Control precoz del foco de infección en los pacientes atendidos en el servicio de urgencias: una revisión sistemática.

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Bibliographic Details
Title:	Control precoz del foco de infección en los pacientes atendidos en el servicio de urgencias: una revisión sistemática.
Alternate Title:	Early source control of infection in patients seen in the emergency department: a systematic review.
Authors:	Julián-Jiménez, Agustín¹ agustinj@sescam.jccm.es, Álvarez, Rocío Lorenzo², Gutiérrez Bueno, Victoria³, Sánchez Trujillo, Miranda³, García, Darío Eduardo⁴
Source:	Revista Española de Quimioterapia. ago2024, Vol. 37 Issue 4, p323-333. 11p.
Abstract (English):	Introduction and 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). Method. 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). [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	Introducción y objetivo. El término control de fuente (o del foco) abarca todas aquellas medidas físicas que pueden usarse para reducir el inóculo y modificar aquellos factores en el medio infeccioso que promueven el crecimiento microbiano o las defensas antimicrobianas extrañas del huésped. El objetivo principal de esta revisión sistemática (RS) es conocer y comparar si la detección y el control precoz del foco (en menos de 6 horas) en pacientes adultos atendidos en los SUH por infección grave o sepsis, en comparación con el no control del foco o el control del foco diferido (más de 12 horas) es más eficaz y seguro (mejora la evolución clínica, mortalidad, complicaciones, estancia hospitalaria o necesidad de ingreso en UCI). Método. Se realiza una revisión sistemática siguiendo la normativa PRISMA en las bases de datos de PubMed, Web of Sciencie, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase y ClinicalTrials.gov desde enero de 2000 hasta 31 de diciembre de 2023 sin restricción de idiomas y utilizando una combinación de términos MESH: "Source Control", "Early" "Infection OR Bacterial Infection OR Sepsis", "Emergencies OR Emergency OR Emergency Department" y "Adults". Se incluyeron estudios de cohortes observacionales. No se realizaron técnicas de metaanálisis, pero los resultados se compararon narrativamente. Resultados. Se identificaron un total de 1.658 artículos de los cuales se analizaron finalmente 2 que cumplían los criterios de inclusión y fueron calificados de calidad alta. Los estudios incluidos representan un total de 2.404 pacientes con 678 casos en los que se realizó una intervención para controlar el foco (28,20%). En el primer estudio, la mortalidad a los 28 días fue menor en los pacientes que se sometieron a una intervención para el control del foco (12,3% frente a un 22,5%; p<0,001), con HR ajustado de 0,538(IC 95%: 0,389-0,744; p<0,001). En el segundo, se demostró que el tiempo transcurrido desde que el paciente se valora por primera vez y se estabiliza hemodinámicamente, hasta el inicio de la cirugía se asoció con su supervivencia a los 60 días con un OR de 0,31 (IC 95%: 0,19-0,45; p<0,0001). De hecho, por cada hora de retraso se establece un OR ajustado de 0,29 (IC 95%: 0,16-0,47; p<0,0001). De forma que si la intervención se realiza antes de 2 horas a los 60 días el 98% de los pacientes continúan vivos, si se realiza entre la 2-4ª horas se reduce al 78%, si es entre la 4-6ª hora baja al 55%, pero si se realiza con más de 6 horas no habrá supervivientes a los 60 días. Conclusiones. Esta revisión muestra que el control del foco o fuente realizado tras la evaluación de los pacientes que acuden al SUH disminuye la mortalidad a corto plazo (30-60 días) y que sería recomendable implementar cualquier intervención de control de fuente requerida tan pronto como sea posible, idealmente con carácter precoz (antes de 6 horas). [ABSTRACT FROM AUTHOR]
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Database:	MedicLatina

Description
Abstract:	Introduction and 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). Method. 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). [ABSTRACT FROM AUTHOR]
ISSN:	02143429
DOI:	10.37201/req/027.2024