Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI) tract. Their successful management typically requires intensive resource utilization, and despite the best therapies, morbidity and mortality remain high. One of the main issues required to appropriately treat IAI that differs from the other etiologies of sepsis is the frequent requirement to provide physical source control. Fortunately, dramatic advances have been made in this aspect of treatment. Historically, source control was left to surgeons only. With new technologies non-surgical less invasive interventional procedures have been introduced. Alternatively, in addition to formal surgery open abdomen techniques have long been proposed as aiding source control in severe intra-abdominal sepsis. It is ironic that while a lack or even delay regarding source control clearly associates with death, it is a concept that remains poorly described. For example, no conclusive definition of source control technique or even adequacy has been universally accepted. Practically, source control involves a complex definition encompassing several factors including the causative event, source of infection bacteria, local bacterial flora, patient condition, and his/her eventual comorbidities. With greater understanding of the systemic pathobiology of sepsis and the profound implications of the human microbiome, adequate source control is no longer only a surgical issue but one that requires a multidisciplinary, multimodality approach. Thus, while any breach in the GI tract must be controlled, source control should also attempt to control the generation and propagation of the systemic biomediators and dysbiotic influences on the microbiome that perpetuate multi-system organ failure and death. Given these increased complexities, the present paper represents the current opinions and recommendations for future research of the World Society of Emergency Surgery, of the Global Alliance for Infections in Surgery of Surgical Infection Society Europe and Surgical Infection Society America regarding the concepts and operational adequacy of source control in intra-abdominal infections.

中文翻译：

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急诊普通外科的源头控制：WSES、GAIS、SIS-E、SIS-A 指南

腹内感染 (IAI) 是最常见的全球医疗保健挑战之一，通常是由于胃肠道 (GI) 受到破坏而引发的。它们的成功管理通常需要密集的资源利用，尽管有最好的治疗方法，但发病率和死亡率仍然很高。与脓毒症其他病因不同的 IAI 需要适当治疗的主要问题之一是经常需要提供物理源控制。幸运的是，这方面的治疗已经取得了巨大的进步。从历史上看，源头控制只留给外科医生。随着新技术的出现，非手术微创介入治疗已被引入。另外，除了正式手术之外，长期以来一直提出开腹技术来帮助控制严重腹内脓毒症的感染源。具有讽刺意味的是，虽然源头控制的缺乏甚至延迟显然与死亡相关，但这个概念仍然没有得到很好的描述。例如，源控制技术甚至充分性的结论性定义尚未被普遍接受。实际上，源头控制涉及一个复杂的定义，涵盖多种因素，包括致病事件、感染细菌来源、当地细菌菌群、患者状况以及他/她最终的合并症。随着对脓毒症的系统病理学和人类微生物组的深远影响有了更深入的了解，充分的源头控制不再只是一个外科问题，而是需要多学科、多模式的方法。因此，虽然必须控制胃肠道的任何破坏，但源头控制还应尝试控制全身生物介质的产生和传播以及对微生物组的生态失调影响，从而使多系统器官衰竭和死亡永久化。鉴于这些日益增加的复杂性，本文代表了世界急诊外科学会、欧洲外科感染学会全球外科感染联盟和美国外科感染学会关于外科感染的概念和操作充分性的当前意见和未来研究建议。腹腔内感染的源头控制。