Prevention of infection in asplenic adult patients by general practitioners in France between 2013 and 2016 : Care for the asplenic patient in general practice

Prevention and treatment of infection in patients with an absent or hypofunctional spleen: A British Society for Haematology guideline

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.

Vaccine coverage for recommended vaccines among splenectomised patients in Apulia, South Italy: a retrospective cohort study

OBJECTIVE

Splenectomised/asplenic patients have a 10-50 fold higher risk than the general population of developing overwhelming postsplenectomy infection. To control this risk, these patients have to receive a specific immunisation schedule, before or in the 2 weeks after the surgical intervention. The study aims to estimate vaccine coverage (VC) for recommended vaccines among splenectomised patients in Apulia (South Italy), and to define the determinants of vaccination uptake in this population.

DESIGN

Retrospective cohort study.

SETTING

Apulia, Southern Italy.

PARTICIPANTS

1576 splenectomised patients.

METHODS

The Apulian regional archive of hospital discharge forms (SDOs) was used to define the splenectomised Apulian inhabitants. The study period went from 2015 to 2020. The vaccination status for Streptococcus pneumoniae (13-valent conjugate anti-pneumococcal vaccine+PPSV23), Haemophilus influenzae type b (Hib; one dose), Neisseria meningitidis ACYW135 (two doses), Neisseria meningitidis B (two doses) and influenza (at least one dose of influenza vaccine before an influenza season after splenectomy) was assessed via data collected from the Regional Immunisation Database (GIAVA). In order to define a subject as fully immunised, we considered the Centers for Diseases Control and Prevention guidelines to define the optimal immunisation status.

RESULTS

Since 2015, 1576 Apulian inhabitants have undergone splenectomy; the VC for anti-Neisseria meningitidis B vaccine was 30.9%, for anti-Neisseria meningitidis ACYW135 was 27.7%, for anti-Streptococcus pneumoniae was 27.0%, for anti-Hib was 30.1%, and 49.2% received at least one dose of influenza vaccine before an influenza season after splenectomy. None of the patients splenectomised in 2015 and 2016 had received the recommended MenACYW₁₃₅ and PPSV23 booster doses 5 years after completing the basal cycles.

CONCLUSIONS

The results of our study highlight low VC values among Apulian splenectomised patients. The task of public health institutions is to implement new strategies aimed at increasing VC in this population, implementing educational measures for patients and families, training for general practitioners and specialists, and ad hoc communication campaigns.

The Impact of Standardized Infectious Diseases Consultation on Post-Splenectomy Care and Outcomes

Background

Patients who receive splenectomy are at risk for overwhelming postsplenectomy infection (OPSI). Guidelines recommend that adult asplenic patients receive a complement of vaccinations, education on the risks of OPSI, and on-demand antibiotics. However, prior literature suggests a majority of patients who have had a splenectomy receive incomplete asplenic patient care and thus remain at increased risk. This study assessed the impact of standardized involvement of infectious diseases (ID) providers on asplenic patient care outcomes in patients undergoing splenectomy.

Methods

A quasi-experimental study design compared a prospective cohort of patients undergoing splenectomy from August 2017 to June 2021 who received standardized ID involvement in care of the asplenic patient with a historic control cohort of patients undergoing splenectomy at the same institution from January 2010 through July 2017 who did not. There were 11 components of asplenic patient care defined as primary outcomes. Secondary outcomes included the occurrence of OPSI, death, and death from OPSI.

Results

50 patients were included in the prospective intervention cohort and 128 in the historic control cohort. There were significant improvements in 9 of the 11 primary outcomes in the intervention arm as compared to the historic controls. Survival analysis showed no statistically significant difference in the incidence of OPSI-free survival between the groups (p = 0.056), though there was a trend towards improvement in the prospective intervention arm.

Conclusions

Standardized involvement of an ID provider in the care of patients undergoing splenectomy improves asplenic patient care outcomes. Routine involvement of ID in this setting may be warranted.