A Single-Center Prospective Cohort Study on Postsplenectomy Sepsis and its Prevention

Abstract

Background: This study evaluated the impact of a dedicated outpatient service on vaccination uptake after splenectomy and on the incidence of postsplenectomy sepsis.

Methods: From 2009 to 2016 at the University Hospital Freiburg (Germany), asplenic patients were referred to a dedicated outpatient service, provided with comprehensive preventive care including vaccinations, and enrolled in a prospective cohort study. The impact of the service on vaccination uptake and the occurrence of severe sepsis/septic shock was compared between patients who had splenectomy (or were asplenic) within 3 months of study entry ("early study entry") and those who had splenectomy (or were asplenic) >3 months before study entry ("delayed study entry").

Results: A total of 459 asplenic patients were enrolled, and 426 patients were followed prospectively over a median period of 2.9 years. Pneumococcal vaccine uptake within 3 months of splenectomy or first diagnosis of asplenia was 27% vs 71% among delayed study entry and early study entry patients, respectively (P < .001). Forty-four episodes of severe sepsis or septic shock occurred in study patients: 22 after study entry and 22 before study entry. Streptococcus pneumoniae was more frequent among sepsis episodes that occurred before study entry (8/22) than after study entry (1/22 episodes). For episodes occurring after study entry, only a higher Charlson comorbidity index score was significantly associated with severe sepsis/septic shock postsplenectomy.

Conclusions: With dedicated outpatient care, high uptake of pneumococcal vaccination postsplenectomy was achieved. Sepsis episodes were largely of nonpneumococcal etiology in patients who had received dedicated postsplenectomy care.

Keywords: asplenia; postsplenectomy sepsis; vaccination.

Figure 1.

Overview of the study flow. Data on the number of patients who were eligible for the study but declined to participate were not collected.

Figure 2.

Cumulative vaccine coverage in patients with splenectomy for pneumococcal, meningococcal, and Haemophilus influenzae type B (HiB) vaccination. Patients who entered the study >3 months after splenectomy were considered “delayed study entry” (n = 191), whereas patients who entered the study within 3 months of splenectomy were considered “early study entry” (n = 268). Pneumococcal vaccination status was defined as the receipt of least 1 dose of the 23-valent pneumococcal polysaccharide vaccine (PPV23) or the 13-valent pneumococcal conjugate vaccine (PCV13) for pneumococcal vaccination. Meningococcal vaccination status was defined by receipt of at least 1 dose of the quadrivalent meningocoocal polysaccharide vaccine (MPSV4), a mono- or quadrivalent meningococcal conjugate vaccine (MenC or MenACWY), or a meningococcal serogroup B vaccine (MenB) for meningococcal vaccination.