Clinical controversies in abdominal sepsis. Insights for critical care settings

Sepsis is a deadly condition in which the outcome is associated with prompt and adequate recognition, intensive supportive care, antibiotic administration and source control. This last item makes abdominal sepsis a unique treatment challenge. Although pneumonia constitutes the leading cause of sepsis, abdominal sepsis has unique features that merit discussion. The abdomen may be implicated as the primary occult, secondary dependent or secondary independent source of infection. The major factors determining whether a patient will develop an uncomplicated infection or septic shock are: (1) patient susceptibility to infections, (2) age, and (3) comorbidities. The epidemiology of abdominal sepsis and its outcomes are difficult to assess due to the large clinical heterogeneity associated with this entity. Further complicating issues is the debate surrounding the effect of early source control (i.e. the "surgeon effect"). This review evaluates and summarizes the current approach to current challenges in patient care and which are the future research directions.