Post-splenectomy sepsis: preventative strategies, challenges, and solutions.

Autor:	Luu S; Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia., Spelman D; Department of Infectious Diseases and Microbiology, Alfred Health, Melbourne, Victoria, Australia.; Spleen Australia, Alfred Health, Melbourne, Victoria, Australia., Woolley IJ; Spleen Australia, Alfred Health, Melbourne, Victoria, Australia.; Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia.; Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia.
Jazyk:	angličtina
Zdroj:	Infection and drug resistance [Infect Drug Resist] 2019 Sep 12; Vol. 12, pp. 2839-2851. Date of Electronic Publication: 2019 Sep 12 (Print Publication: 2019).
DOI:	10.2147/IDR.S179902
Abstrakt:	Removal of the spleen had already been established as a routine technique to treat splenic trauma and other diseases affecting the spleen before the anatomy, physiology, and function of the spleen were known in the mid-twentieth century. It is now widely accepted that the splenectomized individual is at increased risk for infection, in particular, overwhelming post-splenectomy infection (OPSI). OPSI is a syndrome of fulminant sepsis occurring in splenectomized (asplenic) or hyposplenic individuals that is associated with high mortality and morbidity. Poorly opsonized bacteria such as encapsulated bacteria, in particular, Streptococcus pneumoniae , are often implicated in sepsis. The spleen is a reticuloendothelial organ that facilitates opsonization and phagocytosis of pathogens, in addition to cellular maintenance. Splenectomy is associated with an impairment in immunoglobulin production, antibody-mediated clearance, and phagocytosis, leading to an increased risk of infection and sepsis. Early identification of the at-risk patient, early blood cultures prior to antibiotic administration, urgent blood smears and fast pathogen-detection tests, and sepsis bundles should be utilized in these patients. Prompt management and aggressive treatment can alter the course of disease in the at-risk splenectomized patient. Overwhelming post-splenectomy infection can be prevented through vaccination, chemoprophylaxis, and patient education. This article evaluates post-splenectomy sepsis by summarizing the anatomy and function of the spleen, physiological changes after splenectomy that predispose the splenectomized patient to infection, and current management and prevention strategies. Competing Interests: Dr Sarah Luu reports grants from The Royal College of Pathologists of Australasia, outside the submitted work. The authors report no other conflicts of interest in this work. (© 2019 Luu et al.)
Databáze:	MEDLINE
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