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    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 Belin
    BackgroundCandidemia 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.
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    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, Ertugrul
    Background: 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.
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    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]