Impact of Source Control in Patients With Severe Sepsis and Septic Shock.
OBJECTIVE
Time to clearance of pathogens is probably critical to outcome in septic shock. Current guidelines recommend intervention for source control within 12 hours after diagnosis. We aimed to determine the epidemiology of source control in the management of sepsis and to analyze the impact of timing to source control on mortality.


METHODS
Prospective observational analysis of the Antibiotic Intervention in Severe Sepsis study, a Spanish national multicenter educational intervention to improve antibiotherapy in sepsis.


METHODS
Ninety-nine medical-surgical ICUs in Spain.


METHODS
We enrolled 3,663 patients with severe sepsis or septic shock during three 4-month periods between 2011 and 2013.


METHODS
Source control and hospital mortality.


RESULTS
A total of 1,173 patients (32%) underwent source control, predominantly for abdominal, urinary, and soft-tissue infections. Compared with patients who did not require source control, patients who underwent source control were older, with a greater prevalence of shock, major organ dysfunction, bacteremia, inflammatory markers, and lactic acidemia. In addition, compliance with the resuscitation bundle was worse in those undergoing source control. In patients who underwent source control, crude ICU mortality was lower (21.2% vs 25.1%; p = 0.010); after adjustment for confounding factors, hospital mortality was also lower (odds ratio, 0.809 [95% CI, 0.658-0.994]; p = 0.044). In this observational database analysis, source control after 12 hours was not associated with higher mortality (27.6% vs 26.8%; p = 0.789).


CONCLUSIONS
Despite greater severity and worse compliance with resuscitation bundles, mortality was lower in septic patients who underwent source control than in those who did not. The time to source control could not be linked to survival in this observational database.
1Intensive Care Department, Sabadell Hospital, Instituto Universitario Parc Taulí, Autonomous University of Barcelona, Sabadell, Spain. 2Intensive Care Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain. 3CIBER-Enfermedades Respiratorias, Barcelona, Spain. 4Epidemiology and Assessment Unit, Fundació Parc Taulí, Autonomous University of Barcelona, Sabadell, Spain. 5Intensive Care Department, A Coruña University Hospital, A Coruña, Spain. 6Intensive Care Department, Reina Sofía de Córdoba University Hospital, Córdoba, Spain. 7Multidisciplinary Intensive Care Research Organization (MICRO), St James's University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland. 8Medical Intensive Care Unit, Rhode Island Hospital, Brown University School of Medicine, Providence, RI.
María Luisa
ML
Martínez
Ricard
R
Ferrer
Eva
E
Torrents
Raquel
R
Guillamat-Prats
Gemma
G
Gomà
David
D
Suárez
Luis
L
Álvarez-Rocha
Juan Carlos
JC
Pozo Laderas
Ignacio
I
Martín-Loeches
Mitchell M
MM
Levy
Antonio
A
Artigas
D000140:Acidosis, Lactic / Q000453:epidemiology; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007249:Inflammation / Q000453:epidemiology; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology; D011446:Prospective Studies; D018805:Sepsis / Q000401:mortality* / Q000628:therapy*; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy*; D018461:Soft Tissue Infections / Q000628:therapy*; D013030:Spain / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000628:therapy*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D014662:Vasoconstrictor Agents; D002116:Calcitonin; D002097:C-Reactive Protein