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

Abstract

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. 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. 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. 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. 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.