Tracheitis, Bacterial



  • Acute, life-threatening upper airway obstruction due to infraglottic bacterial infection following a primary viral infection (typically parainfluenza or influenza)
  • Historically high mortality rates of up to 20% in children; more recent experience suggests changing epidemiology resulting in a more atypical presentation and variable course (1) but which can still result in severe, acute, upper airway obstruction.
  • Affects two major groups of patients in the pediatric age range:
    • Those with a native intact airway
    • Those with an artificial airway
  • Often preceded by viral infection, such as influenza, parainfluenza, or respiratory syncytial virus
  • Staphylococcus aureus is the most common bacteria identified (1).
  • Diagnostic hallmarks on endoscopy: ulceration, pseudomembranes in the trachea with thick mucopurulent exudates and mucosal sloughing (1)
  • System(s) affected: pulmonary
  • Synonym(s): laryngotracheobronchitis; bacterial croup; pseudomembranous croup



  • Incidence: 4 to 8 per 1 million children
  • Peak incidence in children: fall and winter
  • Mean age: 5 years (2)
  • Infections in adolescents and adults have been reported.

Methicillin-resistant Staphylococcus aureus (MRSA) may contribute to changing epidemiology and virulence.

Etiology and Pathophysiology

  • Methicillin-sensitive S. aureus (MSSA) accounted for 50% cases in Casazza series (2019) (1).
  • Mixed respiratory
  • Streptococcus pneumoniae
  • In children with artificial airway, most common organisms are S. aureus, Haemophilus influenzae, S. pneumoniae, Pseudomonas aeruginosa, and other gram-negative organisms.
  • Viral-induced injury to the respiratory epithelium in conjunction with localized immune impairment can predispose individuals to bacterial superinfection.

No known genetic predisposition

Risk Factors

  • Periods of increased seasonal activity of respiratory viruses
  • Reports following tonsillectomy, adenoidectomy, with chronic tracheal aspiration, and with evidence of other concurrent infections, including sinusitis, otitis, pneumonia, or pharyngitis

General Prevention

  • Standard precautions, with scrupulous attention to handwashing
  • Vaccination against viruses that may predispose to bacterial tracheitis

Commonly Associated Conditions

  • Consider anatomic abnormalities and foreign bodies as well as recent pharyngeal or laryngeal surgery.
  • Predisposing: Down syndrome, immunodeficiency, subglottic hemangioma, tracheoesophageal fistula repair, tracheobronchomalacia
  • More common in children with tracheostomy
  • Viral coinfection may occur.

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