Researcher: İrkören, Pelin
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İrkören, Pelin
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Publication Metadata only Analysis of risk factors associated with candidemia among patients with or without Covid-19 in intensive care units during the pandemic process: a multicenter study(Bilimsel Tıp Yayınevi, 2023) Karakök, Taliha; Gözükara, Melih Gaffar; Uygun Kızmaz, Yeşim; Demir, Yakup; Törüyenler Coşkunpınar, Melike; Altun Demircan, Şerife; Arslan, Yusuf; Alp Göker, Eda; Doğan, Ahmet; Tüzün, Türkan; Sevim, Şükran; Çakır, Yasemin; Işık, Mehmet Emirhan; Mermutluoğlu, Çiğdem; Azap, Alpay; Kınıklı, Sami; Şimşek Yavuz, Serap; Öner, Sedef Zeliha; İrkören, Pelin; Tekin, Süda; School of MedicineIntroduction: The objective of this study was to compare the risk factors and mortality rates of candidemia among patients with and without COVID-19 in the intensive care units (ICU).Materials and Methods: This study is a retrospective multicenter observational study, in ICUs of 12 hospitals (eight tertiary and four secondary hospitals) in Tarkiye. All adult patients (>18 years) hospitalized in ICUs and developed candidemia between 01.01.2020-31.12.2021 were included. The following data were collected: age, gender, nasopharyngeal swab SARS-CoV-2 PCR test, species of Candida (Candida albicans or non-albicans Candida), comorbidities, ICU stay, antibiotic use, corticosteroid, and anti-cytokine therapy, central venous catheter (CVC), abdominal surgery, parenteral nutrition, mechanical ventilation (MV), other cultures isolated Candida spp., echocardiography (ECO), mortality. Data from patients with or without COVID-19 were compared.Results: A total of 188 patients, 66 COVID-19 and 122 non-COVID-19, were included in the study. The median age of the patients was 69.5 and there were no differences between the groups. 185 (98.4%) patients had a history of antibiotic use. Sixteen patients, all from the COVID-19 group, had a history of anti-cytokine therapy. Corticosteroid use was higher in COVID-19 patients (p< 0.001). Intraabdominal surgery was higher in the non-COVID-19 group (p< 0.014). C. albicans was isolated from 36.7% of total patients and the remaining were non-albicans Candida species. The overall mortality was higher in COVID-19 patients (p= 0.014). Alzheimer's and malignancies were higher in non-COVID-19 patients. Intraabdominal surgery, MV, and CVC were higher in tertiary care hospitals whereas parenteral nutrition was higher in secondary care hospitals.Conclusion: Immunosuppressive treatments administered to COVID-19 patients pose a risk in terms of candidemia. Risk factors may differ between secondary and tertiary care hospitals. Preventable risk factors should be determined on a hospital basis and appropriate infection control measures should be taken.Publication Metadata only The association between Acinetobacter baumannii infections and the COVID-19 pandemic in an intensive care unit(Nature Publishing Group (NPG), 2022) N/A; Boral, Jale; Pınarlık, Fatihan; Can, Füsun; Ekinci, Güz; Kuşkucu, Mert Ahmet; Ergönül, Önder; Genç, Zeliha; İrkören, Pelin; Kapmaz, Mahir; Çakar, Nahit; Şentürk, Evren; Yurdakul, Fatma; Dikenelli, Bilge; Tekin, Süda; PhD Student; PhD Student; Faculty Member; Master Student; Faculty Member; Faculty Member; Nurse; Doctor; Doctor; Faculty Member; Faculty Member; Doctor; Doctor; Faculty Member; Koç Üniversitesi İş Bankası Enfeksiyon Hastalıkları Uygulama ve Araştırma Merkezi (EHAM) / Koç University İşbank Center for Infectious Diseases (KU-IS CID); Graduate School of Health Sciences; Graduate School of Health Sciences; School of Medicine; Graduate School of Health Sciences; School of Medicine; School of Medicine; N/A; N/A; N/A; School of Medicine; School of Medicine; N/A; N/A; School of Medicine; Koç University Hospital; N/A; N/A; 103165; N/A; N/A; 110398; N/A; N/A; N/A; 198906; 48359; N/A; N/A; 42146We aimed to describe the increased rate of Acinetobacter baumannii infections during the COVID-19 pandemic and define its significance within the last five years. This study was performed in a tertiary hospital with 280 beds and included all patients infected with A. baumannii in the intensive care unit between January 1, 2018, and June 30, 2022. A. baumannii-infected patients in the intensive care unit 27 months before the pandemic and 27 months during the pandemic were included. Pulsed-field gel electrophoresis was performed to assess clonal relatedness. The infection control measures were specified based on the findings and targeted elimination. In total, 5718 patients were admitted to the intensive care unit from January 1st, 2018, to June 30th, 2022. A. baumannii infection was detected in 81 patients. Compared to the pre-pandemic era, the rate of A. baumannii infection during the pandemic was 1.90 times higher (OR: 1.90, 95% CI: [1.197, 3.033]). Clonality assessment of multidrug-resistant A. baumannii samples revealed eight clusters with one main cluster comprising 14/27 isolates between 2021 and 2022. The case fatality rate of the pre-pandemic and pandemic era was not different statistically (83.33% vs. 81.48%, p=0.835). Univariate analysis revealed the association of mechanical ventilation (p=0.002) and bacterial growth in tracheal aspirate (p=0.001) with fatality. During the COVID-19 pandemic, potential deficits in infection control measures may lead to persistent nosocomial outbreaks. In this study, the introduction of enhanced and customized infection control measures has resulted in the containment of an A. baumannii outbreak.Publication Open Access Appropriate use of tocilizumab in COVID-19 infection(Elsevier, 2020) Keske, Şiran; Sait, Bilgin; Çimen, Cansu; Çelebi, İrfan; Palaoğlu, Erhan; N/A; Tekin, Süda; İrkören, Pelin; Kapmaz, Mahir; Ergönül, Önder; Uğur, Semra; Şentürk, Evren; Çakar, Nahit; Çağlayan, Benan Niku; Tabak, Levent; Bakır, Veli Oğuzalp; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; Graduate School of Sciences and Engineering; N/A; N/A; N/A; 110398; N/A; 48359; N/A; 230719; N/A; N/AObjective: this study aimed to describe the effectiveness and optimum use of tocilizumab (TCZ) treatment by the support of clinical, laboratory and radiologic observations. Methods: all patients were followed up in the hospital with daily interleukin-6 (IL-6), C-reactive protein (CRP), ferritin, D-dimer, full blood count, and procalcitonin. Thoracic computed tomography (CT) was performed on admission, when oxygen support was necessary, and seven days after TCZ started. Disease course of the patients was grouped as severe or critical, according to their clinical, laboratory and radiologic evaluations. Results: forty-three patients were included: 70% were male; the median age was 64 years (minimum– maximum: 27–94); and six (14%) patients died. The median duration of oxygen support before the onset of TCZ was shorter among the severe patient group than the critical patient group (1 vs. 4 days, p < 0.001). Three cases of 21 (14%) who received TCZ in the ward were transferred to ICU, and none of them died. The levels of IL-6, CRP, ferritin, D-dimer, and procalcitonin were significantly lower in the severe cases group than the critical cases group (p = 0.025, p = 0.002, p = 0.008, p = 0.002, and p = 0.001, respectively). Radiological improvement was observed in severe cases on the seventh day of TCZ. Secondary bacterial infection was detected in 41% of critical cases, but none of the severe ones. Conclusion: earlier use of TCZ in COVID-19 infection was beneficial for survival, length of hospitalization and duration of oxygen support. The recommendation for administration of TCZ was based on an increase in requirement of oxygen support, progression in thoracic CT, and elevation of inflammation markers, including IL-6, CRP, ferritin, and D-dimer, and decrease in % lymphocytes.