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Is bacterial tracheitis changing? A 14-month experience in a pediatric intensive care unit
T Bernstein1, R Brilli, B Jacobs
1Division of Critical Care Medicine, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
Insights
Bacterial tracheitis in children is becoming less severe, with older patients and fewer requiring intubation. This study suggests a shift towards a less critical condition, with changing common pathogens observed.
Area of Science:
- Pediatric Intensive Care
- Infectious Diseases
- Respiratory Medicine
Background:
- Bacterial tracheitis historically presented as severe upper-airway obstruction in young, toxic children, often requiring intubation.
- Staphylococcus aureus was previously the predominant pathogen, associated with significant morbidity and mortality.
- Recent trends suggest a potential shift in the epidemiology and clinical presentation of bacterial tracheitis.
Purpose of the Study:
- To analyze the clinical characteristics and outcomes of children diagnosed with bacterial tracheitis.
- To compare current patient demographics and treatment requirements with historical data.
- To identify changes in causative pathogens for bacterial tracheitis.
Main Methods:
- Retrospective review of medical records for 46 children admitted to the pediatric intensive care unit with bacterial tracheitis over 14 months.
- Analysis of patient age, clinical presentation, need for tracheal intubation, and causative microorganisms.
- Comparison of findings with previously published literature on bacterial tracheitis.
Main Results:
- Children in this cohort were older (mean age 69.3 months) and less toxic than historically reported.
- Tracheal intubation was required in 57% of patients, with younger children being more likely to require intubation.
- Moraxella catarrhalis and influenza A virus were identified as common pathogens, differing from historical data.
Conclusions:
- Bacterial tracheitis appears to be evolving into a less severe condition with a changing epidemiological profile.
- The findings suggest a decreased morbidity associated with bacterial tracheitis in the current patient population.
- Continued surveillance for causative agents and clinical trends in bacterial tracheitis is warranted.
Abstract:
Bacterial tracheitis is characterized by acute upper-airway obstruction and purulent secretions within the trachea. Historically, affected children were young, stridorous, and toxic-appearing and required tracheal intubation, and morbidity and mortality were significant. Staphylococcus aureus was the most common organism involved. During the 14 months of this retrospective study, 46 children were admitted to the pediatric intensive care unit because of this diagnosis, and their medical records were reviewed. Compared with those in previous reports, children in this study were older (mean +/- standard error of the mean [SEM], 69.3 +/- 6.8 months) and less toxic. Only 26 (57%) of 46 patients required tracheal intubation. Intubated patients were significantly younger than nonintubated patients (mean +/- SEM, 46.9 +/- 6.5 vs. 98.9 +/- 9.9 months). Moraxella catarrhalis was identified in 12 (27%) of 45 bacterial respiratory cultures, while influenza A virus was recovered from 18 (72%) of 25 viral respiratory cultures. There were no major complications. This series represents the largest reported cohort of patients with this condition and suggests an epidemiological change toward a less morbid condition.
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