Background. Polymicrobial Klebsiella pneumoniae bloodstream infection (KP-BSI) has been reported to account for more than 10% of all KP-BSI, but few studies have characterized polymicrobial KP-BSI. Our study investigated the clinical characteristics, risk factors, and outcomes of polymicrobial KP-BSI by comparing with monomicrobial KP-BSI. Methods. We conducted a single-center retrospective cohort study of patients with KP-BSI from 1 January 2013 to 31 December 2018 and collected the clinical data by reviewing electronic medical records. Results. Of the 818 patients with KP-BSI recruited, 13.9% (114/818) were polymicrobial KP-BSI. The severity of illness in polymicrobial and monomicrobial KP-BSI was similar, while the rate of resistance to carbapenems was obviously higher in polymicrobial KP-BSI (78.1% vs. 65.6%, p = 0.009 ). On multivariate analysis, hospitalization in burn ward (odds ratio (OR) 6.13, 95% confidence interval (CI) 2.00-18.76, p = 0.001 ) and intensive care unit (OR 2.39, 95% CI 1.05-5.43, p = 0.038 ) was independently associated with polymicrobial KP-BSI. Gram-negative bacteria accounted for the highest proportion (68.9%) among copathogens of polymicrobial KP-BSI, whereas gram-positive bacteria (22.9%) and Candida (8.2%) ranked the second and the third, respectively, with Acinetobacter baumannii being the most common (23.0%). Patients with polymicrobial KP-BSI had longer hospital days after BSI onset and total hospital days than patients with monomicrobial KP-BSI (median (interquartile range (IQR)), 19 (5, 39) vs. 12 (6, 25), 37 (21, 67) vs. 29 (16, 53), respectively, p < 0.05 ). The mortality did not differ between polymicrobial KP-BSI and monomicrobial KP-BSI (all p > 0.05 ). Conclusions. It was observed that polymicrobial KP-BSI accounted for a significant proportion among all KP-BSI in the current study. Hospitalization in burn ward and intensive care unit was an independent risk factor for the development of polymicrobial KP-BSI. The patients with polymicrobial KP-BSI had a higher rate of carbapenem-resistant K. pneumoniae and might have poor outcomes compared to monomicrobial KP-BSI.

In China, hepatitis B virus (HBV) is the predominant cause of liver cirrhosis. 1 Decompensated cirrhosis (DeCi) is a major cause of mortality in HBV patients and can be accompanied by various complications. 2 Although several treatments are available, DeCi patients have a high-mortality rate. 2,3 An accurate and convenient predictor is therefore needed to determine the mortality risk for HBV-DeCi patients, and accordingly stratify and help improve clinical management to increase the survival rate.Electrolyte disturbances are a serious complication in patients with advanced cirrhosis. [4][5][6] Clinicians pay most attention to serum sodium and potassium levels, compared to other electrolytes. Some previous study indicated that low sodium parallel liver disease progression and serve as an independent predictor for mortality. [7][8][9] Model for End-Stage Liver Disease (MELD)-sodium score was developed in addition to the MELD score in the light of this finding and accepted as the gold standard in determination of liver transplant need. [10][11][12] On the other hand, potassium disorder is one of the commonest electrolyte derangements and the relationship between potassium levels and poor outcomes is U-shaped. 13,14 Both hypokalemia and hyperkalemia are consistently linked to unfavorable outcomes. 15 For instance, Uslan et al. 16 found that patients with higher potassium levels had higher mortality rates in cirrhotic patients. Moreover, Wallerstedt et al. 17 reported that potassium levels of ≥4.8 mmol/L died within 1 year in a cirrhotic patient with ascites. In addition, Cai and colleagues 18 indicated that hyperkalemia (>5.5 mmol/L) is an independent risk factor for the 90-day mortality

Objective. Currently, the choice between laparoscopic surgery and conventional laparotomy in the surgical treatment of acute cholangitis of severe type (ACST) is debatable. This study compared the clinical efficacy of these two surgical methods through a meta-analysis based on relevant clinical randomized controlled trials (RCT) on ACST. Methods. We systematically searched several databases (PubMed, Web of Science, Embase, China National Knowledge Infrastructure, and WangFang) for RCT on the surgical treatment of ACST between 2010 and 2022. Relevant data were extracted, and a meta-analysis was performed using the statistical software Stata 16.0. Results. From initial 1089 studies retrieved, 15 studies ( n = 1247 patients) were eligible. The total number of patients was 1247, of whom 635 were classified in the treatment group (laparoscopic surgery) and 612 patients in the control group (conventional laparotomy). This meta-analysis showed that compared with conventional laparotomy, laparoscopic surgery was associated with higher effective rate ( OR = 3.808 , 95% CI [2.383, 6.085], P < 0.001 ), lower incidence rate of complications ( OR = 0.192 , 95% CI [0.139, 0.265], P < 0.001 ), shorter operation duration ( SMD = − 3.274 , 95% CI [-4.503, -2.045], P < 0.001 ), and shorter postoperative hospital stay ( SMD = − 2.432 , 95% CI [-2.988, -1.877], P < 0.001 ). Further, the indicators of symptomatic relief (anus exhaust time, jaundice relief time, gastrointestinal function recovery time, and abdominal pain relief time) and inflammatory levels (white blood cell count, alanine aminotransferase, total bilirubin level, and high-sensitivity C-reactive protein level) in the treatment group were better than those in the control group. Conclusion. Laparoscopic surgery was associated with significant improvement in treatment efficiency, reduced risk of complications, and better treatment outcomes in patients with ACST.