BACKGROUND: The spleen plays a crucial role in human defence against infection. Patients who are asplenic or hyposplenic are at increased risk of severe sepsis due to specific organisms. Overwhelming postsplenectomy infection (OPSI) has a mortality rate of up to 50%. OBJECTIVE: This article describes the causes of OPSI and provides strategies to reduce it. DISCUSSION: Streptococcus pneumoniae is responsible for over 50% of cases of OPSI. Strategies to prevent OPSI include education; vaccination against S. pneumoniae, Haemophilus influenzae type b, Neisseria meningitidis and influenza (annually); and daily antibiotics for at least 2 years postsplenectomy and emergency antibiotics in case of infection. Asplenic patients should carry a medical alert and an up-to-date vaccination card. Asplenic patients require specific advice around travel and animal handling as they are at increased risk of severe malaria, and OPSI (due to Capnocytophaga canimorsus) may result from dog, cat or other animal bites. The Victorian Spleen Registry was established to improve adherence to best practice preventive guidelines and thereby reduce the incidence of OPSI.
BACKGROUND: The spleen plays a crucial role in human defence against infection. Patients who are asplenic or hyposplenic are at increased risk of severe sepsis due to specific organisms. Overwhelming postsplenectomy infection (OPSI) has a mortality rate of up to 50%. OBJECTIVE: This article describes the causes of OPSI and provides strategies to reduce it. DISCUSSION: Streptococcus pneumoniae is responsible for over 50% of cases of OPSI. Strategies to prevent OPSI include education; vaccination against S. pneumoniae, Haemophilus influenzae type b, Neisseria meningitidis and influenza (annually); and daily antibiotics for at least 2 years postsplenectomy and emergency antibiotics in case of infection. Asplenic patients should carry a medical alert and an up-to-date vaccination card. Asplenic patients require specific advice around travel and animal handling as they are at increased risk of severe malaria, and OPSI (due to Capnocytophaga canimorsus) may result from dog, cat or other animal bites. The Victorian Spleen Registry was established to improve adherence to best practice preventive guidelines and thereby reduce the incidence of OPSI.
Authors: Juliane Liese; Sven Kohler; Christian Moench; Wolf Otto Bechstein; Frank Ulrich Journal: Langenbecks Arch Surg Date: 2013-02-06 Impact factor: 3.445