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KMID : 0387820130200020095
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Clinical Pediatric Hematology-Oncology
2013 Volume.20 No. 2 p.95 ~ p.101
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Prophylactic Antibiotics Therapy after Splenectomy
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Ryu Mi-Ju
Kwon Nam-Hee
Kim Young-Bae
Park Ji-Kyoung
Lee Soon-Yong
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Abstract
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Background: Patients who are born without spleen or who have impaired splenic func-tion due to disease or splenectomy become vulnerable to sepsis caused by bacteria. Overwhelming post-splenectomy infection (OPSI) occurs at an estimated incidence of 0.23-0.42% per year with a lifetime risk of 5%. The risk of OPSI with encapsulated bac-teria is generally considered greatest in the first 2 years after splenectomy but the in-creased risk remains lifelong. Because vaccination doesn’t completely protect against in-fection with encapsulated bacteria that prevent OPSI, use of prophylactic antibiotics are recommended for prevention of infection after splenectomy.
Methods: A retrospective review of 41 patients who underwent splenectomy from January 1990 to December 2012 in Inje University Busan Paik Hospital were identified through the medical records.
Results: Of 41 patients, 100% (41/41) were vaccinated in pneumococcal vaccines, 27% (11/41) were vaccinated in HIB vaccines. Prophylactic antibiotics (penicillin G benza-thine IM every 4 weeks) were prescribed in 73% (30/41) of patients. We could not find any septic events.
Conclusion: Because of the high mortality, the fulminant course, and the refractoriness to common treatment of overwhelming infections caused by encapsulated bacteria, pre-vention through vaccination and antibiotic prophylaxis is the basis of the management of patients who have had splenectomy or have hyposplenism. Prophylactic antibiotics using Penicillin G benzathine every 4 weeks is effective for preventing septic events in splenectomized patients. But further improvement in coverage of recommended vac-cines and continuous prophylactic antibiotics after splenectomy is needed to reduce the risk of serious infection.
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KEYWORD
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Splenectomy, Prophylactic antibiotics, Vaccination, Encapsulated bacteria, Sepsis
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