UMEM Educational Pearls

Title: Source control for intraabdominal infections leading to sepsis

Category: Infectious Disease

Keywords: sepsis, intrabdominal source, source control (PubMed Search)

Posted: 11/28/2025 by Robert Flint, MD (Updated: 11/29/2025)
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This article looks at source control as it relates to intrabdominal sources for sepsis.  Key take aways are:

  1. They believe surgery is the best service to mange these complex patients in consultation with medicine, heme-onc, transplant, EM, etc.  (Is that how it is done at your institution?)
  2. Source control should be both anatomic as well as physiologic (below)
  3. Timing of source control is controversial
  4. Antibiotic stewardship is still important even in these complex patients

Those at high risk of morbidity and mortality from intraabdominal infection associated sepsis include: 

Mild–moderate immune deficiency: Elderly (according to the age and general status of the patient), Malnourished, Diabetic, Burns, Trauma, Uremic, Active malignancy, not on chemotherapy, HIV with CD4+ count >200/mm3, Splenectomized, Severe immune deficiencyAIDS HIV with CD4+ count <200/mm3, Transplant (solid organ, bone marrow), High-dose steroids (more than 20 mg/day prednisone), Malignancy on chemotherapy, Neutrophil count <1,000/mm3

High-risk population (medical or surgical causes)Low serum albumin concentration Older age Obesity Smoking Diabetes mellitus Ischemia secondary to vascular disease or irradiation Prolonged or delayed/late procedures

References

Coccolini, Federico MD, PhD; Kirkpatrick, Andrew W. CD, MD, MHSc, FRCSC, FACS; Cremonini, Camilla MD, PhD; Sartelli, Massimo MD, PhD. Source control in intra-abdominal infections: What you need to know. Journal of Trauma and Acute Care Surgery 99(5):p 669-678, November 2025. | DOI: 10.1097/TA.0000000000004654