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Quéffélec C, Billet L, Duffau P, Lazaro E, Machelart I, Greib C, Viallard JF, Pellegrin JL, Rivière E. Prevention of infection in asplenic adult patients by general practitioners in France between 2013 and 2016 : Care for the asplenic patient in general practice. BMC FAMILY PRACTICE 2020; 21:163. [PMID: 32787857 PMCID: PMC7425533 DOI: 10.1186/s12875-020-01237-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022]
Abstract
Background Guidelines that detail preventive measures against Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type b, and influenza are published annually in France to decrease the risk of severe infections in immunocompromised patients. We aimed at describing adherence to these guidelines by GPs in the management of their asplenic patients in France between 2013 and 2016. Method We conducted a multicenter retrospective study between January 2013 and December 2016 in three French hospitals: asplenic adults were identified and their GPs were questioned. A descriptive analysis was performed to identify the immunization coverage, type and length of antibiotic prophylaxis, number of infectious episodes, and education of patients. Results 103 patients were finally included in this study: only 57% were adequately vaccinated against Streptococcus pneumoniae or Neisseria meningitidis, 74% against Haemophilus influenzae type b, and 59% against influenza. Only 24% of patients received a combination of all four vaccinations. Two-thirds of patients received prophylactic antibiotics for at least 2 years. Overall, this study found that 50% of splenectomized patients experienced at least one pulmonary or otorhinolaryngological infection, or contracted influenza. Conclusions These data match those reported in other countries, including Australia and the United Kingdom, meaning a still insufficient coverage of preventive measures in asplenic patients. Improved medical data sharing strategies between healthcare professionals, along with educational measures to keep patients and physicians up to date in the prevention of infections after splenectomy would improve health outcomes of asplenic patients.
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Affiliation(s)
- Charlotte Quéffélec
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, F33600, Pessac, France
| | - Louis Billet
- Medical Information Department, Pellegrin Hospital, University Hospital Centre of Bordeaux, F33076, Bordeaux, France
| | - Pierre Duffau
- Internal Medicine and Clinical Immunology Unit, Saint-André Hospital, University Hospital Centre of Bordeaux, F33000, Bordeaux, France.,UMR CNRS 5164, ImmunoConcEpT & FHU ACRONIM, Bordeaux University, F33000, Bordeaux, France
| | - Estibaliz Lazaro
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, F33600, Pessac, France.,UMR CNRS 5164, ImmunoConcEpT & FHU ACRONIM, Bordeaux University, F33000, Bordeaux, France
| | - Irène Machelart
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, F33600, Pessac, France
| | - Carine Greib
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, F33600, Pessac, France
| | - Jean-François Viallard
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, F33600, Pessac, France.,INSERM U1034, Bordeaux University, F33604, Pessac Cedex, France
| | - Jean-Luc Pellegrin
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, F33600, Pessac, France.,UMR CNRS 5164, ImmunoConcEpT & FHU ACRONIM, Bordeaux University, F33000, Bordeaux, France
| | - Etienne Rivière
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, F33600, Pessac, France. .,INSERM U1034, Bordeaux University, F33604, Pessac Cedex, France.
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Mitchell AP, Boggan JC, Lau K, Simel DL. Splenectomy as a Destination: Improving Quality of Care Among Asplenic Veterans Through a Travel Clinic. Am J Med 2017; 130:856-861. [PMID: 28213046 DOI: 10.1016/j.amjmed.2017.01.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/28/2016] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Asplenic patients are at risk for severe infections, but adherence to recommended preventive education and vaccination is poor. The goal of this study was to demonstrate that a targeted intervention can improve vaccination rates in a population of asplenic veterans. METHODS Surgically asplenic patients actively receiving care in our health care system were identified via a database search. Patients were contacted via mailed letters and encouraged to attend an existing travel clinic with a new process designed for asplenic patients. In the clinic, patients were educated on the risks of asplenia and proper preventive precautions, a vaccination history was taken, and patients were administered any additional indicated vaccines. RESULTS The database search yielded 113 patients; an additional 14 asplenic patients were identified and referred to the clinic by providers, and 2 were referred prior to planned splenectomy. Among all asplenic patients, the first-year referral rate to clinic was 38/129 (29%). During the first year of the intervention, there were increases in the rates of 3 of 4 recommended vaccinations: pneumococcal conjugate, 19% to 55% (P <.001); Haemophilus influenzae type B, 19% to 35% (P = .007); and meningococcal vaccine, 24% to 43% (P = .002). The pneumococcal polysaccharide vaccination rate increased from 91% to 93% (P = .62). CONCLUSIONS Targeted interventions can improve guideline-based care for asplenic patients. The creation of a clinic designed for asplenic patients led to increases in 3 of 4 recommended vaccinations. This strategy may be applicable to other health care systems with similar numbers of asplenic patients.
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Affiliation(s)
- Aaron P Mitchell
- Department of Medicine, Durham Veterans Affairs Medical Center, NC; Department of Hematology/Oncology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.
| | - Joel C Boggan
- Department of Medicine, Durham Veterans Affairs Medical Center, NC
| | - Karen Lau
- Department of Medicine, Durham Veterans Affairs Medical Center, NC
| | - David L Simel
- Department of Medicine, Durham Veterans Affairs Medical Center, NC
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Boam T, Sellars P, Isherwood J, Hollobone C, Pollard C, Lloyd DM, Dennison AR, Garcea G. Adherence to vaccination guidelines post splenectomy: A five year follow up study. J Infect Public Health 2017; 10:803-808. [PMID: 28189514 DOI: 10.1016/j.jiph.2017.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 11/21/2016] [Accepted: 01/07/2017] [Indexed: 11/16/2022] Open
Abstract
Following a splenectomy patients are at increased risk of significant infections. In its most severe form, overwhelming post-splenectomy infection (OPSI) has a mortality rate of up to 80%. In this study we aim to establish the adherence to vaccination and antibiotic national guidelines in splenectomised patients. A retrospective study of 100 patients who underwent splenectomy (21 emergency, 79 elective), in two teaching hospitals was undertaken over a five-year period. Patients were followed up for five years. Hospital and GP records were reviewed for adherence to pre, intra and postoperative vaccination, thromboprophylaxis and antibiotic guidance. Eighty-six eligible patients (91.5%) received their Haemophilus influenzae B, meningococcal C and pneumococcus vaccinations peri-operatively. Eighty-one (86%) received post-operative antibiotics. Ninety-nine percent of patients received thromboprophylaxis treatment. Eighty-nine (95%) were treated with long-term antibiotic prophylaxis. Only 20 patients (23%) had an emergency supply of antibiotics. Ninety-five percent of patients were administered an annual influenza vaccination and 84% of eligible patients received a five-year pneumococcal booster vaccination. Improvement in the management of this patient cohort can be achieved by a multidisciplinary approach involving adherence to national guidelines, standardised trust protocols, patient information leaflets and advice detailing risk of infection, standardised GP letters and a splenectomy register to monitor and manage this vulnerable group of patients.
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Affiliation(s)
- Tristan Boam
- Nottingham University Hospitals, Nottingham, UK.
| | | | - John Isherwood
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK(1)
| | - Chloe Hollobone
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK(1)
| | - Cristina Pollard
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK(1)
| | - David M Lloyd
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK(1)
| | - Ashley R Dennison
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK(1)
| | - Giuseppe Garcea
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK(1)
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Jones AD, Khan M, Cheshire J, Bowley D. Postsplenectomy Prophylaxis: A Persistent Failure to Meet Standard? Open Forum Infect Dis 2016; 3:ofw197. [PMID: 27975073 PMCID: PMC5152704 DOI: 10.1093/ofid/ofw197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/13/2016] [Indexed: 12/28/2022] Open
Abstract
A retrospective case review of patients that underwent emergency splenectomy or splenic preservation from May 2003 to April 2014 was undertaken at a single center. The results highlight failures in administration of postsplenectomy vaccination for emergency splenectomy patients. In this study, we highlight methods to improve postsplenectomy care.
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Affiliation(s)
- Alexander David Jones
- Department of Surgery, Heartlands Hospital, Heart of England Foundation Trust , Bordesley Green East, Birmingham
| | - Mashuk Khan
- Department of Surgery, Heartlands Hospital, Heart of England Foundation Trust , Bordesley Green East, Birmingham
| | - James Cheshire
- Department of Surgery, Heartlands Hospital, Heart of England Foundation Trust , Bordesley Green East, Birmingham
| | - Douglas Bowley
- Department of Surgery, Heartlands Hospital, Heart of England Foundation Trust , Bordesley Green East, Birmingham
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