Prevention and therapy of bacterial infections for children with asplenia or hyposplenia

The asplenic state, whether functional or anatomic, is associated with an increased risk of life threatening infection or postsplenectomy sepsis (PSS). Because the risk of bacteremia with encapsulated bacteria is enhanced in children with asplenia, vaccination to prevent infection by Streptococcus pneumoniae, Haemophilus influenzae type b (Hib) and Neiserria meningitidis is recommended. Despite the increasing prevalence of penicillin-resistant S pneumoniae, prophylactic penicillin use is also recommended for children with asplenia who are younger than five years of age, and for at least one year following splenectomy. Continuation of antibiotic prophylaxis beyond these times depends on individual clinical circumstances and the prevalence of penicillin-resistant S pneumoniae in the community. When children with asplenia develop fever or nonspecific symptoms, they should be assessed immediately. If bacterial sepsis is suspected, blood and other appropriate body fluids should be cultured, and treatment should begin immediately with parenteral broad spectrum antibiotics that are also effective against the strains of S pneumoniae circulating in the community. In children with asplenia with overwhelming S pneumoniae bacteremia, the mortality rate is high, even with prompt initiation of appropriate antibiotic therapy. Thus, preventive measures are important.