Purpose: To investigate antimicrobial resistance and risk factors for mortality of Klebsiella pneumoniae (KP) pneumonia in diabetics and nondiabetics. Patients and methods: A retrospective study was conducted among inpatients of KP pneumonia via electronic medical records in a territory hospital between January 2016 and June 2018. Antimicrobial resistance in KP pneumonia was compared between diabetics and nondiabetics. Independent risk factors for mortality in KP pneumonia were identified by univariate and multivariate logistic regression among diabetics and nondiabetics separately. Results: In this study, 456 patients with KP pneumonia were included. There were 156 cases with diabetes and 300 without diabetes. KP showed a lower antimicrobial resistance to a multitude of antimicrobials in pneumonia among diabetics than nondiabetics, namely aztreonam, cefotetan, sulperazone, meropenem, amikacin, tobramycin, sulfamethoxazole, and fosfomycin. In addition, carbapenem-resistant Klebsiella pneumoniae (CRKP) was more prevalent among nondiabetics than diabetics who were admitted to intensive care unit (ICU) (63.0% vs 45.1%, P = 0.038). Multivariable analysis showed that independent risk factors for in-hospital mortality (IHM) in KP pneumonia among diabetics differed from that among nondiabetics as well. Independent predictors for IHM of KP pneumonia among diabetics were male (OR: 5.89, 95% CI: 1.34–25.93, P = 0.019), albumin (ALB) < 35 g/L (OR: 7.00, 95% CI: 2.02–24.28, P = 0.002), bloodstream infection (BSI) (OR: 21.14, 95% CI: 3.18–140.72, P = 0.002), and invasive ventilation during hospitalization (OR: 8.00, 95% CI: 2.99–21.42, P < 0.001). In nondiabetics, independent predictors were higher CURB-65 score (OR: 1.92, 95% CI: 1.29–2.86, P = 0.001), CRKP (OR: 2.72, 95% CI: 1.07–6.90, P = 0.035), BSI (OR: 4.98, 95% CI: 1.34–18.50, P = 0.017), and ICU admission (OR: 4.06, 95% CI: 1.57–10.47, P = 0.004). Conclusion: In KP pneumonia, diabetics showed lower antimicrobial resistance and different independent risk factors for mortality compared with nondiabetics, in line with previous studies. Importantly, further attention should be paid on rational and effective antibiotic and supportive treatments in order to reduce mortality without aggravating antimicrobial resistance and metabolic damage among diabetics.
The study aimed to uncover the risk factors for the new defined pancreatic fistula (PF) and clinical related PF (CR-PF) after pancreaticoduodenectomy (PD) surgery and to evaluate the medico-economic effect of patients. A total of 412 patients were classified into two groups according to different criteria, PF and NOPF according to PF occurrence: CR-PF (grades B and C) and NOCR-PF (grade A) based on PF severity. A total of 28 factors were evaluated by univariate and multivariate logistic regression test. Hospital charges and stays of these patients were assessed. The results showed that more hospital stages and charges are needed for patients in PF and CR-PF groups than in NOPF and NOCR-PF groups (P < 0.05). The excessive drinking, soft remnant pancreas, preoperative albumin, and intraoperative blood transfusion are risk factors affecting both PF and CR-PF incidence. More professional surgeons can effectively reduce the PF and CR-PF incidence. Patients with PF and CR-PF need more hospital costs and stages than that in NOPF and NOCR-PF groups. It is critical that surgeons know the risk factors related to PF and CR-PF so as to take corresponding therapeutic regimens for each patient.
Purpose Bile duct injury (BDI) is a catastrophic complication of cholecystectomy, and misidentification of the cystic anatomy is considered to be the main cause. Although several techniques have been developed to prevent BDI, such as the “critical view of safety”, the infundibular technique, the rates remain higher during laparoscopic cholecystectomy (LC) than during open surgery. We, here, propose a practical new strategy for ductal identification, that can help to prevent laparoscopic bile duct injury. Methods A retrospective study of 5539 patients who underwent LC from March 2007 to February 2019 at a single institution was conducted. The gallbladder infundibulum was classified by its position located on an imaginary clock with the gallbladder neck as the center point of the dial, 3-o’clock position as cranial, 6-o’clock as dorsal, 9-o’clock as caudal, and 12-o’clock as ventral, as well as the axial position. Patient demographics, pathologic variables and infundibulum classification were evaluated. Detailed analysis of ductal identification based on gallbladder infundibulum position was performed in this study. All infundibulum positions were recorded by intraoperative laparoscopic video or photographic images. Results All the patients successfully underwent LC during the study period. No conversion or serious complications such as biliary injury occurred. Gallbladders with infundibulum of 3-o’clock position, 6-o’clock position, 9-o’clock position, 12-o’clock position, axial position were 12.3%, 23.4%, 28.0%, 4.2%, and 32.1%, respectively. The 3-o’clock and 12-o’clock position were pitfalls that might cause biliary injury. Conclusion The gallbladder infundibulum as a navigator is useful for ductal identification to reduce BDI and improve the safety of LC.
The transverse fracture pattern is the most common pattern among patellar fractures. Although open reduction with internal fixation using tension band wiring is the common method for treating the majority of transverse patellar fractures with displacement, this approach has distinct disadvantages, including damage to the blood supply and general post-operative complications. Therefore, minimally invasive techniques have been introduced to overcome these problems. In the present review, the advanced surgical procedures using Kirschner wires with cerclage, cannulated screw optioning of supplementary cerclage tension banding, external fixation and combined tension-band braided polyester with a suture button, as well as post-operative rehabilitation, were described in detail. To improve any malreduction due to poor control of the patellar articular surfaces, the utility of arthroscopically assisted techniques was also presented. The advantages and disadvantages of the above-mentioned techniques were also discussed. Minimally invasive techniques were demonstrated to achieve improved knee joint mobility, shorter hospitalization and more favorable outcomes. Such techniques decrease the risk of complications compared to conventional open reduction and fixation. Although specific problems associated with each technique still require to be resolved to reduce late complications, such as the onset of patella-femoral arthritis, minimally invasive techniques remain an alternative option for treating transverse patellar fractures.
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