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Mon Jan 26 16:00:02 GMT 2009

Although I came from an institution that did a lot of work with  
splenic preservation and who's chair firmly believed in OPSI, i never  
found the science behind this to be compelling. This is a quote from  
the most recent review in 1/08 by Okabayashi: Although the mortality  
rate from OPSI has been reduced by appropriate vaccination and  
education, the precise pathogenesis and a suitable therapeutic  
strategy remain to be elucidated. Protein energy malnutrition (PEM) is  
commonly observed in cirrhotic patients.

Quite simply, many of the studies examining this rare event are forced  
to lump together all kinds of patients with serious underlying  
diseases. People do die of sepsis whether they have spleens or not.  
What would be needed would be a study looking just at normal healthy  
trauma patients who underwent splenectomy because of trauma and  
comparing them to other trauma survivors of similar severity who don't  
lose their spleens.

Rob Smith

On Jan 26, 2009, at 8:06 AM, Gross, Ronald wrote:

> No prophylaxis is my practice.
>
> Ronald I. Gross, MD, FACS
> Chief of Trauma & Emergency Surgery Services
> Baystate Medical Center
> 759 Chestnut Street
> Springfield, MA  01199
> 413-794-4022  phone
> 413-794-0142  fax
> ronald.gross at bhs.org
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org 
> ] On Behalf Of Richard van der Kleyn
> Sent: Saturday, January 24, 2009 9:30 AM
> To: trauma-list at trauma.org
> Subject: AB profilaxis esplenectomia
>
>
>
> A quick question for the trauma gurus: Have a friends mum, 82 yo,  
> very healthy (gym every morning), 2 episodes of TIA (transient  
> ischemic attaques) on asprin 75 mg + atorvastatin, splenectomia 10  
> years ago after falling of a bicycle, pneumokok vacinations up to  
> date. her GP has now put her on penicilin 500 td profilaxis (up  
> until now only took peniciline when she felt ill or if people around  
> her were sick).
>
> did a quick research into the us of continuous AB profilaxis in the  
> esplenic pacient, in children seams to be the standard of care but  
> in adults no concensus.
>
> Questions
>
> 1) do you think esplenic adults should take profilaxtic AB? or thus  
> this lead to more chance of a AB resistent infecion?
>
> 2) if so which antibiotic: penicilin or something that cover gram  
> pos. bacteria better (ciprofloxacin/levofloxacin) ?
>
> Thanks in advance for any advice
>
> Richard van der Kleyn
> metge adjunt servicio de urgencias
> hospital de Figueres.
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AB profilaxis esplenectomia