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Early intervention to control septic focus reduces mortality

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Dr J S Rajkumar, Chairman and Chief Surgeon, Rigid Hospitals, Chennai; Senior Consultant, Laparoscopic Surgeon, VPS, Burjeel group, Dubai    03 August 2022

Early detection and control of the source of infection in hospitalized patients with sepsis reduces risk of death at 90 days, suggests a new study published in JAMA Surgery.1

In this multicenter study, Reitz et al examined data of hospitalized adults with community-acquired sepsis from January 2013 to December 2017 with the aim to investigate the association between time to source control and patient outcomes. Source control procedures were instituted within 6 hours (early) or 6-36 hours (late) after the onset of sepsis. A total of 4962 patients, aged 62 years (mean) with sepsis were enrolled in the study. More than half of the participants were male; the mean Sequential Organ Failure Assessment (SOFA) score was 3.8 (out of 6) and the mean BMI was 30.9. The study subjects were followed-up to January 2019.

Control of infection at source occurred in 15.4 hours (median) after the sepsis had set in, while in 1315 patients, source control was done within 6 hours. Antibiotics were started in 1.5 hours (median). The crude 90-day mortality was comparable between the two groups: it was 14% (n = 177) in the early source control group and 15% (n = 529) in the late source control group. On multivariate analysis, after adjusting for severity of the sepsis severity, patient factors, availability of resources and physiologic stress of procedures, patients in the early source control group had 29% lower risk of 90-day mortality compared with the late source control group with adjusted odds ratio of 0.71. This relationship was more strongly observed in patients who underwent gastrointestinal and abdominal (aOR) and soft tissue procedures (aOR 0.72) in comparison to those who underwent orthopedic and cranial surgeries (aOR 1.33). The risk increased proportionately with each hour of delay in source control. At 3 hours, the mortality risk was reduced by 0.5%. But, the risk rose by 1% at 12 hours, by 3% at 24 hours and by 5% at 36 hours.

This study has shown that initiation of sepsis source control measures within 6 hours of its occurrence reduced mortality at 90 days in hospitalized patients with community-acquired sepsis. The mortality rose with every hour of delay. Hence, early recognition of a septic focus should be a priority followed by initiation of control measures such as debridement, drainage of abscess, removal of infected devices plus appropriate antibiotics in a timely manner to eliminate the source of infection to improve patient outcomes and reduces avoidable deaths.

References

  1. Reitz KM, et al. Association between time to source control in sepsis and 90-day mortality. JAMA Surg. 2022 Jul 13. doi: 10.1001/jamasurg.2022.2761.
  2. Medpage Today. July 14, 2022. https://www.medpagetoday.com/infectiousdisease/generalinfectiousdisease/99722.

 

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