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This article looks at source control as it relates to intrabdominal sources for sepsis. Key take aways are:
- They believe surgery is the best service to mange these complex patients in consultation with medicine, heme-onc, transplant, EM, etc. (Is that how it is done at your institution?)
- Source control should be both anatomic as well as physiologic (below)
- Timing of source control is controversial
- Antibiotic stewardship is still important even in these complex patients
Those at high risk of morbidity and mortality from intraabdominal infection associated sepsis include:
Mild–moderate immune deficiency: Elderly (according to the age and general status of the patient), Malnourished, Diabetic, Burns, Trauma, Uremic, Active malignancy, not on chemotherapy, HIV with CD4+ count >200/mm3, Splenectomized, Severe immune deficiencyAIDS HIV with CD4+ count <200/mm3, Transplant (solid organ, bone marrow), High-dose steroids (more than 20 mg/day prednisone), Malignancy on chemotherapy, Neutrophil count <1,000/mm3
High-risk population (medical or surgical causes)Low serum albumin concentration Older age Obesity Smoking Diabetes mellitus Ischemia secondary to vascular disease or irradiation Prolonged or delayed/late procedures
References
Coccolini, Federico MD, PhD; Kirkpatrick, Andrew W. CD, MD, MHSc, FRCSC, FACS; Cremonini, Camilla MD, PhD; Sartelli, Massimo MD, PhD. Source control in intra-abdominal infections: What you need to know. Journal of Trauma and Acute Care Surgery 99(5):p 669-678, November 2025. | DOI: 10.1097/TA.0000000000004654