General, Emergency and Trauma Surgery Dept., Pisa University Hospital, Via Paradisia, 56124, Pisa, Italy.
General Surgery Dept., Macerata Hospital, Macerata, Italy.
World J Emerg Surg. 2023 Jul 21;18(1):41. doi: 10.1186/s13017-023-00509-4.
Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI) tract. Their successful management typically requires intensive resource utilization, and despite the best therapies, morbidity and mortality remain high. One of the main issues required to appropriately treat IAI that differs from the other etiologies of sepsis is the frequent requirement to provide physical source control. Fortunately, dramatic advances have been made in this aspect of treatment. Historically, source control was left to surgeons only. With new technologies non-surgical less invasive interventional procedures have been introduced. Alternatively, in addition to formal surgery open abdomen techniques have long been proposed as aiding source control in severe intra-abdominal sepsis. It is ironic that while a lack or even delay regarding source control clearly associates with death, it is a concept that remains poorly described. For example, no conclusive definition of source control technique or even adequacy has been universally accepted. Practically, source control involves a complex definition encompassing several factors including the causative event, source of infection bacteria, local bacterial flora, patient condition, and his/her eventual comorbidities. With greater understanding of the systemic pathobiology of sepsis and the profound implications of the human microbiome, adequate source control is no longer only a surgical issue but one that requires a multidisciplinary, multimodality approach. Thus, while any breach in the GI tract must be controlled, source control should also attempt to control the generation and propagation of the systemic biomediators and dysbiotic influences on the microbiome that perpetuate multi-system organ failure and death. Given these increased complexities, the present paper represents the current opinions and recommendations for future research of the World Society of Emergency Surgery, of the Global Alliance for Infections in Surgery of Surgical Infection Society Europe and Surgical Infection Society America regarding the concepts and operational adequacy of source control in intra-abdominal infections.
腹腔内感染 (IAI) 是全球最常见的医疗保健挑战之一，通常由胃肠道 (GI) 道破裂引起。成功治疗此类感染通常需要大量资源，尽管采用了最佳疗法，发病率和死亡率仍然很高。与其他败血症病因不同，IAI 治疗的一个主要问题是需要经常进行物理源控制。幸运的是，在这方面的治疗已经取得了显著进展。从历史上看，源控制仅由外科医生负责。随着新技术的出现，已经引入了非手术微创介入程序。或者，除了正式手术外，开放性腹部技术也长期以来被提议作为严重腹腔内败血症源控制的辅助手段。具有讽刺意味的是，尽管缺乏甚至延迟源控制显然与死亡相关，但这一概念仍未得到充分描述。例如，源控制技术甚至充足性的明确定义尚未被普遍接受。实际上，源控制涉及一个复杂的定义，包括几个因素，包括致病事件、感染源细菌、局部细菌菌群、患者状况及其最终合并症。随着对败血症系统病理生物学的深入了解以及人类微生物组的深远影响，充分的源控制不再仅仅是一个外科问题，而是需要多学科、多模式的方法。因此，虽然必须控制任何 GI 道的破裂，但源控制还应尝试控制全身性生物介质的产生和传播，以及对微生物组的失调影响，这些因素会导致多系统器官衰竭和死亡。鉴于这些复杂性的增加，本文代表了世界急诊外科学会、外科感染学会欧洲全球感染联盟和美国外科感染学会对腹腔内感染源控制概念和操作充足性的当前意见和未来研究建议。
