Machesky K K, Cushing R D
Bon Secours Hospital, Grosse Pointe, Mich 48230, USA.
Arch Fam Med. 1998 Mar-Apr;7(2):178-80. doi: 10.1001/archfami.7.2.178.
Overwhelming postsplenectomy infection is a fulminant process that carries a poor prognosis. Streptococcus pneumoniae is the most likely organism to cause disease. Infection with penicillin-resistant S pneumoniae is increasing; its prevalence ranges from 6.6% to 50% in the United States. If meningeal involvement with resistant pneumococcus is suspected, it should be treated with a third-generation cephalosporin and vancomycin hydrochloride. The long-term management of asplenic patients should focus on preventing infection. The current guidelines and recommendations for vaccination are reviewed. Educating these patients to contact their physician at the first sign of minor illness is also beneficial. The use of antibiotic prophylaxis remains a controversy and is best left to the discretion of the physician.
脾切除术后暴发性感染是一种预后不良的暴发性过程。肺炎链球菌是最可能引发疾病的病原体。耐青霉素肺炎链球菌感染正在增加；在美国，其患病率在6.6%至50%之间。如果怀疑耐药肺炎球菌累及脑膜，应使用第三代头孢菌素和盐酸万古霉素进行治疗。无脾患者的长期管理应侧重于预防感染。本文回顾了当前的疫苗接种指南和建议。教育这些患者在出现轻微疾病的最初迹象时就联系医生也很有帮助。预防性使用抗生素仍存在争议，最好由医生自行决定。
