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Tracheal infections associated with tracheostomy tubes and endotracheal intubation in children

INTRODUCTION

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".)

TERMINOLOGY

Bacterial tracheitis — Bacterial tracheitis is an invasive exudative bacterial infection of the soft tissues of the trachea [1]. 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 [4]. VAT is discussed separately. (See "Endotracheal tube management and complications", section on 'Tracheobronchitis'.)

OVERVIEW

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 [5]. 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.

PATHOGENESIS

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 [5]. 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].

        

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Literature review current through: Jun 2014. | This topic last updated: May 8, 2013.
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