RESUMO
BACKGROUND: Colistin-based combination therapy (CCT) is extensively used to treat infections due to carbapenem-resistant Gram-negative bacteria (CRGNB). There are no data available from India on the usefulness of combination therapy, especially in the oncology setup. The aim of this study was to analyze the clinical effectiveness of CCT over monotherapy in patients with CRGNB. MATERIALS AND METHODS: We conducted a retrospective, observational study of patients with CRGNB bloodstream infections in our oncology and bone marrow transplant center. RESULTS: Over a 3-year study period (2011-2014), we could identify 91 patients satisfying study criteria. There was no statistically significant difference in the 28-day mortality between monotherapy and combination therapy arms (mono n = 26, mortality 10 (38.5%); combination n = 65, mortality 28 (40%); P = 0.886). Neutropenic patients with Enterobacteriaceae bloodstream infections performed better with combination therapy (mono n = 7, mortality 6 (85.7%); combination therapy n = 22, mortality 8 (36.4%); P = 0.035). There was no significant difference in the 28-day mortality between the two treatment arms in other subgroups. CONCLUSION: Our study did not find CCT superior to colistin monotherapy in patients with CRGNB blood stream infections; except in the subgroup of neutropenic patients with Enterobacteriaceae bloodstream infections, where combination therapy performed better.
Assuntos
Antibacterianos/administração & dosagem , Colistina/administração & dosagem , Farmacorresistência Bacteriana/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Adulto , Idoso , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Carbapenêmicos , Quimioterapia Combinada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosAssuntos
Doenças do Esôfago/diagnóstico , Junção Esofagogástrica/fisiologia , Potenciais de Ação , Adulto , Doenças do Esôfago/fisiopatologia , Junção Esofagogástrica/diagnóstico por imagem , Junção Esofagogástrica/fisiopatologia , Feminino , Mucosa Gástrica , Refluxo Gastroesofágico/diagnóstico , Hérnia Diafragmática/diagnóstico , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pressão , RadiografiaRESUMO
A theory is proposed according to which diffuse esophageal spasm associated with carcinoma may be secondary to neural damage due to invasion by carcinoma without obstruction of the esophageal lumen. A case history is presented to support this theory.
