title: Changing epidemiology of life-threatening upper airway infections: the reemergence of bacterial tracheitis.
abstract: OBJECTIVE
  As a consequence of evolving medical practice, the epidemiology of potentially life-threatening upper airway infections is changing. We report our experience over 9 years with viral croup, epiglottitis, and bacterial tracheitis.
  
  
  METHODS
  We studied a retrospective case series of patients admitted to Vermont Children's Hospital with potentially life-threatening upper airway infections viral croup, epiglottitis, or bacterial tracheitis between 1997 and 2006.
  
  
  RESULTS
  There were 107 patients with viral croup admitted to Vermont Children's Hospital, with 16 (15%) admitted to the pediatric intensive care unit. Three patients with croup (17% of pediatric intensive care unit admissions, 3% of total admissions) required intubation. There were no serious complications. Eighteen patients were admitted with bacterial tracheitis. Ninety-four percent (n = 17) were admitted to the pediatric intensive care unit. Eighty-three percent (n = 15) were intubated. Twenty-eight percent of patients (n = 5) developed serious complications. Two adolescent patients were admitted with epiglottitis. Both were intubated and recovered without complications. Of 35 patients admitted to the pediatric intensive care unit with these potentially life-threatening upper airway infections, 20 patients (57%) developed respiratory failure. Fifteen patients (75%) had bacterial tracheitis, 3 patients (15%) had viral croup, and 2 patients (10%) had nonclassic epiglottitis.
  
  
  CONCLUSIONS
  Immunization against Haemophilus influenza type b and widespread use of corticosteroids for the treatment of viral croup have changed the epidemiology of acute infectious upper airway disease. As potentially life-threatening infections, viral croup and epiglottitis have been eclipsed by bacterial tracheitis. In this series, bacterial tracheitis was 3 times more likely to have caused respiratory failure than viral croup and epiglottitis combined. Bacterial tracheitis should be considered in children who present with acute life-threatening upper airway infection.
authors.affiliation: Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA.
authors.forename: Amelia
authors.initials: A
authors.lastname: Hopkins
authors.forename: Thomas
authors.initials: T
authors.lastname: Lahiri
authors.forename: Richard
authors.initials: R
authors.lastname: Salerno
authors.forename: Barry
authors.initials: B
authors.lastname: Heath
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003440:Croup / Q000453:epidemiology* / Q000821:virology; D004826:Epiglottitis / Q000453:epidemiology*; D005260:Female; D006192:Haemophilus Infections / Q000150:complications / Q000453:epidemiology*; D019741:Haemophilus influenzae type b; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D014136:Tracheitis / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology* / Q000821:virology; D014774:Virulence
chemical_list: D000305:Adrenal Cortex Hormones