Prevention and management of overwhelming postsplenectomy infection-An update

OBJECTIVESTo review the diagnosis and management of overwhelming postsplenectomy infection and to discuss various preventative measures. DATA SOURCESData used to prepare this article were drawn from published articles and work in progress. STUDY SELECTIONArticles were selected for relevance to the subject after location by a MEDLINE key word search. DATA EXTRACTIONThe literature was reviewed to summarize the etiology and pathophysiology of postsplenectomy sepsis. Preventative strategies were outlined with a particular emphasis on education, immunoprophylaxis, and chemoprophylaxis. DATA SYNTHESISAlthough physicians have become increasingly aware of overwhelming postsplenectomy infection in children, many remain unaware of the risk to asplenic or hyposplenic adults who may have no underlying medical problems. Recent studies have shown that many patients who have had splenectomies have had neither appropriate vaccinations nor teaching that would explain the lifelong nature of their risk. The increasing incidence of penicillin-resistant pneumococci represents a major area of therapeutic and prophylactic concern. The identification of Howell-Jolly bodies on a peripheral blood smear should alert physicians to the need for follow-up to document possible hyposplenism. Attention has focused on a three-pronged attack to this problem, including education, immunoprophylaxis, and chemoprophylaxis. CONCLUSIONSOverwhelming postsplenectomy infection should be largely preventable if appropriate precautions are taken. Physicians need to know of the spectrum of diseases associated with hyposplenism and how patients noted to have Howell-Jolly bodies should be investigated. They should also be aware of appropriate guidelines for management of patients with asplenia or hyposplenism. (Crit Care Med 1999; 27:836-842)