ICU · Infection / surgical

Source Control — The Fourth Pillar of Sepsis (Drainage, Debridement, Device)

Also known as Source control · The 4 tenets · Drainage · Debridement · Device removal · Definitive repair · Percutaneous drainage · Step-up approach · Infected necrosis · Source control before antibiotics fade

Source control is the set of physical measures that eliminate the microbial source, reduce the bacterial inoculum, and restore organ function — a core pillar of sepsis alongside antibiotics and resuscitation. The four tenets are drainage (abscess, empyema), debridement (necrotic tissue), device removal (infected central line, catheter, prosthetic), and definitive repair (perforation closure, obstruction relief). Timing is early — within 6 to 12 hours for severe sepsis, immediate for necrotising infection — because delayed source control worsens mortality: source control before the antibiotics fade. Modalities run from IR percutaneous drainage (first-line for accessible collections), through endoscopic ERCP for the biliary tree, to open surgery for diffuse peritonitis, with the step-up approach standard for infected pancreatic necrosis. STOP-IT established that four days of antibiotics suffice after adequate source control.