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    Antibiotic consumption in Turkish hospitals; a multi-centre point prevalence study
    (Taylor & Francis Ltd, 2017) Guclu, Ertugrul; Ogutlu, Aziz; Karabay, Oguz; Demirdal, Tuna; Erayman, Ibrahim; Hosoglu, Salih; Turhan, Vedat
    This multi-centre study aimed to determine the antibiotic consumption in Turkish hospitals by point prevalence. Antibiotic consumption of 14 centres was determined using the DDD method. Among hospitalized patients, 44.8% were using antibiotics and the total antibiotic consumption was 674.5 DDD/1000 patient-days (DPD). 189.6 (28%) DPD of the antibiotic consumption was restricted while 484.9 (72%) DPD was unrestricted. Carbapenems (24%) and beta lactam/beta lactamase inhibitors (ampicillin-sulbactam or amoxicillin-clavulanate; 22%) were the most commonly used restricted and unrestricted antibiotics. Antibiotics were most commonly used in intensive care units (1307.7 DPD). Almost half of the hospitalized patients in our hospitals were using at least one antibiotic. Moreover, among these antibiotics, the most commonly used ones were carbapenems, quinolones and cephalosporins, which are known to cause collateral damage. We think that antibiotic resistance, which is seen at considerably high rates in our hospitals, is associated with this level of consumption.
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    The clinical features, treatment and prognosis of neutropenic fever and Coronavirus disease 2019 results of the multicentre teos study
    (Nature Research, 2024) Elik, Dilşah Başkol; Kaya, Şafak; Alkan, Sevil; Demirdal, Tuna; Şener, Alper; Kaya, Selçuk; Tunçcan, Özlem Güzel; Mermutluoğlu, Çiğdem
    This multicentre (22 centres in Turkey) retrospective cohort study aimed to assess the clinical outcomes of patients with neutropenic fever and SARS-CoV-2 positivity. Study period was 15 March 2020–15 August 2021. A total of 170 cases (58 female, aged 59 ± 15.5 years) that fulfilled the inclusion criteria were included in the study. One-month mortality rate (OMM) was 44.8%. The logistic regression analysis showed the following significant variables for the mentioned dependent variables: (i) achieving PCR negativity: receiving a maximum of 5 days of favipiravir (p = 0.005, OR 5.166, 95% CI 1.639–16.280); (ii) need for ICU: receiving glycopeptide therapy at any time during the COVID-19/FEN episode (p = 0.001, OR 6.566, 95% CI 2.137–20.172), the need for mechanical ventilation (p < 0.001, OR 62.042, 95% CI 9.528–404.011); (iii) need for mechanical ventilation: failure to recover from neutropenia (p < 0.001, OR 17.869, 95% CI 3.592–88.907), receiving tocilizumab therapy (p = 0.028, OR 32.227, 95% CI 1.469–707.053), septic shock (p = 0.001, OR 15.4 96% CI 3.164–75.897), and the need for ICU (p < 0.001, OR 91.818, 95% CI 15.360–548.873), (iv) OMM: [mechanical ventilation (p = 0.001, OR 19.041, 95% CI 3.229–112.286) and septic shock (p = 0.010, OR 5.589,95% CI 1.509–20.700)]. Although it includes a relatively limited number of patients, our findings suggest that COVID-19 and FEN are associated with significant mortality and morbidity.
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    İmmünsüpresif hastalarda HBV reaktivasyonunun önlenmesi için tenofovir alafenamid profilaksisi: Çok merkezli bir çalışma
    (Çukurova Üniversitesi Tıp Fakültesi, 2022) Akar, Şebnem Şenol; Sönmez, Ufuk; Demirdal, Tuna; Şen, Pınar; Özer, Deniz; Atalay, Sabri; Akyol, Deniz; Mermutluoğlu, Çiğdem; Çelen, Mustafa Kemal; Yamazhan, Tansu; Pullukçu, Hüsnü
    Amaç: İmmünsupresif tedavi altındaki yüksek riskli hastalarda hepatit B reaktivasyonu antiviral profilaksi ile önlenebilir. Antiviral seçiminde entekavir (ETC) veya tenofovir disoproksil fumarat (TDF) uzun zamandır kullanılabilmekteyken yakın zamanda kullanıma giren tenofovir alafenamid (TAF) güvenli yan etki profili ile iyi bir alternatif olmuştur. Bu çok merkezli geniş hasta sayılı çalışmada immünsüpresif hasta grubunda tenofovir alafenamidin (TAF) etkinliği ve güvenliği araştırılmıştır. Gereç ve Yöntem: Altı eğitim ve araştırma hastanesinin 1 Ocak 2019- 30 Eylül 2021 arasındaki kayıtları retrospektif olarak incelenerek immünsüpresif tedavi altında iken hepatit B için antiviral profilaksi başlanan ve en az 6 ay süre ile takip edilen hastalar çalışmaya dahil edilmiştir. Aldıkları immünsüpresif tedavi veya kemoterapiye ayrıca hepatit B serolojilerine göre risk grupları belirlenmiş, hepatit B reaktivasyon varlığı ve yan etkileri yönünden incelenmiştir. Bulgular: Yaş ortalaması 62.5±29 yıl olan 148 hastanın 85’i (%57.4) TAF, 63’ü (%42.6) tenofovir disoproksil fumarate (TDF) veya entekavir (ETC) ile profilaksi almaktaydı. %83.1’i HBsAg (-) antiHBc (+) %16.9’u HBsAg (+) olarak bulundu; kronik HBV’li hastaların %36 sının HBV DNA’sı saptanabilir düzeyin üzerindeydi. Çoğu (%69.6) hematolojik bir malinite nedeni ile immünsüpresif alırken %89.2’sinin aldığı tedavi yüksek riskli ilaç grubunda idi. Riskler açısından TAF ve diğer tedavileri alanlar arasında farklılık yoktu. Tedavi gruplarının hiçbirinde reaktivasyon ya da yan etkiye rastlanmadı. Sonuç: Kronik HBV tedavisinde olduğu gibi immünsüpresif tedavi alan bireylerde HBV reaktivasyonunun önlenmesinde de TAF en az TDF ve ETC kadar etkindir. TDF nin böbrek ve kemik yan etkilerinin TAF da görülmemesinin etkin ve güvenli bu tedavi seçeneğini immünsüpresif hastalarda öne çıkaracağını düşünmekteyiz.
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    Prognostic significance of transforming growth factor-beta-1 in chronic hepatitis C virus infection
    (Academic Journals, 2012) Deveci, Ozcan; Agalar, Canan; Demirdal, Tuna; Demirturk, Nese; Yula, Erkan; Tekin, Alicem; Kaygusuz, Sedat
    Interferon treatment in hepatitis C virus (HCV) infection is expensive and has various adverse effects. Some markers may help in making decision to stop or maintain the treatment. The aim of this study was to evaluate the effectiveness of serum transforming growth factor beta-1 (TGF-beta 1) in assessing outcome of interferon treatment in patients with HCV infection. Twelve patients with chronic HCV infections included in the study as treatment group [Treatment group: anti-HCV (+), HCV RNA (+)] and 12 patients with anti-HCV positive, HCV-RNA negative and normal liver function tests included as control group. All patients in the treatment group were administered with peginterferon and ribavirin for 24 weeks. HCV-RNA levels were determined by realtime-PCR and TGF-beta 1 levels were measured with ELISA methods, at the beginning and 24th week of the treatment. Mann-Whitney U Test and Wilcoxon Test were used to compare variables within and between groups. Median age and male/female ratios were 46 years and 5/7, and 45 years and 3/9 for treatment groups and control group, respectively. Although no difference was found in TGF-beta 1 levels at the beginning of the treatment between groups (p>0.05), significantly decreased TGF-beta 1 levels were observed following 24 weeks of interferon treatment in treatment group (p=0.015). Despite limited number of patients, our data suggested that, TGF-beta 1 levels may be used as a prognostic marker for effectiveness of interferon treatment in patients with hepatitis C virus infection.
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    Tigecycline in the treatment of multidrug-resistant Acinetobacter baumannii meningitis: Results of the Ege study
    (Elsevier Science Bv, 2018) Sipahi, Oguz Resat; Mermer, Sinan; Demirdal, Tuna; Ulu, Ashhan Candevir; Fillatre, Pierre; Ozcem, Selin Bardak; Kaya, Safak
    Objectives: In this study we retrospectively reviewed A. baumannii meningitis cases treated with tigecycline including regimens and evaluated the efficacy of tigecycline in the therapy. Patients and Methods: Study was performed in seven tertiary-care educational hospitals from five cities of Turkey and one center from France. We extracted data and outcomes of all adult (aged > 18) patients with culture proven A. baumannii meningitis treated with tigecycline including antibiotic therapy until April 2016. Results: A total of 23 patients (15 male and eight female) fulfilled our inclusion criteria. All Acinetobacter strains were carbapenem-resistant and susceptible to tigecycline. Six cases received tigecycline monotherapy while 17 received tigecycline including combination therapy (10 with colistin, 4 with netilmicin, 3 with amikacin, 4 with meropenem). Seven of 23 cases (30%) died during the tigecycline including therapy (1 in monotherapy, 4 in colistin, 2 in netilmicin, 1 amikacin, one case received tigecycline + netilmicin followed by tigecycline + colistin). Hence, overall end of treatment (EOT) success was 70%. However, since further 27% died due to additional nosocomial infections, overall clinical success (relieved symptoms at the EOT and one-month post therapy survival without any relapse or reinfection) decreased to 43%. Conclusion: We conclude that tigecycline may be an alternative in the salvage treatment of nosocomial multi drug-resistant Acinetobacter spp. meningitis. Acinetobacter spp. Meningitis.
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    Withdrawal of Staphylococcus aureus from intensive care units in Turkey
    (Mosby-Elsevier, 2013) Erdem, Hakan; Dizbay, Murat; Karabey, Selma; Kaya, Selcuk; Demirdal, Tuna; Koksal, Iftihar; Inan, Asuman
    Background: In the past, Staphylococcus aureus infections have displayed various patterns of epidemiologic curves in hospitals, particularly in intensive care units (ICUs). This study aimed to characterize the current trend in a nationwide survey of ICUs in Turkey. Methods: A total of 88 ICUs from 36 Turkish tertiary hospitals were included in this retrospective study, which was performed during the first 3 months of both 2008 (period [P] 1) and 2011 (P2). A P value <=.01 was considered significant. Results: Although overall rates of hospital-acquired infection (HAI) and device-associated infection densities were similar in P1 and P2, the densities of HAIs due to S aureus and methicillin-resistant S aureus (MRSA) were significantly lower in P2 (P < .0001). However, the proportion of HAIs due to Acinetobacter was significantly higher in P2 (P < .0001). Conclusions: The incidence of S aureus infections is declining rapidly in Turkish ICUs, with potential impacts on empirical treatment strategies in these ICUs. Copyright (C) 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.