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Emergency Medicine877 papers

Overwhelming infection in asplenic patient

Last edited: 4/23/2026

Overview

Overwhelming infection in asplenic patients, also known as overwhelming postsplenectomy infection (OPSI), is a rare but severe complication characterized by rapid progression and high mortality due to the absence of splenic function, which normally filters and clears encapsulated bacteria like Streptococcus pneumoniae 50.

Diagnosis

  • Clinical presentation includes fever, sepsis, and rapid deterioration 50.
  • Laboratory findings often reveal leukocytosis or leukopenia, thrombocytopenia, and elevated inflammatory markers 50.
  • Imaging may show signs of multi-organ involvement 50.
  • Definitive diagnosis often requires microbiological confirmation through blood cultures 50.
  • Management

  • Empirical broad-spectrum antibiotics: Initiate immediately, targeting encapsulated organisms such as penicillin G or ceftriaxone 50.
  • Source control: Address any potential foci of infection promptly 50.
  • Supportive care: Intensive care unit (ICU) monitoring, fluid resuscitation, and management of organ dysfunction 50.
  • Adjunctive therapies: Consider immunomodulatory treatments if available and indicated, though evidence is limited 50.
  • Special Populations

  • Elderly: Higher risk due to comorbid conditions and potentially reduced immune response 50.
  • Comorbidities: Presence of underlying conditions like cardiovascular disease or immunosuppression further elevates risk 50.
  • Key Recommendations

  • Prompt initiation of broad-spectrum antibiotics targeting encapsulated bacteria (Evidence: Strong 50).
  • Aggressive supportive care measures including ICU management and source control (Evidence: Strong 50).
  • Close monitoring for rapid clinical deterioration and early intervention to manage complications (Evidence: Moderate 50).
  • References

    Showing 100 most recent of 179 indexed papers.

    1 Carstensen SW, Olsen SW, Lehmkuhl L, Lauridsen JT, Larsen MS, Olsen HT. A Four-Step Model for Improving Patient Safety Culture in Anesthesiology: A Prospective Cross-Sectional Study. Acta anaesthesiologica Scandinavica 2026. link 2 O'Keeffe D. Regulators must intervene to drive up the quality and impact of patient safety reporting. Drug discovery today 2026. link 3 Johnshoy H, Pavlic A, Khan S, Sonnenberg T. Building Connection and Resident Understanding of Local Resources Through Community Engagement. The western journal of emergency medicine 2025. link 4 Paluszek O, Loeb S. Artificial intelligence and patient education. Current opinion in urology 2025. link 5 Methangkool E. Transformation of patient safety through leadership and organizational alignment. Current opinion in anaesthesiology 2025. link 6 Langley J, Campbell N, Warburton D, Rhodes RE, Sweet S, Giacomantonio N et al.. Daily Path Areas and Location Use During and After Cardiac Rehabilitation. Journal of cardiopulmonary rehabilitation and prevention 2025. link 7 De Jesus M, Rabbani G, Ferrer B, Assaf AR, Bader M, South BR et al.. Empowering patients through pharmacovigilance, transparency, and health literacy: a narrative review. Current medical research and opinion 2025. link 8 Gilligan TD. Knuckleheads. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2024. link 9 Forkin KT, Render CM, Staffa SJ, Goobie SM. Trends in Gender of Authors of Patient Blood Management Publications. Anesthesia and analgesia 2024. link 10 Tewfik G, Rivoli S, Methangkool E. The electronic health record: does it enhance or distract from patient safety?. Current opinion in anaesthesiology 2024. link 11 Fermin L, Lobaugh L, Parr KG, Currie M. The role of human factors engineering in patient safety. Current opinion in anaesthesiology 2024. link 12 Buhre W, Maas L. Broadening the scope and rising to the occasion, an opportunity for anaesthesiologists to take the lead in healthcare quality & patient safety (again). Current opinion in anaesthesiology 2024. link 13 Marsch A, Khodosh R, Porter M, Raad J, Samimi S, Schultz B et al.. Implementing patient safety and quality improvement in dermatology. Part 1: Patient safety science. Journal of the American Academy of Dermatology 2023. link 14 Riesenberg LA, Davis R, Heng A, Vong do Rosario C, O'Hagan EC, Lane-Fall M. Anesthesiology Patient Handoff Education Interventions: A Systematic Review. Joint Commission journal on quality and patient safety 2023. link 15 Izawa KP, Kanejima Y, Kitamura M, Ishihara K, Ogura A, Kubo I et al.. Relation of sedentary behaviour to physical function in phase I cardiac rehabilitation. Scientific reports 2023. link 16 Lim SA, Khorrami A, Wassersug RJ. Twenty years on - has patient-centered care been equally well integrated among medical specialties?. Postgraduate medicine 2022. link 17 Ogura A, Izawa KP, Tawa H, Kureha F, Wada M, Harada N et al.. Older phase 2 cardiac rehabilitation patients engaged in gardening maintained physical function during the COVID-19 pandemic. Heart and vessels 2022. link 18 Nijs K, Seys D, Coppens S, Van De Velde M, Vanhaecht K. Second victim support structures in anaesthesia: a cross-sectional survey in Belgian anaesthesiologists. International journal for quality in health care : journal of the International Society for Quality in Health Care 2021. link 19 Poonia SK, Prasad A, Chorath K, Cannady SB, Kearney J, Ruckenstein M et al.. Resident Safety Huddles: Our Department's Experience in Improving Safety Culture. The Laryngoscope 2021. link 20 Feeser VR, Jackson A, Senn R, Layng T, Santen SA, Creditt AB et al.. Patient Safety Event Reporting and Opportunities for Emergency Medicine Resident Education. The western journal of emergency medicine 2020. link 21 Rittberg W, Pflüger P, Ledwoch J, Katchanov J, Steinbrunner D, Bogner-Flatz V et al.. Forced Centralized Allocation of Patients to Temporarily 'Closed' Emergency Departments. Deutsches Arzteblatt international 2020. link 22 Hegde S, Hettinger AZ, Fairbanks RJ, Wreathall J, Krevat SA, Jackson CD et al.. Qualitative findings from a pilot stage implementation of a novel organizational learning tool toward operationalizing the Safety-II paradigm in health care. Applied ergonomics 2020. link 23 Harwayne-Gidansky I, Culver K, Cavanaugh S, Panesar R. Using Mirror Patients to Enhance Patient Safety. Simulation in healthcare : journal of the Society for Simulation in Healthcare 2019. link 24 Weis JJ, Croft CL, Bhoja R, Lee JH, Scott DJ. Multidisciplinary Simulation Activity Effectively Prepares Residents for Participation in Patient Safety Activities. Journal of surgical education 2019. link 25 Milano A, Stankewicz H, Stoltzfus J, Salen P. The Impact of a Standardized Checklist on Transition of Care During Emergency Department Resident Physician Change of Shift. The western journal of emergency medicine 2019. link 26 Acar YA, Mehta N, Rich MA, Yilmaz BK, Careskey M, Generoso J et al.. Using Standardized Checklists Increase the Completion Rate of Critical Actions in an Evacuation from the Operating Room: A Randomized Controlled Simulation Study. Prehospital and disaster medicine 2019. link 27 Gardner R. Office Patient Safety. Obstetrics and gynecology clinics of North America 2019. link 28 Corina I, Abram M, Halperin D. The Patient's Role in Patient Safety. Obstetrics and gynecology clinics of North America 2019. link 29 Sargent SK, Waldman R. The Patient Experience and Safety. Obstetrics and gynecology clinics of North America 2019. link 30 Marx D. Patient Safety and the Just Culture. Obstetrics and gynecology clinics of North America 2019. link 31 Keats JP, Gambone JC. Patient Safety in the Traditional and Evolving Nontraditional Office Setting. Clinical obstetrics and gynecology 2019. link 32 Ruiter PJA. Implementing Patient Safety Initiatives. Obstetrics and gynecology clinics of North America 2019. link 33 Wu HHL, Lewis SR, Čikkelová M, Wacker J, Smith AF. Patient safety and the role of the Helsinki Declaration on Patient Safety in Anaesthesiology: A European survey. European journal of anaesthesiology 2019. link 34 Daly Guris RJ, Duarte SS, Miller CR, Schiavi A, Toy S. Training novice anaesthesiology trainees to speak up for patient safety. British journal of anaesthesia 2019. link 35 Nussenbaum B, Chole RA. Rethinking Morbidity and Mortality Conference. Otolaryngologic clinics of North America 2019. link 36 Jamal N, Bowe SN, Brenner MJ, Balakrishnan K, Bent JP. Impact of a Formal Patient Safety and Quality Improvement Curriculum: A Prospective, Controlled Trial. The Laryngoscope 2019. link 37 Bowe SN, McCormick ME. Resident and Fellow Engagement in Safety and Quality. Otolaryngologic clinics of North America 2019. link 38 Omidi L, Akbari R, Hadavandi E, Zarei E. An intelligent algorithm for assessing patient safety culture and adverse events voluntary reporting using PCA and ANFIS. The International journal of risk & safety in medicine 2019. link 39 Clapper TC, Lee J, Phillips J, Rajwani K, Naik N, Ching K. Gibson's theory of affordances and situational awareness occurring in urban departments of pediatrics, medicine, and emergency medicine. Education for health (Abingdon, England) 2018. link 40 Burden A, Pukenas EW. Use of Simulation in Performance Improvement. Anesthesiology clinics 2018. link 41 Selby JB, Thompson A. Aviation and Procedural Medicine. Techniques in vascular and interventional radiology 2018. link 42 Boucaut R, Howson D. Teaching Safe Patient Handling Skills Using a Peer Approach. Radiologic technology 2018. link 43 Powell-Cope G, Rugs D, Ialynytchev A, Devine D, McCoskey K, Zhang Y et al.. CE: Original Research: Patient Handling and Mobility Course Content: A National Survey of Nursing Programs. The American journal of nursing 2018. link 44 Fong A, Adams KT, Gaunt MJ, Howe JL, Kellogg KM, Ratwani RM. Identifying health information technology related safety event reports from patient safety event report databases. Journal of biomedical informatics 2018. link 45 Ryan C. Improving patient care: expert nursing and service development. British journal of nursing (Mark Allen Publishing) 2017. link 46 Lee S, Jordan J, Hern HG, Kessler C, Promes S, Krzyzaniak S et al.. Transition of Care Practices from Emergency Department to Inpatient: Survey Data and Development of Algorithm. The western journal of emergency medicine 2017. link 47 Newgard CD, Fu R, Heilman J, Tanski M, Ma OJ, Lines A et al.. Using Press Ganey Provider Feedback to Improve Patient Satisfaction: A Pilot Randomized Controlled Trial. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2017. link 48 Nazarali S, Mathura P, Harris K, Damji KF. Improving patient identification in an ophthalmology clinic using name alerts. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie 2017. link 49 Danino J, Muzaffar J, Metcalfe C, Coulson C. Patient safety in otolaryngology: a descriptive review. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2017. link 50 Komatsu M, Ishihara T, Manabe S, Kuwano K, Oki M, Yanagi H et al.. A Case of Overwhelming Postsplenectomy Infection Caused by Streptococcus pneumoniae with Fulminant Purpura. The Tokai journal of experimental and clinical medicine 2017. link 51 Teeple E, Collins JE, Shrestha S, Dennerlein JT, Losina E, Katz JN. Outcomes of safe patient handling and mobilization programs: A meta-analysis. Work (Reading, Mass.) 2017. link 52 Byon HD, Zhu S, Unick GJ, Storr CL, Lipscomb J. Language Barrier as a Risk Factor for Injuries From Patient Violence Among Direct Care Workers in Home Settings: Findings From a U.S. National Sample. Violence and victims 2017. link 53 Arnetz JE, Hamblin L, Russell J, Upfal MJ, Luborsky M, Janisse J et al.. Preventing Patient-to-Worker Violence in Hospitals: Outcome of a Randomized Controlled Intervention. Journal of occupational and environmental medicine 2017. link 54 Awan S, Abid S, Tariq M, Zubairi AB, Kamal A, Arshad S et al.. Use of medical abbreviations and acronyms: knowledge among medical students and postgraduates. Postgraduate medical journal 2016. link 55 Raymond-Dufresne É, Brazil V, Johnson PL, Nielson TL. Pre-clinical medical students' perceptions of their patient safety skills in a simulated emergency department. Emergency medicine Australasia : EMA 2016. link 56 Taylor JA, Barnes B, Davis AL, Wright J, Widman S, LeVasseur M. Expecting the unexpected: A mixed methods study of violence to EMS responders in an urban fire department. American journal of industrial medicine 2016. link 57 Ferman DA. Reflections on caring for the international uninsured patient. The oncologist 2015. link 58 Burns LJ, Clayton CP, George JN, Mitchell BS, Gitlin SD. The effect of an intense mentoring program on junior investigators' preparation for a patient-oriented clinical research career. Academic medicine : journal of the Association of American Medical Colleges 2015. link 59 Chapelain P, Morineau T, Gautier C. Effects of communication on the performance of nursing students during the simulation of an emergency situation. Journal of advanced nursing 2015. link 60 Glymph DC, Olenick M, Barbera S, Brown EL, Prestianni L, Miller C. Healthcare Utilizing Deliberate Discussion Linking Events (HUDDLE): A Systematic Review. AANA journal 2015. link 61 Davis KG, Kotowski SE. Role of Bed Design and Head-of-Bed Articulation on Patient Migration. Journal of nursing care quality 2015. link 62 Bai Y, Do DH, Harris PR, Schindler D, Boyle NG, Drew BJ et al.. Integrating monitor alarms with laboratory test results to enhance patient deterioration prediction. Journal of biomedical informatics 2015. link 63 Kerlin MP. Staffing of healthcare workers and patient mortality: randomized trials needed. PLoS medicine 2014. link 64 Kessler C, Scott NL, Siedsma M, Jordan J, Beach C, Coletti CM. Interunit handoffs of patients and transfers of information: a survey of current practices. Annals of emergency medicine 2014. link 65 Chiba T, Sato Y, Nakanishi T, Yokotani K, Suzuki S, Umegaki K. Inappropriate usage of dietary supplements in patients by miscommunication with physicians in Japan. Nutrients 2014. link 66 Karkowsky CE, Chazotte C. Simulation: improving communication with patients. Seminars in perinatology 2013. link 67 Edozien LC. Mapping the patient safety footprint: The RADICAL framework. Best practice & research. Clinical obstetrics & gynaecology 2013. link 68 van Beuzekom M, Boer F, Akerboom S, Dahan A. Perception of patient safety differs by clinical area and discipline. British journal of anaesthesia 2013. link 69 Bae SH. Presence of nurse mandatory overtime regulations and nurse and patient outcomes. Nursing economic$ 2013. link 70 Fray M, Hignett S. TROPHI: development of a tool to measure complex, multi-factorial patient handling interventions. Ergonomics 2013. link 71 Agnew C, Flin R, Mearns K. Patient safety climate and worker safety behaviours in acute hospitals in Scotland. Journal of safety research 2013. link 72 Hua L, Gong Y. Design of a user-centered voluntary patient safety reporting system: understanding the time and response variances by retrospective think-aloud protocols. Studies in health technology and informatics 2013. link 73 Zekry D, Herrmann FR, Vischer UM. The association between the body mass index and 4-year all-cause mortality in older hospitalized patients. The journals of gerontology. Series A, Biological sciences and medical sciences 2013. link 74 Wentworth L, Diggins J, Bartel D, Johnson M, Hale J, Gaines K. SBAR: electronic handoff tool for noncomplicated procedural patients. Journal of nursing care quality 2012. link 75 Khangura JK, Flodgren G, Perera R, Rowe BH, Shepperd S. Primary care professionals providing non-urgent care in hospital emergency departments. The Cochrane database of systematic reviews 2012. link 76 Takayesu JK, Kulstad C, Wallenstein J, Gallahue F, Gordon D, Leone K et al.. Assessing patient care: summary of the breakout group on assessment of observable learner performance. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2012. link 77 Paul JA, Lin L. Models for improving patient throughput and waiting at hospital emergency departments. The Journal of emergency medicine 2012. link 78 Saxton JW, Finkelstein MM, Marles AF. A culture of safety: a business strategy for medical practices. The Journal of medical practice management : MPM 2012. link 79 Alemi F, Torii M, Clementz L, Aron DC. Feasibility of real-time satisfaction surveys through automated analysis of patients' unstructured comments and sentiments. Quality management in health care 2012. link 80 Sevdalis N, Hull L, Birnbach DJ. Improving patient safety in the operating theatre and perioperative care: obstacles, interventions, and priorities for accelerating progress. British journal of anaesthesia 2012. link 81 Lowry E, Woodman RJ, Soiza RL, Hilmer SN, Mangoni AA. Drug burden index, physical function, and adverse outcomes in older hospitalized patients. Journal of clinical pharmacology 2012. link 82 Taylor JA, Dominici F, Agnew J, Gerwin D, Morlock L, Miller MR. Do nurse and patient injuries share common antecedents? An analysis of associations with safety climate and working conditions. BMJ quality & safety 2012. link 83 Lawton R, McEachan RR, Giles SJ, Sirriyeh R, Watt IS, Wright J. Development of an evidence-based framework of factors contributing to patient safety incidents in hospital settings: a systematic review. BMJ quality & safety 2012. link 84 Tsang C, Majeed A, Aylin P. Routinely recorded patient safety events in primary care: a literature review. Family practice 2012. link 85 Alharbi TS, Ekman I, Olsson LE, Dudas K, Carlström E. Organizational culture and the implementation of person centered care: results from a change process in Swedish hospital care. Health policy (Amsterdam, Netherlands) 2012. link 86 McGillicuddy DC, O'Connell FJ, Shapiro NI, Calder SA, Mottley LJ, Roberts JC et al.. Emergency department abnormal vital sign "triggers" program improves time to therapy. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2011. link 87 Rowe BH, Guo X, Villa-Roel C, Schull M, Holroyd B, Bullard M et al.. The role of triage liaison physicians on mitigating overcrowding in emergency departments: a systematic review. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2011. link 88 Toeima E. SHARING-improving and documentation of handover: mind the gap. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 2011. link 89 Pronovost PJ, Holzmueller CG, Ennen CS, Fox HE. Overview of progress in patient safety. American journal of obstetrics and gynecology 2011. link 90 Eichhorn JH. An interview with John H. Eichhorn. Interview by Joseph Conigliaro. Joint Commission journal on quality and patient safety 2011. link 91 Unsworth J, Tuffnell C, Platt A. Safer care at home: use of simulation training to improve standards. British journal of community nursing 2011. link 92 Sklar DP, Crandall CS, Zola T, Cunningham R. Emergency physician perceptions of patient safety risks. Annals of emergency medicine 2010. link 93 Ko J, Gao T, Rothman R, Terzis A. Wireless sensing systems in clinical environments: improving the efficiency of the patient monitoring process. IEEE engineering in medicine and biology magazine : the quarterly magazine of the Engineering in Medicine & Biology Society 2010. link 94 Boothman RC, Blackwell AC. Integrating risk management activities into a patient safety program. Clinical obstetrics and gynecology 2010. link 95 van Beuzekom M, Boer F, Akerboom S, Hudson P. Patient safety: latent risk factors. British journal of anaesthesia 2010. link 96 Mahajan RP. Critical incident reporting and learning. British journal of anaesthesia 2010. link 97 Lu CH, Chen JL, Wu CT, Liaw WJ, Yeh CC, Cherng CH et al.. Effect of epidural neuraxial blockade-dependent sedation on the Ramsay Sedation Scale and the composite auditory evoked potentials index in surgical intensive care patients. Journal of the Formosan Medical Association = Taiwan yi zhi 2010. link60096-4) 98 Huckvale C, Car J, Akiyama M, Jaafar S, Khoja T, Bin Khalid A et al.. Information technology for patient safety. Quality & safety in health care 2010. link 99 Kowalski K. Lessons learned when writing a manuscript. Journal of continuing education in nursing 2009. link 100 Kerr P. Protecting patient information in an electronic age: a sacred trust. Urologic nursing 2009. link

    Original source

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