title: Overwhelming Postsplenectomy Infection: A Prospective Multicenter Cohort Study.
abstract: BACKGROUND
  Recent population-based cohort studies have questioned the role of pneumococci as the most frequent pathogen causing severe infection in patients after splenectomy. The aim of the study was to define the causative pathogens and clinical presentation of patients with overwhelming postsplenectomy infection (OPSI).
  
  
  METHODS
  In a prospective cohort study in 173 German intensive care units, we searched for patients with and without asplenia and community-acquired severe sepsis/septic shock. Clinical and laboratory variables and survival of patients were assessed.
  
  
  RESULTS
  Fifty-two patients with severe sepsis or septic shock with asplenia and 52 without asplenia were included. OPSI patients more often had a history of malignancy (38% vs 17%; P = .016) and had a lower body mass index (24 kg/m(2) vs 28 kg/m(2); P = .004). Streptococcus pneumoniae was detected more frequently in OPSI patients (42% vs 12% without asplenia; P < .001) and more frequently manifested as bloodstream infection (31% vs 6%; P = .002). Gram-negative infection was similar in both groups (12% vs 19%; P = .157). Pneumococcal vaccine coverage of OPSI patients was low overall (42% vs 8% among patients without asplenia; P < .001). Purpura fulminans was a frequent complication, developing in 19% of OPSI patients vs 5% of patients without asplenia (P = .038). The interval between splenectomy and OPSI was 6 years (range, 1 month-50 years). On multivariable Poisson regression, asplenia was the only predictive variable independently associated with pneumococcal sepsis (adjusted relative risk, 2.53 [95% confidence interval, 1.06-6.08]).
  
  
  CONCLUSIONS
  Pneumococcal infections remain the most important cause of severe sepsis and septic shock following splenectomy.
authors.affiliation: Center for Chronic Immunodeficiency.|Division of Infectious Diseases, Department of Medicine.
authors.forename: Christian
authors.initials: C
authors.lastname: Theilacker
authors.affiliation: Center for Sepsis Control and Care.
authors.forename: Katrin
authors.initials: K
authors.lastname: Ludewig
authors.affiliation: Institute for Microbiology and Hygiene.
authors.forename: Annerose
authors.initials: A
authors.lastname: Serr
authors.affiliation: Institute for Microbiology and Hygiene.
authors.forename: Julia
authors.initials: J
authors.lastname: Schimpf
authors.affiliation: Institute for Microbiology and Hygiene.|Mikrobiologisches Institut, Universitätsklinikum Erlangen und Friedrich-Alexander-Universität Erlangen-Nürnberg.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Held
authors.affiliation: Center for Chronic Immunodeficiency.|Division of Infectious Diseases, Department of Medicine.|Clinical Research Unit, Freiburg University Medical Center.
authors.forename: Martin
authors.initials: M
authors.lastname: Bögelein
authors.affiliation: Center for Sepsis Control and Care.
authors.forename: Viola
authors.initials: V
authors.lastname: Bahr
authors.affiliation: Clinical Research Unit,Freiburg University Medical Center.
authors.forename: Stephan
authors.initials: S
authors.lastname: Rusch
authors.affiliation: Center for Chronic Immunodeficiency.|Clinical Research Unit, Freiburg University Medical Center.
authors.forename: Annette
authors.initials: A
authors.lastname: Pohl
authors.affiliation: Klinikum Emden.
authors.forename: Klaus
authors.initials: K
authors.lastname: Kogelmann
authors.affiliation: Klinikum Emden.
authors.forename: Sigrun
authors.initials: S
authors.lastname: Frieseke
authors.affiliation: Klinikum rechts der Isar, Technical University, Munich, Germany.
authors.forename: Ralph
authors.initials: R
authors.lastname: Bogdanski
authors.affiliation: Center for Sepsis Control and Care.|Paul Martini Sepsis Research Group, Jena University Hospital.
authors.forename: Frank M
authors.initials: FM
authors.lastname: Brunkhorst
authors.affiliation: Division of Infectious Diseases, Department of Medicine.
authors.forename: Winfried V
authors.initials: WV
authors.lastname: Kern
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D022242:Pneumococcal Vaccines; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D013156:Splenectomy / Q000009:adverse effects*; D013296:Streptococcus pneumoniae; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D022242:Pneumococcal Vaccines
keywords: Streptococcus pneumoniae; asplenia; overwhelming postsplenectomy infection; pneumococcal vaccine; splenectomy