Overwhelming Postsplenectomy Infection: A Prospective Multicenter Cohort Study
| العنوان: | Overwhelming Postsplenectomy Infection: A Prospective Multicenter Cohort Study |
|---|---|
| المؤلفون: | Annerose Serr, Frank M. Brunkhorst, Viola Bahr, Sigrun Frieseke, Ralph Bogdanski, Stephan Rusch, Martin Bögelein, Annette Pohl, Julia Schimpf, Winfried V. Kern, Christian Theilacker, Katrin Ludewig, Jürgen Held, Klaus Kogelmann |
| المصدر: | Clinical Infectious Diseases. 62:871-878 |
| بيانات النشر: | Oxford University Press (OUP), 2015. |
| سنة النشر: | 2015 |
| مصطلحات موضوعية: | Adult, Male, Microbiology (medical), medicine.medical_specialty, Asplenia, medicine.medical_treatment, Population, Splenectomy, Pneumococcal Infections, Pneumococcal Vaccines, Sepsis, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, Internal medicine, Intensive care, medicine, Humans, Prospective Studies, 030212 general & internal medicine, education, Aged, education.field_of_study, Septic shock, business.industry, Vaccination, Length of Stay, Middle Aged, medicine.disease, Surgery, Pneumococcal infections, Streptococcus pneumoniae, Infectious Diseases, Pneumococcal vaccine, 030220 oncology & carcinogenesis, Female, business |
| الوصف: | BACKGROUND Recent population-based cohort studies have questioned the role of pneumococci as the most frequent pathogen causing severe infection in patients after splenectomy. The aim of the study was to define the causative pathogens and clinical presentation of patients with overwhelming postsplenectomy infection (OPSI). METHODS In a prospective cohort study in 173 German intensive care units, we searched for patients with and without asplenia and community-acquired severe sepsis/septic shock. Clinical and laboratory variables and survival of patients were assessed. RESULTS Fifty-two patients with severe sepsis or septic shock with asplenia and 52 without asplenia were included. OPSI patients more often had a history of malignancy (38% vs 17%; P = .016) and had a lower body mass index (24 kg/m(2) vs 28 kg/m(2); P = .004). Streptococcus pneumoniae was detected more frequently in OPSI patients (42% vs 12% without asplenia; P < .001) and more frequently manifested as bloodstream infection (31% vs 6%; P = .002). Gram-negative infection was similar in both groups (12% vs 19%; P = .157). Pneumococcal vaccine coverage of OPSI patients was low overall (42% vs 8% among patients without asplenia; P < .001). Purpura fulminans was a frequent complication, developing in 19% of OPSI patients vs 5% of patients without asplenia (P = .038). The interval between splenectomy and OPSI was 6 years (range, 1 month-50 years). On multivariable Poisson regression, asplenia was the only predictive variable independently associated with pneumococcal sepsis (adjusted relative risk, 2.53 [95% confidence interval, 1.06-6.08]). CONCLUSIONS Pneumococcal infections remain the most important cause of severe sepsis and septic shock following splenectomy. |
| تدمد: | 1537-6591 1058-4838 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::448a96844373d49107d26c6f7ac24174 https://doi.org/10.1093/cid/civ1195 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....448a96844373d49107d26c6f7ac24174 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15376591 10584838 |
|---|