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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 comparison of continuous interscalene block versus general anesthesia alone on the functional outcomes of the patients undergoing arthroscopic rotator cuff repair
    (Springernature, 2019) Gurger, Murat; Ozer, Ayse Belin
    PurposeThe aim of this prospective and randomized study was to compare the effects of general anesthesia to the combination of general anesthesia and continuous interscalene block on postoperative pain and functional outcomes in patients undergoing arthroscopic rotator cuff repair.MethodsThis study included a total of 85 patients aged 45-74 years, who were scheduled for elective arthroscopic rotator cuff repair. One group consists of patients who underwent only general anesthesia (GA, N=43), and the other group consists of patients who underwent a combination of continuous interscalene brachial plexus block and general anesthesia (CISB+GA, N=42). Pain levels of the patients were evaluated postoperatively by a visual analog scale. Shoulder function was evaluated preoperatively and postoperatively using the Constant score.ResultsPatients in the CISB+GA group had lower postoperative visual analog scores and less additional analgesic needs during the early postoperative period than those in the GA group. Constant scores of the patients in the CISB+GA group at postoperative week 6 were higher than those in the GA group. Evaluation of the functional outcomes at 6 months postoperatively showed that there were no significant differences between the two groups.ConclusionAlthough CISB significantly improved postoperative pain control and early (in the first 6 weeks) functional outcomes following arthroscopic rotator cuff repair, there was no significant difference between the CISB group and CISB+GA group at 6 months.Level of evidenceLevel II, Randomized Controlled Trial, Treatment Study.
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    Comparison of nutritional risk status assessment tools in predicting 30-day survival in critically ill COVID-19 pneumonia patients
    (K Faisal Spec Hosp Res Centre, 2022) Kasapoglu, Umut Sabri; Gok, Abdullah; Delen, Leman Acun; Ozer, Ayse Belin
    BACKGROUND: Few clinical studies have addressed nutritional risk assessment in patients with COVID-19 pneumonia admitted to the intensive care unit (ICU). OBJECTIVES: Assess the nutritional risk status of the critically ill COVID-19 pneumonia patients admitted to the ICU, and compare the nutritional risk screening tools. DESIGN: Medical record review SETTINGS: Tertiary critical care unit PATIENTS AND METHODS: We included adult (age >18 years) PCR-confirmed critically ill COVID-19 pneumonia cases admitted to the ICU between August 2020 and September 2021. Scoring systems were used to assess COVID-19 severity and nutritional status (mNUTRIC: modified Nutrition Risk in Critically Ill, NRS2002: Nutritional Risk Screening 2002). The 30-day mortality prediction performance of nutritional scores and survival comparisons between clinical and demographic factors were assessed. MAIN OUTCOME MEASURES: Compare the nutrition risk tools SAMPLE SIZE: 281 patients with a mean (SD) age of 64.3 (13.3) years; 143 (50.8%) were 65 years and older. RESULTS: The mean mNUTRIC score of the cases was 3.81 (1.66) and the mean NRS-2002 score was 3.21 (0.84.), and 101 (35.9%) were at high risk of malnutrition according to the mNUTRIC score and 229 (81.4%) according to the NRS 2002 score. In cases at high risk of malnutrition by the mNUTRIC score there was a greater need for invasive mechanical ventilation, vasopressors, and renal replacement therapy (P<.001 for all comparisons). The mNUTRIC score was superior to the NRS-2002 score in estimating 30-day mortality. In patients who died within 30 days, the mNUTRIC score and NRS-2002 score on the day of hospitalization were significantly higher (P<.001), and the proportion of patients with NRS2002 score >= 3 and mNUTRIC score >= 5 was significantly higher in the non-surviving group (P<.001). In addition, patients with a high risk of malnutrition had a shorter survival time. The mNUTRIC score was an independent and important prognostic factor for 30-day mortality, and patients with an mNUTRIC score >= 5 had a 6.26-fold risk for 30-day mortality in the multivariate Cox regression. CONCLUSION: One third of critical COVID-19 pneumonia cases hospitalized in the ICU due to acute respiratory failure have a high risk of malnutrition, and a high mNUTRIC score is associated with increased mortality. LIMITATIONS: Single center retrospective study.
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    Evaluation of the Reasons for the Cancellation of Elective Procedures at Level 3 University Hospital on the Day of Surgery
    (Elsevier Science Inc, 2020) Altun, Aysun Yildiz; Ozer, Ayse Belin; Aksoku, Berna Turhan; Karatepe, Umit; Kilinc, Mikail; Erhan, Omer Lutfi; Demirel, Ismail
    Purpose: Unexpected cancellations of planned elective procedures are a global problem for hospitals, causing a waste of hospital resources and manpower, and reduces the efficiency of hospitals. In this study, we tried to identify the causes of cancellations of elective procedures, and to examine the relationship between the causes. Design: A retrospective, descriptive single-center study. Methods: Nine thousand five hundred sixty-six elective procedures scheduled between January 2015 and December 2015 were retrospectively examined. Reasons for cancellation, the associated surgical clinic, and the day and season of the canceled procedures were recorded. Findings: Of the total 9,566 procedures, 496 (5.2%) were canceled. Of the cancellations, 31.3% were due to patient-related reasons, 29.2% because of inadequate anesthesia preparation, and 19% because of nonavailability of operating rooms. Conclusions: Cancellation of elective surgeries causes a waste of time and resources. Determining the reasons for cancellations to reduce cancellation rates is important for each hospital. (c) 2020 American Society of PeriAnesthesia Nurses. Published by Elsevier, Inc. All rights reserved.
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    The role of procalcitonin and C-reactive protein in predicting candidemia in reanimation intensive care unit and burn unit patients
    (2021) Altunisik Toplu, Sibel; Ersoy, Yasemin; Duman, Yucel; Parmaksiz, Emine Nalan; Ozer, Ayse Belin; Firat, Cemal
    Aim: Predicting the diagnosis of candidemia remains a challenge for physicians. It is difficult to distinguish candidemia from other potential conditions, especially in patients under intensive care. Although blood culture is the gold standard in diagnosis, there is continued search for other markers that may be used for early prediction.This study intended to assess if procalcitonin (PCT) and C-reactive protein (CRP) may be able to guide the course of Candidemia.Materials and Methods: The study included patients over the age of 18 admitted to the Reanimation Intensive Care Unit and Burn Unit between June 2018 and June 2019 whose blood cultures exhibited growth of Candida species (spp.). Moreover, the patients’ blood cultures were also tested for Gram negative and Grow positive bacterial growth that may accompany Candida species (spp.). For all patients, we recorded the PCT and CRP values three times.Results: This study examined sixty-six patients exhibiting growth of Candida spp. in their blood cultures; 42 (64%) cases had no accompanying bacterial growth in their culture (Group 1). In addition to the growth of Candida spp., the blood cultures showed that 16 patients also had Gram-negative bacteremia (Group 2), and eight patients had Gram-positive bacteremia (Group 3). When a cut-off value of 0.5 ng/mL was considered for all candidemia patients, the first assessments did not show a statistically significant high value (p=0.053). However, when evaluated with bacteremia, the first PCT results were higher in patients with Gram-negative bacteremia. PCT and CRP changes over time were statistically significant based on two-way repeated measures comparisons (p0.05). There was a positive correlation between PCT values and mortality (p0.01).Conclusion: We believe that the decrease in PCT and CRP values are helpful while clinically monitoring patients with candidemia.