From the Guidelines
The incidence of sepsis after splenectomy is approximately 0.5-2%, with a mortality rate ranging from 30 to 70%, and the risk remains elevated for more than 10 years, probably for life. The risk of overwhelming post-splenectomy infection (OPSI) is highest in the first year after splenectomy, especially among young children, but remains a concern for many years [ 1 ]. Key factors that increase the risk of OPSI include age, with asplenic/hyposplenic children younger than 5 years old having a greater overall risk, and the type of splenectomy, with traumatic splenectomy patients facing unique challenges [ 1 ].
Risk Factors and Prevention
To mitigate this risk, several preventive measures are recommended:
- Vaccination against encapsulated bacteria, including Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis, should be administered at least 14 days before elective splenectomy or as soon as possible after emergency splenectomy [ 1 ].
- Annual influenza vaccination is also recommended for all asplenic/hyposplenic patients over 6 months of age to reduce the risk of secondary bacterial infections [ 1 ].
- Antibiotic prophylaxis should be considered, especially for high-risk patients, with options including amoxicillin or levofloxacin for adults and amoxicillin for children [ 1 ].
Management of Suspected Infection
In cases of suspected infection, prompt administration of standby antibiotics, such as amoxicillin or levofloxacin, is crucial before seeking medical attention [ 1 ]. It is also essential for community physicians to be aware of the patient's asplenic/hyposplenic condition to provide appropriate care [ 1 ]. The management of OPSI requires immediate medical attention, and clinical deterioration can be rapid even after antibiotic administration [ 1 ].
Long-term Considerations
The long-term risk of sepsis after splenectomy necessitates ongoing vigilance and preventive measures. Patients should be educated on the signs of infection and the importance of seeking immediate medical attention if symptoms arise [ 1 ]. Furthermore, the potential for antibiotic prophylaxis failure underscores the need for a comprehensive approach to managing the risk of OPSI in asplenic/hyposplenic patients [ 1 ].
From the Research
Incidence of Sepsis after Splenectomy
- The incidence of sepsis after splenectomy is a significant concern, with overwhelming post-splenectomy infection (OPSI) being a medical emergency that can rapidly progress to fulminant infection and death in 50% of cases within 48 hours 2, 3.
- Encapsulated bacteria, such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, are the most common causes of OPSI in asplenic patients 2, 3, 4, 5, 6.
- The risk of OPSI is highest in older patients, and there are no statistically significant differences in incidence by reason for splenectomy, except for a higher rate in patients with medical hyposplenia 5.
- Registration with a spleen registry, such as Spleen Australia, has been shown to reduce the risk of infection with encapsulated organisms by 69% 4.
- Vaccination against Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis, as well as annual influenza vaccination, is essential in preventing OPSI 2, 3, 4, 6.
- Daily antibiotics for at least 2 years post-splenectomy and emergency antibiotics in case of infection are also recommended to prevent OPSI 2, 3.
- Asplenic patients should carry a medical alert and an up-to-date vaccination card, and require specific advice around travel and animal handling due to increased risk of severe malaria and OPSI from animal bites 3.