Suchergebnisse

Amaç: Bu çalışmada perioperatif antimikrobiyal profilaksi (PAP) uygulamalarında güncel rehberlere uyum oranlarını ve bu oranları etkileyen faktörleri belirlemeyi amaçladık.Gereç ve Yöntemler: 30 Mayıs - 30 Haziran 2013 tarihleri arasında 15 farklı merkezde uygulanan ankete yedi farklı branştan 410 cerrah katıldı. Çoktan seçmeli ve açık uçlu 40 soru içeren anketler yüz yüze görüşme yöntemiyle uygulandı. Bulgular: Katılımcıların ortalama yaşı 38,01±9,1, ,4'ü erkek idi. Ankete katılan cerrahların ,2'si "kurumlarında cerrahi profilaksi rehberi varlığı hakkında bilgisi olmadığını," 'ü ise "rehberin bulunduğunu ve profilaksi uygulamalarının rehbere uygun olduğunu" belirtti. Ankete katılan cerrahların ,1'inin kurum içinde cerrahi profilaksi konusunda herhangi bir eğitim toplantısına katılmadığı, son üç yıl içinde cerrahi profilaksi eğitimi alanlarda rehbere uyumun istatistiksel olarak daha yüksek olduğu belirlendi (p <0,001). Kardiyovasküler cerrahlarda uyum diğer branşlardan cerrahlara kıyasla anlamlı olarak daha yüksek saptandı (p=0,012). Uygulanan profilaksinin süresi katılımcıların 'sında 24 saatten daha uzun idi. Dren kullanılan girişimlerde cerrahların ,7'sinin cerrahi profilaksiyi dren çekildikten sonra sonlandırdığı belirlendi. Ürologların ikinci kuşak ve üçüncü kuşak sefalosporinleri anlamlı olarak (p<0,001; p=0,002) daha sık kullandığı belirlendi. Cerrahların ,6'sı cerrahi profilakside kullanılan antibiyotikte rotasyonel değişiklik yapmadığını ifade etti. Merkezlerin 'ünde 24 saat enfeksiyon konsültasyonu ve mikrobiyoloji laboratuvarı olanağı bulunmadığı belirtildi. Katılımcıların 'si "Cerrahi profilaksi rehberlerine uyumu engelleyen en önemli nedenler nelerdir?" sorusunu yanıtsız bıraktı. En önemli nedenler; "çalışılan kurumdaki hastane enfeksiyonları ve etken mikroorganizmalar hakkında düzenli bilgi verilmemesi" (), "profilaktik ilacın sağlık personeli tarafından planlanan zaman ve dozda uygulanmaması" () ve kurum içi PAP rehberinin hekim tarafından yetersiz bulunması () şeklinde belirlendi.Tartışma ve Sonuç: Kanıta dayalı PAP uygulamalarının yerleşebilmesi için bilimsel rehberler ve kurum içi kılavuzların varlığı kadar cerrahi birimlerin bu kılavuzların hazırlık aşamasına etkin katılımı ve ayrıca düzenli eğitim ve geri bildirim toplantıları ile branşlar arası aktif iletişimin sürdürülmesi de son derece önemlidir. ; Aim: We aimed to determine the rates of compliance with current guidelines for practices of perioperative antimicrobial prophylaxis (PAP) and the factors affecting these rates.Materials and Methods: Four hundred and ten surgeons from seven different branches attended the survey conducted between May 30 and June 30, 2013, in fifteen different centers. A 40-question questionnaire consisting of multiple choice and open-ended questions was prepared and applied by interviewing the surgeons. Results: The mean age was 38.01 ± 9.1 years; and 83.4% of the participants were male. Of the surveyed surgeons 46.2% stated that they had no information about the existence of any guidelines for surgical prophylaxis in their institutions and 34% stated that institutional guidelines were available and their prophylaxis practices were in accordance with them. Surgeons who were trained on surgical prophylaxis within the last three years were found to have a statistically higher (p<0.001) rate of compliance with the guidelines. Compared to surgeons from other branches, compliance rates in cardiovascular surgeons were statistically significantly higher (p=0.012). The duration of prophylaxis applied was longer than 24 hours in 56% of the participants. In procedures involving drains, 63.7% of the surgeons stated that they preferred to terminate surgical prophylaxis after removing the drainage tube. It was found that urologists used second and third generation cephalosporins statistically significantly more frequently (p<0.001; p=0.002). Of the surgeons 87.6% stated that they did not rotationally change the antibiotics they used for surgical prophylaxis. It was found that 33% of the centers did not have 24-hour infection consultation and microbiology laboratory facilities. The question "What are the most important reasons for failure in compliance with surgical prophylaxis guidelines?" was left unanswered by 50% of the participants. The most important reasons of incompliance were found to be "lack of regular feedback about hospital infections and the pathogenic microorganisms" (30%), "failure in application of the prophylactic agent in accordance with the timing and dosing determined by the healthcare personnel" (27%), and physicians' view that institutional PAP guidelines were insufficient (17%).Discussion and Conclusion: Besides the existence of institutional guidelines for the establishment of evidence-based PAP practices, it is also crucial to provide active participation of surgical healthcare units in the preparation of these guidelines and to maintain regular training and feedback meetings and active communication between medical branches.

The aim of this study was to determine the clinical features, and outcome of the patients with miliary tuberculosis (TB). We retrospectively evaluated 263 patients (142 male, 121 female, mean age: 44 years, range: 16–89 years) with miliary TB. Criteria for the diagnosis of miliary TB were at least one of the followings in the presence of clinical presentation suggestive of miliary TB such as prolonged fever, night sweats, anorexia, weight loss: radiologic criterion and pathological criterion and/or microbiological criterion; pathological criterion and/or microbiological criterion. The miliary pattern was seen in 88% of the patients. Predisposing factors were found in 41% of the patients. Most frequent clinical features and laboratory findings were fever (100%), fatigue (91%), anorexia (85%), weight loss (66%), hepatomegaly (20%), splenomegaly (19%), choroid tubercules (8%), anemia (86%), pancytopenia (12%), and accelerated erythrocyte sedimentation rate (89%). Tuberculin skin test was positive in 29% of cases. Fifty percent of the patients met the criteria for fever of unknown origin. Acidfast bacilli were demonstrated in 41% of patients (81/195), and cultures for Mycobacterium tuberculosis were positive in 51% (148/ 292) of tested specimens (predominantly sputum, CSF, and bronchial lavage). Blood cultures were positive in 20% (19/97). Granulomas in tissue samples of liver, lung, and bone marrow were present in 100% (21/21), 95% (18/19), and 82% (23/28), respectively. A total of 223 patients (85%) were given a quadruple anti-TB treatment. Forty-four (17%) patients died within 1 year after diagnosis established. Age, serum albumin, presence of military pattern, presence of mental changes, and hemoglobin concentration were found as independent predictors of mortality. Fever resolved within first 21 days in the majority (90%) of the cases. Miliary infiltrates on chest X-ray should raise the possibility of miliary TB especially in countries where TB is endemic. Although biopsy of the lungs and liver may have higher yield rate of organ involvement histopathologicaly, less invasive procedures including a bone marrow biopsy and blood cultures should be preferred owing to low complication rates.