Multidisipliner Ekip Yaklaşımının Kan Transfüzyonu Üzerine Etkileri

Objective: The Joint Commission and the American Medical Association-Convened Physician Consortium for Performance Improvement reported that the blood transfusions are among the top five overused treatments in modern medicine. Optimal management of blood transfusion is one of the most important factors that increase patient safety, and special education is increasing all over the world in this regard. In this retrospective cohort study, our goal was to investigate the effects of periodic consensus meetings and training on perioperative blood transfusion by a team of different branches of medicine. Methods: Patients over the age of 18 undergoing cardiac surgery and required blood transfusion were included in this study. The transfusions were calculated cumulatively; the change concerning years was determined, as well as side effects and complications associated with transfusion. Patients’ cardiac reserves, laboratory values, anticoagulant drug use frequency, transfused blood volume, complications and mortality rates were recorded. The types of surgery, reexploration rate, length of intensive care and hospital stay were recorded. Results: Patients’ age, BMI, comorbidity ratio and antimicrobial drug use did not differ between years (p>0.05). The length of intensive care and hospital stay, amount of bleeding, mortality rate did not differ (p> 0.05). Cardiopulmonary Bypass time and Cross Clamp time in 2016, were significantly higher (p0.05). Besides, after 2014, an increase was observed in platelet transfusion. The change in Hb, Htc, platelet and INR did not differ significantly in the pre-postoperative period. Conclusion: Training on the restrictive use of blood products did not have a positive influence on blood transfusion in our study. It has been demonstrated that there are challenges in sufficiently transferring the knowledge to the clinical environment.Amaç: Birleşik Komisyon ve Amerikan Tabipler Birliği tarafından toplanan Performans İyileştirme Konsorsiyumu, kan transfüzyonlarının modern tıbbın ilk beş aşırı kullanımı arasında olduğunu bildirmiştir. Kan transfüzyonunun optimal yönetimi, hasta güvenliğini artıran en önemli faktörlerden biridir ve bu anlamda tüm dünyada özel eğitimler artmaktadır. Bu geriye dönük kohort çalışmasında amacımız, periyodik konsensus toplantılarının ve perioperatif kan transfüzyonu üzerine yapılan eğitimin, farklı tıp dallarından oluşan bir ekip tarafından araştırılmasıdır. Gereç ve Yöntem: Kan transfüzyonu gereksinimi bulunan, kalp cerrahisi geçiren 18 yaş üstü hastalar çalışmaya dahil edildi. Transfüzyonlar kümülatif olarak hesaplandı, yıllara göre değişim, yan etkiler ve transfüzyon ile ilişkili komplikasyonlar belirlendi. Hastaların kardiyak rezervleri, laboratuvar değerleri, antikoagülan ilaç kullanım sıklığı, transfüzyon miktarı, komplikasyonlar ve mortalite oranları kaydedildi. Ameliyat tipleri, revizyon oranı, yoğun bakım süresi ve hastanede kalış süresi kaydedildi. Bulgular: Hastaların yaş, VKİ, komorbidite oranı, antimikrobiyal ilaç kullanımı yıllara göre farklılık göstermemiştir (p>0.05). Yoğun bakım ve hastanede kalış süresi, kanama miktarı ve mortalite oranı istatistiksel olarak farklı değildi (p>0.05). 2016 yılında CBP ve CX zamanı, 2014 ve 2015’e göre anlamlı olarak daha yüksekti (p0.05). Ayrıca 2014 sonrası trombosit transfüzyonunda artış gözlendi. Ameliyat öncesi dönemde Hb, Htc, trombosit ve INR’deki değişiklik anlamlı olarak farklılık göstermedi. Sonuç: Çalışmamızda restriktif kan ürünü kullanımı ile ilgili eğitimin kan transfüzyonu üzerinde pozitif bir etkiye sahip olmadığı gösterilmiştir. Bilginin klinik ortama yeterince aktarılması konusunda zorluklar olduğu ortaya konulmuştur

The Evaluation of Clostridium difficile Toxin A ve B Positivity Rates and Epidemiological Characteristics in Febrile Neutropenic Patients with Diarrhea

Introduction: Clostridium difficile (C. difficile) is the most commonly identified causative agent of antibiotic-associated diarrhea. Since immunosuppression is a significant risk factor in febrile neutropenic patients who complain of diarrhea, investigation of toxin A/B is recommended. In this study we aimed at investigating the frequency of C. difficile toxin A or B in stools of patients with malignancies who developed diarrhea during the febrile neutropenic period and to analyze the epidemiological characteristics of toxin-positive patients. Materials and Methods: We analyzed stool samples of patients who were admitted to our hospital. These patients either had hematological malignancies or solid organ tumors and they had developed diarrhea during the febrile neutropenic period. The frequency of C. difficile toxin A and B was identified with chromatographic immunoassay method by using a commercial kit (MonlabTest, Spain) that allowed for qualitative identification of C. difficile toxins A and B at the same time. Results: From January 1, 2012 to August 15, 2015, 197 stool samples were analyzed. C. difficile toxin A+B positivity was identified in 9 samples (4.6%), Ascaris eggs were detected in 14 samples (7%) and Salmonella spp. were found in one sample. The mean age of the toxin-positive patients (6 female, 3 male) was 63.5 years; seven had hematological malignancies (78%) and two had solid organ tumors (22%). All the cases had a history of multiple antibiotic treatments. Seven patients had a history of quinolone prophylaxis, two patients had a history of intensive care admission and all the patients had long-term hospitalization with a mean length of 46 days hospitalization. Conclusion: In febrile neutropenic patients with diarrhea, the rate of C. difficile toxin A+B positivity was 4.6%. Having a history of chemotherapy, quinolone prophylaxis, carbapenem use, long-term hospitalization, and use of multiple antimicrobials were found to be common epidemiological characteristics

The Evaluation of clostridium difficile toxin A ve B positivity rates and epidemiological characteristics in febrile neutropenic patients with diarrhea

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Giriş: Clostridium difficile (C. difficile), antibiyotik ile ilişkili ishallerin en sık nedenidir. Özellikle immünsüpresyon önemli bir risk faktörü olduğu için diyare yakınması olan febril nötropenik hastalarda toksin A ve B araştırılması önerilir. Çalışmamızda febril nötropenik dönemde ishal gelişen maligniteli hastaların dışkılarında C. difficile toksini sıklığını araştırmayı ve toksin pozitif hastaların epidemiyolojik özelliklerini irdelemeyi amaçladık. Gereç ve Yöntem: Hastanemize başvuran hematolojik maligniteli ve solid organ tümörlü hastalarda febril nötropenik dönemde diyare gelişen olguların dışkı örnekleri incelendi. C. difficile toksin A ve B sıklığı kromatografik immünoassay yöntemi ile C. difficile toksin A ve B’nin aynı anda kalitatif olarak belirlenmesini sağlayan ticari kit (MonlabTest, İspanya) ile çalışılmıştır.Introduction: Clostridium difficile (C. difficile) is the most commonly identified causative agent of antibiotic-associated diarrhea. Since immunosuppression is a significant risk factor in febrile neutropenic patients who complain of diarrhea, investigation of toxin A/B is recommended. In this study we aimed at investigating the frequency of C. difficile toxin A or B in stools of patients with malignancies who developed diarrhea during the febrile neutropenic period and to analyze the epidemiological characteristics of toxin-positive patients. Materials and Methods: We analyzed stool samples of patients who were admitted to our hospital. These patients either had hematological malignancies or solid organ tumors and they had developed diarrhea during the febrile neutropenic period. The frequency of C. difficile toxin A and B was identified with chromatographic immunoassay method by using a commercial kit (MonlabTest, Spain) that allowed for qualitative identification of C. difficile toxins A and B at the same time