Bacterial tracheitis - an evolving disease: A 14 month experience in a picu

Introduction: Bacterial tracheitis (BT) is characterized by acute upper airway obstruction and purulent tracheal secretions. Historically, BT was diagnosed in children <3 years of age who presented with a toxic appearance and usually required prolonged tracheal intubation for respiratory distress (1). Staph. aureus was the identified pathogen in > 80% of cases (1). The purpose of this study is to describe a changing pattern of BT, and to characterize the differences between the intubated (I) and non-intubated (NI) patient population. Methods: 46 medical records of patients diagnosed with BT during a 14 month period were reviewed. The diagnosis of BT was confirmed by direct bronchoscopic airway evaluation. Demographic and clinical data were collected. Results are expressed as mean±SEM. Results: The mean age of the study patients was 69.3±6.8 months. The temperature at admission was 100.5±0.3°F. Durations of PICU and hospital stay were 2.8±0.3 and 5.4±0.4 days respectively. 39 of 46 (85%) patients were described as non-toxic. 26 of 46 (57%) patients required tracheal intubation for 3.2±0.2 days. There were no significant differences between the I and NI patients with respect to pre-admission length of illness, toxic appearance, drooling or admission temperature. Staph. aureus was notedin 10 of 45 (22%) patients. I and NI patients are compared in the Table. NI (n=20) I (n=26) p* Age(mos) 98.9±9.9 46.9±6.5 <.01 Stridor 6/20 19/26 .004 PICU stay (days) 1.1±0.1 4.1+0.3 <.01 Hospital stay (days) 3.3±0.1 7.0±0.5 <.01 Moraxella catarrhalis 1/19 11/26 .007 »Unpaired 2-tailed Student's t test or Chi square Conclusions: Compared to previous studies, the patients in this study were older, less toxic, required fewer intubations, and had shorter duration of intubation, PICU and hospital stays. Moraxella catarrhalis was a more common pathogen than Staph. aureus. Younger age, stridor and infection with Moraxella catarrhalis were predictors of intubation. Clinical Implications: Clinicians should consider the diagnosis of BT in older children with a lower severity of illness than has been previously described. Not all patients with BT require tracheal intubation.