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    Epidemiology and Risk Factors of 28-Day Mortality of Hospital-Acquired Bloodstream Infection in Turkish Intensive Care Units: A Prospective Observational Cohort Study
    (2023) Erol, Cigdem; 37264485; AAJ-1219-2021
    Synopsis Objectives To uncover clinical epidemiology, microbiological characteristics and outcome determinants of hospital-acquired bloodstream infections (HA-BSIs) in Turkish ICU patients. Methods The EUROBACT II was a prospective observational multicontinental cohort study. We performed a subanalysis of patients from 24 Turkish ICUs included in this study. Risk factors for mortality were identified using multivariable Cox frailty models. Results Of 547 patients, 58.7% were male with a median [IQR] age of 68 [55-78]. Most frequent sources of HA-BSIs were intravascular catheter [182, (33.3%)] and lower respiratory tract [175, (32.0%)]. Among isolated pathogens (n = 599), 67.1% were Gram-negative, 21.5% Gram-positive and 11.2% due to fungi. Carbapenem resistance was present in 90.4% of Acinetobacter spp., 53.1% of Klebsiella spp. and 48.8% of Pseudomonas spp. In monobacterial Gram-negative HA-BSIs (n = 329), SOFA score (aHR 1.20, 95% CI 1.14-1.27), carbapenem resistance (aHR 2.46, 95% CI 1.58-3.84), previous myocardial infarction (aHR 1.86, 95% CI 1.12-3.08), COVID-19 admission diagnosis (aHR 2.95, 95% CI 1.25-6.95) and not achieving source control (aHR 2.02, 95% CI 1.15-3.54) were associated with mortality. However, availability of clinical pharmacists (aHR 0.23, 95% CI 0.06-0.90) and source control (aHR 0.46, 95% CI 0.28-0.77) were associated with survival. In monobacterial Gram-positive HA-BSIs (n = 93), SOFA score (aHR 1.29, 95% CI 1.17-1.43) and age (aHR 1.05, 95% CI 1.03-1.08) were associated with mortality, whereas source control (aHR 0.41, 95% CI 0.20-0.87) was associated with survival. Conclusions Considering high antimicrobial resistance rate, importance of source control and availability of clinical pharmacists, a multifaceted management programme should be adopted in Turkish ICUs.
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    A Prospective Clinical Study of Flow-Mediated Dilatation in Burn Injury
    (2014) Turk, Emin; Caliskan, Mustafa; Karagulle, Erdal; Aydogan, Cem; Oguz, Hakan; Kulaksizoglu, Sevsen; Yildirim, Erkan; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0003-4766-3373; https://orcid.org/0000-0002-8522-4956; https://orcid.org/0000-0003-1547-1297; https://orcid.org/0000-0002-7613-2240; https://orcid.org/0000-0002-9057-722X; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 24165669; AAJ-5609-2021; JYO-9455-2024; C-6247-2017; AAJ-5296-2021; AAI-8932-2021; ABI-3856-2020; AAE-1041-2021; AAJ-8097-2021
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    Coronary Flow Velocity Reserve in Burn Injury: A Prospective Clinical Cohort Study
    (2016) Caliskan, Mustafa; Turk, Emin; Karagulle, Erdal; Ciftci, Ozgur; Oguz, Hakan; Kostek, Osman; Moray, Gokhan; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0003-2498-7287; 0000-0002-8522-4956; 0000-0002-1901-5603; 0000-0003-4766-3373; 26284645; AAJ-8097-2021; AAE-1041-2021; C-6247-2017; AAA-3604-2019; AAJ-5609-2021
    The authors sought to evaluate coronary microvascular function and left ventricular diastolic dysfunction using transthoracic Doppler echocardiography in burn patients. In this study, 32 adult burn patients with partial or full-thickness scald burns that were hospitalized and treated were included. The control group was matched for age and sex and was composed of otherwise healthy volunteers. Transthoracic Doppler echocardiography examinations and simultaneous laboratory tests for cardiac evaluation were performed on the sixth month after burn injury as well as with the control group. High-sensitivity C-reactive protein levels were significantly higher in the burn patients than in controls (5.17 +/- 3.86 vs 2.42 +/- 1.78; P =.001). Lateral isovolumic relaxation time was significantly higher in the burn injury group than in the control group (92.7 +/- 15.7 vs 85.5 +/- 8.3; P =.03). Baseline coronary diastolic peak flow velocity of the left anterior descending artery was similar in both groups. However, hyperemic diastolic peak flow velocity and coronary flow velocity reserve (2.26 +/- 0.48 vs 2.94 +/- 0.47; P <.001) were significantly lower in the burn injury group than in the control group. Coronary flow velocity reserve was significantly and inversely correlated with high-sensitivity C-reactive protein, burn ratio, creatinine, and mitral A-wave max velocity. At the sixth month of treatment, burn patients had high-sensitivity C-reactive protein levels during this period, suggesting that inflammation still exists. In addition, subclinical coronary microvascular and left ventricular diastolic dysfunction can occur in burn patients without traditional cardiovascular risk factors. However, these results must be supported by additional studies.