Overwhelming postsplenectomy infection: is quality of patient knowledge enough for prevention?
OBJECTIVE
Fulminant, potentially life-threatening infection represents a major long-term risk after splenectomy. This study examines the impact of patient's knowledge and compliance on the prevention of overwhelming postsplenectomy infection (OPSI).


METHODS
A Total of 318 splenectomized patients (median age: 18 years (10-26 years); M : F, 187 : 131) were enrolled in this study. A questionnaire was administered to assess the degree of knowledge and patient compliance and their role in the prevention of postsplenectomy risks; while identifying the group of health-care providers most successful in conveying information.


RESULTS
The 318 patients had been splenectomized and followed up through a 17-year period. OPSI occurred among 5.7% (n=18) of patients. Of these, 56% occurred within the first 6 months and 44% in the following 10 years post splenectomy. Three patients died of OPSI, two during the first 6 months and one 2 years later. Of the followed up patients, 44.8% (n=142) had good knowledge of the risks of splenectomy and their prevention, 30.4% (n=96) had fair knowledge and 24.8% (n=79) had poor knowledge. Patients displaying greatest knowledge had a prevalence of OPSI of 1.4% compared to 16.5% among those with poor knowledge (P<0.001). In all, 60% of patients with good knowledge got their information principally from their tending hematologist. Among patients on regular and irregular prophylactic oral penicillin, OPSI occurred in 2.7 and 10% respectively (P<0.01). The incidence of OPSI also decreased from 7.3 to 3.2% after routine administration of pneumococcal vaccine (P<0.05).


CONCLUSIONS
Although good knowledge, prophylactic penicillin and pneumococcal vaccination have remarkably reduced OPSI, it was not enough for complete prevention. The use of lifelong antibiotic prophylaxis remains of disputed value since no OPSI was recorded more than 10 years post splenectomy.
El-Alfy
Mohsen Saleh
MS
Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. elalfy@hotmail.com
El-Sayed
Manal Hamdy
MH
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007239:Infections / Q000209:etiology*; D008297:Male; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000592:standards; D010406:Penicillins / Q000627:therapeutic use; D022242:Pneumococcal Vaccines; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D013156:Splenectomy / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D014611:Vaccination
D010406:Penicillins; D022242:Pneumococcal Vaccines