Person: KÜÇÜKDEMİRCİ KAYA, PINAR
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KÜÇÜKDEMİRCİ KAYA
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PINAR
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Publication Sepsis episodes caused by pressure injuries in critical illness: A retrospective observational cohort study(Hmp, 2023-11-01) Kaya, Pınar Küçükdemirci; Kaya, Murad; Girgin, Nermin Kelebek; Kahveci, Ferda S.; Akalın, Emin Halis; İsçimen, Remzi; KÜÇÜKDEMİRCİ KAYA, PINAR; KAYA, MURAD; KELEBEK GİRGİN, NERMİN; KAHVECİ, FERDA ŞÖHRET; AKALIN, EMİN HALİS; İŞÇİMEN, REMZİ; Tıp Fakültesi; 0000-0002-8428-8245; 0000-0002-5882-1632; JGB-6637-2023; CYJ-4124-2022; DTU-3148-2022; IMY-6211-2023; AAU-8952-2020; DWL-9897-2022BACKGROUND: Critically -ill patients (CIPs) with pressure injuries (PIs) may develop bloodstream infections (BSIs). PURPOSE: To identify predisposing factors and discuss diagnosis and management of sepsis -related PIs in CIPs. METHODS: The records of CIPs in the intensive care unit (ICU) between January 1, 2014, and January 1, 2020, with PI with sepsis -diagnoses and with different site cultures that were positive concurrent with bloodstream -cultures were retrospectively reviewed. RESULTS: Ninety-one sepsis episodes were included in the study. Low albumin level ( U = 382.00, P = .006), renal failure (odds ratio [OR], 0.108 [95% CI, 0.015-0.783]; P = .025), and length of ICU stay ( U = 130.00, P < .001) were identified as risk factors of BSIs due to PIs. The probability of BSI during a sepsis episode was lower in CIPs with PIs with higher C -reactive protein levels ( U = 233.00, P < .001) and whose injury resulted from trauma or surgery (OR, 0.101 [95% CI, 0.016-0.626]; P = .014). The mortality was higher in CIPs with PI -induced BSIs (OR, 0.051 [95% CI, 0.008-0.309]; P = .001). CONCLUSIONS: Pressure injury -induced sepsis was associated with a high risk of 28 -day mortality. The findings suggest that CIPs with PI are at increased risk of BSIs if they have low albumin levels, renal -failure, and prolonged ICU stay during sepsis episodes.Publication Evaluation of the combination treatments with intravenous fosfomycin for carbapenem-resistant Klebsiella pneumoniae(Assoc Medica Brasileira, 2023-01-01) ÖNAL, UĞUR; Tüzemen, Nazmiye Ülkü; TÜZEMEN, NAZMİYE ÜLKÜ; Kaya, Pınar Küçükdemirci; KELEBEK GİRGİN, NERMİN; KÜÇÜKDEMİRCİ KAYA, PINAR; İŞÇİMEN, REMZİ; ÖZAKIN, CÜNEYT; Özakın, Cüneyt; Kahveci, Ferda Şöhret; KAHVECİ, FERDA ŞÖHRET; Akalın, Halis; AKALIN, EMİN HALİS; Tıp Fakültesi; Mikrobiyoloji Ana Bilim Dalı; 0000-0003-3544-3509; 0000-0002-8428-8245; 0000-0002-5882-1632; 0000-0001-7530-1279; JCO-3678-2023; AAU-8952-2020; A-4290-2018OBJECTIVE: The aim of this study was to evaluate the combination treatments with intravenous fosfomycin for carbapenem-resistant Klebsiella pneumoniae infections in a tertiary-care center.METHODS: Between December 24, 2018 and November 21, 2022, adult patients diagnosed with bloodstream infection or ventilator-associated pneumonia due to culture-confirmed carbapenem-resistant Klebsiella pneumoniae in the anesthesiology and reanimation intensive care units were investigated retrospectively.RESULTS: There were a total of 62 patients fulfilling the study inclusion criteria. No significant difference was recorded in 14-and 30-day mortality among different types of combination regimens such as fosfomycin plus one or two antibiotic combinations. Hypokalemia (OR:5.651, 95%CI 1.019- 31.330, p=0.048) was found to be a significant risk factor for 14-day mortality, whereas SOFA score at the time of diagnosis (OR:1.497, 95%CI 1.103- 2.032, p=0.010) and CVVHF treatment (OR:6.409, 95%CI 1.395-29.433, p=0.017) were associated with 30-day mortality in multivariate analysis.CONCLUSION: In our study, high mortality rates were found in patients with bloodstream infection or ventilator-associated pneumonia due to carbapenem-resistant Klebsiella pneumoniae, and no significant difference was recorded in 14-and 30-day mortality among different types of combination regimens such as fosfomycin plus one or two antibiotic combinations.Publication Effects of covid-19 variation on the treatment response and disease severity in critical illness: A retrospective observational cohort study(Verduci Publisher, 2022-01-01) Küçükdemirci, Ömer; Çalışkan, G.; Girgin, Nermin Kelebek; Kaya, Pınar Küçükdemirci; KÜÇÜKDEMİRCİ KAYA, PINAR; Tıp Fakültesi; Anestezi ve Reanimasyon Ana Bilim Dalı; JCO-2264-2023OBJECTIVE: Even though the treatment of the original variant was not fully determined, variants of COVID-19 emerged. Whether the clinic of COVID-19 has changed because of variation is controversial. The present study aimed to examine the COVID-19 severity and treatment responsiveness of critically ill patients between the original virus and emergent variations with a more comprehensive set of measures.PATIENTS AND METHODS: Treatment responses, laboratory findings, and clinical conditions of critically ill patients with COVID-19 who were identified with variants between February 1st, and May 30th, 2021, were examined in two medical Intensive Care Units (ICUs) in tertiary care centers. Each patient received treatment in the ICU for at least one week.RESULTS: Sixty-five (30 patients with the original variant: POV) critically ill patients were included in the study. SOFA scores, blood glucose. total bilirubin. urea-creatinine and lactate dehydrogenase levels decreased significantly in POV (p=.031, p=.002. p=.002, p=.008, and p=.007. respectively). Overall, patients with emergent variants (PEV) (M = 76.58, SD = 8.64) had lower partial-pressure-of-oxygen/fraction-of-inspired-oxygen ratios (P/F) than POV (M = 123.16. SD = 9.49). Use of the prone position and steroid therapy did not result in significant improvements in oxygenation of critically III PEV. Hypertension was identified as the common comorbidity in PEV (OR=5.287).CONCLUSIONS: We showed that the state of PEV was more severe than POV at the time of ICU admission. However, the prone position and steroids were not efficient in improving the P/F ratios. P/F ratios of PEV were significantly lower in non-invasive ventilation. These results suggest that early intubation might be necessary for PEV.Publication The impact of the COVID-19 pandemic on tracheostomy applications in the COVID and non-COVID intensive care units: A single-center experience(Galenos Yayıncılık, 2023-06-01) Çalışkan, Gülbahar; Topal, Serra; Kaya, Pınar Küçükdemirci; Tüzemen, Gökhan; Ulutaş, Elifgül; Girgin, Nermin Kelebek; KÜÇÜKDEMİRCİ KAYA, PINAR; ULUTAŞ, ELİFGÜL; Tıp Fakültesi; Anesteziyoloji ve Reanimasyon Ana Bilim Dalı; 0000-0002-8428-8245; JCO-2264-2023; JOJ-0316-2023Objective: In the early stages of the pandemic, there were reservations about early tracheostomy due to the high risk of infection transmission. We reported the clinical characteristics and outcomes of patients who underwent an elective tracheostomy during the pandemic.Materials and Methods: The data from patients who underwent the elective tracheostomy between March 20, 2020, and January 01, 2021, were evaluated retrospectively. Medical records were analyzed for age, gender, comorbidities, complications, and outcomes. The duration from intubation to tracheostomy and the length of intensive care unit (ICU) and hospital stay were calculated. The data of coronavirus disease-2019 (COVID-19) patients (group I) and non-COVID-19 patients (group II) were compared. Additionally, early tracheostomy (<= 14 days) and late tracheostomy (>14 days) groups were compared in terms of clinical outcomes.Results: A total of 144 patients, 70 of whom were diagnosed with COVID-19, were included. Tracheostomy was performed on the median 19th day in both groups (p=0.85). Percutaneous tracheostomy (68.6%) was performed more frequently in COVID-19 patients. The time of tracheostomy application had no positive effect on mortality in either groups. Bleeding occurred less frequently in group I.Conclusion: Percutaneous tracheostomy was performed more frequently in COVID-19 patients. Percutaneous tracheostomy is feasible to be conducted by the ICU team at the bedside with few complications.Publication Nephrotoxicity caused by colistin use in icu: A single centre experience(Bmc, 2023-10-13) Kılıç, İsa; Ayar, Yavuz; Ceylan, İlkay; Çalışkan, Gülbahar; Kaya, Pınar Küçükdemirci; KÜÇÜKDEMİRCİ KAYA, PINAR; Tıp Fakültesi; Anesteziyoloji Ana Bilim Dalı; JCO-2264-2023Background We aimed to determine the risk factors that may be associated with colistin-induced acute kidney injury (AKI) to promote the safer use of colistin in the treatment of nosocomial infections caused by multidrug-resistant Gram-negative bacteria in intensive care units.Materials and methods This retrospective observational study was conducted among adult patients who received a minimum of 48 h of intravenous colistin from January 2020 to December 2020 at the intensive care unit of a tertiary care hospital. AKI diagnosis and staging were made based on the Kidney Disease Improving Global Outcome Criteria.Results Of 148 patients who received intravenous colistin at a daily dose of 9 million IU, 54 (36%) developed AKI. In the univariate analysis, age, Charlson comorbidity index, APACHE II score, duration of colistin treatment, basal creatinine level, use of vasopressors, and vancomycin were significantly associated with AKI (p < 0.05). The multivariate analysis revealed that the independent predictor of AKI was the use of vasopressors (OR: 3.14; 95% confidence interval: 1.39-97.07; p = 0.06).Conclusion The use of vasopressors in critically ill patients was independently associated with AKI developing during colistin treatment.Publication Oxa-48 dominance meets ceftazidime-avibactam: A battle against life-threatening carbapenem-resistant klebsiella pneumoniae infections in the intensive care unit(Springernature, 2023-10-10) Önal, Uğur; Tüzemen, Ülkü; Kaya, Pınar K.; İşçimen, Remzi; Girgin, Nermin Küçükdemirci; Özakın, Cüneyt; Kahveci, Ferda; Akalın, Halis; ÖNAL, UĞUR; TÜZEMEN, NAZMİYE ÜLKÜ; KÜÇÜKDEMİRCİ KAYA, PINAR; ÖZAKIN, CÜNEYT; KAHVECİ, FERDA ŞÖHRET; İŞÇİMEN, REMZİ; Girgin, Nermin Küçükdemirci; AKALIN, EMİN HALİS; Tıp Fakültesi; Mikrobiyoloji Bölümü; 0000-0001-6194-3254; 0000-0002-8428-8245; JCO-3678-2023; JCO-2264-2023; JNY-9122-2023; JMU-3479-2023; DTU-3148-2022; JNH-9929-2023; CYR-2043-2022; CYR-2043-2022; AAU-8952-2020ObjectiveIn this study, we aimed to describe the outcomes in ICU patients with bloodstream infection (BSI) or ventilatory-associated pneumonia (VAP) due to carbapenem-resistant Klebsiella pneumoniae (CRKP) who received ceftazidime-avibactam treatment at a tertiary care university hospital.MethodsPatients aged 18 years or older who were admitted to the Anesthesiology and Reanimation ICU at Bursa Uludag University Faculty of Medicine Hospital between June 13, 2021, and July 16, 2023, and diagnosed with BSI or VAP due to CRKP were included in this study.ResultsA total of 42 patients treated with ceftazidimeavibactam were included. Total crude mortality rates were 33.3% on day 14 and 54.8% on day 30. Mortality rates on the 14th and 30th days were 37.5% and 62.5% in patients with BSI and 27.8% and 44.4% in patients with VAP, respectively. There was no statistically significant difference between monotherapy and combination therapy in terms of mortality rates on days 14 and 30, respectively (3/11 vs. 11/31, p=0.620; 5/11 vs. 18/31, p=0.470). Immunosuppression (10/11 vs. 13/31, p=0.005), the Sequential Organ Failure Assessment (SOFA) score >= 8 (at the initiation of treatment; 19/25 vs. 4/17, p<0.001), INCREMENT-CPE score >= 10 (12/16 vs. 3/10, p=0.024) and longer duration (in days) from culture collection to treatment initiation (5.0 +/- 0.61 vs. 3.11 +/- 0.48, p=0.024) were found to have a statistically significant effect on 30-day mortality. In multivariate analysis, a SOFA score >= 8 at the initiation of treatment (p=0.037, OR: 17.442, 95% CI: 1.187-256.280) was found to be a significant risk factor affecting mortality (30-day).ConclusionThe mortality rates of patients with CRKP infection who were followed up in the ICU were found to be high, and it was observed that whether ceftazidime-avibactam treatment was given as a combination or monotherapy did not affect mortality. Further multicentre studies with a larger number of patients are needed to gain a comprehensive understanding of the topic, given that this treatment is typically reserved for documented infections.Publication Sepsis episodes caused by pressure injuries in critical illness: A retrospective observational cohort study(Hmp, 2023-11-01) KELEBEK GİRGİN, NERMİN; Girgin, Nermin Kelebek; Kaya, Pınar Küçükdemirci; KÜÇÜKDEMİRCİ KAYA, PINAR; Kahveci, Ferda S.; İşcimen, Remzi; İŞÇİMEN, REMZİ; Kaya, Murad; KAYA, MURAD; Akalin, Emin Halis; AKALIN, EMİN HALİS; Tıp Fakültesi; Anestezi ve Reanimasyon Ana Bilim Dalı; 0000-0002-8428-8245; 0000-0002-5882-1632BACKGROUND: Critically -ill patients (CIPs) with pressure injuries (PIs) may develop bloodstream infections (BSIs). PURPOSE: To identify predisposing factors and discuss diagnosis and management of sepsis -related PIs in CIPs. METHODS: The records of CIPs in the intensive care unit (ICU) between January 1, 2014, and January 1, 2020, with PI with sepsis -diagnoses and with different site cultures that were positive concurrent with bloodstream -cultures were retrospectively reviewed. RESULTS: Ninety-one sepsis episodes were included in the study. Low albumin level ( U = 382.00, P = .006), renal failure (odds ratio [OR], 0.108 [95% CI, 0.015-0.783]; P = .025), and length of ICU stay ( U = 130.00, P < .001) were identified as risk factors of BSIs due to PIs. The probability of BSI during a sepsis episode was lower in CIPs with PIs with higher C -reactive protein levels ( U = 233.00, P < .001) and whose injury resulted from trauma or surgery (OR, 0.101 [95% CI, 0.016-0.626]; P = .014). The mortality was higher in CIPs with PI -induced BSIs (OR, 0.051 [95% CI, 0.008-0.309]; P = .001). CONCLUSIONS: Pressure injury -induced sepsis was associated with a high risk of 28 -day mortality. The findings suggest that CIPs with PI are at increased risk of BSIs if they have low albumin levels, renal -failure, and prolonged ICU stay during sepsis episodes.