Identifying sources of infection and establishing source control is an essential component of the workup and treatment of sepsis. Investigation with history, physical examination, laboratory tests, and imaging can in identifying sources of infection. All organ systems have the potential to develop sources of infection. However, there are inherent difficulties presented by some that require additional diligence, namely, urinalysis, chest radiographs, and intraabdominal infections. Interventions include administration of antibiotics and may require surgical or other specialist intervention. This is highlighted by the Surviving Sepsis Campaign with specific recommendations for time to antibiotics and expeditious time to surgical source control.
Key points
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Rapid time to antibiotics is important, but they may not themselves provide adequate source control.
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A broad differential is essential in septic patients, because the source of infection may not immediately identifiable.
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Typical workup strategies in sepsis such as the chest radiograph and urinalysis can be inherently misleading.
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Intraabdominal sources of sepsis are difficult to diagnose, treat, and frequently require rapid surgical intervention.
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