[Perioperative management of asplenic patients].
OBJECTIVE
In 2003, asplenia had involved 250000 patients in France. These patients are at risk of severe infection, mostly with capsulated bacteria as pneumococci, meningococci and Haemophilus. The higher mortality and morbidity due to infection in asplenic patient led in June 2003 a French expert committee to propose preventive management based on vaccination and antibioprophylaxis.


METHODS
Update article.


RESULTS
For vaccination, two vaccines against pneumococci are available. The first one, the antipolysaccharide (Pneumo 23) is recommended for adults. It is effective for the majority of the serotypes even if its efficacy can be variable. The second one a conjugated pneumococcal vaccine (Prenevar) is used for children under two years because it has higher activity on antibiotic resistant strains therefore increasing antibiotic prophylaxis efficiency. When splenectomy is required, vaccination against pneumococci, Haemophilus (b type) and C meningococci must be performed at least 15 days before surgery, in order to get better immune stimulation. In case of emergency, vaccines have to be administrated within 30 days after surgery. Antibioprophylaxis is based on cefazolin injection before splenectomy and by postoperative intravenous amoxicillin administration. As soon as oral intake is allowed, antibioprophylaxis is continued for at least two years in adults and five years in children. Both antibiotic and vaccination have been reported to reduce pneumococcus infections.
Legrand
A
A
Clinique d'anesthésie réanimation, CHRU Claude-Huriez, rue Michel-Polonovski, 59037 Lille cedex, France.
Bignon
A
A
Borel
M
M
Zerbib
P
P
Langlois
J
J
Chambon
J-P
JP
Lebuffe
G
G
Vallet
B
B
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000517:prevention & control*; D005602:France / Q000453:epidemiology; D006192:Haemophilus Infections / Q000517:prevention & control; D018073:Haemophilus Vaccines; D019741:Haemophilus influenzae type b; D006801:Humans; D008589:Meningococcal Infections / Q000517:prevention & control; D022401:Meningococcal Vaccines / Q000627:therapeutic use; D019990:Perioperative Care; D011008:Pneumococcal Infections / Q000517:prevention & control; D022242:Pneumococcal Vaccines; D013154:Spleen / Q000502:physiology* / Q000503:physiopathology; D013156:Splenectomy; D014611:Vaccination
D000900:Anti-Bacterial Agents; D018073:Haemophilus Vaccines; D022401:Meningococcal Vaccines; D022242:Pneumococcal Vaccines