SCCM Resource Library-Sepsis: The Source Matters!

Video Transcription

Video Summary

Dr. Ryan Mavis, an infectious disease and critical care physician, presented a talk entitled "Sepsis: The Source Matters" at STCM. He emphasized that sepsis is not a single disease, but rather a collection of different disorders with common features such as organ failure. Dr. Mavis discussed the importance of individualized approaches to care and the need for timely and appropriate antimicrobial therapy. He highlighted common pitfalls in antimicrobial therapy selection, including missing the causative pathogen or using a regimen that does not cover the pathogen due to resistance. He also discussed the importance of site penetration and pharmacokinetic and pharmacodynamic dosing strategies in achieving appropriate antimicrobial therapy. Dr. Mavis stressed the significance of source control in the care of septic patients, recommending a goal of source control within 6 to 12 hours of diagnosis. He cited studies showing a correlation between inadequate early source control and increased mortality. While timing of source control may vary depending on the specific patient and disease process, the overall goal is to remove or eliminate the focus of infection as soon as possible. In the second half of the talk, Dr. Matthew Tadlock, a trauma and critical care surgeon, focused on source control in intra-abdominal sepsis. He discussed the principles of drainage, debridement, device removal, and definitive reconstructive measures. Dr. Tadlock explained that prompt source control is crucial in intra-abdominal sepsis and highlighted the negative consequences of leaving the abdomen open for too long, such as entero-atmospheric fistulas and large ventral hernias. He referenced the Surgical Infection Society's guidelines, which recommend routine source control procedures within 24 hours of diagnosis, unless a non-interventional approach is associated with a good clinical outcome. In cases where immediate closure is not possible, such as with mesenteric ischemia or abdominal wall necrotizing soft tissue infections, a planned second look or ongoing monitoring may be necessary. Dr. Tadlock ended by discussing percutaneous drainage in intra-abdominal abscesses and the importance of timely placement of percutaneous cholocystitis tubes. In conclusion, both Dr. Mavis and Dr. Tadlock emphasized the critical role of source control in the management of sepsis and the need for individualized approaches based on the specific patient and disease process.

Asset Subtitle

Sepsis, 2021

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Learning Objectives

Review differences in antimicrobial spectra, tissue penetration, and resistance that may influence therapy selection in the patient with sepsis
Identify pathogen-specific factors, including virulence factors and immunologic responses, that impact the course of disease in the patient with sepsis
Recognize the role of early source control in sepsis and septic shock, including an understanding of the need for early expert consultation

Common Pitfalls in Antimicrobial Therapy Selection
Eric W. Mueller

Drugs Won't Save You: The Impact of Source Control
Matthew D. Tadlock

Meta Tag

Content Type Presentation

Knowledge Area Sepsis

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Infection

Tag Guidelines

Year 2021

Keywords

Dr. Ryan Mavis

infectious disease

critical care physician

sepsis

source matters

organ failure

individualized approaches

antimicrobial therapy

source control

intra-abdominal sepsis

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