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Ladhani SN, Fernandes S, Garg M, Borrow R, de Lusignan S, Bolton-Maggs PHB. Prevention and treatment of infection in patients with an absent or hypofunctional spleen: A British Society for Haematology guideline. Br J Haematol 2024; 204:1672-1686. [PMID: 38600782 DOI: 10.1111/bjh.19361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 04/12/2024]
Abstract
Guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen were published by the British Committee for Standards in Haematology in 1996 and updated in 2002 and 2011. With advances in vaccinations and changes in patterns of infection, the guidelines required updating. Key aspects included in this guideline are the identification of patients at risk of infection, patient education and information and immunisation schedules. This guideline does not address the non-infective complications of splenectomy or functional hyposplenism (FH). This replaces previous guidelines and significantly revises the recommendations related to immunisation. Patients at risk include those who have undergone surgical removal of the spleen, including partial splenectomy and splenic embolisation, and those with medical conditions that predispose to FH. Immunisations should include those against Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus) and influenza. Haemophilus influenzae type b (Hib) is part of the infant immunisation schedule and is no longer required for older hyposplenic patients. Treatment of suspected or proven infections should be based on local protocols and consider relevant anti-microbial resistance patterns. The education of patients and their medical practitioners is essential, particularly in relation to the risk of serious infection and its prevention. Further research is required to establish the effectiveness of vaccinations in hyposplenic patients; infective episodes should be regularly audited. There is no single group ideally placed to conduct audits into complications arising from hyposplenism, highlighting a need for a national registry, as has proved very successful in Australia or alternatively, the establishment of appropriate multidisciplinary networks.
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Affiliation(s)
- Shamez N Ladhani
- Centre for Neonatal and Paediatric Infections (CNPI), St. George's University of London, London, UK
- Immunisation and Countermeasures Division, UK Health Security Agency Colindale, London, UK
| | - Savio Fernandes
- Department of Haematology, Dudley Group Foundation NHS Trust, Russell's Hall Hospital, Dudley, UK
| | - Mamta Garg
- Leicester Royal Infirmary, Leicester, UK
| | - Ray Borrow
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), University of Oxford, Oxford, UK
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2
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Lin CC, Hsu SD, Chien WC, Chung CH, Chen CJ, Liang CM, Hong ZJ. Comparison of Long-Term Pneumonia Risk between Spleen Injury and Non-Spleen Injury after Total Splenectomy—A Population-Based Study. J Pers Med 2022; 12:jpm12020308. [PMID: 35207798 PMCID: PMC8877515 DOI: 10.3390/jpm12020308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 11/23/2022] Open
Abstract
Patients who undergo splenectomy are at a high risk of infection. We aimed to investigate the rate of pneumonia in patients who underwent splenectomy, specifically comparing those who had splenectomy due to spleen injury and those who had it for other reasons. A population-based cohort study was conducted. Overall, 17,498 patients who underwent splenectomy between 2000 and 2015 were enrolled, including 11,817 patients with a history of spleen injury and 5681 controls without spleen injury. The incidence of pneumonia was calculated at the end of 2016. A multivariable Cox proportional hazards regression model was used to compare the hazard ratio with 95% CI for pneumonia associated with the spleen injury-caused splenectomy and splenectomy due to other causes. The crude HR for patients with splenectomy due to spleen injury to develop pneumonia was 1.649. After adjusting for covariates, the adjusted hazard ratio was 1.567. There were statistically significant differences in all subgroups, except for the group with a tracking duration >10 years. We found an increase in pneumonia risk in the ‘spleen injury’ group when comparing it to that of the ‘other causes’ group, regardless of age, sex, and area of residence.
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Affiliation(s)
- Chun-Cheng Lin
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Sheng-Der Hsu
- Division of Traumatology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (C.-J.C.); (C.-M.L.); (Z.-J.H.)
- Correspondence:
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Cheng-Jueng Chen
- Division of Traumatology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (C.-J.C.); (C.-M.L.); (Z.-J.H.)
| | - Chia-Ming Liang
- Division of Traumatology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (C.-J.C.); (C.-M.L.); (Z.-J.H.)
| | - Zhi-Jie Hong
- Division of Traumatology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (C.-J.C.); (C.-M.L.); (Z.-J.H.)
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Ullrich SJ, Kisa P, Muzira A, Kakembo N, Nabukenya M, Tumukunde J, Sekabira J, Chang DC, Ozgediz D. Pediatric surgical quality improvement in low- and middle-income countries: What data to collect? Surgery 2022; 171:1067-1072. [PMID: 35078626 DOI: 10.1016/j.surg.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND As surgical access expands in low- and middle-income countries, risk-adjusted outcomes data are needed to measure and improve surgical quality. Existing data collection tools in high-income countries are complex and may be burdensome to implement in low and middle income countries. This study determined the minimum dataset needed for adequate risk adjustment to predict perioperative mortality using data collected in a low- and middle-income countries. METHODS All patients admitted to the pediatric surgery ward at Mulago National Referral Hospital in Kampala, Uganda, from January 1, 2014 through December 31, 2018 were included. Studies were performed modelling the effects of reducing data granularity and reducing number of variables on the area under the receiver operating curve. RESULTS Of the 3,194 patients included, 1,941(61%) were male, 957(30%) were neonates, 1,714 (54%) had an operation, and the overall mortality rate was 14%. Granularity reduction analyses found that measuring age in ranges was equivalent to recording age in days (area under the receiver operating curve = 0.776; 95% confidence interval, 0.754%-0.798%, vs 0.815, 95% confidence interval, 0.794%-0.837%). Variable reduction analyses found that models with 3 predictor variables (diagnosis, procedure, and district) reached a maximum area under the receiver operating curve of 0.915 (95% confidence interval, 0.903%-0.928%), which was equivalent to the model using all available predictor variables (area under the receiver operating curve = 0.932; 95% confidence interval, 0.922%-0.943%). For all 3-variable models, the primary diagnosis contributed most to predictive ability (P < .001). CONCLUSION Effective risk adjustment for perioperative mortality can be performed in low and middle income countries using minimal, objective variables often already part of the patient's medical record. This approach can be used by clinicians, hospital administrators, and policymakers low- and middle-income countries looking to begin data collection to track and improve patient outcomes.
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Affiliation(s)
- Sarah J Ullrich
- Department of Surgery, Yale University School of Medicine, New Haven, CT.
| | - Phyllis Kisa
- Department of Surgery, Mulago National Referral Hospital, Kampala, Uganda
| | - Arlene Muzira
- Department of Surgery, Mulago National Referral Hospital, Kampala, Uganda
| | - Nasser Kakembo
- Department of Surgery, Mulago National Referral Hospital, Kampala, Uganda
| | - Mary Nabukenya
- Department of Anesthesia, Mulago National Referral Hospital, Kampala, Uganda
| | - Janat Tumukunde
- Department of Anesthesia, Mulago National Referral Hospital, Kampala, Uganda
| | - John Sekabira
- Department of Surgery, Mulago National Referral Hospital, Kampala, Uganda
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Doruk Ozgediz
- Department of Surgery, University of California San Francisco, San Francisco, CA
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4
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Luu S, Sheldon J, Dendle C, Ojaimi S, Jones P, Woolley I. Prevalence and distribution of functional splenic tissue after splenectomy. Intern Med J 2021; 50:556-564. [PMID: 31449712 DOI: 10.1111/imj.14621] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/20/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Individuals splenectomised for trauma have lower infection rates than those splenectomised for other conditions. Residual functional splenic tissue (FST) after splenectomy may provide ongoing immunological protection. AIMS To quantify the prevalence and volume of residual FST post-splenectomy using standard testing. METHODS Splenectomised adults were recruited from the Spleen Australia clinical registry. Eligible individuals had been splenectomised at least 1 year prior to their visit and resided in Victoria. Splenic function was identified by evaluating Howell-Jolly bodies and IgM memory B cells. A 99m-Technetium-labelled, heat-denatured erythrocyte scintigraphic scan was performed if splenic function was detected. RESULTS Initially, 75 splenectomised individuals (all cause) were recruited, with a median of 58 years of age and who were splenectomised a median of 14 years previously. The most common indications for splenectomy were trauma (30.7%) and haematological disease (28.0%). Scintigraphy identified FST in nine individuals (12.0%). Eight had been splenectomised for trauma. In this cohort, 34.8% of individuals splenectomised for trauma had residual FST. To explore our findings further, 45 additional individuals were recruited, predominately individuals splenectomised for trauma. Twenty-five individuals completed assessments by December 2018. An additional 11 individuals had FST, of whom 9 had been splenectomised for trauma. Overall, we identified 20 individuals with residual FST. Volumes ranged from 2.2 to 216.0 cc. We saw individuals with accessory spleens and splenotic nodules and an individual with both. Seventeen individuals had been splenectomised for trauma. CONCLUSIONS Residual FST is commonly seen in individuals splenectomised for trauma. It can present in varying distributions and of varying volume. The clinical significance is unclear.
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Affiliation(s)
- Sarah Luu
- Monash Infectious Diseases, Monash University, Clayton, Victoria, Australia.,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
| | - James Sheldon
- Monash Imaging, Monash Health, Clayton, Victoria, Australia
| | - Claire Dendle
- Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia.,Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia
| | - Samar Ojaimi
- Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia.,Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia.,Monash Children's Infection and Immunity, Monash Health, Clayton, Victoria, Australia
| | - Penelope Jones
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
| | - Ian Woolley
- Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia.,Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia.,Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
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5
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Ko T, Yeo AL, Luu S, Dendle C, Woolley I, Morand E, Hoi A. Routine testing for hyposplenism in a lupus clinic diagnoses; new cases and opportunities for intervention. Lupus 2021; 30:687-688. [PMID: 33497304 DOI: 10.1177/0961203320988601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tina Ko
- Department of Rheumatology, Monash Health, Clayton, VIC, Australia
| | - Ai Li Yeo
- Department of Rheumatology, Monash Health, Clayton, VIC, Australia.,Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia 3Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Sarah Luu
- Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Claire Dendle
- Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Ian Woolley
- Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Eric Morand
- Department of Rheumatology, Monash Health, Clayton, VIC, Australia.,Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Alberta Hoi
- Department of Rheumatology, Monash Health, Clayton, VIC, Australia.,Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
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6
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Balaceanu A, Omer S, Stirban R, Zara O, Dina I. Hyposplenism, Hashimoto's Autoimmune Thyroiditis and Overlap Syndrome (Celiac Disease and Autoimmune Hepatitis Type 1). Am J Med Sci 2020; 360:293-299. [PMID: 32563569 DOI: 10.1016/j.amjms.2020.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/02/2020] [Accepted: 04/18/2020] [Indexed: 01/25/2023]
Abstract
Hyposplenism is associated with autoimmune diseases, inflammatory bowel disease, severe celiac disease, autoimmune thyroiditis, untreated HIV infection and chronic graft-versus-host disease. The aim of this study was to review the existing data on hyposplenism associated with celiac disease and Hashimoto's autoimmune thyroiditis. Our research was based on a clinical case concerning a 41-year-old female who presented with asthenia, fatigue, dyspepsia and chronic diarrhea. The medical history revealed autoimmune Hashimoto's thyroiditis, type 2 diabetes, fatty liver disease, chronic gastritis and thrombocytosis. Multiple investigations showed hyposplenism and complex autoimmune dysfunction with positive serum markers for celiac disease and type 1 autoimmune hepatitis along with minor symptomatology. The intestinal symptomatology of celiac disease is often hid by hypothyroidism-associated autoimmune thyroiditis. Asymptomatic or minimally symptomatic celiac disease associated with Hashimoto's autoimmune thyroiditis is diagnosed by biomarkers. Hyposplenism in celiac disease can occur regardless of the disease stage, latent or symptomatic.
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Affiliation(s)
- Alice Balaceanu
- "Carol Davila" University of Medicine and Pharmacy, "Sf. Ioan" Clinical Emergency Hospital, Internal Medicine Department, Bucharest, Romania.
| | - Secil Omer
- "Carol Davila" University of Medicine and Pharmacy, "Sf. Ioan" Clinical Emergency Hospital, Gastroenterology Department, Bucharest, Romania
| | - Raluca Stirban
- "Sf. Ioan" Clinical Emergency Hospital, Internal Medicine Department, Bucharest, Romania
| | - Octavian Zara
- "Sf. Ioan" Clinical Emergency Hospital, Interventional Cardiology Department, Bucharest, Romania
| | - Ion Dina
- "Carol Davila" University of Medicine and Pharmacy, "Sf. Ioan" Clinical Emergency Hospital, Gastroenterology Department, Bucharest, Romania
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7
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Eisen DP, McBryde ES, Vasanthakumar L, Murray M, Harings M, Adegboye O. Linking administrative data sets of inpatient infectious diseases diagnoses in far North Queensland: a cohort profile. BMJ Open 2020; 10:e034845. [PMID: 32193270 PMCID: PMC7202725 DOI: 10.1136/bmjopen-2019-034845] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To design a linked hospital database using administrative and clinical information to describe associations that predict infectious diseases outcomes, including long-term mortality. PARTICIPANTS A retrospective cohort of Townsville Hospital inpatients discharged with an International Classification of Diseases and Related Health Problems 10th Revision Australian Modification code for an infectious disease between 1 January 2006 and 31 December 2016 was assembled. This used linked anonymised data from: hospital administrative sources, diagnostic pathology, pharmacy dispensing, public health and the National Death Registry. A Created Study ID was used as the central identifier to provide associations between the cohort patients and the subsets of granular data which were processed into a relational database. A web-based interface was constructed to allow data extraction and evaluation to be performed using editable Structured Query Language. FINDINGS TO DATE The database has linked information on 41 367 patients with 378 487 admissions and 1 869 239 diagnostic/procedure codes. Scripts used to create the database contents generated over 24 000 000 database rows from the supplied data. Nearly 15% of the cohort was identified as Aboriginal or Torres Strait Islanders. Invasive staphylococcal, pneumococcal and Group A streptococcal infections and influenza were common in this cohort. The most common comorbidities were smoking (43.95%), diabetes (24.73%), chronic renal disease (17.93%), cancer (16.45%) and chronic pulmonary disease (12.42%). Mortality over the 11-year period was 20%. FUTURE PLANS This complex relational database reutilising hospital information describes a cohort from a single tropical Australian hospital of inpatients with infectious diseases. In future analyses, we plan to explore analyses of risks, clinical outcomes, healthcare costs and antimicrobial side effects in site and organism specific infections.
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Affiliation(s)
- Damon P Eisen
- Infectious Diseases, Townsville Hospital, Townsville, Queensland, Australia
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Emma S McBryde
- Australian Institute of Tropical Health and Medicine, Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Luke Vasanthakumar
- Infectious Diseases, Townsville Hospital, Townsville, Queensland, Australia
| | | | - Miriam Harings
- Infectious Diseases, Townsville Hospital, Townsville, Queensland, Australia
| | - Oyelola Adegboye
- Australian Institute of Tropical Health and Medicine, Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
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8
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Lee P, Chin K, Liew D, Stub D, Brennan AL, Lefkovits J, Zomer E. Economic evaluation of clinical quality registries: a systematic review. BMJ Open 2019; 9:e030984. [PMID: 31843824 PMCID: PMC6924778 DOI: 10.1136/bmjopen-2019-030984] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The objective of this systematic review was to examine the existing evidence base for the cost-effectiveness or cost-benefit of clinical quality registries (CQRs). DESIGN Systematic review and narrative synthesis. DATA SOURCES Nine electronic bibliographic databases, including MEDLINE, EMBASE and CENTRAL, in the period from January 2000 to August 2019. ELIGIBILITY CRITERIA Any peer-reviewed published study or grey literature in English which had reported on an economic evaluation of one or more CQRs. DATA EXTRACTION AND SYNTHESIS Data were screened, extracted and appraised by two independent reviewers. A narrative synthesis was performed around key attributes of each CQR and on key patient outcomes or changes to healthcare processes or utilisation. A narrative synthesis of the cost-effectiveness associated with CQRs was also conducted. The primary outcome was cost-effectiveness, in terms of the estimated incremental cost-effectiveness ratio (ICER), cost savings or return-on-investment (ROI) attributed to CQR implementation. RESULTS Three studies and one government report met the inclusion criteria for the review. A study of the National Surgical Quality Improvement Programme (NSQIP) in the USA found that the cost-effectiveness of this registry improved over time, based on an ICER of US$8312 per postoperative event avoided. A separate study in Canada estimated the ROI to be US$3.43 per US$1.00 invested in the NSQIP. An evaluation of a post-splenectomy CQR in Australia estimated that registry cost-effectiveness improved from US$234 329 to US$18 358 per life year gained when considering the benefits accrued over the lifetime of the population. The government report evaluating five Australian CQRs estimated an overall return of 1.6-5.5 times the cost of investment. CONCLUSIONS Available data indicate that CQRs can be cost-effective and can lead to significant returns on investment. It is clear that further studies that evaluate the economic and clinical impacts of CQRs are necessary. PROSPERO REGISTRATION NUMBER CRD42018116807.
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Affiliation(s)
- Peter Lee
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ken Chin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Departrment of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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9
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Lau JSY, Korman TM, Woolley I. Life-long antimicrobial therapy: where is the evidence? J Antimicrob Chemother 2019; 73:2601-2612. [PMID: 29873746 DOI: 10.1093/jac/dky174] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The decision to prescribe long-term or 'life-long' antibiotics in patients requires careful consideration by the treating clinician. While several guidelines exist to help assist in this decision, the long-term consequences are yet to be well studied. In this review, we aim to provide a summary of the available evidence for patient populations where long-term antibiotic therapy is currently recommended in clinical practice. We will also discuss the pitfalls of this approach, including medication adverse effects, economic cost and any possible contribution to the emerging epidemic of microbial resistance.
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Affiliation(s)
- Jillian S Y Lau
- Monash University, Clayton, Victoria, Australia.,Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia
| | - Tony M Korman
- Monash University, Clayton, Victoria, Australia.,Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia
| | - Ian Woolley
- Monash University, Clayton, Victoria, Australia.,Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia
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10
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Luu S, Jones P, Woolley I, Spelman D, Gold L. Initial modelling and updates on cost effectiveness from the first 10 years of a spleen registry. Aust N Z J Public Health 2018; 42:463-466. [PMID: 30238558 DOI: 10.1111/1753-6405.12832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/01/2018] [Accepted: 07/01/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To validate our estimates from our original model and re-evaluate the cost-effectiveness 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 cost-effective. 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.
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Affiliation(s)
- Sarah Luu
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria.,Monash Infectious Diseases, Monash Health, Victoria
| | - Penelope Jones
- Spleen Australia, Department of Infectious Diseases, Alfred Health, Victoria
| | - Ian Woolley
- Monash Infectious Diseases, Monash Health, Victoria.,Spleen Australia, Department of Infectious Diseases, Alfred Health, Victoria.,Centre for Inflammatory Diseases, Monash University, Victoria
| | - Denis Spelman
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria.,Spleen Australia, Department of Infectious Diseases, Alfred Health, Victoria
| | - Lisa Gold
- Deakin Health Economics, Deakin University, Victoria
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11
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Cardoso DL, Cardoso Filho FDEA, Cardoso AL, Gonzaga ML, Grande AJ. Should splenic autotransplantation be considered after total splenectomy due to trauma? Rev Col Bras Cir 2018; 45:e1850. [PMID: 29995152 DOI: 10.1590/0100-6991e-20181850] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/29/2018] [Indexed: 11/22/2022] Open
Abstract
Trauma is a public health problem and the most common cause of death in people under the age of 45. In blunt abdominal trauma, the spleen is the most commonly injured organ. Splenectomy remains the most common treatment, especially in high-grade lesions, despite increased nonoperative treatment. Removal of the spleen leads to increased susceptibility to infections due to its role in the immune function. Postsplenectomy sepsis is an important complication and presents a high mortality rate. Patients undergoing splenectomy should be immunized for encapsulated germs, as these are the agents most commonly associated with such infections. Splenic autotransplantation is a simple procedure, which can be an alternative to reduce infection rates consequent to total splenectomy, and reduce costs related to hospitalizations. This review aims to provide evidence-based information on splenic autotransplantation and its impact on the prognosis of patients undergoing total splenectomy. We searched the Cochrane Library, Medline/PubMed, SciELO and Embase, from January 2017 to January 2018 and selected articles in English and Portuguese, dated from 1919 to 2017. We found that the adjusted risk of death in splenectomized patients is greater than that of the general population, and when total splenectomy is performed, splenic autotransplantation is the only method capable of preserving splenic function, avoiding infections, especially postsplenectomy sepsis. Health professionals should be familiar with the consequences of the method chosen to manage the patient suffering from splenic trauma.
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Affiliation(s)
| | | | | | | | - Antônio José Grande
- - State University of Mato Grosso do Sul, Faculty of Medicine, Dourados, MS, Brazil
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12
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Premawardena C, Bowden D, Kaplan Z, Dendle C, Woolley IJ. Understanding of the significance and health implications of asplenia in a cohort of patients with haemaglobinopathy: possible benefits of a spleen registry. ACTA ACUST UNITED AC 2017; 23:526-530. [PMID: 29237357 DOI: 10.1080/10245332.2017.1414910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Asplenia and hyposplenism carry a significant risk of ongoing morbidity and mortality which can be reduced by education, vaccination and antibiotic use. We aimed to assess education and other methods of prevention in a cohort of patients with haemoglobinopathy in a tertiary referral centre, which also had access to a post-splenectomy registry created to reduce post-splenectomy infection risk. METHODS A standardized questionnaire was used on patients who attended the service for regular therapy. Patients were also asked about standard post-splenectomy preventive therapies including antibiotics and vaccinations. RESULTS There were 49 patients who had either had a splenectomy or knew their spleen to be non-functional. Of these, nearly half knew themselves to be on the Victorian Spleen Registry (51.0%). The median knowledge score was 12 (range 4-17) out of a possible 18. Most significantly the benefits of the registry were not seen in terms of knowledge but in delivery of recommended vaccines and the use of a medical alert card. CONCLUSION This study examined knowledge and attitudes about splenectomy in a cohort of haemoglobinopathy patients in an Australian tertiary referral centre. The majority had good or fair knowledge with a strong association of some elements of post-splenectomy care with being placed on a spleen registry and having received targeted education. Implementation of systematic approaches by medical staff is likely to be the main benefit of a clinical registry approach in this setting.
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Affiliation(s)
- Chamath Premawardena
- a Faculty of Medicine, Nursing and Health Sciences , Monash University , Clayton , Australia
| | - Donald Bowden
- a Faculty of Medicine, Nursing and Health Sciences , Monash University , Clayton , Australia.,b Department of Haematology , Monash Health , Clayton , Australia
| | - Zane Kaplan
- a Faculty of Medicine, Nursing and Health Sciences , Monash University , Clayton , Australia.,b Department of Haematology , Monash Health , Clayton , Australia
| | - Claire Dendle
- a Faculty of Medicine, Nursing and Health Sciences , Monash University , Clayton , Australia.,c Department of Infectious Diseases , Monash Health , Clayton , Australia
| | - Ian John Woolley
- a Faculty of Medicine, Nursing and Health Sciences , Monash University , Clayton , Australia.,c Department of Infectious Diseases , Monash Health , Clayton , Australia
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Kanhutu K, Jones P, Cheng AC, Grannell L, Best E, Spelman D. Spleen Australia guidelines for the prevention of sepsis in patients with asplenia and hyposplenism in Australia and New Zealand. Intern Med J 2017; 47:848-855. [DOI: 10.1111/imj.13348] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/14/2016] [Accepted: 11/22/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Kudzai Kanhutu
- Victorian Infectious Diseases Service; Royal Melbourne Hospital; Melbourne Victoria Australia
- Dentistry and Health Sciences, Faculty of Medicine; The University of Melbourne; Melbourne Victoria Australia
| | - Penelope Jones
- Spleen Australia, Department of Infectious Diseases; Alfred Health; Melbourne Victoria Australia
| | - Allen C. Cheng
- Spleen Australia, Department of Infectious Diseases; Alfred Health; Melbourne Victoria Australia
- Infection Prevention and Healthcare Epidemiology Unit; Alfred Health; Melbourne Victoria Australia
- School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Louise Grannell
- Spleen Australia, Department of Infectious Diseases; Alfred Health; Melbourne Victoria Australia
- Pharmacy Department; Alfred Health; Melbourne Victoria Australia
| | - Emma Best
- University of Auckland and Starship Children's Hospital; Auckland New Zealand
| | - Denis Spelman
- Spleen Australia, Department of Infectious Diseases; Alfred Health; Melbourne Victoria Australia
- Microbiology Unit, Department of Pathology; Alfred Health; Melbourne Victoria Australia
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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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Martino C, Gallone MS, Quarto M, Germinario C, Tafuri S. Immunization coverage among splenectomized patients: Results of an ad hoc survey in Puglia Region (South of Italy). Hum Vaccin Immunother 2016; 12:1277-9. [PMID: 26890256 DOI: 10.1080/21645515.2015.1138025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Patients with anatomic or functional asplenia have a 10-50 times higher risk than general population to develop Overwhelming Post-Splenectomy Infection. Evidences are unanimous in recommending splenectomised patients to receive meningococcal, antipneumococcal and Haemophilus influenzae type B vaccinations according to a specific timing. In Italy there are no current data on the immunisation coverage in these patients. This study aims to investigate immunisation coverage in patients undergoing elective or urgent splenectomy for 2012-2013 in the 3 Apulian hospitals. The patients discharged with the code ICD-9-CM 41.5 - "Total splenectomy" were enrolled. The administration of vaccines was verified through consultation of medical records, archives of general practitioners and vaccination offices. In the study period, 166 subjects underwent splenectomy and none of them received vaccinations during hospitalization. 25 splenectomised patients (15.1%) received at least one of the recommended vaccinations. 21 patients (12.6%) received vaccine against Streptococcus pneumonia, 13 (7.8%) meningococcal vaccine, 10 patients (6%) Haemophilus influenzae type B vaccine. The low vaccination coverage could be due both to poor perception of the risk of infection and to a lack of knowledge on vaccinations by surgeons. For this reason it is necessary to draw up and share operational protocols that establish the administration of vaccines.
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Affiliation(s)
- Carmen Martino
- a Department of Biomedical Science and Human Oncology , Aldo Moro University of Bari , Bari , Italy
| | - Maria Serena Gallone
- a Department of Biomedical Science and Human Oncology , Aldo Moro University of Bari , Bari , Italy
| | - Michele Quarto
- a Department of Biomedical Science and Human Oncology , Aldo Moro University of Bari , Bari , Italy
| | - Cinzia Germinario
- a Department of Biomedical Science and Human Oncology , Aldo Moro University of Bari , Bari , Italy
| | - Silvio Tafuri
- a Department of Biomedical Science and Human Oncology , Aldo Moro University of Bari , Bari , Italy
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Cost-effectiveness of endovascular repair, open repair, and conservative management of splenic artery aneurysms. J Vasc Surg 2015; 61:1432-40. [PMID: 25827968 DOI: 10.1016/j.jvs.2014.12.064] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 12/21/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Open repair (OPEN) and conservative management (CONS) have been the treatments of choice for splenic artery aneurysms (SAAs) for many years. Endovascular repair (EV) has been increasingly used with good short-term results. In this study, we evaluated the cost-effectiveness of OPEN, EV, and CONS for the treatment of SAAs. METHODS A decision analysis model was developed using TreeAge Pro 2013 software (TreeAge Inc, Williamstown, Mass) to evaluate the cost-effectiveness of the different treatments for SAAs. A hypothetical cohort of 10,000 55-year-old female patients with SAAs was assessed in the reference-case analysis. Perioperative mortality, disease-specific mortality rates, complications, rupture risks, and reinterventions were retrieved from a recent and extensive meta-analysis. Costs were analyzed with the 2014 Medicare database. The willingness to pay was set to $60,000/quality-adjusted life years (QALYs). Outcomes evaluated were QALYs, costs from the health care perspective, and the incremental cost-effectiveness ratio (ICER). Extensive sensitivity analyses were performed and different clinical scenarios evaluated. Probabilistic sensitivity analysis was performed to include the uncertainty around the variables. A flowchart for clinical decision-making was developed. RESULTS For a 55-year-old female patient with a SAA, EV has the highest QALYs (11.32; 95% credibility interval [CI], 9.52-13.17), followed by OPEN (10.48; 95% CI, 8.75-12.25) and CONS (10.39; 95% CI, 8.96-11.87). The difference in effect for 55-year-old female patients between EV and OPEN is 0.84 QALY (95% CI, 0.42-1.34), comparable with 10 months in perfect health. EV is more effective and less costly than OPEN and more effective and more expensive compared with CONS, with an ICER of $17,154/QALY. Moreover, OPEN, with an ICER of $223,166/QALY, is not cost-effective compared with CONS. In elderly individuals (age >78 years), the ICER of EV vs CONS is $60,503/QALY and increases further with age, making EV no longer cost-effective. Very elderly patients (age >93 years) have higher QALYs and lower costs when treated with CONS. The EV group has the highest number of expected reinterventions, followed by CONS and OPEN, and the number of expected reinterventions decreases with age. CONCLUSIONS EV is the most cost-effective treatment for most patient groups with SAAs, independent of the sex and risk profile of the patient. EV is superior to OPEN, being both cost-saving and more effective in all age groups. Elderly patients should be considered for CONS, based on the high costs in relation to the very small gain in health when treated with EV. The very elderly should be treated with CONS.
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Wang J, Jones P, Cheng AC, Leder K. Adherence to infection prevention measures in a statewide spleen registry. Med J Aust 2014; 200:538-40. [DOI: 10.5694/mja13.10630] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 02/20/2014] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Allen C Cheng
- Alfred Hospital, Melbourne, VIC
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
| | - Karin Leder
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
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18
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Davies JM, Lewis MPN, Wimperis J, Rafi I, Ladhani S, Bolton-Maggs PHB. Review of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen: prepared on behalf of the British Committee for Standards in Haematology by a working party of the Haemato-Oncology task force. Br J Haematol 2012; 155:308-17. [PMID: 21988145 DOI: 10.1111/j.1365-2141.2011.08843.x] [Citation(s) in RCA: 163] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen were first published by the British Committee for Standards in Haematology (BCSH) in 1996 and formally reviewed in 2002. Although the guidelines originated from discussion within the BCSH, the intended readership is wide given the multidisciplinary nature of the management of hyposplenism.
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Affiliation(s)
- John M Davies
- Western General Hospital, Crewe Road, Edinburgh, Manchester, UK.
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19
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Adherence to preventive measures after splenectomy in the hospital setting and in the community. J Infect Public Health 2011; 4:187-94. [PMID: 22000846 DOI: 10.1016/j.jiph.2011.06.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 06/22/2011] [Accepted: 06/25/2011] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED Overwhelming post-splenectomy infection (OPSI) remains a long-term risk in asplenic patients, which may be reduced by appropriate preventive measures. Specific guidelines have been developed to lower its incidence. AIMS To assess the implementation of guidelines by specialized physicians of a university hospital and primary care physicians. METHODS A retrospective review of splenectomized patients' medical files over a six year period was carried out. Patients' general practitioners were contacted and a questionnaire was sent to them. RESULTS 154 individuals who underwent splenectomy between 2000 and 2005 were eligible (62 children and 92 adults): 70.8% received pneumococcal vaccine, 44% received vaccine against Haemophilus influenzae type b with a good cover of children population (88.7%), 24% received meningococcal vaccine. Prophylactic antibiotics were prescribed in 74% of patients. Septic events were found in 8.4%, and global mortality was 11.7% during a mean follow-up period of 4.5 years. CONCLUSIONS Management of the infectious risk in asplenic patient has to be improved: some of the patients are not correctly identified as at risk of OPSI, and vaccination against Neisseria meningitidis is insufficient. Hospital specialists should improve the implementation of guidelines and give better information to general practitioners involved.
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Abstract
The spleen is crucial in regulating immune homoeostasis through its ability to link innate and adaptive immunity and in protecting against infections. The impairment of splenic function is defined as hyposplenism, an acquired disorder caused by several haematological and immunological diseases. The term asplenia refers to the absence of the spleen, a condition that is rarely congenital and mostly post-surgical. Although hyposplenism and asplenia might predispose individuals to thromboembolic events, in this Review we focus on infectious complications, which are the most widely recognised consequences of these states. Because of the high mortality, the fulminant course, and the refractoriness to common treatment of overwhelming infections caused by encapsulated bacteria, prevention through vaccination and antibiotic prophylaxis is the basis of the management of patients who have had splenectomy or have hyposplenism. In this Review, we critically assess clinical and diagnostic aspects of splenic dysfunction and highlight new perspectives in the prevention of overwhelming post-splenectomy infections.
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Affiliation(s)
- Antonio Di Sabatino
- First Department of Medicine, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S Matteo, University of Pavia, Italy
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21
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The influence of splenectomy on the infectious complications and outcomes of people with HIV: marked, sustained elevation in risk of severe infection with bacteria including Streptococcus pneumoniae. J Acquir Immune Defic Syndr 2010; 55:e24-6. [PMID: 20948385 DOI: 10.1097/qai.0b013e3181f465f1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Langley JM, Dodds L, Fell D, Langley GR. Pneumococcal and influenza immunization in asplenic persons: a retrospective population-based cohort study 1990-2002. BMC Infect Dis 2010; 10:219. [PMID: 20649965 PMCID: PMC2920873 DOI: 10.1186/1471-2334-10-219] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 07/22/2010] [Indexed: 01/19/2023] Open
Abstract
Background Splenectomy is associated with increased risk for bacteremia, due to impaired clearance of bloodborne agents and to altered phagocytosis and humoral immunity. We conducted a retrospective cohort study of patients at risk for splenectomy for a 13-year period to determine immunization coverage, and outcomes of those with and without splenectomy, and with or without receipt of influenza or pneumococcal vaccine. Methods Data were extracted from the provincial Medical Services Insurance database for insured services rendered by a physician for 1990-2002, and from the Vital Statistics Death database. The eligible cohort was selected based on diagnostic codes for hematologic conditions for which splenectomy might be considered, such as immune thrombocytopenia. Each patient was followed longitudinally from the date of first diagnosis until 31Dec2002, or death, or relocation out-of province. In addition, persons with splenectomy and no hematologic condition were identified and followed for 6 months post-surgery. Infectious illness rates per 100 person-years of observation and death rates were calculated with and without splenectomy. Death rates were determined using splenectomy status as a time-dependent covariate. The relationship between splenectomy and death according to immunization status was examined using Cox proportional hazard ratios. Results Of 38,812 persons in the cohort 427 subjects with a hematologic diagnosis had splenectomy and another 452 subjects without a hematologic diagnosis had this surgery. 72% were > 18 years of age. Pneumococcal immunization was recorded in 16.5% of asplenic patients overall, and was not associated with reduced risk of death in these persons (adjusted Hazard Ratio [HR] = 1.07, 95% CI 0.70 - 1.65). Influenza immunization was recorded in 53.1% of asplenic patients overall, and was associated with reduced risk of death (adjusted HR = 0.46, 0.33-0.62). No pneumococcal or influenza immunization was recorded in patients with a hematologic diagnosis without splenectomy. Infectious illness visits were higher among all patients who had a splenectomy than among those without a splenectomy (151 visits/100 person-years of observation in the post-splenectomy period vs. 120 visits/100 person-years; p < 0.0001). Conclusions In asplenic patients, influenza immunization is associated with a 54% reduced risk of death compared to unimmunized asplenic persons; no reduction in risk was demonstrated with (polysaccharide) pneumococcal vaccine. Vaccine coverage in the entire cohort was less than routinely recommended. Improved delivery of infection prevention programs to this population is warranted. Conjugate pneumococcal vaccines should be urgently studied in this immunocompromised population.
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Affiliation(s)
- Joanne M Langley
- Department of Pediatrics, Dalhousie University, IWK Health Centre, 5850 University Avenue, Halifax Nova Scotia B3K6R8, Canada.
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Abstract
Individuals who do not have a spleen are highly susceptible to severe infections. The purpose of this article was to present vaccination guidelines for prophylactic treatment of sepsis following splenectomy. Nursing considerations for the prevention of sepsis after splenectomy are discussed.
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Denholm JT, Jones PA, Spelman DW, Cameron PU, Woolley IJ. Spleen registry may help reduce the incidence of overwhelming postsplenectomy infection in Victoria. Med J Aust 2010; 192:49-50. [DOI: 10.5694/j.1326-5377.2010.tb03404.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 10/19/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Justin T Denholm
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC
| | - Penelope A Jones
- Department of Infectious Diseases, Alfred Hospital, Melbourne, VIC
| | - Denis W Spelman
- Department of Infectious Diseases, Alfred Hospital, Melbourne, VIC
| | - Paul U Cameron
- Department of Infectious Diseases, Alfred Hospital, Melbourne, VIC
| | - Ian J Woolley
- Department of Infectious Diseases, Monash Medical Centre, Melbourne, VIC
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Ponticelli C, Alberighi ODC. Haemophagocytic syndrome--a life-threatening complication of renal transplantation. Nephrol Dial Transplant 2009; 24:2623-7. [PMID: 19525363 DOI: 10.1093/ndt/gfp282] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yapp AR, Lindeman R, Gilroy N, Gao Z, Macintyre CR. Infection outcomes in splenectomized patients with hemoglobinopathies in Australia. Int J Infect Dis 2009; 13:696-700. [PMID: 19136288 DOI: 10.1016/j.ijid.2008.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2008] [Accepted: 10/19/2008] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess the infection risk of splenectomized persons with hemoglobinopathies in Australia. METHODS This was an Australia cohort study of infections and vaccinations in 63 patients with hemoglobinopathies followed longitudinally from 1967 to 2006, and an investigation into the risk factors for poor outcome. RESULTS There were 28 cases of bacterial infection that necessitated hospitalization in the cohort, resulting in an incidence of 1.4 bacterial infections per 100 patient-years. There was one death (1.6%) as a direct result of bacterial infection. Hepatitis C was diagnosed in 28 patients (44%). The spectrum of infection included pneumonia (6/28), cellulitis (6/28), bacteremia (4/28), and skin abscess (3/28). Notably, Klebsiella species organisms were isolated in 9/28 cultures. CONCLUSIONS Infectious complications in this group of patients cause serious morbidity and mortality. This cohort may be a target for novel preventive strategies such as more immunogenic vaccines, patient registries, and/or education programs.
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Affiliation(s)
- Alvin R Yapp
- Centre for Clinical Research Excellence-Infection and Bioethics in Haematological Malignancies Level 3, ICPMR, Westmead Hospital, Institute Road, Westmead, NSW 2145, Australia.
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Abstract
BACKGROUND Splenectomy is associated with a lifelong increase in the risk of sepsis. The aim of this study was to determine the level of knowledge of patients who have undergone splenectomy within an Australian area health service. METHODS Adults undergoing a splenectomy between 1994 and 2004 within the Hunter Area Health Service were invited to participate in the study. Consenting participants were contacted by telephone and a standardized questionnaire completed. RESULTS More than 50% of participants displayed a good active knowledge of the risk of infection post-splenectomy and an understanding of the role of vaccinations in reducing the risk of infection. Few participants (11.3%) had standby antibiotics readily available. Knowledge of travel precautions and risk of sepsis following animal bites was poor. CONCLUSION Although most participants displayed a good knowledge of infection risk post-splenectomy, deficiencies in knowledge were identified. We propose the development of a splenectomy protocol and patient briefing to improve patient education.
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Affiliation(s)
- Anna Wilkes
- Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia.
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