Christian Theilacker1,2, Katrin Ludewig3, Annerose Serr4, Julia Schimpf4, Jürgen Held4,5, Martin Bögelein1,2,6, Viola Bahr3, Stephan Rusch7, Annette Pohl1,6, Klaus Kogelmann8, Sigrun Frieseke8, Ralph Bogdanski9, Frank M Brunkhorst3,10, Winfried V Kern2. 1. Center for Chronic Immunodeficiency. 2. Division of Infectious Diseases, Department of Medicine. 3. Center for Sepsis Control and Care. 4. Institute for Microbiology and Hygiene. 5. Mikrobiologisches Institut, Universitätsklinikum Erlangen und Friedrich-Alexander-Universität Erlangen-Nürnberg. 6. Clinical Research Unit, Freiburg University Medical Center. 7. Clinical Research Unit,Freiburg University Medical Center. 8. Klinikum Emden. 9. Klinikum rechts der Isar, Technical University, Munich, Germany. 10. Paul Martini Sepsis Research Group, Jena University Hospital.
Abstract
BACKGROUND: Recent population-based cohort studies have questioned the role of pneumococci as the most frequent pathogen causing severe infection in patients after splenectomy. The aim of the study was to define the causative pathogens and clinical presentation of patients with overwhelming postsplenectomy infection (OPSI). METHODS: In a prospective cohort study in 173 German intensive care units, we searched for patients with and without asplenia and community-acquired severe sepsis/septic shock. Clinical and laboratory variables and survival of patients were assessed. RESULTS: Fifty-two patients with severe sepsis or septic shock with asplenia and 52 without asplenia were included. OPSI patients more often had a history of malignancy (38% vs 17%; P = .016) and had a lower body mass index (24 kg/m(2) vs 28 kg/m(2); P = .004). Streptococcus pneumoniae was detected more frequently in OPSI patients (42% vs 12% without asplenia; P < .001) and more frequently manifested as bloodstream infection (31% vs 6%; P = .002). Gram-negative infection was similar in both groups (12% vs 19%; P = .157). Pneumococcal vaccine coverage of OPSI patients was low overall (42% vs 8% among patients without asplenia; P < .001). Purpura fulminans was a frequent complication, developing in 19% of OPSI patients vs 5% of patients without asplenia (P = .038). The interval between splenectomy and OPSI was 6 years (range, 1 month-50 years). On multivariable Poisson regression, asplenia was the only predictive variable independently associated with pneumococcal sepsis (adjusted relative risk, 2.53 [95% confidence interval, 1.06-6.08]). CONCLUSIONS: Pneumococcal infections remain the most important cause of severe sepsis and septic shock following splenectomy.
BACKGROUND: Recent population-based cohort studies have questioned the role of pneumococci as the most frequent pathogen causing severe infection in patients after splenectomy. The aim of the study was to define the causative pathogens and clinical presentation of patients with overwhelming postsplenectomy infection (OPSI). METHODS: In a prospective cohort study in 173 German intensive care units, we searched for patients with and without asplenia and community-acquired severe sepsis/septic shock. Clinical and laboratory variables and survival of patients were assessed. RESULTS: Fifty-two patients with severe sepsis or septic shock with asplenia and 52 without asplenia were included. OPSI patients more often had a history of malignancy (38% vs 17%; P = .016) and had a lower body mass index (24 kg/m(2) vs 28 kg/m(2); P = .004). Streptococcus pneumoniae was detected more frequently in OPSI patients (42% vs 12% without asplenia; P < .001) and more frequently manifested as bloodstream infection (31% vs 6%; P = .002). Gram-negative infection was similar in both groups (12% vs 19%; P = .157). Pneumococcal vaccine coverage of OPSI patients was low overall (42% vs 8% among patients without asplenia; P < .001). Purpura fulminans was a frequent complication, developing in 19% of OPSI patients vs 5% of patients without asplenia (P = .038). The interval between splenectomy and OPSI was 6 years (range, 1 month-50 years). On multivariable Poisson regression, asplenia was the only predictive variable independently associated with pneumococcal sepsis (adjusted relative risk, 2.53 [95% confidence interval, 1.06-6.08]). CONCLUSIONS: Pneumococcal infections remain the most important cause of severe sepsis and septic shock following splenectomy.
Authors: Mohammad A Khasawneh; Nicolas Contreras-Peraza; Matthew C Hernandez; Christine Lohse; Donald H Jenkins; Martin D Zielinski Journal: Pediatr Surg Int Date: 2019-02-02 Impact factor: 1.827
Authors: Giuseppe Ercoli; Vitor E Fernandes; Wen Y Chung; Joseph J Wanford; Sarah Thomson; Christopher D Bayliss; Kornelis Straatman; Paul R Crocker; Ashley Dennison; Luisa Martinez-Pomares; Peter W Andrew; E Richard Moxon; Marco R Oggioni Journal: Nat Microbiol Date: 2018-04-16 Impact factor: 17.745