Prävention von Infektionen und Thrombosen nach Splenektomie oder bei Funktionsverlust der Milz

Zusammenfassung

Infektionen, insbesondere durch Kapsel-tragende Bakterien wie Pneumokokken, stellen für Patienten nach Splenektomie eine ernste und potentiell lebensbedrohliche Komplikation dar. Sie wird in internationalen Veröffentlichungen als „post-Splenektomie Sepsis” (PSS) oder „overwhelming postsplenectomy infection” (OPSI) bezeichnet. Zu den Indikationen für eine Splenektomie zählen die traumatische Milzruptur und diverse hämatologische Erkrankungen. Als Erreger bei PSS finden sich am häufigsten Pneumokokken, seltener Haemophilus influenzae, Meningokokken und verschiedene andere Infektionserreger. Es existieren mehrere Strategien, um schweren Infekten nach Splenektomie und ebenso bei Funktionsverlust der Milz vorzubeugen: hierzu zählen Impfungen, die prophylaktische Antibiotikagabe (bei Kindern und Jugendlichen immer in den ersten 3 Jahren nach Splenektomie!), sofortige Antibiotikatherapie bei Infektionsverdacht, umfassende Aufklärung der betroffenen Patienten über die Risiken nach Splenektomie und ein als Dokument getragenes Patientenmerkblatt (bzw. -karte), das über die Splenektomie informiert. Wenn diese Maßnahmen berücksichtigt werden, ist das PSS-Risiko deutlich zu senken.

Summary

Overwhelming Post-Splenectomy Infection (OPSI or PSS), most frequently caused by encapsulated Gram-positive pathogens, is a complication after splenectomy. Reasons for splenectomy include trauma, or malignant and non-malignant hematologic diseases. OPSI-inducing bacteria are mainly Streptococcus pneumoniae and less frequently Haemophilus influenzae, Neisseria meningitides and Gram-negative bacilli. There exist very efficient – albeit often neglected – strategies, how to prevent infections in patients after splenectomy. These include vaccination, prophylactic antibiotics (always for 3 years during childhood and adolescence) and prompt antibiotic treatment, if an infection is suspected. Patients need to know the nature and likelihood of PSS and they should seek immediate medical attention if they become ill or febrile. Each patient should carry at all times a letter or card documenting the splenectomy. With these measures and precautions, the PSS-risk can be significantly reduced or at best be completely avoided.

Schlüsselwörter

Splenektomie - Infektionen - Impfung - Antibiotikaprophylaxe

Keywords

splenectomy - infections - vaccination - antibiotic prophylaxis

Literatur

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