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Master Thesis

Évaluation de l’application des recommandations de prévention chez les personnes splénectomisées et enquête auprès des acteurs de santé

Abstract : Introduction. Splenectomized patients have increased risks of severe infections. The aims of the study were to assess the application of measures to prevent the risk of infection in splenectomized patients, primarily through vaccination, antibiotic prophylaxis and patient awareness, then to identify the most appropriate tools to improve patients’ medical care. Materials and methods. From 2012 to 2018, we conducted a monocentric retrospective study including splenectomized adults at Annecy hospital. Data on vaccination, antibiotic prophylaxis and emergency antibiotic therapy were collected by telephone interviews with patients and their general practitioners and from hospital medical records. A descriptive analysis was carried out to calculate the vaccination coverage rate in line with the recommendations from the 2014 Haut Conseil de Santé Publique (HCSP). A questionnaire was then sent to specialists and general practitioners in order to collect their proposals for improving the medical care of splenectomized patients. Results. Fifty-four patients were included, with a median post-splenectomy aftercare of 4.5 years. In 2020, only 57.4% of patients received the recommended anti-pneumococcal regimen; 29.6% and 33.3% received the 2 doses of anti-meningococcal ACYW and B vaccinations respectively; 98.1% were vaccinated against Haemophilus influenzae type b and 68.5% against seasonal influenza. In total, only 24.1% of patients had an overall vaccination coverage consistent with the recommendations of the HCSP. Postoperative antibiotic prophylaxis was prescribed for all patients. The preempted prescription of emergency antibiotic therapy was very rarely implemented. No patient had received this type of prescription on discharge from hospital, and only 13% had one in 2020. According to the survey carried out among general practitioners and hospital specialists, the most relevant tool to implement would be to systematically deliver to the patients and personal physicians a post-splenectomy information brochure including recommended vaccinations and the mention of antibiotic prophylaxis and emergency antibiotic therapy. Conclusion. The results of our study are similar to national and international data, noticing insufficient overall vaccination coverage. Better collaboration between hospital doctors and general practitioners would improve the prevention of infection risks of splenectomized patients.
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Master Thesis
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Submitted on : Thursday, January 7, 2021 - 10:22:07 AM
Last modification on : Saturday, January 9, 2021 - 3:23:52 AM
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Émilie Durand, Camille Fontaine. Évaluation de l’application des recommandations de prévention chez les personnes splénectomisées et enquête auprès des acteurs de santé. Médecine humaine et pathologie. 2020. ⟨dumas-03101448⟩

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