Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed

D J Waghorn, D J Waghorn

Abstract

Aims: Patients without spleens are at increased risk of overwhelming infection. Recently, greater efforts, including the publication of national guidelines, have been made to improve the management of asplenic individuals. In theory, risks of serious sepsis can be reduced by good advice, immunisation, and antibiotic prophylaxis. In practice, such preventive measures might not be followed or may fail. A study of recent cases of overwhelming postsplenectomy infection (OPSI) was undertaken to examine specific associated factors and to determine whether currently recommended preventive measures are being followed.

Methods: Cases of OPSI were identified and reported mainly by microbiologists across the country using a specifically designed proforma. Data including the nature of the infection and vaccination/ antibiotic prophylaxis history since splenectomy were obtained.

Results: Seventy seven cases were reported. The age range varied from 3 months (congenital asplenia) to 87 years. In those who had undergone surgical splenectomy, the time interval between surgery and OPSI varied from 24 days to 65 years. Overall mortality reached 50%, with underlying haematological malignancy associated with the highest death rate. Streptococcus pneumoniae caused approximately 90% episodes. Only 31% individuals had received pneumococcal vaccination before OPSI. Seven of 17 pneumococcal infections in immunised cases could be considered vaccine failures. Few patients had been adequately advised on antibiotic prophylaxis or other measures.

Conclusions: Currently accepted best practice for managing asplenic patients is not being followed. Some OPSI cases may still be preventable but many asplenic individuals remain unrecognised. The compilation of asplenic patient registers might help to implement agreed policies with audit necessary to evaluate compliance. More is needed to ensure optimal management for this cohort of the population.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/1731383/bin/00140.f1.jpg
Figure 1 Time interval between splenectomy and sepsis in 72 cases of overwhelming postsplenectomy infection (OPSI).

References

    1. Br J Gen Pract. 1996 Nov;46(412):691
    1. J Public Health Med. 1997 Jun;19(2):208-12
    1. Acta Paediatr Scand. 1991 Apr;80(4):423-7
    1. Am J Infect Control. 1998 Aug;26(4):418-22
    1. BMJ. 1996 May 25;312(7042):1360; author reply 1361
    1. Blood Rev. 1994 Sep;8(3):179-91
    1. Lancet. 1993 Jan 23;341(8839):248
    1. Lancet. 1990 Apr 14;335(8694):898-901
    1. Clin Exp Immunol. 1992 Sep;89(3):327-9
    1. JAMA. 1982 Nov 12;248(18):2279-83
    1. Clin Infect Dis. 1997 Sep;25(3):738
    1. J Clin Pathol. 1999 Jun;52(6):424-9
    1. BMJ. 1994 Jan 8;308(6921):132
    1. Qual Health Care. 1995 Sep;4(3):194-6
    1. J Antimicrob Chemother. 1994 Jan;33(1):4-6
    1. Commun Dis Rep CDR Rev. 1995 Nov 10;5(12):R173-7
    1. Br J Gen Pract. 1995 Sep;45(398):502-3
    1. Scand J Infect Dis. 1994;26(5):615-7
    1. Infection. 1997 Nov-Dec;25(6):368-71
    1. Clin Microbiol Infect. 1996 Jun;1(4):266-272
    1. Med J Aust. 1996 Jun 3;164(11):648
    1. Br J Surg. 1991 Jun;78(6):716-21
    1. Infect Dis Clin North Am. 1996 Dec;10(4):693-707
    1. Br J Surg. 1989 Oct;76(10):1074-81

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir