Overwhelming postsplenectomy infection in a patient with penicillin-resistant Streptococcus pneumoniae.
Overwhelming postsplenectomy infection is a fulminant process that carries a poor prognosis. Streptococcus pneumoniae is the most likely organism to cause disease. Infection with penicillin-resistant S pneumoniae is increasing; its prevalence ranges from 6.6% to 50% in the United States. If meningeal involvement with resistant pneumococcus is suspected, it should be treated with a third-generation cephalosporin and vancomycin hydrochloride. The long-term management of asplenic patients should focus on preventing infection. The current guidelines and recommendations for vaccination are reviewed. Educating these patients to contact their physician at the first sign of minor illness is also beneficial. The use of antibiotic prophylaxis remains a controversy and is best left to the discretion of the physician.
Machesky
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KK
Bon Secours Hospital, Grosse Pointe, Mich 48230, USA.
Cushing
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RD
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008586:Meningitis, Pneumococcal / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D010403:Penicillin Resistance; D011008:Pneumococcal Infections / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D013156:Splenectomy / Q000009:adverse effects*; D013296:Streptococcus pneumoniae / Q000187:drug effects*; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D014640:Vancomycin