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Öğe Can antibiotics affect the clinical features of patients with candidemia? The retrospective evaluation of 5 years of data in an intensive care unit(Bmj Publishing Group, 2023) Durmus, Mefkure; Kalkan, Serkan; Karahan, Sena Guzel; Bicakcioglu, Murat; Ozdemir, Nesligul; Gun, Zeynep Ulku; Ozer, Ayse BelinBackgroundCandidemia is an opportunistic infection of intensive care units (ICUs) and causes morbidity and mortality. Multiple antibiotic exposure was found to be an independent risk factor for mortality and non-albicans candidemia (NAC) in candidemia patients. AimThe aim of this study was to determine the relationship between antibiotics and clinical features of patients with candidemia, and to determine the independent risk factors for hospital stay >50 days, 30-day mortality in hospital, candidemia types, and septic shock in candidemia patients. MethodsPatients were evaluated retrospectively for 5 years. A total of 148 candidemia cases were detected and included in the study. Characteristics of cases were defined and recorded. The relationship between qualitative data was determined by the chi(2) test. Logistic regression analysis was used to determine the independent risk factors for hospital stay >50 days, 30-day mortality in hospital, candidemia types, and septic shock in candidemia patients. ResultsThe incidence of candidemia for 5 years was 4.5%. Candida parapsilosis was the most reported species with 65% (n=97). Linezolid and central venous catheters (CVC) were found to be independent risk factors for NAC. Carbapenems and cephalosporins were found in association to lower mortality. No antibiotics or characteristics were found to be independent risk factors for mortality. Some broad spectrum antibiotics and antibiotic combinations were found in relationship with hospital stay >50 days; however, none of them were found to be independent risk factors. Metisilin resistant staphylococcus aureus (MRSA) antibiotics, meropenem+linezolid piperacillin-tazobactam+fluoroquinolones and comorbidity were found in association with septic shock, although only piperacillin-tazobactam+fluoroquinolones and comorbidity were found to be independent risk factors for septic shock. ConclusionsThis study concluded that many antibiotics were safe for candidemia patients. However, clinicians should pay attention when prescribing linezolid or piperacillin-tazobactam and flouroquinolons concomitantly or sequentially for patients with candidemia risk factors.Öğe Daptomycin in combination with rosuvastatin induced blood creatine phosphokinase elevation(Bmj Publishing Group, 2021) Durmus, Mefkure; Bahcecioglu, Omer Faruk; Gok, SelimWe present the case of a 73-year-old male patient who was hospitalised with infective endocarditis, and report an elevation in his blood creatine phosphokinase (CPK) after receiving daptomycin and rosuvastatin therapy concomitantly. His previous home-scheduled medications included apixaban, ivabradine, metformin, rosuvastatin 20 mg, ginkgo biloba and trimetazidine, and he continued to receive these medications at the hospital. After three sets of blood cultures were taken, empirical treatment was started with vancomycin and gentamicin. On the eighth day of treatment, daptomycin and ampicillin-sulbactam were initiated due to ampicillin-resistant Enterococcus faecalis growth in the patient's blood culture. Daptomycin and rosuvastatin were discontinued on the 23rd day of treatment because of blood CPK elevation (2416 U/L) and linezolid was started instead of daptomycin. Six days after discontinuation of daptomycin and rosuvastatin, the CPK concentrations returned to normal range.Öğe EVALUATION OF DRUG-DRUG INTERACTIONS IN A LIVER TRANSPLANTATION UNIT(Springer, 2025) Guzel Karahan, Sena; Durmus, Mefkure; Gun, Zeynep Ulku[No abstract available]Öğe Factors Associated with Candidemia After Living Donor Liver Transplantation: A Case-Control Study(Mdpi, 2025) Durmus, Mefkure; Karahan, Sena Guzel; Akbulut, Sami; Yilmaz, Zeynep Burcin; Karabulut, ErtugrulBackground: Liver transplant recipients are highly susceptible to invasive fungal infections, particularly candidemia, due to intensive immunosuppressive therapy and postoperative complications. However, few studies have comprehensively examined postoperative antimicrobial and immunosuppressive factors in this context. Aim: This study aimed to identify perioperative and postoperative factors associated with the development of candidemia in living donor liver transplant (LDLT) recipients, with a particular focus on antimicrobial and immunosuppressive regimens during initial hospitalization. Methods: A retrospective case-control analysis was conducted involving 36 LDLT recipients who developed candidemia (candidemia group) and 72 matched controls without candidemia (non-candidemia group) between January 2019 and November 2023. Demographic and clinical variables were compared using univariate and multivariate logistic regression analyses to identify independent associations. A post hoc power analysis demonstrated a high statistical power (97.3%) to detect large effect sizes. Results: Univariate analysis revealed significant associations with prolonged intubation (p < 0.001), bile leaks (p < 0.001), relaparotomy (p < 0.001), chronic renal disease (p = 0.011), hepatocellular carcinoma (p = 0.011), and the use of antimicrobials including meropenem (p = 0.048), linezolid (p = 0.005), tigecycline (p = 0.045), third-generation cephalosporins (p = 0.003), anidulafungin (p < 0.001), fluconazole (p = 0.006), mycophenolate (p = 0.011), and total parenteral nutrition (TPN) (p = 0.049). CMV prophylaxis (p < 0.001) and CMV-PCR positivity (p = 0.015) were also significantly associated with candidemia. Multivariate logistic regression analysis identified prolonged intubation (OR = 1.07; p = 0.019), bile leaks (OR = 10.9; p = 0.002), anidulafungin use (OR = 4.70; p = 0.032), fluconazole use (OR = 35.8; p = 0.005), and absence of CMV prophylaxis (OR = 11.7; p = 0.021) as independent factors associated with increased odds of candidemia. Conclusions: Prolonged intubation, bile leaks, antifungal exposure, and lack of CMV prophylaxis are independently associated with higher odds of candidemia after LDLT. Targeted prophylaxis, prudent antimicrobial stewardship, and timely biliary intervention may reduce fungal morbidity and mortality in post-transplant patients.Öğe Is it safe to use remdesivir in combination with a combined p-glycoprotein and CYP3A4 inhibitor?(Bmj Publishing Group, 2021) Bahcecioglu, Omer Faruk; Gok, Selim; Durmus, Mefkure[Abstract Not Available]Öğe Is sitagliptin effective for the treatment of COVID-19?(Bmj Publishing Group, 2022) Memis, Hasan; Cakir, Ahmet; Durmus, Mefkure; Gok, Selim; Bahcecioglu, Omer Faruk[Abstract Not Available]Öğe Is there any difference between busulfan-cyclophosphamide and cyclophosphamide-busulfan in patients underwent allogeneic transplantation?(Elsevier, 2021) Bahcecioglu, Omer Faruk; Gok, Selim; Durmus, Mefkure; Sarici, Ahmet[Abstract Not Available]Öğe Prospective evaluation of medication-related problems and pharmacist interventions in liver transplant recipients(Frontiers Media Sa, 2026) Guzel Karahan, Sena; Durmus, Mefkure; Cakir, Ahmet; Gun, Zeynep Ulku; Yilmaz, SezaiBackground: Medication-related problems (MRPs) are a common patient safety issue among hospitalized individuals, often associated with reduced quality of life, increased healthcare costs, and higher mortality. Due to the chronic and complex nature of post-transplant care, liver transplant recipients are particularly vulnerable to MRPs. Clinical pharmacists play a critical role in identifying and resolving MRPs, thereby promoting the rational use of medications. The objective of this study was to characterize MRPs among liver transplant recipients and assess the clinical determinants associated with their occurrence. Method: This prospective study was conducted between 5 October 2023 to 31 April 2024 at the Liver Transplantation Institute. A total of 373 hospitalized liver transplant recipients in inpatient wards and intensive care units who were receiving at least one medication were included. Donors and patients not receiving any medication were excluded. The Pharmaceutical Care Network Europe (PCNE) classification system version 9.1 was used to categorize MRPs. Clinical and demographic characteristics of patients with and without MRPs were compared statistically and risk factors were analyzed through logistic regression. Results: Among the 373 patients included in this study, at least one MRP was identified in 311 patients, yielding 620 MRPs in total. A total of 620 interventions were proposed, of which 547 (88.2%) were accepted, while 73 (11.8%) were rejected. The leading causes of MRPs was dose selection (C3) was the most common cause (44.2%), followed by drug selection (C1) at 26.1%. The presence of at least one comorbidity and acute kidney injury were significant risk factors for the occurrence of MRPs (p < 0.05). Conclusion: To our knowledge, this is the first and most comprehensive study applying the PCNE v.9.1 method to liver transplant recipients hospitalized in both ward and intensive care unit settings. The most prevalent MRPs were related to treatment effectiveness, primarily caused by dose selection and drug selection. Clinical pharmacists and physicians should particularly focus on these aspects when reviewing transplant patients' medication regimens. The results achieved in this study suggest that clinicians should exercise caution when prescribing new medications to transplant recipients with at least one comorbidity and a history of acute kidney injury.Öğe The safety profile of favipiravir in COVID-19 patients with severe renal impairment(Wiley-Hindawi, 2021) Gok, Selim; Bahcecioglu, Omer Faruk; Durmus, Mefkure; Gun, Zeynep Ulku; Ersoy, Yasemin; Aytemur, Zeynep Ayfer; Ulutas, OzkanObjective The safety profile of favipiravir in patients with severe renal impairment has not been investigated and available data are insufficient. The study aimed to compare the incidence of favipiravir-associated adverse events amongst patients with varying renal function statuses. Methods Records of 921 patients who were hospitalised for COVID-19 and had received at least 5 days of favipiravir treatment were retrospectively evaluated and 228 patients were included in the study. Patients' age, sex, comorbidities, estimated glomerular filtration rate (eGFR) and haematological and biochemical values were recorded. The incidence of adverse events was compared with the age, sex, comorbidities and eGFR of the patients. Results The mean age of the patients was 59.3 +/- 15.6 years, and 38.2% of the patients were women. One hundred and thirty-one (57.5%) patients had experienced adverse events. These adverse effects consisted of ALT elevation (35.5%), AST elevation (21.5%), anaemia (16.2%), hyperuricaemia (10.5%), hepatocellular injury (9.2%), neutropenia (3.5%) and thrombocytopenia (2.6%). The incidence of adverse events was not significantly different when patients had eGFR >60 mL/min/1.73 m(2) or eGFR 30-60 mL/min/1.73 m(2) (P > .05), but significantly increased when the eGFR dropped to <30 (P < .05). The differences seen with hyperuricaemia and anaemia were significant (P < .05). Conclusion Even though favipiravir appeared to be well tolerated in the individuals with renal failure in this study, its use in this population remains a challenge that requires more research and analysis.Öğe THE ANTIHYPERTENSIVE DRUG REGIMEN PATTERNS AT THE ADMISSION TO THE INTENSIVE CARE UNIT DETECTED BY A CLINICAL PHARMACIST(Springer, 2025) Durmus, Mefkure; Karahan, Sena Guzel; Kucuk, Ahmet O.; Kucuk, Mehtap Pehlivanlar[No abstract available]Öğe The safety profile of trimethoprim-sulfamethoxazole regarding concomitant other drugs: a comparative analysis of adverse effects in a tertiary level adult intensive care unit(Bmc, 2025) Durmus, Mefkure; Aydin, Davut; Ustaomer, Sena; Guzel Karahan, Sena; Kucuk, Ahmet Oguzhan; Pehlivanlar Kucuk, MehtapBackground Trimethoprim-sulfamethoxazole (TMP-SMX) has been used clinically against many gram-positive and gram-negative bacteria, Pneumocystis, and certain protozoa. Beside its beneficial effects, it has many adverse reactions such as hyperkalemia, aplastic anemia, fulminant hepatic necrosis, hematological and neurological toxicity. Evaluation of TMP-SMX-related adverse reactions in intensive care unit (ICU) patients who generally with polipharmacy is lacking. We aimed to identify TMP-SMX-related adverse effects associated with mortality, and to determine independent predictors of this outcome, and factors associated with adverse reactions in critically ill patients who generally with polypharmacy undergoing TMP-SMX therapy. Methods This retrospective observational cohort study was conducted in a 16-bed adult medical ICU in T & uuml;rkiye. To assess the impact of various factors on TMP-SMX-related adverse reactions, patients were categorized into two independent groups based on the presence or absence of adverse effects. Additionally, to analyze changes in laboratory parameters associated with TMP-SMX therapy, paired comparisons were made between pre-therapy and post-therapy values within the same patients. Statistical analyses were conducted using IBM SPSS Statistics for Windows, Version 23.0. Results Serum creatinin (sCr) elevation, AST elevation, hyperbilirubinemia, thrombocytopenia, and metabolic acidosis were significantly associated with mortality, also sCr elevation was found to be an independent risk factor for mortality. Any of drugs or diseases were increased the risk of hyperkalemia concomitant TMP-SMX. ALT elevation were significantly associated with concomitantly teicoplanin. Endocrinologic disease or respiratory causes of ICU admission were found independent risk factors for AST elevation or acidosis respectively. Thrombocytopenia was associated with concomitantly colistin-echinocandin combination. Cardiovascular diseases concomitant TMP-SMX were found to be an independent risk factor for serum creatinin (sCr) elevation. There was no relationship between sCr elevation and TMP-SMX concomitantly colistimethate. Conclusions Physicians should pay attention when prescribing TMP-SMX to patients with cardiovascular diseases. Teicoplanin, colistin-echinocandin, piperacillin tazobactam and acyclovir should be administered carefully concomitantly TMP-SMX regarding liver enzyme elevation, thrombocytopenia and hyponatremia respectively.
