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    Comparison of the healthcare-associated infections in intensive care units in Turkey before and during COVID-19
    (Springernature, 2023) Sari, Sema; Arslan, Ferhat; Turan, Sema; Mengi, Tugce; Ankarali, Handan; Sari, Ahmet; Cavus, Mine Altinkaya
    BackgroundSecondary bacterial infections are an important cause of mortality in patients with coronavirus disease 2019 (COVID-19). All healthcare providers acted with utmost care with the reflex of protecting themselves during the COVID-19 period. We aimed to compare the rates of ventilator-associated pneumonia (VAP) and bloodstream infections (BSIs) in our intensive care units (ICUs) before and during the COVID-19 outbreak surges.MethodsThis multicenter, retrospective, cross-sectional study was performed in six centers in Turkey. We collected the patient demographic characteristics, comorbidities, reasons for ICU admission, mortality and morbidity scores at ICU admission, and laboratory test data.ResultsA total of 558 patients who required intensive care from six centers were included in the study. Four hundred twenty-two of these patients (males (62%), whose mean age was 70 [IQR, 58-79] years) were followed up in the COVID period, and 136 (males (57%), whose mean age was 73 [IQR, 61-82] years) were followed up in the pre-COVID period. BSI and VAP rates were 20.7 (19 events in 916 patient days) and 17 (74 events in 4361 patient days) with a -3.8 difference (P = 0.463), and 33.7 (31 events in 919 patient days) and 34.6 (93 events in 2685 patient days) with a 0.9 difference (P = 0.897), respectively. The mortality rates were 71 (52%) in pre-COVID and 291 (69%) in COVID periods.ConclusionProtective measures that prioritize healthcare workers rather than patients and exceed standard measures made no difference in terms of reducing mortality.
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    Post-extubation Dysphagia and COVID-2019
    (Galenos Publ House, 2021) Yilmaz, Dilek; Mengi, Tugce; Sari, Sema
    Objective: Coronavirus disease-2019 (COVID-19) is a global pandemic that affects worldwide. Most patients who need intensive care due to COVID-19 develop acute respiratory distress syndrome and patients need long-term mechanical ventilation. This situation increases the risk of dysphagia, aspiration, and aspiration pneumonia in patients. Information about COVID-19-associated dysphagia is still limited. Thus, this study aimed to evaluate the frequency of postextubation dysphagia (PED) and its effect on clinical outcomes. Materials and Methods: Patients with COVID-19 in the adult intensive care unit (ICU) who were left on a mechanical ventilator for at least 24 h and are extubated were retrospectively screened. Gugging swallowing screen (GUSS) test was performed 24 h after extubation to evaluate swallowing function. Patients were examined in two groups as with and without dysphagia. Results: This study included 40 patients who were followed up on a mechanical ventilator and extubated due to COVID-19. According to the bedside GUSS test results, patients were divided into two groups as dysphagia group (n=24) and the non-dysphagia group (n=16). The mean age was higher in the dysphagia group (p<0.001). Re-intubation rate and ICU, and in-hospital mortality were higher in the dysphagia group (p<0.001 for all), whereas the length of stay in the ICU and mechanical ventilation time were longer (p=0.005 and p=0.001). ICU mortality was higher in patients with severe dysphagia (p=0.026). Conclusion: Our study revealed that the risk of PED increased with the age of patients with COVID-19 and PED increased the incidence of re-intubation, which was an important prognostic parameter that indicates mortality. Recognizing dysphagia with the early evaluation of swallowing in extubated patients with COVID-19 diagnosis is important to minimize the risk of aspiration pneumonia with proper nutrition, reduce the increased health cost, and prevent poor clinical outcomes.