Post-TPIAT (total pancreatectomy with islet autotransplantation) patients are asplenic and at risk for overwhelming post-splenectomy infection (OPSI). They should be seen by a medical provider and treated immediately with antibiotics at the earliest sign of sepsis. It is also important to seek immediate treatment in the event of any animal bite, including dogs.
Signs of sepsis may include:
Fever equal to or greater than 38C or 100.4F
Chills and/or shivering
Headache
Drowsiness/confusion
Nausea/vomiting/diarrhea
Severe abdominal pain
Pinpoint purplish red spots on the skin or larger bluish bruises
Low blood pressure, lightheadedness, fainting
Evaluation of the outpatient post-TPIAT patient with fever:
1. Emergent medical evaluation, peripheral blood cultures, central line cultures if applicable, and IV antibiotics
Treatment and disposition based on clinical assessment:
1. If the patient is well-appearing, fully vaccinated and has reliable follow up:
a. Notify Pediatric Surgery Consult Resident on patient arrival
b. Administer IV ceftriaxone 50 mg/kg (max dose 1000 mg) once
c. Repeat medical evaluation in 24 hours (consider repeat dose of IV ceftriaxone)
2. If the patient is ill-appearing, unvaccinated/partially vaccinated, and/or follow up is unreliable:
a. Notify Pediatric Surgery Consult Resident on patient arrival
b. Administer IV ceftriaxone 50 mg/kg (max dose 1000 mg)
c. Consider broadening coverage with Vancomycin if critically ill (or alternative antimicrobial based on patient microbiologic history)
d. Admit to hospital for further evaluation/management