Splenectomy or with an Absent or Dysfunctional Spleen - Prevention of Infection in Adult Patients
|Last review: 01/02/2018|
|Next review: 01/02/2021|
|Approved By: Improving Antimicrobial Prescribing Group|
|Copyright© Leeds Teaching Hospitals NHS Trust 2018|
This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
Guideline for the prevention of infection in adult patients following splenectomy or with an absent or dysfunctional spleen
Criteria for use of guidelines
Antimicrobial Management algorithm
Asplenic individuals are at increased risk of life threatening infections1,2 These infections are often referred to as post splenectomy sepsis (PSS), or overwhelming post splenectomy infection (OPSI). The risk of PSS is highest in children, but increased risk of infection is life long3. Fulminant sepsis has occurred 20-40 years after splenectomy4. The relative risk of severe infection in patients that have had a traumatic splenectomy is ten-times greater than in the non-splenectomised population3. The relative risk is 100-fold greater in children and patients with Hodgkin’s disease3.
The mortality from post splenectomy sepsis (PSS) has been predicted to be up to 600 times greater than the general population, with an estimated lifetime risk for post splenectomy sepsis (PSS) being approximately 5%5.
This guideline applies to adult patients who have had a splenectomy or are functionally asplenic who do not have clinical signs of infection – patients with symptoms or signs of infection should be rapidly assessed and treated – if necessary according to severe sepsis guidelines.
This guideline applies to adult patients who have had a splenectomy and to patient with functional asplenia.
Lifelong antimicrobial prophylaxis is recommended for patients who have had a splenectomy or with functional asplenia and who are considered at high risk of pneumococcal infection. Patients at high risk include those aged <16 or >50, previous invasive pneumococcal disease, inadequate response to pneumococcal vaccination, patients in the immediate post-operative period after splenectomy for trauma, splenectomy or splenic radiation for haematological malignancy)1,2,7.
Compliance with lifelong antibiotics can be a problem so patients not at high risk should be counselled regarding the risks and benefits of lifelong antibiotics and may choose to continue or discontinue prophylaxis
Patients who are taking prophylactic antibiotics may require additional antibiotics for intercurrent infection. If the additional antibiotic has a similar or broader spectrum of antimicrobial cover (e.g. cephalosporins, beta-lactams, macrolides or tetracyclins), the prophylactic antibiotic may be interrupted until the course has been completed.
Vaccination is recommended according to table 1 [Evidence level B/C] 1,2,4,7
Table 1. Showing which vaccines and re-immunisation# are required in associated with splenectomy/functional asplenia1, 4, 11.
# Immunisations should be delayed if undergoing chemotherapy, whilst ensuring adequate antibiotic cover is prescribed in the interim.
Administration of Vaccines
Pregnancy / Breast-feeding
Immunosuppressed patients / Chemotherapy
Educate all patients as to the potential risks of overseas travel especially regarding malaria and unusual infections such as from animal bites.
Other Key Recommendations
- PPV= pneumococcal polysaccharide vaccine9 http://www.medicines.org.uk/EMC/medicine/1446/SPC/Pneumovax+II/
- Hib/MenC10 http://www.medicines.org.uk/EMC/medicine/17189/SPC/Menitorix/
- Bexsero11 https://www.medicines.org.uk/emc/product/5168
To improve the prevention of infection in adult patients with an absent or dysfunctional spleen.To improve the prevention of infection in adult patients with an absent or dysfunctional spleen.
|Clinical condition:||Splenectomy and functional asplenia|
|Target patient group:||All patients undergoing splenectomy and with functional asplenia|
|Target professional group(s):||Primary Care Doctors
Secondary Care Doctors
- Davies J. M., Lewis, M.P.N., Wimperis, J., Rafi, I., Ladhani, S. & Bolton-Maggs, P. H. B. (2011). Review of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen: Prepared on behalf of the British Committee for Standards in Haematology by a Working Party of the Haemato-Oncology Task Force British Journal of Haematology, 155, 308–317
- Davies, J. M., Barnes, R. & Milligan, D. (2002). Update of Guidelines for the Prevention and Treatment of Infection in Patients with an Absent or Dysfunctional Spleen. Clinical Medicine 2(5): 440-443.
- Lewis, S. M. & Swirsky, D. (1996). The spleen and its disorders. In Oxford textbook of medicine, pp. 3587-3596. Edited by D. A. Weatherall, J. G. G. Ledingham & D. A. Warrell. Oxford: Oxford University Press
- The Green Book; Public Health England; update version available online
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/674074/GB_Chapter_25_Pneumococcal_V7_0.pdf [Accessed 29th January 2018].
- Read, R. & Finch. R. (1994). Prophylaxis after splenectomy. J. Antimicrob. Chemother. 33: 4-6
- Newland, A., Provan, D. & Myint, S. (2005). Preventing severe infection after splenectomy. BMJ 331: 20-27
- Working party of the British Committee for standards in Haematology, BMJ 1996; 312: 430 -434
- Nottingham University Hospitals Guidance; Adults and Children Guidelines for Patients with Absent or Dysfunctional, January 2016. [Accessed 29th January 2018].
- Summary of Product Characteristics - Pneumococcal Polysaccharide Vaccine - - (eMC) Pneumovax. II - Aventis Pasteur
- Summary of Product Characteristics - Menitorix - - (eMC) Menitorix GlaxoSmithKline UK
- Summary of Product Characteristics - Bexsero Meningococcal Group B vaccine for injection in pre-filled syringe - Summary of Product Characteristics (SmPC) - (eMC) Bexsero GlaxoSmithKline UK
Improving Antimicrobial Prescribing Group
LHP version 1.0
Equity and Diversity
The Leeds Teaching Hospitals NHS Trust is committed to ensuring that the way that we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group.