Source control challenges - #EuAsia17
•
4 likes•450 views
Source control is a key part of treating many infections but is often poorly studied, difficult to quantify, and outsourced. It involves eliminating the infection source, controlling ongoing contamination, and restoring anatomy and function. Lack of source control can lead to prolonged antibiotics, intestinal flora changes, resistant infections, and poor healing. Source control improves antimicrobial effectiveness and is recommended within 24 hours of diagnosis for sepsis and septic shock. Challenges include delays in diagnosis and accessing interventional radiology or the operating room. A multidisciplinary approach is needed to identify the source using imaging or point-of-care ultrasound and determine the least invasive source control strategy based on the patient and infection characteristics. Timing source control appropriately is
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Source control challenges - #EuAsia17
Similar to Source control challenges - #EuAsia17 (20)
Recently uploaded
Recently uploaded (20)
Source control challenges - #EuAsia17
- 2. Sepsis in 2017Antibiotictherapy • Appropriate antibiotic therapy • Timing of administration • Antibiotic stewardship programs Supportivemeasures • Resuscitation • Monitoring • Steroids • Toxin removal • Organ support Source control • Poorly studied • Hard to quantify • Often outsourced
- 3. What is source control? All physical measures undertaken to • eliminate a source of infection • control ongoing contamination • restore premorbid anatomy and function Schein M et al: Source control. A guide to the management of surgical infections. Heidelberg: Springer Verlag; 2002.
- 7. Impact of source control • Prerequisite for antimicrobial effectiveness Lagunes, L. Eur J Clin Microbiol Infect Dis 2016
- 8. Percutaneous drainage • Primary choice • Postoperative abscess • Visceral abscess • Hostile abdomen Surgical drainage • Ongoing contamination • Diffuse peritonitis • Multiple abscesses • Associated necrosis (?) • Failed percutaneous drainage (2 or more procedures) Source control strategy
- 9. Source control strategy • Imaging often critical • Ultrasound - limitations • CT scan – superior • Not always necessary
- 10. Source control strategy • Hemodynamics • Respiration • Coagulation • Intra-abdominal pressure • Prior surgery Patient • Surgeon experience • OR availability • PCD availablity Hospital
- 11. Open vs. percutaneous drainage Predictors of mortality (n=686) Politano, AD. Am Surg 2011 7:862-867
- 12. Timing of source control Urgency of source control measures determined by § Presence and magnitude of ongoing contamination § Degree and dynamics of organ dysfunction § Patient physiology at presentation § Risk of collateral damage § Immediate, urgent or delayed source control
- 13. 2017 SIS recommendation • Use source control to remove infected fluid and tissue and to prevent ongoing contamination • Within 24h of diagnosis • More urgent in sepsis and septic shock Mazuski, JE. Surg Infect (Larchmt) 2017 1:1-76 1-A 2-B 2-C
- 14. 2017 SIS recommendation • Use least invasive approach • Temporizing strategy • Do not use planned relaparotomy when source control is adequate Mazuski, JE. Surg Infect (Larchmt) 2017 1:1-76 1-B 1-B
- 15. Obstacles to early source control Delay in diagnosis § Lack of clinical symptoms § Concommitant infections § Preceived need for more investigations § Access to radiology Delay in therapy § Interventional radiology availability § OR availability – planned and emergency procedures
- 16. Clinical approach Source identification critical • History • Clinical examination • Imaging • Directed • POCUS interesting strategy
- 19. Clinical approach Sepsis – septic shock Antibiotic therapy Source control necessary? Supportive measures Source identification Timing ü ASAPA for severe infection Modality ü Minimally invasive preferred ü Many exceptions Evaluation ü Identify endpoints ü Follow up
- 20. Broadly clinically applicable… Peritonitis Cholangitis Pyelonephritis CLABSI NSTI Ventriculitis Mastoiditis Pneumonia Empyema Catheter associated UTI Postop wound infection Pancreatitis
- 23. Source control in pancreatitis Mortality van Santvoort HC et al., N Engl J Med 2010, 362: 1491-502. 0 5 10 15 20 25 Overall Open PCD only PCD+VARD Overall Open PCD only PCD+VARD
- 26. Summary • Source control pivotal for many infections • Part of diagnostic work-up • Source control – not only for surgeons • Minimize damage - prefer PCD when justified • Timing equally important • Multidisciplinary approach • Patient-tailored decision making
- 27. Thank you for your attention Email: Jan.DeWaele@UGent.be @CriticCareDoc