Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Evaluation of Sepsis and Extensively Drug Resistant Infections in Deceased Critically Ill Patients(2022) Yesiler, Fatma Irem; Yazar, Cagla; Ordu, Irem Ulutas; Sahinturk, Helin; Yalcin, Tugba Yanik; Zeyneloglu, Pinar; 0000-0003-0159-4771; 0000-0002-0612-8481; AAJ-1419-2021; AAJ-4212-2021Objective: Sepsis due to the drug resistant infections is associated with the higher mortality rates in an intensive care unit (ICU). The aim of this study was to determine the demographic characteristics of the deceased critically ill patients, prevalence of the sepsis, and extensively drug resistant infectious-related (XDR) deaths within a year in the ICU. Materials and Methods: The data of patients who died in the ICU between January 1, 2019 and 2020 was retrospectively analyzed. Results: Out of 525 patients admitted to the ICU, 269 of them died. One hundred fifty-one of those deceased patients (56.1%) were in medical and 118 (43.9%) in the surgical ICU. Their mean age was 70.5 +/- 15 years and 126 (46.8%) of them were female. The mean Acute Physiology and Chronic Health Evaluation-II, Glasgow coma score, Sequential Organ Failure Assessment scores at ICU admission were 23.4 +/- 20.9, 9.8 +/- 4.4, and 8.2 +/- 3.6, respectively. A few reasons for the ICU admission were: respiratory failure (34.9%), neurologic dysfunction (19%), sepsis (17.8%), and cardiovascular failure (16%). Infection occurred in the 231 (85.9%) patients. Of the 109 (40.5%) deceased patients with the diagnosis of sepsis, 48 (40%) of them were admitted in the ICU with sepsis. The most common site of infection was the respiratory system (34.6%). Septic shock was seen in 170 patients (63.2%) and renal replacement therapy was needed in 61 (22.7%) of them. XDR developed in 34.6% of the deceased patients and was more frequent among those with an antibiotic usage before the ICU admission (p=0.02). The mean length of stay at hospital before the ICU admission and length of the ICU stay were 22 +/- 25.8 and 10.1 +/- 12.7 days, respectively. The number of the deceased medical patients were significantly higher than the surgical patients (p=0.018). Conclusion: The deceased critically ill medical patients were higher than the surgical patients. A total of 40% of the deceased critically ill patients were diagnosed with a sepsis, and one third of them had XDR infection. XDR infections were more frequent among the patients with an antibiotic usage before the ICU admission.Item Fifteen Years Of Central Catheter Applications And Outcomes In Intensive Care Patients: A Single-Center Pediatric Experience(2022) Silahli, Musa; Kesim, Cagri; https://orcid.org/0000-0003-0944-7178; https://orcid.org/0000-0002-8964-291X; 35100890; AAD-5996-2021Background: To investigate the clinical outcome of central line placement in the pediatric age group and to evaluate the risk factors for central line-associated bloodstream infection (CLABSI). Methods: We retrospectively examined the outcomes and CLABSI risk factors of pediatric patients aged 0-17 years admitted to intensive care units who had central catheters placed between January 2005 and December 2020. Results: Of the 2718 catheter admissions, 1502 catheter admissions were eligible for the regression and other outcome analyses. Fifty-seven percent of the study group were umbilical artery and vein catheters and 43% were other central catheter admissions, including ultrasound-guided catheter admissions. Logistic regression analysis showed us that right internal jugular vein (RIJV) (OR = 1.5, 95% CI = 1.15-2.02, p = 0.030) was the insertion site and ultrasound-guided interventional radiology catheter placement was the technique (OR = 1.7, 95% CI = 1.07-2.90, p = 0.024), duration of catheter stay (OR = 1.07, 95%CI = 1.06-1.08, p < 0.001), catheter placement in patients older than 2 years (OR = 2.42, 95% CI = 1.69-3.45, p < 0.001), were risk factors for CLABSI. Conclusion: Although CLABSI has variable risk factors, the most important risk factor seems to be the length of catheter stay.Item Effects of personality traits on severity of sepsis(2021) Pehlivanlar Kucuk, Mehtap; Kucuk, Ahmet Oguzhan; Komurcu, Ozgur; Dikmen, Yalim; Kadioglu, Mustafa; Uzan, Cagdas Alp; Ergin Ozcan, Perihan; Orhun, Gunseli; Unal Akdemir, Neslihan; Eroglu, Ahmet; Ilyas, Yasir; Zeyneloglu, Pinar; Sahinturk, Helin; Dai Ozcengiz, Dilek; Firat, Ahmet; Aydin, Davut; Ozlu, Tevfik; Pehlivanlar, Aysegul; Kirakli, Cenk; Acar Cinleti, Burcu; Gok, Funda; Yosunkaya, Alper; Aktas, Murat; Ozturk, Cagatay Erman; Ulger, Fatma; 0000-0003-0159-4771; 34581156; AAJ-1419-2021Introduction: The aim of this study was to reveal the effect of the individual's lifestyle and personality traits on the disease process in patients with sepsis and to have clinical predictions about these patients. Materials and Methods: The study was planned as a multi-center, prospective, observational study after obtaining the approval of the local ethics committee. Patients were hospitalized in different intensive care units. Besides demographics and personal characteristics of patients, laboratory data, length of hospital and ICU stay, and mortality was recorded. Two hundred and fifty-nine patients were followed up in 11 different intensive care units. Mortality rates, morbidities, blood analyses, and personality traits were evaluated as primary outcomes. Results: Of the 259 patients followed up, mortality rates were significantly higher in men than in women (p=0.008). No significant difference was found between the patients' daily activity, tea and coffee consumption, reading habits, smoking habits, blood groups, atopy histories and mortality rates. Examining the personal traits, it was seen that 90 people had A-type personality structure and 51 (56.7%) of them died with higher mortality rate compared to type B (p=0.038). There was no difference between personalities, in concomitant ARDS occurrence, need for sedation and renal replacement therapies. Conclusion: Among individuals diagnosed with sepsis/septic shock, mortality increased significantly in patients with A-type personality trait compared to other personality traits. These results showed that personal traits may be useful in predicting the severity of disease and mortality in patients with sepsis/septic shock.Item An Investigation into Bacterial Bloodstream Infections and Antibiotic Resistance Profiles in a Tertiary Hospital for a Ten-Year Period(2020) Mataj, Valbona; Guney, Mustafa; Sig, Ali Korhan; Uskudar-Guclu, Aylin; Albay, Ali; Bedir, Orhan; Baysallar, Mehmet; 0000-0002-1872-028X; 32776752; AAU-6196-2020Background: Bloodstream infections are one of the major causes of healthcare-associated morbidity and mortality. The present study aims to investigate the prevalence of the microorganisms isolated from blood cultures and to evaluate susceptibilities to antimicrobial agents in a tertiary center, Gulhane Training and Research Hospital, Ankara, Turkey. Methods: Blood cultures (BCs) were incubated in BACTEC/9050 (Becton Dickinson, USA) (2007 - 2015) and BacT/ALERT (bio-Merieux, France) (2014 - 2016) automated systems. Phoenix (TM) 100 system (Becton Dickinson, USA) (2007 - 2014), MALDI-TOF MS (Bruker, USA) (2015 - 2016) and conventional techniques were used for the identification of isolated microorganisms. According to CLSI (2007 - 2014) and EUCAST (2015 - 2016) criteria, Kirby-Bauer disc diffusion method, Phoenix (TM) system, and broth microdilution were applied for antimicrobial susceptibility testing. Two five-year periods were statistically compared regarding antibiotic resistance. Results: From the overall evaluated 31,380 BCs, 7,367 cultures (23.5%) were positive, excluding 503 BCs (6.4%), which were interpreted as contamination. Of 7,367 isolated microorganisms, 3,680 (50.0%) were gram-negative, 3,303 (44.8%) were gram-positive bacteria, and 384 (5.2%) were fungi. Coagulase-negative staphylococci (CoNS) were predominantly isolated (n = 2,075; 28.2%) among gram-positives. E.coli (n = 978; 13.3%) was the most frequently isolated gram-negative species. Between the first and the last five-year period, three genera (Enterococcus spp., Acinetobacter spp., Streptococcus spp.) showed significant differences when isolated, and only Enterococcus spp. showed increased isolation rates. In total, 90.3% of CoNS and 32% of S. aureus were methicillin-resistant. Only 75 strains of Enterococcus spp. (12.1%) were vancomycin-resistant. ESBL was detected in 40.6% of E. coli and 30.7% of Klebsiella spp. isolates. Carbapenem resistance showed a significant increase, particularly in K. pneumoniae (> 20%). Conclusions: The findings suggest that there was a threatening condition in antimicrobial resistance rates, especially for some antimicrobials between two periods. Although antimicrobial resistance is usually associated with MRSA, carbapenem resistance, ESBL, and VRE, the problem is far beyond these definitions, consisting of not just medicine, but also commercial companies, food industry, veterinarians, and other areas.Item Exogenous Recombinant Adiponectin Improves Survival in Experimental Abdominal Sepsis(2014) Salman, Bulent; Yilmaz, Tonguc Utku; Tezcaner, Tugan; Demir, Ebru fluoglu; Pasaoglu, Ozge Tugce; 25337421Background: Adiponectin, which has anti-inflammatory features, is an important substance in several metabolic mechanisms. Aims: The aim of this study is to evauate the effects of exogenous intraperitoneal administration of adiponectin on the survival, intrabdominal adhesion and inflammatory cytokine levels in an experimental sepsis model. Study Design: Animal experimentation. Methods: Ninety rats were divided into a control group, adiponectin group and sham group. A cecal puncture abdominal sepsis model was performed in the adiponectin and control groups. Every three hours, exogenous adiponectin was administrated to the adiponectin group. At the 3(rd) and 24(th) hours, 10 rats were sacrified in each group in order to measure plasma tumor necrosis factor-alpha (TNF-alpha), interleukin (IL) 10, soluble intracellular adhesion molecule (ICAM)-1, IL-6 and macrophage inhibitory factor levels, and the activity of nuclear factor (NF)-kappa B. The remaining rats were followed for survival. Results: The plasma levels of TNF-alpha, soluable ICAM-1, IL-6, and macrophage inhibitory factor were significantly higher in the control group than in the adiponectin and sham group (p<0.05). The increase in inflammatory cytokines with time was more prominent in the control group. The activity of NF-kappa B in the control group was higher than in the adiponectin group (p<0.05). The survival rate of the adiponectin group was higher than in the control group. Conclusion: Administration of exogenous adiponectin to the peritoneum in abdominal sepsis increased survival and decreased intrabdominal adhesions by decreasing the inflammatory response.