PDF(Pubmed)
Abstract：
OBJECTIVE: The term source (or focus) control encompasses all those physical measures that can be used to reduce the inoculum and modify those factors in the infectious medium that promote microbial growth or foreign antimicrobial defenses of the host. The main objective of this systematic review (SR) is to know and compare whether early detection and control of the focus (in less than 6 hours) in adult patients treated in the ED for severe infection or sepsis, compared to not controlling the focus or delayed focus control (more than 12 hours) is more effective and safer (improves clinical evolution, mortality, complications, hospital stay or need for ICU admission).
METHODS: A systematic review is carried out following the PRISMA regulations in the databases of PubMed, Web of Science, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase and ClinicalTrials.gov from January 2000 to December 31, 2023 without language restrictions and using a combination of MESH terms: \"Source Control\", \"Early\" \"Infection OR Bacterial Infection OR Sepsis\", \"Emergencies OR Emergency OR Emergency Department\" and \"Adults\". Observational cohort studies were included. No meta-analysis techniques were performed, but results were compared narratively.
RESULTS: A total of 1,658 articles were identified, of which 2 that met the inclusion criteria and were classified as high quality were finally analyzed. The included studies represent a total of 2,404 patients with 678 cases in which an intervention was performed to control the focus (28.20%). In the first study, 28-day mortality was lower in patients who underwent an intervention to control the focus (12.3% vs. 22.5%; P <0.001), with an adjusted HR of 0.538 (95% CI: 0.389-0.744; P<0.001). In the second, it was demonstrated that the time elapsed from when the patient was evaluated for the first time and was hemodynamically stabilized, until the start of surgery was associated with his survival at 60 days with an OR of 0.31 (95% CI: 0.19-0.45; P <0.0001). In fact, for each hour of delay an adjusted OR of 0.29 (95% CI: 0.16-0.47; P<0.0001) is established. So if the intervention is performed before 2 hours at 60 days, 98% of the patients are still alive, if it is performed between 2-4 hours it is reduced to 78%, if it is between 4-6 hours it drops to 55%, but if it is done for more than 6 hours there will be no survivors at 60 days.
CONCLUSIONS: This review shows that source control carried out after the evaluation of patients attending the ED reduces short-term mortality (30-60 days) and that it would be advisable to implement any required source control intervention as soon as possible, ideally early (within 6 hours).
METHODS: A systematic review is carried out following the PRISMA regulations in the databases of PubMed, Web of Science, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase and ClinicalTrials.gov from January 2000 to December 31, 2023 without language restrictions and using a combination of MESH terms: \"Source Control\", \"Early\" \"Infection OR Bacterial Infection OR Sepsis\", \"Emergencies OR Emergency OR Emergency Department\" and \"Adults\". Observational cohort studies were included. No meta-analysis techniques were performed, but results were compared narratively.
RESULTS: A total of 1,658 articles were identified, of which 2 that met the inclusion criteria and were classified as high quality were finally analyzed. The included studies represent a total of 2,404 patients with 678 cases in which an intervention was performed to control the focus (28.20%). In the first study, 28-day mortality was lower in patients who underwent an intervention to control the focus (12.3% vs. 22.5%; P <0.001), with an adjusted HR of 0.538 (95% CI: 0.389-0.744; P<0.001). In the second, it was demonstrated that the time elapsed from when the patient was evaluated for the first time and was hemodynamically stabilized, until the start of surgery was associated with his survival at 60 days with an OR of 0.31 (95% CI: 0.19-0.45; P <0.0001). In fact, for each hour of delay an adjusted OR of 0.29 (95% CI: 0.16-0.47; P<0.0001) is established. So if the intervention is performed before 2 hours at 60 days, 98% of the patients are still alive, if it is performed between 2-4 hours it is reduced to 78%, if it is between 4-6 hours it drops to 55%, but if it is done for more than 6 hours there will be no survivors at 60 days.
CONCLUSIONS: This review shows that source control carried out after the evaluation of patients attending the ED reduces short-term mortality (30-60 days) and that it would be advisable to implement any required source control intervention as soon as possible, ideally early (within 6 hours).
摘要：
目的：术语“来源（或重点）控制”包括可用于减少接种物并改变感染培养基中促进微生物生长或宿主外来抗菌防御的那些因素的所有物理措施。本系统评价（SR）的主要目的是了解和比较在ED治疗严重感染或败血症的成年患者中是否早期发现和控制病灶（在不到6小时内），与不控制焦点或延迟焦点控制（超过12小时）相比，更有效，更安全（改善临床进展，死亡率,并发症,住院或需要入住ICU)。
方法：根据PubMed数据库中的PRISMA规定进行系统审查，WebofScience,EMBASE,丁香花,科克伦,认识论，Tripdatabase和ClinicalTrials.gov从2000年1月至2023年12月31日，没有语言限制，并使用MESH术语的组合：“源代码控制”，\"早期\"\"感染或细菌感染或败血症\",“紧急情况或紧急情况或急诊科”和“成人”。纳入观察性队列研究。没有进行荟萃分析技术，但结果进行了叙述比较。
结果：共确定了1,658篇文章，其中符合纳入标准并被归类为高质量的2项进行最终分析。纳入的研究代表了总共2,404名患者，其中678例进行了干预以控制焦点（28.20％）。在第一项研究中，接受干预以控制焦点的患者的28天死亡率较低(12.3%vs.22.5%；P<0.001），调整后的HR为0.538（95%CI：0.389-0.744；P<0.001）。在第二个，结果表明，从患者首次接受评估并达到血流动力学稳定的时间，直到手术开始与60天的生存率相关,OR为0.31(95%CI:0.19-0.45;P<0.0001).事实上,每延迟一小时的校正OR为0.29(95%CI:0.16-0.47;P<0.0001)。因此，如果干预是在60天的2小时之前进行的，98%的病人还活着,如果在2-4小时之间执行，则减少到78％，如果在4-6小时之间，则下降到55％，但如果超过6小时，60天就不会有幸存者。
结论：本综述显示，在对参加ED的患者进行评估后进行的来源控制可降低短期死亡率（30-60天），建议尽快实施任何所需的来源控制干预措施，最好提前（6小时内）。
方法：根据PubMed数据库中的PRISMA规定进行系统审查，WebofScience,EMBASE,丁香花,科克伦,认识论，Tripdatabase和ClinicalTrials.gov从2000年1月至2023年12月31日，没有语言限制，并使用MESH术语的组合：“源代码控制”，\"早期\"\"感染或细菌感染或败血症\",“紧急情况或紧急情况或急诊科”和“成人”。纳入观察性队列研究。没有进行荟萃分析技术，但结果进行了叙述比较。
结果：共确定了1,658篇文章，其中符合纳入标准并被归类为高质量的2项进行最终分析。纳入的研究代表了总共2,404名患者，其中678例进行了干预以控制焦点（28.20％）。在第一项研究中，接受干预以控制焦点的患者的28天死亡率较低(12.3%vs.22.5%；P<0.001），调整后的HR为0.538（95%CI：0.389-0.744；P<0.001）。在第二个，结果表明，从患者首次接受评估并达到血流动力学稳定的时间，直到手术开始与60天的生存率相关,OR为0.31(95%CI:0.19-0.45;P<0.0001).事实上,每延迟一小时的校正OR为0.29(95%CI:0.16-0.47;P<0.0001)。因此，如果干预是在60天的2小时之前进行的，98%的病人还活着,如果在2-4小时之间执行，则减少到78％，如果在4-6小时之间，则下降到55％，但如果超过6小时，60天就不会有幸存者。
结论：本综述显示，在对参加ED的患者进行评估后进行的来源控制可降低短期死亡率（30-60天），建议尽快实施任何所需的来源控制干预措施，最好提前（6小时内）。
