The biological rationale for source control is, indeed, a fascinating and challenging concept. Dr. Dunn in this introductory chapter has concisely iterated the major concepts and beliefs underlying the rationale for efficient and effective source control of infectious processes. A major implication of this overview is that primary surgical source control remains unproven by prospective randomized controlled trials (RCTs) and, as such, is in large part an empiric act of faith. In contrast, as cogently stated, there have been seemingly unlimited prospective randomized trials investigating the impact of improvements in the secondary components of source control, such as antibiotic selection. However, these secondary issues are not the critical issue in most cases. In fact, the ethical acceptability of such trials is based on the presumed near equivalence of expected outcomes. In most cases, adequate surgical debridement or mechanical elimination of infected tissues or contaminated devices will suffice for a cure. Unfortunately, there have been very limited Level I prospective RCTs to clearly define the true contribution and importance of mechanical source control to subsequent morbidity and mortality. In addition, the extent of debridement and approach (e.g., open vs. closed) have been minimally investigated. And, because of the ethical dilemma inherent in the use of a control group when mortality is the end point in these potential trials, they are unlikely to ever be performed.
KeywordsNecrotizing Fasciitis Source Control Intraabdominal Infection Infectious Focus Prospective RCTs
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