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Objective: In this study, we aimed to investigate the link between healthcare-associated infections and mortality in critically ill patients who stayed in a third level intensive care unit (ICU) more than 90 days. Methods: Records of patients who were over 18 years old and stayed in ICU more than 90 days between January 2010 and August 2014 were analyzed retrospectively. Results: 60 out of 65 patients that met the specified criteria were included in the study. The mean age was 64.5 (range 14-95) years and the mean length of hospitalization was 129 (range 90-235) days. Half of the patients were women. The most common diagnosis at admission was cerebrovascular disease (41.2%) and pneumonia (15%). No infections were observed in 25% of the patients. There were totally 87 infections detected in 45 patients who had infection. Of these, 48% had bloodstream infections, while 33% of them had ventilator-associated pneumonia, and 10% had urinary tract infection. There was no significant difference between patients with (64.4%) and without (53.3%) infections in terms of mortality. Length of stay in patients with multiple episodes of infection was significantly higher than patients with no infection and with one episode of infection. Conclusions:We have found that prolonged length of stay in ICU is an important result of healthcare-associated infections. Precautions should be taken for common infections and compliance levels with control precautions should be increased. Klimik Dergisi 2016; 29(2): 71-6.Key Words: Healthcare-associated infections, length of stay, intensive care units, Gram-negative bacterial infections, Acinetobacter baumannii.

Objective. We aimed to investigate the effect of peritubal local anesthetic and opioid infiltration on pain scores and analgesic consumption in patients who underwent percutaneous nephrolithotomy. Material and Methods. Patients aged between 18 and 65 years and ASA I-III were included in this double-blind, randomized study. The patients were divided into two groups. All patients underwent spinoepidural anesthesia. 20 mL of 0.25 percent bupivacaine + 5 mg morphine (0.5 mL), in Group P (n = 66), infiltrated the renal capsule, perinephric fat, muscles, subcutaneous tissue, and skin under fluoroscopy. In Group C (n = 64), none of the patients received a peritubal injection. In the first 24 h pain scores, time of the first analgesic demand, the mean number of analgesic demands, and postoperative complications were compared between groups. Results. The mean VAS score at postoperative 8, 12, and 24 h and dynamic VAS score at postoperative 4, 8, 12, and 24 h were significantly lower in Group P. VAS score at postoperative 4 h was not significant. Time of the first analgesic demand was significantly longer in Group P. Conclusion. Our study results suggest that peritubal infiltration of bupivacaine with morphine after percutaneous nephrolithotomy is an effective method for postoperative pain control and reduces analgesic consumption.

Objectives: Colistimethate sodium (colistin) is the member of polymyxins, the cyclic structured cationic polypeptide antibiotics. The purpose of our study is to determine the patients' nephrotoxicity rates and risk factors related to nephrotoxicity development that are under colistin treatment in the tertiary intensive care unit (ICU). Methods: One-hundred colistin received patients files were reviewed retrospectively, who were in tertiary ICU in Bursa Yüksek Ihtisas Training and Research Hospital. Fifteen patients with the history of renal failurewere excluded from the study. The data before the first colistin treatment was taken into consideration for the patients received repetitive colistin treatment. RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) classification was used for the evaluation of nephrotoxicity. Results: The patients mean age was 67.81 ± 16.56 years (range: 21-94) and 52.9% were male. Nephrotoxicity was determined in 35 (41.2%) patients. According to the RIFLE classification the nephrotoxicity rates were determined for risk, injury and deficiency were 24.7%, 10.6% and 5.9%, respectively. Nephrotoxicity was detectedin 9 (25.7%) out of 35 patients on the first day of the colistin treatment. Mortality rate was observed as 82.9% in patients with nephrotoxicity. Conclusions: Colistin treatment is preferable for the treatment of multi drug resistant infections in intensive care unit. The patients, under certain circumstances, i.e., malignancy, using additional nephrotoxic agent and elder age must be closely monitored for the possible nephrotoxicity development.