Spleen Australia guidelines for the prevention of sepsis in patients with asplenia and hyposplenism in Australia and New Zealand

Kanhutu, Kudzai; Jones, Penelope; Cheng, Allen; Grannell, Louise; Best, Emma; Spelman, Denis

doi:10.1111/imj.13348

Cited by 58 publications

(74 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The infectious disease team reviewed the literature on the risk of overwhelming sepsis with asplenia. The lifetime risk of overwhelming infection in anyone with asplenia is often quoted at 5% but may vary from condition to condition and with age, usually being higher in younger children. The mortality is stated as being up to 50% .…”

Section: Case Historymentioning

confidence: 99%

“…The lifetime risk of overwhelming infection in anyone with asplenia is often quoted at 5% but may vary from condition to condition and with age, usually being higher in younger children. The mortality is stated as being up to 50% . The major risk is from Streptococcus pneumoniae (pneumococcus) and other capsulated organisms, Neisseria meningitidis (meningococcus) and Haemophilus influenzae type b (Hib), although other non‐capsulated organisms can also cause sepsis …”

Section: Case Historymentioning

confidence: 99%

“…The mortality is stated as being up to 50% . The major risk is from Streptococcus pneumoniae (pneumococcus) and other capsulated organisms, Neisseria meningitidis (meningococcus) and Haemophilus influenzae type b (Hib), although other non‐capsulated organisms can also cause sepsis …”

Section: Case Historymentioning

confidence: 99%

“…1,2 The major risk is from Streptococcus pneumoniae (pneumococcus) and other capsulated organisms, Neisseria meningitidis (meningococcus) and Haemophilus influenzae type b (Hib), although other non-capsulated organisms can also cause sepsis. 1,2 We attempted to estimate the risk to unimmunised children by searching for studies of children before the current vaccines were available. Harvard paediatricians from Boston, USA reported that 16 of 52 children with congenital heart disease and asplenia seen between 1950 and 1975 developed overwhelming sepsis, and 10 of these children died.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Does asplenia make some immunisations obligatory?

Isaacs

Preisz

Britton

et al. 2019

J Paediatrics Child Health

View full text Add to dashboard Cite

Section: Case Historymentioning

confidence: 99%

Section: Case Historymentioning

confidence: 99%

Section: Case Historymentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Does asplenia make some immunisations obligatory?

Isaacs

Preisz

Britton

et al. 2019

J Paediatrics Child Health

View full text Add to dashboard Cite

“…O ur objective was to validate our estimates from our original model 1 and re‐evaluate the cost‐effectiveness of Spleen Australia, the Australian post‐splenectomy registry, 2 using our original model with updated parameters based on advances in the literature and experience of the registry over the past decade.…”

mentioning

confidence: 99%

Initial modelling and updates on cost effectiveness from the first 10 years of a spleen registry

Luu

Jones

Woolley

et al. 2018

Australian and New Zealand Journal of Public Health

Self Cite

View full text Add to dashboard Cite

Objective: To validate our estimates from our original model and re-evaluate the costeffectiveness of Spleen Australia, the Australian post-splenectomy registry, using our original model with updated model parameters based on advances in the literature and experience of the registry over the past decade. Methods:We revisited a decision model from 2005, comparing 1,000 hypothetical registered patients with asplenia or hyposplenism against 1,000 who were not registered, and updated the model parameters. The cost-effectiveness of the registry was evaluated from a healthcare perspective in terms of additional cost per case of overwhelming post-splenectomy infection (OPSI) avoided and as additional cost per life year gained. Results:Over a cohort lifetime the registry was associated with an additional cost of $125,724 per case of OPSI avoided or $19,286 per life year gained. Conclusions:Despite our initial over-estimation of immunisation and chemoprophylaxis uptake and increases in unit costs, our re-evaluation confirmed use of the registry to be costeffective.Implications for public health: Improved outcomes for patients with asplenia or hyposplenism can be achieved by a cost-effective registry. Additional research into effectiveness of interventions, OPSI prevalence associated with varying intervention use, and compliance rates over time after registration would provide improved accuracy of cost-effectiveness estimates.

show abstract

Perioperative Immunization for Splenectomy and the Surgeon’s Responsibility

2020

View full text Add to dashboard Cite

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...

show abstract

Spleen Australia guidelines for the prevention of sepsis in patients with asplenia and hyposplenism in Australia and New Zealand

Cited by 58 publications

References 27 publications

Does asplenia make some immunisations obligatory?

Does asplenia make some immunisations obligatory?

Initial modelling and updates on cost effectiveness from the first 10 years of a spleen registry

Perioperative Immunization for Splenectomy and the Surgeon’s Responsibility

Contact Info

Product

Resources

About