Overwhelming Postsplenectomy Infection: A Prospective Multicenter Cohort Study

Theilacker, Christian; Ludewig, Katrin; Serr, Annerose; Schimpf, Julia; Held, Jürgen; Bögelein, Martin; Bahr, Viola; Rusch, Stephan; Pohl, Annette; Kogelmann, Klaus; Frieseke, Sigrun; Bogdanski, Ralph; Brunkhorst, Frank M.; Kern, Winfried V.

doi:10.1093/cid/civ1195

Cited by 102 publications

(77 citation statements)

References 27 publications

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“…In the reported case only the urine-culture yielded a MDR Acinetobacter baumanni, a pathogen of hospital origin. Additionally, the mortality rate of OPSI is 50%-70% despite aggressive therapy that includes intravenous fluids, antimicrobial treatment, vasopressors, steroids, heparin, packed red blood cells, platelets, cryoprecipitates, and fresh frozen plasma (16). The patient was treated according to these guidelines at the ICU and showed improvement after 7 days of treatment.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous splenic artery aneurysm rupture in a 38-year old female: a case report

Koutserimpas¹,

Papachristou²,

Nikitakis³

et al. 2017

GHIR

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Section: Discussionmentioning

confidence: 99%

Spontaneous splenic artery aneurysm rupture in a 38-year old female: a case report

Koutserimpas¹,

Papachristou²,

Nikitakis³

et al. 2017

GHIR

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“…In accordance with the guidelines for the treatment of severe sepsis and septic shock, we (a) intubated the patient which led to excellent oxygenation but despite (b) increase of fluid resuscitation and (c) application of intravenous norepinephrine in continuously increasing dosages the patient died in a septic shock [3], [5]. Administration of albumin and additional application of vasopressin or dobutamin might have been beneficial [3].…”

Section: Discussionmentioning

confidence: 99%

“…However, the septic shock was complicated by purpura fulminans, which is a frequent complication of pneumococcal sepsis in asplenic patients (19%) [3]. This complication is characterized by haemorrhagic infarction of the skin caused by disseminated intravascular coagulation and dermal vascular thrombosis, which initially appears as bluish or livid skin spots [5]. …”

Section: Discussionmentioning

confidence: 99%

“…Our patient died 16 hours after the onset of the first and unspecific clinical symptoms despite full vaccination. Awareness of the risk OPSI among patients and physicians remains low [5]. This is reflected by the generally poor follow-up immunisation rates of splenectomised patients [5].…”

Section: Discussionmentioning

confidence: 99%

“…Awareness of the risk OPSI among patients and physicians remains low [5]. This is reflected by the generally poor follow-up immunisation rates of splenectomised patients [5]. As a consequence of the case we report here, we implemented standard operating procedures for the assessment of splenectomised patients in our departments of emergency medicine, which partly address these issues (see Attachment 1).…”

Section: Discussionmentioning

confidence: 99%

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The sword of Damocles for the splenectomised: death by OPSI

Blumentrath¹,

Ewald

Petridou

et al. 2016

GMS German Medical Science; 14:Doc10

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Perioperative Immunization for Splenectomy and the Surgeon’s Responsibility

2020

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plenectomy is a common operation, accounting for at least 25 000 procedures per year in the US. Indications include hematological diseases, traumatic injuries, and benign and malignant gastrointestinal, urological, and gynecologic conditions. The most dreadful sequel of splenectomy is overwhelming postsplenectomy infection (OPSI), a syndrome consisting of a nonspecific prodrome rapidly evolving toward pneumonia, meningitis, or fulminating sepsis. Although several strategies have been embraced, namely antibiotic prophylaxis, rescue therapy, and even splenic autotransplant, the cornerstone of OPSI prevention remains prophylactic immunization. Beyond the operating theater, surgeons play a determinant role in the care of patients who have had splenectomy. As the responsible physician in the immediate perioperative period, it is incumbent on them to first educate the patient regarding the nature of asplenic immunodeficiency and then prescribe appropriate immunization. Methods MEDLINE/PubMed, Cochrane Library, and ClinicalTrials.gov databases were searched for randomized clinical trials (RCTs) published from January 1, 1990, to December 31, 2019, addressing immunization in patients who had had splenectomy (eMethods in the Supplement). References of retrieved articles were searched manually, and current clinical guidelines were checked for further relevant literature. Research was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline methodology. 1 The research revealed 5 RCTs and 1 phase III nonrandomized trial (eFigure in the Supplement), Given the dearth of level I evidence focusing on the population of interest, results of systematic reviews, meta-analyses, and observational studies were also considered. Fi-IMPORTANCE Patients who have had splenectomy have a lifelong risk of overwhelming postsplenectomy infection (OPSI), a condition associated with high mortality rates. Surgeons must be aware of the rationale of vaccination in the case of splenectomy, to provide appropriate immunization in the perioperative time.OBSERVATIONS English-language articles published from January 1, 1990, to December 31, 2019, were retrieved from MEDLINE/PubMed, Cochrane Library, and ClinicalTrials.gov databases. Randomized clinical trials as well as systematic reviews and observational studies were considered. Asplenia yields an impairment of both innate and adaptive immunity, thus increasing the risk of severe encapsulated bacterial infections. Current epidemiology of OPSI ranges from 0.1% to 8.5% but is hard to ascertain because of ongoing shifts in patients' baseline conditions and vaccine penetration. Despite the lack of randomized clinical trials, immunization appears to be effective in reducing OPSI incidence. Unfortunately, vaccination coverage is still suboptimal, with a great variability in vaccination rates being reported across institutions and time frames. Notably, current guidelines do not advocate any particular health care qualification responsible for vac...

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Overwhelming Postsplenectomy Infection: A Prospective Multicenter Cohort Study

Abstract: Pneumococcal infections remain the most important cause of severe sepsis and septic shock following splenectomy.

Cited by 102 publications

References 27 publications

Spontaneous splenic artery aneurysm rupture in a 38-year old female: a case report

Spontaneous splenic artery aneurysm rupture in a 38-year old female: a case report

The sword of Damocles for the splenectomised: death by OPSI

Perioperative Immunization for Splenectomy and the Surgeon’s Responsibility

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