Source control in bloodstream infections in patients with sepsis, septic shock, or requiring ICU admission: a scoping review with recommendations.....
Javier Amador-Castañeda, BHS, RRT, FCCM, PNAP
| Respiratory Care Practitioner | Author | Speaker | Veteran | ESICM Representative, North America
Tabah, A., De Waele, J., Ssi Yan Kai, N. et al. Source control in bloodstream infections in patients with sepsis, septic shock, or requiring ICU admission: a scoping review with recommendations for standardizing research. Intensive Care Med 51, 1462–1475 (2025). https://doi.org/10.1007/s00134-025-08026-5
Summary
This scoping review examines source control (SC) in bloodstream infections (BSI) among critically ill patients with sepsis, septic shock, or intensive care unit (ICU) admission, highlighting the substantial variability in definitions, interventions, timing, and adequacy reporting. The review analyzed 77 studies, finding significant methodological inconsistencies and an overrepresentation of catheter-related infections and candidemia. It emphasizes the urgent need for standardized reporting practices and consistent definitions to improve research quality, clinical decision-making, and ultimately patient outcomes.
Key Points
Clinical Significance of Source Control (SC): Bloodstream infections account for a significant proportion of ICU infections, frequently leading to sepsis and septic shock with mortality rates as high as 50%, underscoring the crucial role of SC interventions.
Objectives and Methodology: This review systematically evaluated existing literature for definitions, interventions, timing, adequacy, and outcomes related to SC in critically ill patients, proposing a standardized framework to improve consistency across future research.
Heterogeneity in Source Control Definitions: Definitions varied widely, with only a minority of studies providing comprehensive descriptions of SC. Most studies were limited to minimal or concise definitions, leading to potential misclassification and difficulty comparing results across studies.
Prevalence of Catheter-related Infections and Candidemia: Studies predominantly focused on catheter-related bloodstream infections and candidemia, reflecting a bias toward easily identifiable sources, thus neglecting other infection sources requiring more complex interventions.
Inconsistency in Timing of Source Control: The timing of SC interventions was inconsistently defined, ranging from time of blood culture collection to diagnosis or clinical suspicion, significantly limiting the generalizability and comparability of results.
Limited Assessment of Source Control Adequacy: Only a small percentage of studies adequately assessed the completeness or appropriateness of SC interventions, with most studies merely reporting the occurrence of procedures without evaluating their effectiveness or success.
Reported Outcomes and Clinical Impact: SC interventions were generally associated with improved outcomes; however, due to inconsistent reporting standards and methodologies, the true clinical impact remains difficult to quantify accurately.
Proposed Standardized Framework: The authors propose a detailed framework for defining and reporting SC, emphasizing clarity in describing patient populations, infection sources, SC procedures, intervention timing, and adequacy criteria, aiming to facilitate future research consistency.
Research Gaps and Recommendations: Significant research gaps were identified, notably the absence of robust randomized controlled trials and limited prospective multicenter observational data, emphasizing the need for future high-quality studies with standardized methodologies.
Future Directions and Clinical Implementation: Adoption of standardized definitions and reporting criteria could substantially improve research quality, enhance clinical decision-making, and potentially reduce morbidity and mortality associated with bloodstream infections in ICU patients.
Conclusion
The review identifies substantial methodological inconsistencies in SC research for critically ill patients with bloodstream infections, underscoring the need for standardized definitions and reporting. Implementing uniform criteria would enable more accurate evaluation of SC efficacy, enhancing clinical practices and patient outcomes.
Discussion Questions
What specific barriers currently prevent widespread implementation of standardized definitions and reporting criteria for source control interventions in bloodstream infection research?
How can clinical teams systematically integrate robust criteria for assessing SC adequacy into routine practice within diverse healthcare settings?
What role could international consensus statements or guidelines play in harmonizing SC practices across different regions and healthcare systems?
Javier Amador-Castañeda, BHS, RRT, FCCM, PNAP
Interprofessional Critical Care Network (ICCN)
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