Postoperative Complications and Mortality of the Patients with Esophagectomy for Esophageal Carcinoma

Between 1970 and 1989, 154 patients underwent esophagectomy for esophageal cancer in our department. One hundred and twenty-one patients underwent esophageal resection and reconstruction and 14 had esopahgectomy alone without reconstruction. There were 26 operative deaths within 30 days after operation. However, the mortality rate was 29.1% during the 1970 to 1979 period, and 10.1% after 1980. Predominant postoperative complications were anastomotic leak, pneumnia, sepsis and recurrent laryngeal nerve paralysis. The rates of postoperative complications during 1970 to 1970, was 67.3% and was 43.3% after 1980. The rate of anastomotic leak was 45.4% in the former years, but it improved to 26.6% in the later period. To prevent the postoperative complications, careful perioperative management of the patients are essential

Polymyxin triple combinations against polymyxin-resistant, multidrug-resistant, KPC-producing klebsiella pneumoniae

Resistance to polymyxin antibiotics is increasing. Without new antibiotic classes, combination therapy is often required. We systematically investigated bacterial killing with polymyxin-based combinations against multidrug-resistant (including polymyxin-resistant), carbapenemase-producing Klebsiella pneumoniae. Monotherapies and double- and triple-combination therapies were compared to identify the most efficacious treatment using static time-kill studies (24 h, six isolates), an in vitro pharmacokinetic/pharmacodynamic model (IVM; 48 h, two isolates), and the mouse thigh infection model (24 h, six isolates). In static time-kill studies, all monotherapies (polymyxin B, rifampin, amikacin, meropenem, or minocycline) were ineffective. Initial bacterial killing was enhanced with various polymyxin B-containing double combinations; however, substantial regrowth occurred in most cases by 24 h. Most polymyxin B-containing triple combinations provided greater and more sustained killing than double combinations. Standard dosage regimens of polymyxin B (2.5 mg/kg of body weight/day), rifampin (600 mg every 12 h), and amikacin (7.5 mg/kg every 12 h) were simulated in the IVM. Against isolate ATH 16, no viable bacteria were detected across 5 to 25 h with triple therapy, with regrowth to ~2-log10 CFU/ml occurring at 48 h. Against isolate BD 32, rapid initial killing of ~3.5-log10 CFU/ml at 5 h was followed by a slow decline to ~2-log10 CFU/ml at 48 h. In infected mice, polymyxin B monotherapy (60 mg/kg/day) generally was ineffective. With triple therapy (polymyxin B at 60 mg/kg/day, rifampin at 120 mg/kg/day, and amikacin at 300 mg/kg/day), at 24 h there was an ~1.7-log10 CFU/thigh reduction compared to the starting inoculum for all six isolates. Our results demonstrate that the polymyxin B-rifampin-amikacin combination significantly enhanced in vitro and in vivo bacterial killing, providing important information for the optimization of polymyxin-based combinations in patients. Copyright © 2020 American Society for Microbiology. All Rights Reserved