Variability in the Management of Antibiotic Prophylaxis for Patients with Asplenia
Kathryn E Weakley1, Marylou M Dryer2, David S Foley3
1Department of Pediatrics, Norton Children's and the University of Louisville School of Medicine, Louisville, KY; Division of Pediatric Infectious Diseases, University of Louisville School of Medicine, Louisville, KY.
Insights
Pediatric specialists show significant variation in prescribing antibiotic prophylaxis duration for patients with asplenia (lack of spleen function). This highlights a need for standardized guidelines to ensure consistent patient care.
Area of Science:
- Pediatric Subspecialty Care
- Infectious Disease Management
- Clinical Practice Variation
Background:
- Asplenia and hyposplenia increase infection risk, necessitating antibiotic prophylaxis.
- Current antibiotic prophylaxis guidelines for asplenic pediatric patients lack specificity regarding duration.
- Varied prescribing practices among subspecialists may impact patient outcomes.
Purpose of the Study:
- To evaluate the variability in antibiotic prophylaxis prescribing duration for pediatric patients with asplenia across different US subspecialties.
- To identify factors influencing prophylaxis duration decisions.
Main Methods:
- A survey was distributed to pediatric infectious diseases, hematology/oncology, cardiology, and surgery providers at US academic medical centers.
- The survey focused on current practices for managing antibiotic prophylaxis in patients with asplenia or hyposplenia.
Main Results:
- Fifty-eight subspecialists responded, managing antibiotic prophylaxis for asplenic/hyposplenic patients.
- Prophylaxis duration varied significantly based on the cause of asplenia (e.g., sickle cell disease, congenital disorders, post-splenectomy).
- Prophylaxis was generally longer for patients younger at splenectomy and for those with medical splenectomy indications versus trauma.
Conclusions:
- Significant practice variation exists in antibiotic prophylaxis duration for pediatric asplenia/hyposplenia.
- This variability underscores the need for evidence-based outcomes research.
- Expert consensus guidance is crucial to standardize care and improve patient management.
Objective:
To assess the variation in the duration of antibiotic prophylaxis prescribed for patients with asplenia among US pediatric subspecialists.
Methods:
A survey was e-mailed to pediatric infectious diseases, hematology/oncology, cardiology, and surgery providers at US academic medical centers. Questions addressed prescribing practices in patients with asplenia/hyposplenia.
Results:
There were 58 respondents who managed antibiotic prophylaxis in patients with asplenia/hyposplenia. Thirty-nine managed patients with nonsurgical disorders of the spleen; most prescribed prophylaxis until 5 years of age for patients with sickle cell disease, but duration varied for congenital anatomic asplenia, situs inversus, polysplenia, and hereditary spherocytosis. Thirty-three managed patients who had undergone surgical splenectomy due to a medical condition. Thirty-five managed patients who had undergone surgical splenectomy due to trauma. Duration of prophylaxis was longer for patients who were younger at the time of splenectomy. Respondents were more likely to prescribe prophylaxis for patients who underwent surgical splenectomy for a medical reason compared with trauma. Thirty-seven institutions were represented; 17 had ≥2 respondents. There was practice variation among individuals from the same institution. Ninety-three percent of all respondents reported their clinical practice would benefit from consensus guidance.
Conclusions:
There is wide practice variation in the duration of antibiotic prophylaxis prescribed for patients with asplenia or hyposplenia. These varying practice patterns illustrate the need for outcomes research and expert consensus guidance.
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