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OBJECTIVES: To compare mortalities in patients with sepsis due to biliary tract infections (BTIs) and due to infections from other sources, and to identify independent predictors of mortality in these patients. METHODS: This study was part of a community-acquired bloodstream infection (BSI) study that prospectively collected comprehensive clinical, laboratory, and outcome data from 937 consecutive patients with microbiologically documented BSI in the emergency department. BTI was the confirmed source of 145 of the 937 BSIs. We determined the independent prognostic factors by evaluating the correlation between 30-day mortality and various factors, for example, comorbidity, clinical severity, related hepatobiliary complication, and decompressive procedures. RESULTS: Patients with biliary sepsis had a high percentage of Gram-negative (88.3%), polymicrobial (26.9%), and anaerobic infections (6.9%). The 30-day overall mortality was 11.7%. Cox proportional hazard regression analysis disclosed five significant independent predictors: acute renal failure (hazard ratio, 95% confidence interval: 6.86, 6.02–25.5), septic shock (5.83, 4.36–15.64), malignant obstruction (4.35, 1.89–12.96), direct type hyperbilirubinemia (1.26, 1.1–1.42), and Charlson score ≥6 (1.57, 1.12–2.22). Compared with the remaining 792 patients in the source population, patients with bacteremic BTI had significantly better prognosis (log-rank test, P= 0.007). Adjusting for age, comorbidity, and clinical severity, BTI was still independently associated with better 30-day survival (0.25–0.76). CONCLUSIONS: Though the mortality rate in patients with bacteremic BTI is substantial, survival is better than in those with bacteremia from other sources. The main prognostic factors identified in this study may help clinicians recognize patients at high risk for early mortality so that they can give prompt, appropriate treatment. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the incidence, risk factors, foci, isolated organisms, and outcomes of infections in the survivors of out-of-hospital cardiac arrest (OHCA) within the first 7 days after resuscitation. Design and setting: Retrospective cohort study in the intensive care unit of a university hospital. Patients and participants: We enrolled 117 survivors of adult nontraumatic OHCA victims who survived more than 24 h between January 1999 and May 2004. We collected patients' demographics, the causes and initial electrocardiographic rhythm of cardiac arrest, and the process of cardiopulmonary resuscitation. The incidence, clinical presentations and outcomes of infections occurring in the first 7 days after resuscitation were evaluated. Variables were compared between the infected and noninfected patients. Measurements and results: Among our OHCA survivors asystole was the most common initial rhythm (66%). Eighty-three patients (71%) were found to have infection. Pneumonia was the most common infection (61%) followed by bacteremia (13%). Although the Gram-negative bacteria were responsible for most infections, the most commonly isolated organism was Staphylococcus aureus. The infection group had more patients with dementia and noncardiac causes of OHCA. The survival curves did not differ significantly between infection and noninfection groups. Conclusions: Infections were common in OHCA survivors during the first 7 days. The most common responsible organisms were Gramnegative bacteria, and the most commonly isolated organism was S. aureus. Infections in the early stage after return of spontaneous circulation did not change the hospital mortality and hospitalization duration. [ABSTRACT FROM AUTHOR]