Overwhelming XXXX : A Prospective Multicenter Cohort Study.

@entity1 @entity295 @entity7706 @entity326 @entity5 @entity281 @entity4032 @entity328
BACKGROUND:    Recent population-based cohort studies have questioned the role of pneumococci as the most frequent pathogen causing severe @entity281 in @entity1 after splenectomy. The aim of the study was to define the causative pathogens and clinical presentation of @entity1 with @entity281 ( @entity281 ). METHODS:    In a prospective cohort study in 173 German intensive care units, we searched for @entity1 with and without @entity4032 and community-acquired severe @entity295 / @entity326 . Clinical and laboratory variables and survival of @entity1 were assessed. RESULTS:    Fifty-two @entity1 with severe @entity295 or @entity326 with @entity4032 and 52 without @entity4032 were included. @entity281 @entity1 more often had a history of @entity5 (38% vs 17%; P = .016) and had a lower body mass index (24 kg/m(2) vs 28 kg/m(2); P = .004). @entity328 was detected more frequently in @entity281 @entity1 (42% vs 12% without @entity4032 ; P < .001) and more frequently manifested as @entity281 (31% vs 6%; P = .002). Gram-negative @entity281 was similar in both groups (12% vs 19%; P = .157). Pneumococcal vaccine coverage of @entity281 @entity1 was low overall (42% vs 8% among @entity1 without @entity4032 ; P < .001). Purpura fulminans was a frequent complication, developing in 19% of @entity281 @entity1 vs 5% of @entity1 without @entity4032 (P = .038). The interval between splenectomy and @entity281 was 6 years (range, 1 month-50 years). On multivariable Poisson regression, @entity4032 was the only predictive variable independently associated with @entity295 (adjusted relative risk, 2.53 [95% confidence interval, 1.06-6.08]). CONCLUSIONS:    @entity7706 remain the most important cause of severe @entity295 and @entity326 following splenectomy.
