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  • Küçük Resim
    Öğe
    Bir Üniversite Hastanesinde yoğun bakım ünitelerinde nozokomiyal pnömoni risk faktörleri
    (2013) Akkoyunlu, Yasemin; Öztoprak, Nefise; Aydemir, Hande; Pişkin, Nihal; Çelebi, Güven; Ankaralı, Handan; Akduman, Deniz
    Amaç: Nozokomiyal pnömoni (NP) yoğun bakım ünitesi (YBÜ)'nde en sık karşılaşılan nozokomiyal enfeksiyondur. NP gelişen hastalardaki risk faktörlerinin değerlendirilmesi YBÜ ihtiyacı olan hastalar için yol gösterici olabilir. Bu çalışmanın amacı YBÜ'de gelişen NP risk faktörlerinin belirlenmesidir. Yöntemler: Altı aylık süre içerisinde, bir üniversite hastanesinin YBÜ'lerinde 48 saatten uzun kalan hastalar çalışmaya alındı. Toplam olarak 304 hasta prospektif izlenirken, bu hastaların NP gelişen 78'i NP grubunu oluşturdu. Herhangi bir enfeksiyon gelişmeyen hastalar ise kontrol grubu olarak tanımlandı. Tek değişkenli analiz ile NP risk faktörü olabileceği düşünülen veya saptanan değişkenler çok değişkenli lojistik regresyon analizi ile incelendi. Bulgular: 304 hastanın 78'inde (% 25,6) NP gelişti. Çok değişkenli analiz ile ileri yaş (odds ratio [OR] 1, %95 güven aralığı [CI] 1,00-1,06), YBÜ'de yatış süresi (OR 1,3, % 95 CI 1,17-1,39), YBÜ öncesi enfeksiyon varlığı (OR 6,7, %95 CI 1,52-29,94), kan ürünü transfüzyonu (OR 4, %95 CI 1,43-11,46) ve YBÜ yatışından önceki 2 hafta içerisinde antibiyotik kullanım öyküsü (OR 3,3, %95 CI 1,28-8,48) NP için bağımsız risk faktörleri olarak tanımlandı. Ayrıca, NP gelişen hastaların ortalama APACHE II skoru (16,76,7) kontrol grubundan anlamlı olarak yüksek bulundu (11,58,1; p
  • Küçük Resim
    Öğe
    Evaluation of Bone Mineral Density and Bone Turnover Markers in Patients with non-Cirrhotic Chronic Hepatitis B
    (Ortadogu Ad Pres & Publ Co, 2012) Çelebi, Güven; Sarıkaya, Selda; Özdolap, Şenay; Mungan, Görkem; Ankaralı, Handan; Çelik, Yavuz; Akduman, Deniz
    Objective: To evaluate the bone mineral density (BMD) and the biochemical markers of bone turnover in non-cirrhotic chronic hepatitis B patients. Material and Methods: We compared 18-65 years old non-cirrhotic chronic hepatitis B patients and healthy controls for BMD and biochemical markers of bone turnover. BMD was measured at the lumbar spine and the left hip using DXA. Results: There were 31 hepatitis B patients (19 males, 12 females) and 72 healthy controls (56 males, 16 females) in the study. Their mean age was 37.4 +/- 10.0 years in the study group and 38.5 +/- 7.1 years in the controls. There were no differences between the two groups for the mean BMD levels and T scores. However, left hip BMD and T scores were significantly lower in male patients with chronic hepatitis B infection when compared to males in the control group. Serum calcium, phosphate, osteocalcine, intact parathyroid hormone, deoxypyridinoline and 25-hydroxycholecalciferol levels did not differ between the groups. Conclusion: In our study, left hip BMD and T scores were found to be significantly lower in the male patients with chronic hepatitis B infection when compared to males in the control group, however a significant difference was not detected when all cases were compared with the control group. Therefore, we suppose that further studies on a larger population are needed in this issue.
  • Küçük Resim
    Öğe
    Piperacillin-tazobactam Versus Carbapenem Therapy With and Without Amikacin as Empirical Treatment of Febrile Neutropenia in Cancer Patients: Results of an Open Randomized Trial at a University Hospital
    (Oxford Univ Press, 2010) Öztoprak, Nefise; Pişkin, Nihal; Aydemir, Hande; Çelebi, Güven; Akduman, Deniz; Keskin, Ayşegül Seremet; Ankaralı, Handan
    Empirical beta-lactam monotherapy has become the standard therapy in febrile neutropenia. The aim of this study was to compare the efficacy and safety of piperacillin-tazobactam versus carbapenem therapy with or without amikacin in adult patients with febrile neutropenia. In this prospective, open, single-center study, 127 episodes were randomized to receive either piperacillin-tazobactam (4 x 4.5 g IV/day) or carbapenem [meropenem (3 x 1 g IV/day) or imipenem (4 x 500 mg IV/day)] with or without amikacin (1 g IV/day). Doses were adjusted according to renal function. Clinical response was determined during and at completion of therapy. One hundred and twenty episodes were assessable for efficacy (59 piperacillin-tazobactam, 61 carbapenem). Mean duration of treatment was 14.8 +/- 9.6 days in the piperacillin-tazobactam group and 14.7 +/- 8.8 days in the carbapenem group (P > 0.05). Mean days of fever resolution were 5.97 and 4.48 days for piperacillin-tazobactam and carbapenem groups, respectively (P > 0.05). Similar rates of success without modification were found in the piperacillin-tazobactam (87.9%) and in the carbapenem groups (75.4%; P > 0.05). Fungal infection occurrence rates were 30.5 and 18% in piperacillin-tazobactam and carbapenem groups, respectively (P = 0.05). Antibiotic modification rates were 30.5 and 13.1% (P = 0.02) and the addition of glycopeptides to empirical antibiotic regimens rates were 15.3 and 44.3% for piperacillin-tazobactam and carbapenem groups, respectively (P = 0.001). The rude mortality rates were 14% (6/43) and 29.3% (12/41) in piperacillin-tazobactam and carbapenem groups, respectively (P = 0.08). The effect of empirical regimen of piperacillin-tazobactam regimen is equivalent to carbapenem in adult febrile neutropenic patients.