From the Guidelines
Antibiotic treatment for sepsis in splenectomy patients should be initiated immediately with broad-spectrum antibiotics, such as Amoxycillin or Levofloxacin, due to the high risk of mortality from overwhelming post-splenectomy infection syndrome (OPSI) 1.
Key Considerations
- The risk of OPSI is highest in the first year after splenectomy, but remains elevated for more than 10 years and probably for life 1.
- Asplenic/hyposplenic patients, especially children younger than 5 years old, have a greater overall risk of OPSI with an increased death rate compared to adults 1.
- Vaccination against encapsulated bacteria, such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, is crucial, but does not guarantee complete protection 1.
Recommended Antibiotic Regimens
- For adults: Amoxycillin 3g starting dose followed by 1g every 8h, or Levofloxacin 500mg every 24h for beta-lactam allergic patients 1.
- For children: Amoxycillin 50mg/Kg in three divided daily doses, with alternative options for beta-lactam allergic patients to be determined by a specialist 1.
Important Notes
- Antibiotic prophylaxis should be considered in patients with asplenia/hyposplenia who are bitten by dogs and other animals due to the increased risk of severe sepsis 1.
- Patients should be educated to seek immediate medical attention for any sudden onset of unexplained fever, malaise, chills, or other constitutional symptoms, especially when medical review is not readily accessible 1.
- Clinical deterioration can be rapid, even after antibiotic administration, and patients should be warned that prophylaxis reduces but does not abolish the risk of sepsis 1.
From the Research
Antibiotic Treatment for Sepsis in Splenectomy
- The risk of sepsis is increased in individuals who have undergone splenectomy, with a lifetime risk of 5% 2.
- Overwhelming post-splenectomy infection (OPSI) is a medical emergency that requires prompt diagnosis and management with fluid resuscitation and immediate administration of empirical antimicrobials 3.
- Encapsulated bacteria, such as Streptococcus pneumoniae, are the most common cause of OPSI, accounting for 50-90% of isolates from blood cultures 2, 4.
- Antibiotic prophylaxis is a key strategy in preventing OPSI, and patients should be educated on the risks and management of sepsis 2, 3.
- The initial management of sepsis involves immediate, empiric, broad-spectrum antibiotic therapy, which should be accompanied by a commitment to de-escalation and antimicrobial stewardship 5.
- Biomarkers such as procalcitonin can provide decision support for antibiotic use and guide duration of antibiotic therapy 5.
- The spleen plays a crucial role in immune-mediated bacterial clearance, and its removal can lead to an increased risk of infection and sepsis 6, 4.