ABSTRACT
BACKGROUND:Splenectomy in patients with liver cirrhosis (LC) is expected to become more common owing to its efficacy on portal hemodynamics. In this report we describe an alarming case of group B streptococcus (GBS) infection after splenectomy in a patient with LC. METHODS:A 72-year-old woman with a history of LC was admitted to our emergency department because of respiratory failure. The patient had received left lateral segmentectomy of the liver and splenectomy three months before admission. Pulmonary examination revealed significant wheezing during inspiration and expiration, but no crackles and stridor. Chest radiography and CT showed no infiltrates. A presumptive diagnosis of bronchial asthma caused by upper respiratory infection was made. Four days after admission, GBS infection was confirmed by blood culture and penicillin G was administered. Antibiotics were given intravenously for a total of 12 days. RESULTS:The patient was discharged on the 12th day after admission. CONCLUSIONS:Although efficacy of splenectomy in patients with LC has been reported, immune status should be evaluated for a longer period. Patients who have undergone splenectomy are highly susceptible to bacteria; moreover, LC itself is an independent risk factor for mortality in patients with sepsis. Since prophylaxis against GBS has not been established, immediate action should be taken. Emergency physicians should be aware of invasive GBS infection in the context of the critical risk factors related to splenectomy and LC, particularly the expected increase of splenectomy performed in LC patients.
ABSTRACT
Background: Group B streptococcus (GBS) infection is one of the leading causes of morbidity and mortality in the neonatal period in the USA. The Centers for Disease Control and Prevention (CDC) issued a recommendation to prevent early-onset GBS infection in 1996 and a revised recommendation in 2002. Objectives: To perform a health economic analysis of the CDC recommendation using clinical data currently available in Thailand. Study design: Health economic analysis. Materials and Methods: After reviewing the literature regarding clinical data I Thailand, a decision analysis was performed to evaluate the outcomes of 3 strategies: universal culture screening, intrapartum risk factors assessment, and no prevention. Outcomes: The medical care cost for each strategy and incremental medical care cost for the prevention of one GBS case were analyzed. Results: Under the present conditions in Thailand and using the cost estimated from Siriraj Hospital’s charge in the year 2005, the no prevention practice was the most cost-effective strategy. The incremental medical care cost to prevent one GBS case for the universal culture screening and the intrapartum risk assessment were 594,754.17 Baht and 83,677.78 Baht, respectively. Conclusion: Although neither of the preventive strategies recommended by the CDC was cost-effective in general clinical practice in the present situation in Thailand, the intrapartum risk assessment strategy may be reasonable because the incremental cost to prevent one GBS case was less than 100,000 Baht.