Bacterial tracheitis

Last updated: July 6, 2023

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Summarytoggle arrow icon

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.

Epidemiologytoggle arrow icon

  • Rare; primarily occurs in children < 6 years of age [2]
  • > [2][3]
  • More common during the fall and winter [2]

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

Clinical featurestoggle arrow icon

In contrast to croup, the symptoms of bacterial tracheitis do not improve with nebulized epinephrine. [7]

Managementtoggle arrow icon

Approach [5][6][7]

Bacterial tracheitis is an airway emergency. Do not delay treatment to obtain diagnostic studies.

Immediate stabilization [6][7][8][9]

Most patients (> 75%) have severe airway compromise requiring intubation and intensive care management. [6][7][9]

In children with signs of airway compromise, minimize any agitation, as this can worsen airway obstruction.

Medical therapy [6][8][13]

Direct visualization [6][7]

Additional studies [6]

Differential diagnosestoggle arrow icon

The differential diagnoses listed here are not exhaustive.

Complicationstoggle arrow icon

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

Acute management checklisttoggle arrow icon

Referencestoggle arrow icon

  1. Blaney SM, Giardino AP, Orange JS, et al. Rudolph's Pediatrics, 23rd Edition. McGraw-Hill Education / Medical ; 2018
  2. Shargorodsky J, Whittemore KR, Lee GS. Bacterial tracheitis: A therapeutic approach. Laryngoscope. 2010; 120 (12): p.2498-2501.doi: 10.1002/lary.21105 . | Open in Read by QxMD
  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
  5. 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
  6. McGann KA, Long SS. Respiratory Tract Symptom Complexes. Elsevier ; 2017: p. 164-172.e2
  7. Jones R, Santos JI, Overall JC Jr. Bacterial tracheitis.. JAMA. 1979; 242 (8): p.721-6.
  8. Casazza G, Graham ME, Nelson D, Chaulk D, Sandweiss D, Meier J. Pediatric Bacterial Tracheitis—A Variable Entity: Case Series with Literature Review. Otolaryngol Head Neck Surg. 2018; 160 (3): p.546-549.doi: 10.1177/0194599818808774 . | Open in Read by QxMD
  9. Wheeler DS. Life-Threatening Diseases of the Upper Respiratory Tract. Springer London ; 2014: p. 19-39
  10. AAP Committee on Infectious Diseases. Red Book: 2021–2024 Report of the Committee on Infectious Diseases. American Academy of Pediatrics ; 2021
  11. 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
  12. Rybak MJ, Le J, Lodise TP, et al. Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. American Journal of Health-System Pharmacy. 2020; 77 (11): p.835-864.doi: 10.1093/ajhp/zxaa036 . | Open in Read by QxMD
  13. 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
  14. Perretta J. Neonatal and Pediatric Respiratory Care. F.A. Davis ; 2014
  15. $Contributor Disclosures - Bacterial tracheitis. None of the individuals in control of the content for this article reported relevant financial relationships with ineligible companies. For details, please review our full conflict of interest (COI) policy:.
  16. DeBlasio D, Real FJ. Tracheitis. Pediatr Rev. 2020; 41 (9): p.495-497.doi: 10.1542/pir.2019-0181 . | Open in Read by QxMD
  17. Zoorob R, Sidani M, Murray J. Croup: an overview.. Am Fam Physician. 2011; 83 (9): p.1067-73.

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