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Öğe Diyabetik Ayak Yarası Olan Hastalarda Staphylococcus aureus Burun Taşıyıcılığı Sıklığı ve Taşıyıcılıkla İlişkili Risk Faktörleri(2015) Kurultak, İlhan; Altay, Mustafa; Cesur, Salih; Yıldız, Eda; Duranay, MuratAmaç: Bu çalışmada, diyabetik ayak (DA) yarası olan hastalardaki Staphylococcus aureus burun taşıyıcılığı insidansının, risk faktörlerinin ve taşıyıcılığın yara kültürüyle olası ilişkisinin tespit edilmesi amaçlanmıştır. Yöntemler: Her biri 40 hastadan oluşmak üzere diyabeti olmayan (Grup 1), diabetes mellitus tanısı olan ancak DA yarası olmayan (Grup 2) ve diabetes mellitus tanısı olan ve DA yarası gelişmiş hastalardan (Grup 3) üç grup oluşturuldu. DA yaraları Wagner derecelendirmesine göre sınıflandırıldı. Üç gruptaki S. aureus burun taşıyıcılığı insidansı ve belirlenmiş faktörlerin burun taşıyıcılığına etkisi değerlendirildi. Son grupta burun kültürü ve yara kültürü sonuçları arasındaki ilişki de araştırıldı.Bulgular: S. aureus burun taşıyıcılığı insidansı Grup 1'de %17.5, Grup 2'de %20 ve Grup 3'te %10'du (p=0.47). Yaş, cinsiyet, insülin/oral antidiyabetik kullanımı, diyabet süresi, HbA1c düzeyi, açlık ve tokluk kan glukoz düzeylerinin S. aureus burun taşıyıcılığı üzerine etkisi yoktu. İstatistiksel olarak anlamlı olmasa da diyabetik hastalardaki S. aureus'un metisiline dirençli olma ihtimalinin, kontrol grubundan daha yüksek olduğu gözlendi. Yaraların Wagner derecesi ve yara kültürüyle S. aureus burun taşıyıcılığı arasında bir ilişki saptanmadı. Sonuçlar: Çalışmamızda, hastanın DA yarasının ve/veya diyabetinin olmasının S. aureus burun taşıyıcılığı riskini değiştirmediği ve burun taşıyıcılığının da yara kültürlerinin sonuçlarını etkilemediği saptandı. Klimik Dergisi 2015; 28(3): 112-6Öğe Effect of Local Polyhexanide Application in Preventing Exit-Site Infection and Peritonitis: A Randomized Controlled Trial(Wiley, 2020) Ceri, Mevlut; Yilmaz, Seref Rahmi; Unverdi, Selman; Kurultak, Ilhan; Duranay, MuratTopical antibiotic and antiseptic agents have been documented to reduce exit-site infection (ESI) and peritonitis in PD. The aim of this randomized controlled study was to evaluate the efficacy of polyhexanide in the prevention of ESI and peritonitis. Patients were excluded if they had active infection, > 18 years of age, ESI and peritonitis within the previous 4 weeks, received PD for less than 3-months and history of allergy to either drug. All patients were followed up until catheter removal, death, switch to dialysis, transplantation or the end of the study. ESI, tunnel infection, peritonitis, catheter removal and microorganism cause of catheter-related infection were recorded prospectively during clinic follow-up. A total of 88 patients (41 povidone-iodine group; 47 polyhexanide group) were enrolled with a total follow-up duration of 480 and 555 patient-months for povidone-iodine and alternating group, respectively. There were no significant differences in the age, sex, BMI, time of PD, rate of DM, and S. aureus carriage state. A total of 8 ESI and 25 peritonitis episodes were detected during the study. ESI and peritonitis rates tended to be lower in polyhexanide group compared with the povidone-iodine group (0.06 episodes/patient-year vs. 0.12 episodes/patient-year; 0.26 episodes/patient-year vs. 0.32 episodes/patient-year, respectively), but were not significant statistically. Moreover, catheter removal was similar in both groups (0.04 / patient-year vs. 0.05 / patient-year). Polyhexanide is efficient and safe for the prevention of ESI and peritonitis and it may be used as an alternative procedure for the care of healthy exit sites.Öğe Incidence of Staphylococcus aureus Nasal Carriage in Patients With Diabetic Foot Wounds and Related Risk Factors(Aves, 2015) Kurultak, Ilhan; Altay, Mustafa; Cesur, Salih; Yildiz, Eda; Duranay, MuratObjective: In this study, we aimed to detect the incidence and risk factors of Staphylococcus aureus nasal carriage and possible relationship between wound culture and nasal carriage in patients with diabetic foot (DF) wounds. Methods: Three groups each one comprising 40 patients were established with nondiabetics (Group 1), diabetics without DF wounds (Group 2), and diabetics with DF wounds (Group 3). Wagner grading was used for classification of DF lesions. The incidence of S. aureus nasal carriage and effects of determined factors to nasal carriage were investigated. The relationship between nasal carriage and result of wound culture was also investigated in the last group. Results: The incidence of S. aureus nasal carriage were 17.5%, 20% and 10% in Groups 1, 2 and 3, respectively (p=0.47). Age, sex, use of insulin/oral anti-diabetic drugs, duration of diabetes, HbA1c level, fasting and after meal glucose measures did not affect the S. aureus nasal carriage. We observed a higher possibility of nasal swab positivity for MRSA in diabetic patients compared to the controls. We did not detect any relationship between Wagner grade and culture results of wounds and S. aureus nasal carriage in Group 3. Conclusions: We detected that having DF wound or diabetes did not alter the risk of S. aureus nasal carriage, and likewise nasal carriage did not affect the results of wound cultures.Öğe Subcutaneous C.E.R.A. for the Treatment of Chronic Renal Anemia in Predialysis Patients(2016) Üstündağ, Sedat; Doğan, Ekrem; Duranay, Murat; Kazancıoğlu, Rümeyza; Çelik, Vedat; Ünsal, Abdülkadir; Yıldız, AlaattinBackground: We investigated the efficacy, safety and tolerability of once-monthly administration of C.E.R.A. in erythropoiesis stimulating agents (ESAs) naive predialysis patients with CKD for anemia treatment Study Design: Single arm, open label study. Methods: A total of 75 patients (mean (SD) age was 52.8 (16.4) years, 76.0% were female) were included in this study conducted between 12 August 2008 and 30 October 2009 in 9 centers across Turkey. The mean change in Hb concentration (g/dL) between baseline (week 0) and the efficacy evaluation period (EEP) was the primary efficacy parameter evaluated in three consecutive periods including a dose titration period (DTP; with initial 1.2 ?g/kg dose of C.E.R.A., subcutaneously, 28 weeks), EEP (8 weeks) and a long-term safety period (16 weeks). Results: Our analysis revealed an improvement in Hb levels from baseline value of 9.4 (0.4) g/dL to time adjusted average level of 11.4 (0.7) g/dL in EEP in the per protocol (PP) population and from 9.3 (0.5) g/dL to 11.1 (1.0) g/dL in intent-to-treat (ITT) population. Mean (SD) change in Hb levels from baseline to EEP was 2.0 (0.7) g/dl in the PP population (primary endpoint) and 1.7 (1.1) g/dL in the ITT population. The percentage of patients whose Hb concentrations remained within the target range of 10.0-12.0 g/dL throughout the EEP was 43.9% (95% CI: 28.5-60.3%) in the PP population and 38.7% (95% CI: 27.6% to 50.6%) in the ITP population. A total of 206 adverse events (AE) were reported in 77.0% of patients with hypertension (20%) as the most frequent AE. Conclusion: Once-monthly subcutaneous C.E.R.A. administration is effective and safe in the treatment of anemia in pre-dialysis patients with CKD, who are not currently treated with ESAs.Öğe Subcutaneous CERA for the Treatment of Chronic Renal Anemia in Predialysis Patients(Galenos Publ House, 2016) Ustundag, Sedat; Dogan, Ekrem; Duranay, Murat; Kazancioglu, Rumeyza; Celik, Vedat; Unsal, Abdulkadir; Altintepe, LutfullahBackground: We investigated the efficacy, safety and tolerability of once-monthly administration of C.E.R.A. in erythropoiesis stimulating agents (ESAs) naive predialysis patients with CKD for anemia treatment Study Design: Single arm, open label study. Methods: A total of 75 patients (mean (SD) age was 52.8 (16.4) years, 76.0% were female) were included in this study conducted between 12 August 2008 and 30 October 2009 in 9 centers across Turkey. The mean change in Hb concentration (g/dL) between baseline (week 0) and the efficacy evaluation period (EEP) was the primary efficacy parameter evaluated in three consecutive periods including a dose titration period (DTP; with initial 1.2 mu g/kg dose of C.E.R.A., subcutaneously, 28 weeks), EEP (8 weeks) and a long-term safety period (16 weeks). Results: Our analysis revealed an improvement in Hb levels from baseline value of 9.4 (0.4) g/dL to time adjusted average level of 11.4 (0.7) g/dL in EEP in the per protocol (PP) population and from 9.3 (0.5) g/dL to 11.1 (1.0) g/dL in intent-to-treat (ITT) population. Mean (SD) change in Hb levels from baseline to EEP was 2.0 (0.7) g/dl in the PP population (primary endpoint) and 1.7 (1.1) g/dL in the ITT population. The percentage of patients whose Hb concentrations remained within the target range of 10.0-12.0 g/dL throughout the EEP was 43.9% (95% CI: 28.5-60.3%) in the PP population and 38.7% (95% CI: 27.6% to 50.6%) in the ITP population. A total of 206 adverse events (AE) were reported in 77.0% of patients with hypertension (20%) as the most frequent AE. Conclusion: Once-monthly subcutaneous C.E.R.A. administration is effective and safe in the treatment of anemia in pre-dialysis patients with CKD, who are not currently treated with ESAs.
