Impact of a spleen registry on optimal post-splenectomy vaccination and care

Luu, Sarah; Dendle, Claire; Jones, Penelope; Ojaimi, Samar; Woolley, Ian

doi:10.1080/21645515.2018.1498282

Cited by 9 publications

(10 citation statements)

References 28 publications

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“…Unlike the United Kingdom, the Spleen Australia, a clinical service based at The Alfred Hospital in Melbourne, provides education and ongoing management recommendations for patients and their physicians. Studies have shown that our local clinical registry, the Spleen Australia clinical registry, has a positive effect on patient uptake of ongoing (booster) vaccinations,84–86 is associated with a reduction in invasive pneumococcal disease,87 and is cost-effective in its activities 88. Improved uptake of vaccination with participation with a registry program has also been shown elsewhere 80.…”

Section: Solutionsmentioning

confidence: 85%

<p>Post-splenectomy sepsis: preventative strategies, challenges, and solutions</p>

Luu

Spelman

Woolley

2019

IDR

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Removal of the spleen had already been established as a routine technique to treat splenic trauma and other diseases affecting the spleen before the anatomy, physiology, and function of the spleen were known in the mid-twentieth century. It is now widely accepted that the splenectomized individual is at increased risk for infection, in particular, overwhelming post-splenectomy infection (OPSI). OPSI is a syndrome of fulminant sepsis occurring in splenectomized (asplenic) or hyposplenic individuals that is associated with high mortality and morbidity. Poorly opsonized bacteria such as encapsulated bacteria, in particular, Streptococcus pneumoniae, are often implicated in sepsis. The spleen is a reticuloendothelial organ that facilitates opsonization and phagocytosis of pathogens, in addition to cellular maintenance. Splenectomy is associated with an impairment in immunoglobulin production, antibody-mediated clearance, and phagocytosis, leading to an increased risk of infection and sepsis. Early identification of the at-risk patient, early blood cultures prior to antibiotic administration, urgent blood smears and fast pathogen-detection tests, and sepsis bundles should be utilized in these patients. Prompt management and aggressive treatment can alter the course of disease in the at-risk splenectomized patient. Overwhelming post-splenectomy infection can be prevented through vaccination, chemoprophylaxis, and patient education. This article evaluates post-splenectomy sepsis by summarizing the anatomy and function of the spleen, physiological changes after splenectomy that predispose the splenectomized patient to infection, and current management and prevention strategies.

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Section: Solutionsmentioning

confidence: 85%

<p>Post-splenectomy sepsis: preventative strategies, challenges, and solutions</p>

Luu

Spelman

Woolley

2019

IDR

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“…Recent work in other regions of France and Australia also showed a low pneumococcal vaccination rate of 18.8 and 7%, respectively [ 10 , 15 ]. Similar to our study, international studies have reported a pneumococcal vaccination rate between 60 and 88% [ 10 , 12 , 16 – 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…A dedicated healthcare network has been reported useful for the follow-up of asplenic patients in several countries [ 21 , 28 – 32 ]. Moreover, creating nationwide registries of asplenic patients has correlated with improved implementation of established guidelines among physicians and allowed for the dissemination of useful information, medical advice, and vaccination reminder in a cost-effective manner [ 15 , 26 , 33 ]. We insist on the central role of hospital specialists taking care of the patient before and at the time of splenectomy for starting the preventive measures against infection, and beginning patient’s medical education about his future asplenic state.…”

Section: Discussionmentioning

confidence: 99%

Prevention of infection in asplenic adult patients by general practitioners in France between 2013 and 2016

Quéffélec¹,

Billet²,

Duffau³

et al. 2020

BMC Fam Pract

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Background Guidelines that detail preventive measures against Streptococcus pneumoniae , Neisseria meningitidis , Haemophilus influenzae type b, and influenza are published annually in France to decrease the risk of severe infections in immunocompromised patients. We aimed at describing adherence to these guidelines by GPs in the management of their asplenic patients in France between 2013 and 2016. Method We conducted a multicenter retrospective study between January 2013 and December 2016 in three French hospitals: asplenic adults were identified and their GPs were questioned. A descriptive analysis was performed to identify the immunization coverage, type and length of antibiotic prophylaxis, number of infectious episodes, and education of patients. Results 103 patients were finally included in this study: only 57% were adequately vaccinated against Streptococcus pneumoniae or Neisseria meningitidis , 74% against Haemophilus influenzae type b, and 59% against influenza. Only 24% of patients received a combination of all four vaccinations. Two-thirds of patients received prophylactic antibiotics for at least 2 years. Overall, this study found that 50% of splenectomized patients experienced at least one pulmonary or otorhinolaryngological infection, or contracted influenza. Conclusions These data match those reported in other countries, including Australia and the United Kingdom, meaning a still insufficient coverage of preventive measures in asplenic patients. Improved medical data sharing strategies between healthcare professionals, along with educational measures to keep patients and physicians up to date in the prevention of infections after splenectomy would improve health outcomes of asplenic patients.

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“…45 Assessment of adherence to guidelines and long-term management demonstrated that 77% had good knowledge of key educational points to reduce the chances of infection, but they were less likely to receive the most recent vaccines. 46 The majority were taking or had used antibiotic prophylaxis (70%) and had a supply of emergency antibiotics (66%). More than 12 000 patients are registered (June 2023), including 89% postsplenectomy, 6% with a non-functioning spleen and 5% previously treated by splenic artery embolisation.…”

Section: Registriesmentioning

confidence: 99%

Prevention and treatment of infection in patients with an absent or hypofunctional spleen: A British Society for Haematology guideline

Ladhani,

Fernandes,

Garg

et al. 2024

Br J Haematol

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SummaryGuidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen were published by the British Committee for Standards in Haematology in 1996 and updated in 2002 and 2011. With advances in vaccinations and changes in patterns of infection, the guidelines required updating. Key aspects included in this guideline are the identification of patients at risk of infection, patient education and information and immunisation schedules. This guideline does not address the non‐infective complications of splenectomy or functional hyposplenism (FH). This replaces previous guidelines and significantly revises the recommendations related to immunisation. Patients at risk include those who have undergone surgical removal of the spleen, including partial splenectomy and splenic embolisation, and those with medical conditions that predispose to FH. Immunisations should include those against Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus) and influenza. Haemophilus influenzae type b (Hib) is part of the infant immunisation schedule and is no longer required for older hyposplenic patients. Treatment of suspected or proven infections should be based on local protocols and consider relevant anti‐microbial resistance patterns. The education of patients and their medical practitioners is essential, particularly in relation to the risk of serious infection and its prevention. Further research is required to establish the effectiveness of vaccinations in hyposplenic patients; infective episodes should be regularly audited. There is no single group ideally placed to conduct audits into complications arising from hyposplenism, highlighting a need for a national registry, as has proved very successful in Australia or alternatively, the establishment of appropriate multidisciplinary networks.

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Impact of a spleen registry on optimal post-splenectomy vaccination and care

Cited by 9 publications

References 28 publications

<p>Post-splenectomy sepsis: preventative strategies, challenges, and solutions</p>

<p>Post-splenectomy sepsis: preventative strategies, challenges, and solutions</p>

Prevention of infection in asplenic adult patients by general practitioners in France between 2013 and 2016

Prevention and treatment of infection in patients with an absent or hypofunctional spleen: A British Society for Haematology guideline

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