Tracheal infections associated with tracheostomy tubes and endotracheal intubation in children
- Charles R Woods, MD, MS
Charles R Woods, MD, MS
- Professor of Pediatrics
- University of Louisville School of Medicine
- Section Editors
- Glenn C Isaacson, MD, FAAP
Glenn C Isaacson, MD, FAAP
- Section Editor — Pediatric Otolaryngology
- Professor, Department of Otolaryngology, Head and Neck Surgery and Pediatrics
- Temple University School of Medicine
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
Tracheal infections associated with tracheostomy tubes and endotracheal intubation in children will be discussed here. The clinical features, diagnosis, treatment, and prevention of bacterial tracheitis in children are discussed separately. (See "Bacterial tracheitis in children: Clinical features and diagnosis" and "Bacterial tracheitis in children: Treatment and prevention".)
Bacterial tracheitis — Bacterial tracheitis is an invasive exudative bacterial infection of the soft tissues of the trachea . It is the focus of this topic review. (See "Bacterial tracheitis in children: Clinical features and diagnosis".)
Ventilator-associated tracheobronchitis — Ventilator-associated tracheobronchitis (VAT, also called nosocomial tracheobronchitis) has been proposed as a clinical entity distinct from, and possibly a precursor to, ventilator-associated pneumonia (VAP) in adults [2,3]. The existence of VAT as a distinct entity, its intermediary role in development of VAP, and whether early treatment for potential VAT reduces risk for subsequent VAP remain uncertain . VAT is discussed separately. (See "Endotracheal tube management and complications", section on 'Tracheobronchitis'.)
Children who require artificial airways are at increased risk for bacterial tracheopulmonary infections, including bacterial tracheitis, because of bacterial colonization of the artificial airway and mucosal injuries related to airway cannulation . Children with laryngeal diversion and tracheostoma without a tracheostomy tube also may develop bacterial tracheitis, but it is unclear if they have increased risk relative to children with intact airways.
Artificial airways generally are colonized with potentially pathogenic microbes [6,7]. Colonizing bacteria may arise from the upper airway, ventilator tubing or reservoirs, or humidification circuits . Common colonizing bacteria include Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Acinetobacter species, Klebsiella pneumoniae, Escherichia coli, Serratia marcescens, Enterobacter species, other gram-negative enteric organisms, and Pseudomonas aeruginosa [6-8].
- Jones R, Santos JI, Overall JC Jr. Bacterial tracheitis. JAMA 1979; 242:721.
- Nseir S, Ader F, Marquette CH. Nosocomial tracheobronchitis. Curr Opin Infect Dis 2009; 22:148.
- Craven DE. Ventilator-associated tracheobronchitis (VAT): questions, answers, and a new paradigm? Crit Care 2008; 12:157.
- Dallas J, Kollef M. VAT vs VAP: are we heading toward clarity or confusion? Chest 2009; 135:252.
- Graf J, Stein F. Tracheitis in pediatric patients. Semin Pediatr Infect Dis 2006; 17:11.
- Brook I. Bacterial colonization, tracheobronchitis, and pneumonia following tracheostomy and long-term intubation in pediatric patients. Chest 1979; 76:420.
- Morar P, Singh V, Makura Z, et al. Oropharyngeal carriage and lower airway colonisation/infection in 45 tracheotomised children. Thorax 2002; 57:1015.
- Niederman MS, Ferranti RD, Zeigler A, et al. Respiratory infection complicating long-term tracheostomy. The implication of persistent gram-negative tracheobronchial colonization. Chest 1984; 85:39.
- Friedberg SA, Griffith TE, Hass GM. Histologic changes in the trachea following tracheostomy. Ann Otol Rhinol Laryngol 1965; 74:785.
- Cline JM, Woods CR, Ervin SE, et al. Surveillance tracheal aspirate cultures do not reliably predict bacteria cultured at the time of an acute respiratory infection in children with tracheostomy tubes. Chest 2012; 141:625.