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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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    A clinical pharmacist's intervention on interaction between meropenem and valproic acid in paediatric inpatient clinic: A case report
    (Istanbul Univ, Fac Pharmacy, 2023) Cakir, Ahmet; Memis, Hasan; Ozdemir, Nesligul; Gun, Zeynep Ulku
    Background and Aims: Drug-drug interactions cause many complex drug events, especially adverse drug effects. It is known that drug interactions occur when meropenem and valproic acid are used together. It was aimed to back up existing research on the interaction of valproic acid. Methods: After an interaction had been suspected by the ward pharmacists, all of the patient's drugs were assessed via UpToDate (R) and Micromedex (R) databases and the interaction management was shared with the physician in charge. Results: The patient's serum valproic acid through level was in therapeutic range before meropenem administration. After the administration of meropenem, the patient's number of seizures increased and the serum trough level of valproic acid decreased to 4.3 mu g/ml. The valproic acid levels turned back to normal range after switching to a carbapenem antibiotic. Conclusion: Drug interactions are often encountered in paediatric patients and it is of critical importance in terms of seizure control. Because of the drug interaction between valproic acid and meropenem, one should avoid using these medications concomitantly. If that is impossible, daily serum valproic acid levels should be monitored with caution. Clinical pharmacists could increase the clinicians' awareness about drug-drug interactions.
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    Definition and prevalence over the years of polypharmacy in Turkey: A systematic review
    (Marmara Univ, 2023) Goncuoglu, Cansu; Ozdemir, Nesligul; Kara, Emre; Bayraktar-Ekincioglu, Aygin
    Identification of the trend of polypharmacy over the years is as valuable as determining the common definitions for taking precautions. The aim of this systematic review is to reveal the frequency, commonly used definitions and its change over the years of polypharmacy in Turkey. The reporting of this systematic review follows to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020) checklist. The MEDLINE and ULAKBIM TR Dizin databases were searched for relevant studies published until April, 2021. The studies conducted with patients >18 years in Turkey were included. A total of 361 articles were identified and 52 articles met the inclusion criteria. The most common definition of polypharmacy was 'combination of 5 or more drugs', followed by the definitions of 'two or more drugs' to '10 or more drugs; and its prevalence ranged between 9% and 95% in the studies. It was determined that the most commonly used definition of polypharmacy was 'the use of 5 or more drugs'. The prevalence of polypharmacy in Turkey was appeared in a wide range and found higher than the studies in the literature. The prevalence and trends of polypharmacy over the years should be carefully observed, inappropriate use of medicines should be examined and necessary precautions should be taken accordingly.
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    Factors associated with intention of clinical pharmacists and candidates to provide pharmaceutical care: application of theory planned behaviour
    (Bmc, 2023) Tecen-Yucel, Kamer; Ozdemir, Nesligul; Kara, Emre; Demirkan, Kutay; Sancar, Mesut; Okuyan, Betul
    Background Postgraduate education programs in clinical pharmacy have become widespread in Turkiye. This study aimed to identify factors associated with the intention of Turkish clinical pharmacists and candidates (who were graduates and students of postgraduate clinical pharmacy programs) to provide pharmaceutical care.Methods This prospective observational study was conducted between June 2021 and May 2022. After searching relevant studies, an expert panel discussion, translation, cultural adaptation, and a pilot study developed a 52-item Turkish scale based on the Theory of Planned Behavior (TBP). Cronbach alpha for each construct was calculated after an explanatory factor and test-retest reliability analysis. An online survey link was sent to all graduates or candidates of postgraduate clinical pharmacy programs in Turkiye. After univariate regression analysis, the multiple linear regression model was performed.Results One hundred fifty-six participants completed the survey (response rate: 59.1%). The Cronbach's alpha for attitude (9 items), subjective norm (6 items), perceived behavioural control (5 items), self-efficacy (6 items), intention (11 items) and past behaviour (15 items) were 0.945, 0.720, 0.751, 0.864, 0.934 and 0.955 respectively. The multiple linear regression analysis found a higher score of the subjective norm (p = 0.016), a higher score of self-efficacy (p < 0.001), younger age (p < 0.001) and having PhD (p = 0.038) were associated with increased intention score.Conclusions It was shown that higher self efficacy and positive beliefs of their peers and other healthcare professionals were associated with their higher intention score for providing pharmaceutical care. Younger age and having a PhD were other factors associated with their intention to provide pharmaceutical care.
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    Impact of pharmacist-led educational intervention on pneumococcal vaccination rates in cancer patients: a randomized controlled study
    (Springer, 2023) Ozdemir, Nesligul; Aktas, Burak Y. Y.; Gulmez, Ahmet; Inkaya, Ahmet C. C.; Bayraktar-Ekincioglu, Aygin; Kilickap, Saadettin; Unal, Serhat
    Purpose This study aimed to evaluate clinical pharmacist's contribution to the pneumococcal vaccination rate by providing education to cancer patients in hospital settings. Methods This study was conducted in 2 tertiary-care hospitals' medical oncology outpatient clinics. Patients over 18 years of age and diagnosed with cancer for less than 2 years, in remission stage, and have not previously received the pneumococcal vaccine were included. Patients were randomized to intervention and control groups. The intervention group was provided vaccination education and recommended to receive the PCV13 vaccine. The control group received routine care. Patients' knowledge about pneumonia/pneumococcal vaccine, Vaccine Attitude Examination Scale (VAX) score, and vaccination rates were evaluated at baseline and 3 months after the education. Results A total of 235 patients (intervention: 117, control: 118) were included. The mean age +/- SD was 57.86 +/- 11.88 years in the control and 60.68 +/- 11.18 years in the intervention groups. The numbers of correct answers about pneumonia/pneumococcal vaccine (p = 0.482) and VAX scores (p = 0.244) of the groups were similar at baseline. After the intervention, the median (IQR) number of correct answers in intervention group [10(3)] was higher than control group [8(4)] (p < 0.001). After the education, the total VAX score (mean +/- SD) was less in intervention group (33.09 +/- 7.018) than the control group (36.07 +/- 6.548) (p = 0.007). Three months after the education, 20.2% of the patients in the intervention and 6.1% in the control groups were vaccinated with pneumococcal vaccine (p = 0.003). Conclusions The pneumococcal vaccination rate in cancer patients has increased significantly by the education provided by a clinical pharmacist in hospital settings.