title: Epidemiology and prognostic determinants of bacteraemic biliary tract infection.
abstract: OBJECTIVE
  To determine the epidemiology of bacteraemia due to biliary tract infection (BTI) and to identify independent predictors of mortality.
  
  
  METHODS
  This study was part of a bloodstream infection surveillance study that prospectively collected data on consecutive patients with bacteraemia in our institution from 1991 to 2010. BTI was the confirmed source of 1373 patients with bacteraemia, and the independent prognostic factors of 30 day mortality were determined.
  
  
  RESULTS
  The mean age of patients with biliary sepsis was 71 years (± 14 years). The most frequent comorbidities were biliary lithiasis and solid-organ cancer [484 cases (35%) and 362 cases (26%), respectively]. The BTI was healthcare-associated in 33% of patients. Shock and mortality accounted for 209 and 126 cases, respectively (15% and 9%). The most frequent microorganisms isolated were Escherichia coli (749, 55%), Klebsiella spp. (240, 17%), Enterococcus spp. (171, 12%), Pseudomonas aeruginosa (86, 6%) and Enterobacter spp. (63, 5%). There were 47 (3%) cefotaxime-resistant (CTX-R) E. coli or Klebsiella spp. Inappropriate empirical antibiotic treatment was an independent factor associated with mortality (OR 1.4, 95% CI 1.1-1.7). Inappropriate empirical treatment was more frequent in P. aeruginosa and CTX-R Enterobacteriaceae bacteraemia. These microorganisms were significantly more common in patients with previous antibiotic therapy, solid-organ cancer or transplantation and in healthcare-associated bacteraemia.
  
  
  CONCLUSIONS
  In patients with bacteraemic BTI, inappropriate empirical therapy was more frequent in P. aeruginosa and CTX-R Enterobacteriaceae infection and was associated with a higher mortality rate. In patients with bacteraemia due to BTI and solid-organ cancer or transplantation, healthcare-associated infection or previous antibiotic treatment, initial therapy with piperacillin/tazobactam or a carbapenem would be advisable.
authors.affiliation: Emergency Department and Infectious Diseases Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain. mortega@clinic.ub.es
authors.forename: M
authors.initials: M
authors.lastname: Ortega
authors.forename: F
authors.initials: F
authors.lastname: Marco
authors.forename: A
authors.initials: A
authors.lastname: Soriano
authors.forename: M
authors.initials: M
authors.lastname: Almela
authors.forename: J A
authors.initials: JA
authors.lastname: Martínez
authors.forename: J
authors.initials: J
authors.lastname: López
authors.forename: C
authors.initials: C
authors.lastname: Pitart
authors.forename: J
authors.initials: J
authors.lastname: Mensa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality*; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality*; D001660:Biliary Tract Diseases / Q000150:complications* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents