Risk and patterns of bacteraemia after splenectomy: a population-based study

Area of Science:

• Infectious Diseases
• Clinical Medicine
• Epidemiology

Background:

• Splenectomy, the surgical removal of the spleen, is associated with an increased risk of severe infections.
• Vaccination of splenectomized patients has been recommended, but data on infection patterns are crucial.

Purpose of the Study:

• To analyze the incidence and patterns of severe post-splenectomy infections (bacteraemia and meningitis) in a population-based cohort.
• To evaluate the impact of pneumococcal vaccination on infection risk in these patients.

Main Methods:

• A cohort of 561 patients undergoing splenectomy between 1984-1993 in a Danish county was identified.
• Eligible patients (n=538) were followed for 1731 person-years to record severe infections and mortality.
• Cox proportional hazard regression was used to assess the effect of vaccination on bacteraemia risk.

Main Results:

• 38 patients developed bacteraemia post-splenectomy, with 45% occurring within 30 days.
• The incidence rate of bacteraemia was 2.3 per 100 person-years, with an 8-fold increased risk beyond the postoperative period.
• Pneumococcal vaccination (received by 60%) significantly reduced the risk of bacteraemia beyond the postoperative period.

Conclusions:

• Splenectomy leads to a substantial increase in the risk of severe infections, primarily bacteraemia.
• Pneumococcal vaccination is effective in lowering the risk of post-splenectomy bacteraemia.
• Enterobacteria were the predominant pathogens, highlighting the need for broad-spectrum coverage and vaccination strategies.