Source control is defined as all those physical measures necessary to eradicate a focus of infection as well as to control factors that maintain infection, promote microbial growth or impair host antimicrobial defences [1]. Sepsis is defined as infection plus systemic manifestations of infection. Severe sepsis is defined as sepsis plus sepsis-induced organ dysfunction or tissue hypoperfusion [2, 3]. The term source control was first used in the early twentieth century but regained attention over the past 10 years when a panel of experts was asked to provide guidelines for treating severe sepsis and septic shock during the Surviving Sepsis Campaign project. The campaign was promoted by the European Society of Intensive Care Medicine (ESICM), the International Sepsis Forum (ISF) and the Society of Critical Care Medicine (SCCM) to increase awareness of and improve outcomes in severe sepsis [4]. The last updated guidelines were published in 2008 [5]. Recently, the campaign provided “bundles” to help improve guideline outcomes. Bundles help to simplify the complex processes of a septic patient’s care. A bundle is a simple principle of care resulting from evidence-based practice guidelines that, when implemented as a group, have a significant effect on outcomes beyond implementing the individual elements alone. Each hospital can elaborate a sepsis protocol, but it must meet the standards created by the bundle [6].


Severe Sepsis Source Control Percutaneous Cholecystostomy Temporary Abdominal Closure Definitive Measure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Marshall JC, Lowry SF (1995) Evaluation of the adequacy of source control in clinical trials in sepsis. In: Sibbald WJ, Vincent JL (eds) Clinical trials for the treatment of sepsis. Springer, New York pp. 327–344Google Scholar
  2. 2.
    Levy MM, Fink MP, Marshall JC et al (2003) 2001 SCCM/ESICM/ACCP/ATS/ SIS International Sepsis Definitions Conference. Crit Care Med 31: 1250–1256PubMedCrossRefGoogle Scholar
  3. 3.
    Lever A, Mackenzie I (2007) Sepsis: definition, epidemiology, and diagnosis. BMJ 335 (7625): 879–883PubMedCrossRefGoogle Scholar
  4. 4.
    Marshall J, Maier RV, Jimenez M, Dellinger EP (2004) Source control in the management of severe sepsis and septic shock: an evidence-based review Crit Care Med 32 (11 Suppl): S513–526Google Scholar
  5. 5.
    Dellinger EP, Levy MM, Carlet JM et al (2008) Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med 34: 17–60PubMedCrossRefGoogle Scholar
  6. 6.
    Gullo A, Foti A, Murabito P et al (2010) Spectrum of sepsis, mediators, source control and management of bundles. Front Biosci (Elite Ed) 1; 2: 906–911CrossRefGoogle Scholar
  7. 7.
    Reijnen MM, Bleichrodt RP, van Goor H (2003) Pathophysiology of intraabdominal adhesion and abscess formation, and the effect of hyaluronan. Br J Surg 90 (5): 533–541PubMedCrossRefGoogle Scholar
  8. 8.
    Finlay-Jones JJ, Davies KV, Sturm LP et al (1999) Inflammatory processes in a murine model of intraabdominal abscess formation. J Leuk Biol 66: 583–587Google Scholar
  9. 9.
    Sprung CL, Bernard GR, Dellinger RP (2001) Guidelines for the management of severe sepsis and septic shock. Intensive Care Med 27 (Suppl 1): S1–S134Google Scholar
  10. 10.
    Angus DC, Linde-Zwirble WT, Lidicker J et al (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29: 1303–1310PubMedCrossRefGoogle Scholar
  11. 11.
    Jimenez MF, Marshall JC (2001) Source control in the management of sepsis. Intensive Care Med 27: S49–S6PubMedCrossRefGoogle Scholar
  12. 12.
    O’Grady NP, Alexander M, Dellinger EP et al (2002) Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR 51 (RR-10): 1–29PubMedGoogle Scholar
  13. 13.
    Bufalari A, Giustozzi G, Moggi L (1996) Postoperative intraabdominal abscesses: Percutaneous versus surgical treatment. Acta Chir Belg 96: 197–200PubMedGoogle Scholar
  14. 14.
    Moss RL, Musemeche CA, Kosloske AM (1996) Necrotizing fascitis in children: prompt recognition and aggressive therapy improve survival. J Pediatr Surg 31: 1142–1146PubMedCrossRefGoogle Scholar
  15. 15.
    Mier J, Leon EL, Castillo A et al (1997) Early versus late necrosectomy in severe necrotizing pancreatitis. Am J Surg 173: 71–75PubMedCrossRefGoogle Scholar
  16. 16.
    Hemming A, Davis NL, Robins RE (1991) Surgical versus percutaneous drainage of intraabdominal abscesses. Am J Surg 161: 593–595PubMedCrossRefGoogle Scholar
  17. 17.
    Betsch A, Wiskirchen J, Trubenbach J et al (2002) CT-guided percutaneous drainage of intraabdominal abscesses: APACHE III score stratification of 1-year results. Eur Radiol 12: 2883–2889PubMedGoogle Scholar
  18. 18.
    Benoist S, Panis Y, Pannegeon V et al (2002) Can failure of percutaneous drainage of postoperative abdominal abscesses be predicted? Am J Surg 184: 148–153PubMedCrossRefGoogle Scholar
  19. 19.
    Kok KY, Yapp SK (2000) Laparoscopic drainage of postoperative complicated intraabdominal abscesses. Surg Laparosc Endosc Percutan Tech 10: 311–313PubMedGoogle Scholar
  20. 20.
    Mughal MM, Bancewicz J, Irving MH (1986) Laparostomy: A technique for the management of intractable intraabdominal sepsis. Br J Surg 73: 253PubMedCrossRefGoogle Scholar
  21. 21.
    Schein M, Hirshberg A, Hashmonai M (1992) Current surgical management of severe intraabdominal infection. Surgery 112: 489–496PubMedGoogle Scholar
  22. 22.
    Schein M (1991) Planned re-operations and open management in critical intraabdominal infections: Prospective personal experience in 52 cases. World J Surg 15: 537–545PubMedCrossRefGoogle Scholar
  23. 23.
    Cinat ME, Wison SE, Din AM (2002) Determinants for successful percutaneous image-guided drainage of intra-abdominal abscess. Arch Surg 137: 845–849PubMedCrossRefGoogle Scholar
  24. 24.
    Ramundo J, Gray M (2009) Collagenase for enzymatic debridement: a systematic review. J Wound Ostomy Continence Nurs 36 (6 Suppl): S4–S11PubMedCrossRefGoogle Scholar
  25. 25.
    Attinger CE, Janis JE, Steinberg J et al (2006) Clinical approach to wounds: debridement and wound bed preparation including the use of dressings and wound- healing adjuvants. Plast Reconstr Surg 117 (7 Suppl): 72S–109SPubMedCrossRefGoogle Scholar
  26. 26.
    Whitaker IS, Twine C, Whitaker MJ et al (2007) Larval therapy from antiquity to the present day: mechanisms of action, clinical applications and future potential. Postgrad Med J 83 (980): 409–413PubMedCrossRefGoogle Scholar
  27. 27.
    Eneroth M, van Houtum WH (2008) The value of debridement and Vacuum-Assisted Closure (VAC) Therapy in diabetic foot ulcers. Diabetes Metab Res Rev 24 (Suppl 1): S76–S80PubMedCrossRefGoogle Scholar
  28. 28.
    Lalliss SJ, Stinner DJ, Waterman SM et al (2010) Negative pressure wound therapy reduces pseudomonas wound contamination more than Staphylococcus aureus. J Orthop Trauma 24 (9): 598–602PubMedCrossRefGoogle Scholar
  29. 29.
    Everts PA, Knape JT, Weibrich G et al (2006) Platelet-rich plasma and platelet gel: a review. J Extra Corpor Technol 38 (2): 174–187PubMedGoogle Scholar
  30. 30.
    Sganga G, Brisinda G, Castagneto M (2002) Trauma operative procedures: timing of surgery and priorities. In: Gullo A (ed) Critical care medicine. Springer, Heidelberg, pp. 447–467Google Scholar
  31. 31.
    Van Ruler O, Mahler CW, Boer KR et al, for the Dutch Peritonitis Study Group (2007) Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis: a randomized trial. JAMA 298(8):865–872PubMedCrossRefGoogle Scholar
  32. 32.
    Adkins AL, Robbins J, Villalba M et al (2004) Open abdomen management of intra-abdominal sepsis. Am Surg 70 (2): 137–140PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • G. Sganga
  • V. Cozza

There are no affiliations available

Personalised recommendations