Source control in bloodstream infections in patients with sepsis, septic shock, or requiring ICU admission: a scoping review with recommendations for standardizing research

Abstract

Background: Bloodstream infections (BSI) account for 15% of intensive care unit (ICU) infections, often causing sepsis with mortality rates up to 50%. Source control (SC), encompassing interventions to reduce bacterial or fungal load and prevent infection spread, is a critical yet under-investigated component of management.

Objectives: This scoping review examines SC definitions, interventions, timing, adequacy, and outcomes in BSI literature in patients with sepsis, septic shock, or ICU admission, and offers a proposal for standardized reporting.

Methods: We searched Medline, EMBASE, and Cochrane Library for studies on adult BSI addressing SC in populations with ≥ 50% ICU admission, ≥ 75% sepsis, or ≥ 25% septic shock, extracted and reported data following established guidance.

Results: From 2193 abstracts, 77 studies were included. SC was a primary objective in 21%, with others reporting it alongside other objectives. Candidemia (47%) and catheter removal (60%) studies were predominant, with 34% evaluating catheter removal regardless of BSI source. SC definitions varied from no definition (8%), minimal (7%), concise (17%), comprehensive (9%) definitions and catheter removal (60%). Forty-seven % reported proportions receiving SC for the entire cohort rather than those requiring SC. Timing was reported by 68%, with inconsistent definitions. SC adequacy was assessed by 3%. SC improved outcomes in 65%, with no reported harm.

Conclusion: SC research in severe BSI is limited by inconsistent definitions, poor SC efficacy assessments, and overrepresentation of catheter-source BSI and candidemia. Standardized reporting is essential to enhance evidence quality and optimize BSI management in critically ill patients.

Keywords: Bloodstream infection; Sepsis; Source; Source control.

Fig. 1

Measures of time to source control. Percentages calculated with 52 studies that assessed timing as a denominator. The figure displays the two components of time-to-source-control measurement: the various starting points ("time 0″) used by studies on the left, and whether studies defined the endpoint on the right. The lower part of the figure shows the proportion of studies using each definition, illustrating the substantial heterogeneity in how timing is measured across the literature. BC Blood Culture, ED Emergency department. Time to source control equals the interval between "time zero" and "time of SC”