglottic pathology | ||
*Antibiotics<ref>Bacterial Tracheitis - Treatment and Management. Medscape. http://emedicine.medscape.com/article/961647-treatment</ref> | *Antibiotics<ref>Bacterial Tracheitis - Treatment and Management. Medscape. http://emedicine.medscape.com/article/961647-treatment</ref> | ||
**Third generation cephalosporin (cefotaxime or ceftriaxone) | **Third generation cephalosporin (cefotaxime or [[ceftriaxone]]) | ||
**PLUS MRSA coverage, options below depending on prevalence of CA-MRSA | **PLUS MRSA coverage, options below depending on prevalence of CA-MRSA | ||
***Clindamycin 40mg/kg/d IV divided q8hr | ***[[Clindamycin]] 40mg/kg/d IV divided q8hr | ||
***OR vancomycin 45mg/kg/d IV divided q8hr | ***OR [[vancomycin]] 45mg/kg/d IV divided q8hr | ||
==Disposition== | ==Disposition== | ||
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==See Also== | ==See Also== | ||
*[[Stridor (Peds)]] | |||
*[[Stridor]] | |||
==References== | ==References== | ||
Revision as of 19:09, 27 March 2017
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
<6 Months Old
- Laryngotracheomalacia
- Accounts for 60%
- Usually exacerbated by viral URI
- Diagnosed with flexible fiberoptic laryngoscopy
- Vocal cord paralysis
- Stridor associated with feeding problems, hoarse voice, weak and/or changing cry
- May have cyanosis or apnea if bilateral (less common)
- Subglottic stenosis
- Congenital vs secondary to prolonged intubation in premies
- Airway hemangioma
- Usually regresses by age 5
- Associated with skin hemangiomas in beard distribution
- Vascular ring/sling
>6 Months Old
- Croup
- viral laryngotracheobronchitis
- 6 mo - 3 yr, peaks at 2 yrs
- Most severe on 3rd-4th day of illness
- Steeple sign not reliable- diagnose clinically
- Epiglottitis
- H flu type B
- Have higher suspicion in unvaccinated children
- Rapid onset sore throat, fever, drooling
- Difficult airway- call anesthesia/ ENT early
- H flu type B
- Bacterial tracheitis
- Rare but causes life-threatening obstruction
- Symptoms of croup + toxic-appearing = bacterial tracheitis
- Foreign body (sudden onset)
- Marked variation in quality or pattern of stridor
- Retropharyngeal abscess
- Fever, neck pain, dysphagia, muffled voice, drooling, neck stiffness/torticollis/extension
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