Guidelines for the prevention of sepsis in asplenic and hyposplenic patients

Spelman, Dennis; Buttery, Jim; Daley, Andrew J; Isaacs, David; Jennens, Ian; Kakakios, Alyson; Lawrence, Robert L.; Roberts, Steven; Torda, Adrienne; Watson, Ashley; Woolley, Ian; Anderson, Thomas F.; Street, and A.

doi:10.1111/j.1445-5994.2007.01579.x

Cited by 73 publications

(49 citation statements)

References 48 publications

(60 reference statements)

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“…Splenic preservation is of paramount importance in these patients, considering their young age and that risks of asplenic status are lifelong [25][26][27][28]. In our experience, intraoperative Doppler ultrasonography proved invaluable in supporting a conservative approach whenever arterial blood flow, albeit demodulated, was detected by the probe placed on the spleen's surface; more sound information can be achieved by duplex or echo-color-Doppler devices [3].…”

Section: Discussionmentioning

confidence: 91%

Prospective randomized comparison of open versus laparoscopic management of splenic artery aneurysms: a 10-year study

et al. 2012

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Background The literature does not support the choice between open and laparoscopic management of splenic artery aneurysms (SAA). Methods We designed a prospective, randomized comparison between open and laparoscopic surgery for SAA. Primary end points were types of surgical procedures performed and clinical outcomes. Analysis was developed on an intention-to-treat basis. Results Fourteen patients were allocated to laparotomy (group A) and 15 to laparoscopy (group B). Groups displayed similar patient-and aneurysm-related characteristics. The conversion rate to open surgery was 13.3 %. The type of surgical procedure performed on the splenic artery was similar in the two groups: aneurysmectomy with splenic artery ligature or direct anastomosis was performed in 51 % and 21 % of patients in group A and in 60 % and 20 % in group B, respectively. The splenectomy rate was similar (14 % vs. 20 %). Postoperative splenic infarction was observed in one case in each group. Laparoscopy was associated with shorter procedures (p = 0.0003) and lower morbidity (25 % vs. 64 %, p = 0.045). Major morbidity requiring interventional procedures and blood transfusion was observed only in group A. Laparoscopy was associated with quicker resumption of oral diet (p \ 0.001), earlier drain removal (p = 0.046), and shorter hospital stay (p \ 0.01). During a mean follow-up of 50 months, two patients in group A required hospital readmission. In group B, two patients developed a late thrombosis of arterial anastomoses. Conclusions Our study demonstrates that laparoscopy permits multiple technical options, does not increase the splenectomy rate, and reduces postoperative complications. It confirms the supposed clinical benefits of laparoscopy when ablative procedures are required but laparoscopic anastomoses show poor long-term results.Keywords Clinical paper Á Trials Á Splenic artery aneurysms Recent literature reports on the feasibility, safety, and effectiveness of laparoscopic management of splenic artery aneurysms (SAA) as well as its appreciation by patientsoften young females-who harbour the disease [1][2][3][4][5][6][7][8][9][10][11][12][13]. Thus, laparoscopy may represent an interesting alternative to open surgery and provided that the same range of technical solutions offered by open surgery can be achieved with similar results [1,[14][15][16][17][18] and the general advantages of laparoscopy are confirmed in this specific application, the laparoscopic option may represent a challenging alternative not only to laparotomic surgery but also to endovascular procedures. Endovascular management, albeit minimally invasive, requires accurate patient selection and presents some Registration Number: NCT01387828.

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Section: Discussionmentioning

confidence: 91%

Prospective randomized comparison of open versus laparoscopic management of splenic artery aneurysms: a 10-year study

et al. 2012

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“…For prevention of overwhelming sepsis, guidelines concerning the management of asplenic patients, recommends vaccination (pneumococcal and Hib vaccines), antibiotic prophylaxis with penicillin [4,18,19]. However, in the case of congenital isolated asplenia, sepsis may be the first sign of the disease [4].…”

Section: Discussionmentioning

confidence: 99%

Congenital Asplenia Revealed by Streptococcus oralis septicemia: Case Report

Fane¹,

Sodqi²,

Marih³

et al. 2017

J Antimicrob Agents

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Congenital asplenia is a rare life-threatening condition, often presenting with sepsis caused by encapsulated pathogens. It may arise as part of situs abnormalities or result from an unrelated specific defect of spleen development. Isolated congenital asplenia is a very rare condition. We report a case of asplenia revealed by severe sepsis and multi-organ failure in a previously healthy 25-year-old male how had never undergone any surgical procedures. Blood cultures grew Streptococcus oralis four days after admission. Computed tomography revealed pneumonia and asplenia. The patient was finally diagnosed as Streptococcal sepsis revealing isolated congenital asplenia. Cephalosporin and levofloxacin were administered and the patient died following cardiopulmonary arrests. No family history for this condition was reported. Clinicians should pay attention to the congenital asplenia in Streptococcal disease, particularly in the event of overwhelming sepsis. In affected individuals, the use of appropriate antibiotic prophylaxis and immunisations could save lives.

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“…The current hyposplenia treatment guidelines in United States and Europe recommend long-term antibiotic prophylaxis for high-risk patients (21)(22)(23). However, the suggested treatment duration is controversial (23), ranging from 2 y to lifelong, and the antibiotic prophylaxis recommendation has often been questioned.…”

Section: Low Igm Memory B-cell Percentage In Heterotaxy Patients Is Cmentioning

confidence: 99%

“…However, the suggested treatment duration is controversial (23), ranging from 2 y to lifelong, and the antibiotic prophylaxis recommendation has often been questioned. First, the guideline does not consider individual disease differences (24).…”

Section: Low Igm Memory B-cell Percentage In Heterotaxy Patients Is Cmentioning

confidence: 99%

“…First, the guideline does not consider individual disease differences (24). The only evidence of antibiotic prophylaxis in children is from sickle cell disease cases (23). Second, the guideline does not consider antibiotic resistance, which is an emerging problem because of antibiotic overuse (25,26).…”

Section: Low Igm Memory B-cell Percentage In Heterotaxy Patients Is Cmentioning

confidence: 99%

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Low immunoglobulin M memory B-cell percentage in patients with heterotaxy syndrome correlates with the risk of severe bacterial infection

et al. 2015

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Guidelines for the prevention of sepsis in asplenic and hyposplenic patients

Cited by 73 publications

References 48 publications

Prospective randomized comparison of open versus laparoscopic management of splenic artery aneurysms: a 10-year study

Prospective randomized comparison of open versus laparoscopic management of splenic artery aneurysms: a 10-year study

Congenital Asplenia Revealed by Streptococcus oralis septicemia: Case Report

Low immunoglobulin M memory B-cell percentage in patients with heterotaxy syndrome correlates with the risk of severe bacterial infection

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