Tracheitis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Tracheitis is a bacterial infection of the trachea and is capable of producing airway obstruction.
Causes
Bacterial tracheitis is most often caused by the bacteria Staphylococcus aureus. It frequently follows a recent viral upper respiratory infection. Common causes include
Streptococcus Pyogenes, Haemophilus Influenza, Moraxella Catarrhalis, Mycoplasma Pneumonia, Echoviruses Klebsiella Pneumonia, Adenovirus, Rhinovirus, Coxsakievirus and Influenza virus.
Risk Factors
Common risk factors in the development of tracheitis include pediatric age group, viral upper respiratory tract infection, mechanical ventilation and immunocompromised state. The individuals most likely to be affected are between 2-10 years of age. Staphylococcus Aureus is the most commonly cultured organism on tracheal aspirate. Mechanical ventilation allows easy colonization of the trachea by bacteria and cause tracheitis. Invasive fungal infections commonly develop among immunocompromised individuals and can cause tracheitis.
Diagnosis
Physical Examination
Physical examination of patients with tracheitis is usually remarkable for stridor, tracheal tenderness, and intercostal retractions. The may appear toxic, lethargic and in respiratory distress. Coarse crackles can be heard on auscultation of the chest, signifying underlying pneumonia.
Treatment
Medical Therapy
Treatment of tracheitis involves prompt intiation of antibiotics and clinical assessment of airway. Signs of impending respiratory failure include intercostal retractions, cyanosis, lethargy and confusion. Endotracheal intubation is performed in impending respiratory failure to maintain airway, perform frequent pulmonary toilet and manage acute respiratory failure. Operative bronchoscopy can be performed for direct visualisation of trachea, confirmation of the diagnosis and removal of pseudomembranes. Endotracheal intubation rate has been reported between 38% to 100% and the mean duration of intubation is 3.2 days. It is therefore a crucial part of management of tracheitis which requires judicious assessment of the airway patency and the urgent availability of skills and expertise required for immediate airway intubation. Empiric broad spectrum antibiotics are initially used to control the infection. As the tracheal culture result becomes available the antibiotics can be changed according to the organism isolated. Most commonly isolated organisms include Staphylococcus Aureus, Streptococcus Pneumonia and Moraxella Catarrhalis. Third generation cephalosporin combined with an anti staphylococcal antibiotic e.g Nafcillin, Vancomycin , Clindamycin are included in the initial antibiotic regimen. Current guidelines have outlined a total treatment duration of 10 to 14 days. Supportive respiratory care is provided in less severe clinical presentation. This includes supplemental oxygen ( Sp02=94%)and bronchodilators (Epinephrine or Albuterol). Anti-pyretics can be used for fever. Corticosteroids have not proven benefit but are still used nonetheless.