Current understanding in source control management in septic shock patients: a review

Lagunes, Leonel; Encina, Belén; Ramirez-Estrada, Sergio

doi:10.21037/atm.2016.09.02

Cited by 34 publications

(22 citation statements)

References 36 publications

(25 reference statements)

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“…Rationale: Source control is defined as physical modalities taken to control or remove the source of infection or to prevent spread of the infection systemically or to adjacent tissues [171]. Source control may include percutaneous or deep abscess drainage, drainage of an empyema, septic joint, or subperiosteal abscess, removal of infected hardware or CVCs, or debridement of necrotizing soft-tissue infection.…”

Section: We Recommend Removal Of Intravascular Access Devices That Armentioning

confidence: 99%

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

et al. 2020

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Objectives: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction.Design: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those The Society of Critical Care Medicine guidelines are intended for general information only, are not medical advice, and do not replace professional advice, which should be sought for any medical condition. The full disclaimer for guidelines can be accessed at https ://www.sccm.org/Resea rch/Guide lines /Guide lines . panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. Methods:The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. Results:The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 52 research priorities were identified. Conclusions:A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research. S14 the group heads, panel members, and methodologists. Searches utilized ...

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Section: We Recommend Removal Of Intravascular Access Devices That Armentioning

confidence: 99%

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

et al. 2020

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“…Source-control-documentation is defined as the postsurgery documentation of infection source control by the surgeons. Source control involves all actions undertaken to eradicate the infection source, reduce the bacterial inoculum, and restore normal physiologic function through correcting anatomic derangements [28]. Clinical indications for antibiotics in SICU are further divided into prophylactic antibiotics use for 24-48 h, empirical antibiotics therapy of 5-7 days for a post-operative complication, and targeted therapy of antibiotics in case of culture-proven infections [29].…”

Section: Operational Definitionsmentioning

confidence: 99%

An antibiotic stewardship program in a surgical ICU of a resource-limited country: financial impact with improved clinical outcomes

Hussain

Khan

Gul

et al. 2020

J of Pharm Policy and Pract

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Background Antibiotic resistance (ABX-R) is alarming in lower/middle-income countries (LMICs). Nonadherence to antibiotic guidelines and inappropriate prescribing are significant contributing factors to ABX-R. This study determined the clinical and economic impacts of antibiotic stewardship program (ASP) in surgical intensive care units (SICU) of LMIC. Method We conducted this pre and post-test analysis in adult SICU of Aga Khan University Hospital, Pakistan, and compared pre-ASP (September–December 2017) and post-ASP data (April–July 2018). January–March 2018 as an implementation/training phase, for designing standard operating procedures and training the team. We enrolled all the patients admitted to adult SICU and prescribed any antibiotic. ASP-team daily reviewed antibiotics prescription for its appropriateness. Through prospective-audit and feedback-mechanism changes were made and recorded. Outcome measures included antibiotic defined daily dose (DDDs)/1000 patient-days, prescription appropriateness, antibiotic duration, readmission, mortality, and cost-effectiveness. Result 123 and 125 patients were enrolled in pre-ASP and post-ASP periods. DDDs/1000 patient-days of all the antibiotics reduced in the post-ASP period, ceftriaxone, cefazolin, metronidazole, piperacillin/tazobactam, and vancomycin showed statistically significant (p < 0.01) reduction. The duration of all antibiotics use reduced significantly (p < 0.01). Length of SICU stays, mortality, and readmission reduced in the post-ASP period. ID-pharmacist interventions and source-control-documentation were observed in 62% and 50% cases respectively. Guidelines adherence improved significantly (p < 0.01). Net cost saving is 6360US$ yearly, mainly through reduced antibiotics consumption, around US$ 18,000 (PKR 2.8 million) yearly. Conclusion ASP implementation with supplemental efforts can improve the appropriateness of antibiotic prescriptions and the optimum duration of use. The approach is cost-effective mainly due to the reduced cost of antibiotics with rational use. Better source-control-documentation may further minimize the ABX-R in SICU.

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“…SSC guidelines recommend any required source control intervention be implemented as soon as medically and logistically practical . Clinical data supporting imperatives for early source control are limited and entirely observational, with mixed results . However, a broad range of source control interventions are implemented (Table ).…”

Section: Source Controlmentioning

confidence: 99%

“…Removal of vascular grafts for early source control are limited and entirely observational, with mixed results. 65,66 However, a broad range of source control interventions are implemented ( Table 2). From the perspective of the ED clinician, timely demonstration of infection source through bedside and investigational techniques is paramount, given the logistic impediments associated with surgical intervention.…”

Section: Removal Of Infected Venous Access Devicesmentioning

confidence: 99%

Review article: Sepsis in the emergency department – Part 3: Treatment

Williams

Keijzers

Macdonald

et al. 2018

Emerg Medicine Australasia

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Although comprehensive guidelines for treatment of sepsis exist, current research continues to refine and revise several aspects of management. Imperatives for rapid administration of broad-spectrum antibiotics for all patients with sepsis may not be supported by contemporary data. Many patients may be better served by a more judicious approach allowing consideration of investigation results and evidence-based guidelines. Conventional fluid therapy has been challenged with early evidence supporting balanced, restricted fluid and early vasopressor use. Albumin, vasopressin and hydrocortisone have each been shown to support blood pressure and reduce catecholamine requirements but without effect on mortality, and as such should be considered for ED patients with septic shock on a case-by-case basis. Measurement of quality care in sepsis should incorporate quality of blood cultures and guideline-appropriateness of antibiotics, as well as timeliness of therapy. Local audit is an essential and effective means to improve practice. Multicentre consolidation of data through agreed minimum sepsis data sets would provide baseline quality data, required for the design and evaluation of interventions.

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Current understanding in source control management in septic shock patients: a review

Cited by 34 publications

References 36 publications

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

An antibiotic stewardship program in a surgical ICU of a resource-limited country: financial impact with improved clinical outcomes

Review article: Sepsis in the emergency department – Part 3: Treatment

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