{"id":17480,"date":"2023-04-11T17:57:36","date_gmt":"2023-04-11T10:57:36","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=17480"},"modified":"2023-04-13T15:44:28","modified_gmt":"2023-04-13T08:44:28","slug":"bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/11\/bo-y-te\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng \u1edf ng\u01b0\u1eddi l\u1edbn theo B\u1ed9 Y t\u1ebf"},"content":{"rendered":"<p><strong>B\u1ed9 Y t\u1ebf \u0111\u00e3 ban h\u00e0nh Quy\u1ebft \u0111\u1ecbnh s\u1ed1 4815\/Q\u0110-BYT v\u00e0o 22\/11\/2020 v\u1ec1 vi\u1ec7c ban h\u00e0nh t\u00e0i li\u1ec7u chuy\u00ean m\u00f4n \u201cH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng \u1edf ng\u01b0\u1eddi l\u1edbn\u201d. H\u01b0\u1edbng d\u1eabn nh\u1ea5n m\u1ea1nh, Ti\u00eam ph\u00f2ng c\u00fam \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c ph\u00f2ng b\u1ec7nh vi\u00eam ph\u1ed5i, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i c\u00f3 suy gi\u1ea3m mi\u1ec5n d\u1ecbch&#8230;<\/strong><\/p>\n<p>T\u00e0i li\u1ec7u chuy\u00ean m\u00f4n \u201cH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng \u1edf ng\u01b0\u1eddi l\u1edbn\u201d c\u1ee7a B\u1ed9 Y t\u1ebf \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng t\u1ea1i c\u00e1c c\u01a1 s\u1edf kh\u00e1m b\u1ec7nh, ch\u1eefa b\u1ec7nh trong c\u1ea3 n\u01b0\u1edbc. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 tr\u00edch d\u1eabn h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng \u1edf ng\u01b0\u1eddi l\u1edbn \u0111\u01b0\u1ee3c ban h\u00e0nh b\u1edfi B\u1ed9 Y t\u1ebf n\u0103m 2020.<\/p>\n<p><strong>M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb<\/strong><\/p>\n<p>&#8211; \u0110\u1ea1t hi\u1ec7u qu\u1ea3 l\u00e2m s\u00e0ng<\/p>\n<p>&#8211; Gi\u1ea3m t\u1eed vong<\/p>\n<p>&#8211; Tr\u00e1nh kh\u00e1ng thu\u1ed1c<\/p>\n<p>Nhi\u1ec1u h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb VPC\u0110 tr\u00ean th\u1ebf gi\u1edbi ph\u00e2n t\u1ea7ng b\u1ec7nh nh\u00e2n d\u1ef1a v\u00e0o y\u1ebfu t\u1ed1 nguy c\u01a1 m\u1eafc vi khu\u1ea9n kh\u00e1ng thu\u1ed1c, b\u1ec7nh \u0111\u1ed3ng m\u1eafc, kh\u1ea3 n\u0103ng vi khu\u1ea9n g\u00e2y b\u1ec7nh v\u00e0 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh.<\/p>\n<p><strong>1<\/strong><strong>. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh theo h\u01b0\u1edbng d\u1eabn c\u1ee7a B\u1ed9 Y t\u1ebf<\/strong><\/p>\n<p>&#8211; C\u1ea7n \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh s\u1edbm trong 4 gi\u1edd \u0111\u1ea7u nh\u1eadp vi\u1ec7n d\u1ef1a theo kinh nghi\u1ec7m, khi c\u00f3 k\u1ebft qu\u1ea3 nu\u00f4i c\u1ea5y v\u00e0 kh\u00e1ng sinh \u0111\u1ed3 c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh theo kh\u00e1ng sinh \u0111\u1ed3 v\u00e0 \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh nh\u00e2n. Tr\u00e1nh d\u00f9ng kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng n\u1ebfu kh\u00f4ng c\u1ea7n thi\u1ebft.<\/p>\n<p>&#8211; S\u1eed d\u1ee5ng kh\u00e1ng sinh theo d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc v\u00e0 d\u01b0\u1ee3c l\u1ef1c h\u1ecdc, hi\u1ec7u ch\u1ec9nh li\u1ec1u theo m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn.<\/p>\n<p>&#8211; L\u1ea5y b\u1ec7nh ph\u1ea9m (nhu\u1ed9m Gram v\u00e0 c\u1ea5y \u0111\u1eddm, c\u1ea5y m\u00e1u) tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh \u1edf b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n.<\/p>\n<p>&#8211; N\u00ean ch\u1ecdn thu\u1ed1c di\u1ec7t khu\u1ea9n, \u0111\u1eb7c bi\u1ec7t \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd n\u1ec1n n\u1eb7ng v\u00e0\/ho\u1eb7c suy gi\u1ea3m mi\u1ec5n d\u1ecbch<\/p>\n<p>&#8211; B\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n n\u00ean b\u1eaft \u0111\u1ea7u v\u1edbi kh\u00e1ng sinh \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch, \u0111\u1ee7 li\u1ec1u. Sau v\u00e0i ng\u00e0y c\u00f3 th\u1ec3 chuy\u1ec3n sang u\u1ed1ng n\u1ebfu c\u00f3 \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng.<\/p>\n<p>&#8211; Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb t\u00f9y theo b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng v\u00e0 X-quang, th\u01b0\u1eddng 3-5 ng\u00e0y sau khi h\u1ebft s\u1ed1t \u0111\u1ed1i v\u1edbi\u00a0<em>S.pneumoniae<\/em>. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh trung b\u00ecnh t\u1eeb 7 \u2013 10 ng\u00e0y \u0111\u1ed1i v\u1edbi VPMPC\u0110 kh\u00f4ng bi\u1ebfn ch\u1ee9ng. N\u1ebfu do\u00a0<em>Legionella, Chlamydia\u00a0<\/em>th\u1eddi gian t\u1ed1i thi\u1ec3u 2-3 tu\u1ea7n. BN s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch v\u00e0 \u0111i\u1ec1u tr\u1ecb l\u00e2u d\u00e0i corticoid: &gt; 14 ng\u00e0y<\/p>\n<p>&#8211; \u0110\u00e1nh gi\u00e1 \u0111i\u1ec1u tr\u1ecb sau 48-72h, n\u1ebfu t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng kh\u00f4ng c\u1ea3i thi\u1ec7n ho\u1eb7c x\u1ea5u h\u01a1n c\u1ea7n thay \u0111\u1ed5i ph\u00e1c \u0111\u1ed3.<\/p>\n<p>&#8211; Chuy\u1ec3n sang \u0111\u01b0\u1eddng u\u1ed1ng khi b\u1ec7nh nh\u00e2n c\u1ea3i thi\u1ec7n ho, kh\u00f3 th\u1edf, h\u1ebft s\u1ed1t 2 l\u1ea7n c\u00e1ch 8 gi\u1edd v\u00e0 b\u1ec7nh nh\u00e2n u\u1ed1ng \u0111\u01b0\u1ee3c.<\/p>\n<p>&#8211; Xu\u1ea5t vi\u1ec7n: khi \u1ed5n \u0111\u1ecbnh l\u00e2m s\u00e0ng v\u00e0 chuy\u1ec3n sang kh\u00e1ng sinh u\u1ed1ng cho \u0111\u1ee7 li\u1ec7u tr\u00ecnh.<\/p>\n<p><strong>2<\/strong><strong>. \u0110i\u1ec1u tr\u1ecb ban \u0111\u1ea7u theo kinh nghi\u1ec7m<\/strong><\/p>\n<p>\u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh ban \u0111\u1ea7u theo kinh nghi\u1ec7m n\u00ean h\u01b0\u1edbng \u0111\u1ebfn nh\u1eefng t\u00e1c nh\u00e2n th\u01b0\u1eddng g\u1eb7p ngo\u00e0i c\u1ed9ng \u0111\u1ed3ng nh\u01b0\u00a0<em>S.pneumoniae, H.influenzae v\u00e0 M.catarrhlis<\/em>. Kh\u00e1ng sinh c\u00f3 hi\u1ec7u qu\u1ea3 l\u00e0 betalactam\/\u1ee9c ch\u1ebf betalactamase +\/- macrolide hay quinolone h\u00f4 h\u1ea5p (levofloxacin, moxifloxacin).<\/p>\n<p>Tr\u01b0\u1edbc khi l\u1ef1a ch\u1ecdn ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb c\u1ea7n \u0111\u00e1nh gi\u00e1 v\u00e0 ph\u00e2n lo\u1ea1i b\u1ec7nh nh\u00e2n theo c\u00e1c m\u1ee9c \u0111\u1ed9 n\u1eb7ng v\u00e0 nh\u00f3m nguy c\u01a1.<\/p>\n<p><strong>2<\/strong><strong>.<\/strong><strong>1.<\/strong><strong> B\u1ec7nh nh\u00e2n VPC\u0110 m\u1ee9c \u0111\u1ed9 nh\u1eb9, \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa:<\/strong><\/p>\n<p>Nh\u1eefng nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p:\u00a0<em>S.pneumoniae, M.pneumoniae, C.pneumoniae\u00a0<\/em>(m\u1ed9t m\u00ecnh hay nhi\u1ec5m tr\u00f9ng k\u1ebft h\u1ee3p),\u00a0<em>H.influenzae<\/em>, Virus h\u00f4 h\u1ea5p.<\/p>\n<ul>\n<li>B\u1ec7nh nh\u00e2n &lt; 65 tu\u1ed5i, kh\u00f4ng c\u00f3 b\u1ec7nh \u0111i k\u00e8m, kh\u00f4ng d\u00f9ng kh\u00e1ng sinh trong 3 th\u00e1ng tr\u01b0\u1edbc: ampicillin hay amoxicillin h\u01b0\u1edbng \u0111\u1ebfn\u00a0<em>S.pneumoniae\u00a0<\/em>ho\u1eb7c macrolid th\u1ebf h\u1ec7 m\u1edbi khi ch\u01b0a lo\u1ea1i tr\u1eeb\u00a0<em>M.pneumoniae<\/em>.<\/li>\n<\/ul>\n<p>C\u00f3 th\u1ec3 d\u00f9ng: Amoxicillin 1g x 3 l\u1ea7n\/ng\u00e0y ho\u1eb7c Doxycycline 100mg x 2 l\u1ea7n\/ng\u00e0y ho\u1eb7c macrolid: Azithromycin (u\u1ed1ng ho\u1eb7c IV) 500mg ng\u00e0y \u0111\u1ea7u, sau \u0111\u00f3 250mg \u1edf nh\u1eefng ng\u00e0y ti\u1ebfp theo ho\u1eb7c Clarithromycin (u\u1ed1ng ho\u1eb7c IV) 500mg 2 l\u1ea7n\/ng\u00e0y ho\u1eb7c Clarithromycin ph\u00f3ng th\u00edch ch\u1eadm 1g 1 l\u1ea7n\/ng\u00e0y.<\/p>\n<p>N\u1ebfu nhi\u1ec1u kh\u1ea3 n\u0103ng\u00a0<em>H.influenzae\u00a0<\/em>n\u00ean d\u00f9ng betalactam + \u1ee9c ch\u1ebf betalactamase \u0111\u01b0\u1eddng u\u1ed1ng v\u00ec g\u1ea7n 50%\u00a0<em>H.influenzae\u00a0<\/em>ti\u1ebft betalactamase t\u1ea1i Vi\u1ec7t Nam. Nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y h\u1ea1n ch\u1ebf d\u00f9ng quinolone h\u00f4 h\u1ea5p ngo\u1ea1i tr\u1eeb b\u1ec7nh nh\u00e2n d\u1ecb \u1ee9ng v\u1edbi betalactam hay macrolid.<\/p>\n<ul>\n<li>B\u1ec7nh nh\u00e2n &gt; 65 tu\u1ed5i, c\u00f3 b\u1ec7nh \u0111\u1ed3ng m\u1eafc (b\u1ec7nh tim, ph\u1ed5i, b\u1ec7nh gan, b\u1ec7nh th\u1eadn m\u1ea1n t\u00ednh, ung th\u01b0), suy gi\u1ea3m mi\u1ec5n d\u1ecbch, \u0111\u00e3 d\u00f9ng kh\u00e1ng sinh 3 th\u00e1ng tr\u01b0\u1edbc ho\u1eb7c nguy c\u01a1\u00a0<em>S.pneumoniae\u00a0<\/em>kh\u00e1ng thu\u1ed1c ho\u1eb7c trong v\u00f9ng\u00a0<em>S.pneumoniae\u00a0<\/em>kh\u00e1ng macrolid cao (MIC \u2265 16\u00b5g\/mL).<\/li>\n<\/ul>\n<p>Nh\u1eefng nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p trong nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y ngo\u00e0i nh\u1eefng vi khu\u1ea9n th\u00f4ng th\u01b0\u1eddng tr\u00ean c\u1ea7n l\u01b0u \u00fd \u0111\u1ebfn vi khu\u1ea9n gram \u00e2m \u0111\u01b0\u1eddng ru\u1ed9t\u00a0<em>S.pneumoniae, M.pneumoniae, C.pneumoniae,\u00a0<\/em>nhi\u1ec5m tr\u00f9ng ph\u1ed1i h\u1ee3p (vi khu\u1ea9n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh hay virus,\u00a0<em>H.influenzae, K.pneumoniae,\u00a0<\/em>virus h\u00f4 h\u1ea5p<em>.<\/em><\/p>\n<p>Kh\u00e1ng sinh ch\u1ecdn l\u1ef1a g\u1ed3m: ph\u1ed1i h\u1ee3p betalactam\/\u1ee9c ch\u1ebf betalactamase + macrolid th\u1ebf h\u1ec7 m\u1edbi ho\u1eb7c Quinolone h\u00f4 h\u1ea5p \u0111\u01a1n tr\u1ecb li\u1ec7u.<\/p>\n<p>Nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y n\u1ebfu to\u00e0n tr\u1ea1ng suy ki\u1ec7t, X quang ng\u1ef1c c\u00f3 nh\u1eefng t\u1ed5n th\u01b0\u01a1ng n\u1eb7ng (th\u00e2m nhi\u1ec5m &gt; 1 thu\u1ef3, t\u1ed5n th\u01b0\u01a1ng ho\u1ea1i t\u1eed, t\u1ed5n th\u01b0\u01a1ng ti\u1ebfn tri\u1ec3n trong 48-72 gi\u1edd th\u00ec n\u00ean cho b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa v\u1edbi kh\u00e1ng sinh \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, m\u1eb7c d\u00f9 thang \u0111i\u1ec3m PSI hay CURB-65 ch\u01b0a \u0111\u1ee7 ti\u00eau chu\u1ea9n nh\u1eadp vi\u1ec7n.<\/p>\n<p><strong>2.<\/strong><strong>2. <\/strong><strong>\u00a0B\u1ec7nh nh\u00e2n VPMPC\u0110 m\u1ee9c \u0111\u1ed9 trung b\u00ecnh, nh\u1eadp vi\u1ec7n<\/strong><\/p>\n<p>Nh\u00f3m b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n \u0111\u01b0\u1ee3c chia l\u00e0m 2 nh\u00f3m, n\u1eb1m t\u1ea1i khoa n\u1ed9i\/h\u00f4 h\u1ea5p\/truy\u1ec1n nhi\u1ec5m v\u00e0 ICU.<\/p>\n<p><strong>2<\/strong><strong>.2.1. Nh\u00f3m b\u1ec7nh nh\u00e2n n\u1eb1m t\u1ea1i khoa n\u1ed9i\/khoa h\u00f4 h\u1ea5p\/truy\u1ec1n nhi\u1ec5m:<\/strong><\/p>\n<p>Nh\u1eefng t\u00e1c nh\u00e2n th\u01b0\u1eddng g\u1eb7p:\u00a0<em>S.pneumoniae, H.influenzae, M.pneumiae, C. pneumoniae<\/em>, Nhi\u1ec5m tr\u00f9ng k\u1ebft h\u1ee3p, Gram \u00e2m \u0111\u01b0\u1eddng ru\u1ed9t, Vi khu\u1ea9n y\u1ebfm kh\u00ed do h\u00edt, Virus,\u00a0<em>Legionella.\u00a0<\/em>\u0110i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p betalactam +\/- \u1ee9c ch\u1ebf betalactamase k\u1ebft h\u1ee3p macrolide (Azithromycin, Clarithromycin) TM ho\u1eb7c quinolone h\u00f4 h\u1ea5p (levofloxacin, moxifloxacin) TM (khi \u0111\u00e3 lo\u1ea1i tr\u1eeb lao khi nh\u1eadp vi\u1ec7n). C\u1ea7n x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n lao cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd.<\/p>\n<p>Ch\u01b0a c\u00f3 b\u1eb1ng ch\u1ee9ng \u0111\u1ee7 m\u1ea1nh ch\u1ee9ng minh ph\u00e1c \u0111\u1ed3 k\u1ebft h\u1ee3p betalactam +\/- \u1ee9c ch\u1ebf betalactamase ph\u1ed1i h\u1ee3p macrolid hay fluoroquinolone h\u01a1n h\u1eb3n betalactam +\/- \u1ee9c ch\u1ebf betalactamase hay quinolone \u0111\u01a1n thu\u1ea7n.<\/p>\n<p>N\u00ean l\u01b0u \u00fd t\u00e1c nh\u00e2n vi khu\u1ea9n gram \u00e2m \u0111\u01b0\u1eddng ru\u1ed9t (l\u01b0u \u00fd bao g\u1ed3m\u00a0<em>P.aeruginosae\u00a0<\/em>n\u1ebfu c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 nhi\u1ec5m t\u00e1c nh\u00e2n n\u00e0y) v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u00ean bao ph\u1ee7 lu\u00f4n t\u00e1c nh\u00e2n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh. N\u00ean d\u00f9ng kh\u00e1ng sinh \u0111\u01b0\u1eddng ti\u00eam betalactam\/\u1ee9c ch\u1ebf betalactamase k\u1ebft h\u1ee3p macrolide hay quinolone.<\/p>\n<p><strong>2<\/strong><strong>.2.2. Nh\u00f3m b\u1ec7nh nh\u00e2n nh\u1eadp ICU<\/strong><\/p>\n<p>Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p r\u1ea5t n\u1eb7ng, c\u1ea7n n\u1eb1m ICU c\u00f3 nguy c\u01a1 t\u1eed vong cao nh\u01b0 c\u00f3 suy h\u00f4 h\u1ea5p c\u1ea7n th\u1edf m\u00e1y hay s\u1ed1c nhi\u1ec5m khu\u1ea9n.<\/p>\n<p>Vi khu\u1ea9n g\u00e2y b\u1ec7nh c\u1ea7n h\u1ebft s\u1ee9c l\u01b0u \u00fd nguy c\u01a1 nhi\u1ec5m\u00a0<em>S. aureus\u00a0<\/em>v\u00e0\u00a0<em>P.aeruginosae<\/em>. Kh\u00e1ng sinh c\u1ea7n s\u1eed d\u1ee5ng l\u00e0 carbapenem th\u1ebf h\u1ec7 1 (kh\u00f4ng bao ph\u1ee7\u00a0<em>Pseudomonas<\/em>) hay th\u1ebf h\u1ec7 2 k\u1ebft h\u1ee3p Fluoroquinolone hay macrolide +\/- thu\u1ed1c bao ph\u1ee7 S.\u00a0<em>aureus\u00a0<\/em>n\u1ebfu ch\u01b0a lo\u1ea1i tr\u1eeb (vancomycin, teicoplanin, linezolid.<\/p>\n<p>Khi nghi ng\u1edd\u00a0<em>P. aeruginosae<\/em>, n\u00ean ph\u1ed1i h\u1ee3p betalactam +\/- \u1ee9c ch\u1ebf betalactamase ch\u1ed1ng\u00a0<em>Pseudomonas\u00a0<\/em>k\u1ebft h\u1ee3p quinolone ch\u1ed1ng\u00a0<em>Pseudomonase\u00a0<\/em>hay aminoglycosid (B\u1ea3ng 1.1)<\/p>\n<p><strong>B\u1ea3ng <\/strong><strong>1<\/strong><strong>.1. Nh\u1eefng \u0111i\u1ec3m c\u1ea7n nh\u1edb \u0111i\u1ec1u tr\u1ecb VPC\u0110 theo h\u01b0\u1edbng d\u1eabn c\u1ee7a B\u1ed9 Y t\u1ebf<\/strong><\/p>\n<table width=\"100%\">\n<tbody>\n<tr>\n<td width=\"100%\"><strong>B\u1ec7nh nh\u00e2n VPMPC\u0110 m\u1ee9c \u0111\u1ed9 nh\u1eb9 ngo\u1ea1i tr\u00fa:<\/strong><\/p>\n<p>&#8211;\u00a0Amoxicillin \u0111\u01a1n thu\u1ea7n hay k\u1ebft h\u1ee3p v\u1edbi \u1ee9c ch\u1ebf betalactamase (n\u1ebfu nghi ng\u1edd\u00a0<em>H. influenzae , M. catarrhalis<\/em>): ampicillin-sulbactam, amoxicillin-clavulanic acid\/sulbactam. N\u1ebfu nhi\u1ec1u kh\u1ea3 n\u0103ng VK kh\u00f4ng \u0111i\u1ec3n h\u00ecnh th\u00ec ch\u1ecdn azithromycin hay clarithromycin .<\/p>\n<p>&#8211;\u00a0Quinolone h\u00f4 h\u1ea5p (levofloxacin, moxifloxacin) n\u1ebfu d\u1ecb \u1ee9ng v\u1edbi betalactam<\/p>\n<p>&#8211;\u00a0N\u1ebfu nghi ng\u1edd\u00a0<em>S. pneumoniae\u00a0<\/em>kh\u00e1ng thu\u1ed1c: amoxicillin li\u1ec1u cao ho\u1eb7c quinolone h\u00f4 h\u1ea5p.<\/p>\n<p>&#8211;\u00a0BN l\u1edbn tu\u1ed5i c\u00f3 b\u1ec7nh \u0111\u1ed3ng m\u1eafc, suy gi\u1ea3m mi\u1ec5n d\u1ecbch: k\u1ebft h\u1ee3p betalactam\/\u1ee9c ch\u1ebf betalactamase v\u00e0 macrolid hay quinolone h\u00f4 h\u1ea5p \u0111\u01a1n tr\u1ecb, Cefdinir, Cefpodoxime.<\/td>\n<\/tr>\n<tr>\n<td width=\"100%\"><strong>B\u1ec7nh nh\u00e2n VPMPC\u0110 m\u1ee9c \u0111\u1ed9 trung b\u00ecnh, n\u1ed9i tr\u00fa, kh\u00f4ng n\u1eb1m ICU<\/strong><\/p>\n<p>&#8211;\u00a0Quinolone h\u00f4 h\u1ea5p (moxifloxacin, levofloxacin)<\/p>\n<p>&#8211;\u00a0Beta-lactam +\/- \u1ee9c ch\u1ebf betalactamase: (cefotaxime, ceftriaxone, ampicillin\/amoxilline + clavulanic acid\/sulbactam, ertapenem) + macrolide\/quinolone TTM. (Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 nhi\u1ec5m\u00a0<em>P. aerusinosa\u00a0<\/em>c\u1ea7n ch\u1ecdn nh\u1eefng betalactam ch\u1ed1ng\u00a0<em>Pseudomonas<\/em>.)<\/td>\n<\/tr>\n<tr>\n<td width=\"100%\"><strong>B\u1ec7nh nh\u00e2n VPMPC\u0110 m\u1ee9c \u0111\u1ed9 n\u1eb7ng, n\u1eb1m ICU<\/strong><\/p>\n<p>Betalactam ph\u1ed5 r\u1ed9ng +\/- \u1ee9c ch\u1ebf betalactamase, ertapenem, ceftazidime, ceftriaxone, cefepim \u2026 k\u1ebft h\u1ee3p quinolone hay macrolide TTM.<\/p>\n<p><strong><em>N\u1ebfu c\u00f3 nguy c\u01a1 nhi\u1ec5m Pseudomonas:<\/em><\/strong><\/p>\n<p>&#8211;\u00a01 \u03b2-lactam ch\u1ed1ng\u00a0<em>Pseudomonas\u00a0<\/em>[piperacillin\/tazobactam, ceftazidim, cefepime, imipenem, meropenem, doripenem] + ciprofloxacin ho\u1eb7c levofloxacin.<\/p>\n<p>&#8211;\u00a0\u03b2-lactams k\u1ec3 tr\u00ean + 1 aminoglycoside v\u00e0 azithromycin\/clarithromycin<\/p>\n<p>&#8211;\u00a0\u03b2-lactams k\u1ec3 tr\u00ean + quinolone (levofloxacin hay ciprofloxacin)<\/p>\n<p><strong><em>N\u1ebfu c\u00f3 nguy c\u01a1 nhi\u1ec5m S. aureus kh\u00e1ng methicillin c\u1ed9ng \u0111\u1ed3ng (CA-MRSA):<\/em><\/strong><\/p>\n<p>&#8211;\u00a0Th\u00eam Vancomycin, Teicoplanin, hay Linezolid<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ol start=\"3\">\n<li><strong>3<\/strong><strong>. Khi c\u00f3 k\u1ebft qu\u1ea3 vi sinh v\u00e0 kh\u00e1ng sinh \u0111\u1ed3: \u0111i\u1ec1u tr\u1ecb theo kh\u00e1ng sinh \u0111\u1ed3 <\/strong><\/li>\n<\/ol>\n<p>Nh\u1eefng thu\u1ed1c c\u00f2n hi\u1ec7u qu\u1ea3 cho t\u1eebng t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh:<\/p>\n<p><strong>3.1. <\/strong><strong>\u00a0S. pneumoniae :<\/strong><\/p>\n<p>&#8211; Penicillin G: 1-3 tri\u1ec7u \u0111v x 3-4 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p>&#8211; Ampicillin: 2g x 6 l\u1ea7n\/ng\u00e0y TTM.<\/p>\n<p>&#8211; Amox\/clav.acid 1g x 3 l\u1ea7n\/ng\u00e0y u\u1ed1ng<\/p>\n<p>&#8211; Ampicillin\/sulbactam: 1,5-3g x 4 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p>&#8211; Amoxillin\/sulbactam: 1g x 2 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p>&#8211; Ceftriaxone: 1-2g 1 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p>&#8211; Ceftazidime: 1g x 3-4 l\u1ea7n\/ng\u00e0y, 2g x 3 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p>&#8211; Ertapenem: 1g x 1 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p>&#8211; Moxifloxacine 400mg: 1 l\u1ecd\/ng\u00e0y TTM<\/p>\n<p>&#8211; Levofloxacine 750 mg\/ng\u00e0y TTM. Tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng c\u00f3 th\u1ec3 d\u00f9ng 500mg x 2 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p><strong>3.2.<\/strong><strong> H. influenzae , M. catarrhalis :<\/strong><\/p>\n<p>&#8211; Amox\/clav.acid 1g x 3 l\u1ea7n\/ng\u00e0y u\u1ed1ng<\/p>\n<p>&#8211; Ampicillin\/sulbactam: 1,5-3g x 4 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p>&#8211; Amoxillin\/sulbactam: 1g x 2 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p>&#8211; Ceftriaxone:1-2g TTM 1 l\u1ea7n\/ng\u00e0y<\/p>\n<p>&#8211; Ceftazidime: 1g x 3-4 l\u1ea7n\/ng\u00e0y, 2g x 3 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p>&#8211; Ertapenem: 1g x 1 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p>&#8211; Moxifloxacine 400mg: 1 l\u1ecd\/ng\u00e0y TTM<\/p>\n<p>&#8211; Levofloxacine 750 mg\/ng\u00e0y TTM. Tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng c\u00f3 th\u1ec3 d\u00f9ng 500mg x 2 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p><strong>3.3. <\/strong><strong>K. pneumoniae :<\/strong><\/p>\n<p>&#8211; Ceftriaxone: 1-2g TTM 1 l\u1ea7n\/ng\u00e0y<\/p>\n<p>&#8211; Ceftazidime: 1g x 3-4 l\u1ea7n\/ng\u00e0y, 2g x 2 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p>&#8211; Cefepim: 1-2g x 3 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p>&#8211; Ertapenem: 1g x 1 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p>&#8211; Levofloxacine 750 mg\/ng\u00e0y TTM. Tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng c\u00f3 th\u1ec3 d\u00f9ng 500mg x 2 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p>&#8211; Amikacin 15-20mg\/kg\/24h TTM (kh\u00f4ng d\u00f9ng \u0111\u01a1n tr\u1ecb li\u1ec7u)<\/p>\n<p>&#8211; Imipenem: 0,5g x 4 l\u1ea7n\/ng\u00e0y hay 1g x 3 l\u1ea7n\/ng\u00e0y TTM,<\/p>\n<p>&#8211; Meropenem 1g x 3 l\u1ea7n\/ng\u00e0y TTM khi ch\u01b0a lo\u1ea1i tr\u1eeb VK sinh ESBL.<\/p>\n<p><strong>3.4<\/strong>.<strong><em>\u00a0P. aerusinosa:\u00a0<\/em><\/strong>ph\u1ed1i h\u1ee3p 2 kh\u00e1ng sinh betalactam v\u00e0 quinolon ho\u1eb7c aminoglycosid<\/p>\n<p>&#8211; Levofloxacine 750 mg\/ng\u00e0y TTM. Tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng c\u00f3 th\u1ec3 d\u00f9ng 500mg x 2 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p>&#8211; Ciprofloxacin 400 mg: 1 l\u1ecd x 3 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p>&#8211; Imipenem: 0,5g x 4 l\u1ea7n\/ng\u00e0y hay 1g x 3 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p>&#8211; Meropenem 1g x 3 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p>&#8211; Ceftazidime: 1g x 3-4 l\u1ea7n\/ng\u00e0y, 2g x 3 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p>&#8211; Piperacillin\/tazobactam 4,5g x 4 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p>&#8211; Amikacin 15-20mg\/kg\/24h TTM (kh\u00f4ng d\u00f9ng \u0111\u01a1n tr\u1ecb li\u1ec7u)<\/p>\n<p><strong>3.5. <\/strong><strong>S. aureus\u00a0:<\/strong><\/p>\n<p>&#8211;\u00a0<em>S. aureus\u00a0<\/em>nh\u1ea1y methicillin: (MSSA): s\u1eed d\u1ee5ng betalactam k\u1ebft h\u1ee3p aminoglycoside hay quinolon.<\/p>\n<p>&#8211;\u00a0<em>S. aureus\u00a0<\/em>kh\u00e1ng Methicillin (MRSA)<em>:<\/em><\/p>\n<p>+ Vancomycin: 15-30mg\/kg m\u1ed7i12h TTM, c\u00e2n nh\u1eafc li\u1ec1u n\u1ea1p 25-30mg\/kg trong tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng<\/p>\n<p>+ Teicoplanin: li\u1ec1u t\u1ea3i 12mg\/kg m\u1ed7i 12h x 3 li\u1ec1u \u00a0\u2192 duy tr\u00ec 12mg\/kg\/24h TTM<\/p>\n<p>+ Linezolid: 600mg x 2 l\u1ea7n\/ng\u00e0y TTM<\/p>\n<p><strong><em>3.6.<\/em><\/strong><strong><em>\u00a0<\/em><\/strong><strong>Vi khu\u1ea9n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh:\u00a0<\/strong>(<em>Legionella pneumophila, Mycoplasma pneumoniae , Chlamydia pneumoniae<\/em>): Macrolid th\u1ebf h\u1ec7 m\u1edbi ho\u1eb7c Quinolon h\u00f4 h\u1ea5p.<\/p>\n<p>&#8211; Azithromycin (u\u1ed1ng ho\u1eb7c TTM) ho\u1eb7c<\/p>\n<p>&#8211; Clarithromycin (u\u1ed1ng ho\u1eb7c TTM) ho\u1eb7c<\/p>\n<p>&#8211; Moxifloxacin 400mg x 1 l\u1ecd\/ng\u00e0y TTM x 1-2 tu\u1ea7n ho\u1eb7c<\/p>\n<p>&#8211; Levofloxacin 750mg\/ng\u00e0y TTM x 1-2 tu\u1ea7n ho\u1eb7c<\/p>\n<p>&#8211; Doxycycline 200mg TTM m\u1ed7i 12h x 3 ng\u00e0y, sau \u0111\u00f3 100mg TTM m\u1ed7i 12h x 4-11 ng\u00e0y.<\/p>\n<p><strong>3.7. <\/strong><strong>Burkholderia pseudomallei<\/strong><\/p>\n<ul>\n<li><strong>Giai \u0111o\u1ea1n t\u1ea5n c\u00f4ng:\u00a0<\/strong>k\u00e9o d\u00e0i \u00edt nh\u1ea5t hai tu\u1ea7n, s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, tr\u01b0\u1eddng h\u1ee3p vi\u00eam ph\u1ed5i n\u1eb7ng ho\u1eb7c vi\u00eam ph\u1ed5i ph\u1ea3i n\u1eb1m \u0111i\u1ec1u tr\u1ecb t\u1ea1i ICU, h\u1ea1ch trung th\u1ea5t, vi\u00eam ph\u1ed5i c\u00f3 k\u00e8m theo \u00e1p xe c\u00e1c c\u01a1 quan, vi\u00eam kh\u1edbp nhi\u1ec5m khu\u1ea9n, vi\u00eam t\u1ee7y x\u01b0\u01a1ng, melioidosis th\u1ea7n kinh, th\u1eddi gian c\u00f3 th\u1ec3 k\u00e9o d\u00e0i 4-8 tu\u1ea7n ho\u1eb7c d\u00e0i h\u01a1n. S\u1eed d\u1ee5ng m\u1ed9t trong c\u00e1c ph\u00e1c \u0111\u1ed3 sau:<\/li>\n<\/ul>\n<p><strong>Ceftazidime\u00a0<\/strong>(50 mg\/kg \u0111\u1ebfn 2g t\u0129nh m\u1ea1ch m\u1ed7i 6h)<\/p>\n<p><strong>Meropenem\u00a0<\/strong>(25 mg\/kg \u0111\u1ebfn 1g t\u0129nh m\u1ea1ch m\u1ed7i 8h)<\/p>\n<p><strong>Imipenem\u00a0<\/strong>(25 mg\/kg \u0111\u1ebfn 1g t\u0129nh m\u1ea1ch m\u1ed7i 6h)<\/p>\n<ul>\n<li><strong>Pha th\u1ea3i s\u1ea1ch:\u00a0<\/strong>th\u1ef1c hi\u1ec7n ngay sau pha t\u1ea5n c\u00f4ng, th\u1eddi gian k\u00e9o d\u00e0i 3 th\u00e1ng, tr\u01b0\u1eddng h\u1ee3p vi\u00eam ph\u1ed5i c\u00f3 k\u00e8m theo vi\u00eam t\u1ee7y x\u01b0\u01a1ng, melioidosis th\u1ea7n kinh, th\u1eddi gian k\u00e9o d\u00e0i 6 th\u00e1ng, s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c kh\u00e1ng sinh \u0111\u01b0\u1eddng u\u1ed1ng, m\u1ed9t trong c\u00e1c ph\u00e1c \u0111\u1ed3 sau:<\/li>\n<\/ul>\n<p><strong>Biseptol\u00a0<\/strong>(trimethoprim-sulfamethoxazole): hi\u1ec7u ch\u1ec9nh li\u1ec1u theo tu\u1ed5i v\u00e0 c\u00e2n n\u1eb7ng. Tr\u1ebb em: 6mg\/kg t\u00ednh theo trimethoprim ho\u1eb7c \u0111\u1ebfn t\u1ed1i \u0111a 240mg\/li\u1ec1u x 2 l\u1ea7n\/ng\u00e0y. Ng\u01b0\u1eddi l\u1edbn: (1) c\u00e2n n\u1eb7ng 40-60 kg, li\u1ec1u 240mg x 2 l\u1ea7n\/ng\u00e0y t\u00ednh theo trimethoprim; (2) c\u00e2n n\u1eb7ng &gt; 60kg, li\u1ec1u 320mg x 2 l\u1ea7n\/ng\u00e0y t\u00ednh theo trimethoprim. N\u00ean b\u1ed5 sung th\u00eam acid folic \u0111\u01b0\u1eddng u\u1ed1ng 0,1mg\/kg \u0111\u1ebfn t\u1ed1i \u0111a 5mg\/ ng\u00e0y.<\/p>\n<p><strong>Doxycycline:\u00a0<\/strong>100mg x 2 l\u1ea7n\/ ng\u00e0y<\/p>\n<p><strong>Amoxicillin-clavulanate:\u00a0<\/strong>(20mg amoxicillin + 5mg clavulanate) \/kg x 3 l\u1ea7n\/ng\u00e0y. (Ph\u00e1c \u0111\u1ed3 amoxicillin-clavulanate \u01b0u ti\u00ean cho ph\u1ee5 n\u1eef mang thai v\u00e0 tr\u1ebb em &lt; 8 tu\u1ed5i ho\u1eb7c trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng dung n\u1ea1p v\u1edbi trimethoprim-sulfamethoxazole c\u00f3 th\u1ec3 thay b\u1eb1ng doxycycline.)<\/p>\n<p><strong><em>3.8. <\/em><\/strong><strong>Vi\u00eam ph\u1ed5i do virus c\u00fam<\/strong><\/p>\n<p>\u1ede b\u1ec7nh nh\u00e2n vi\u00eam ph\u1ed5i do c\u00fam (A ho\u1eb7c B) ngo\u1ea1i tr\u00fa ho\u1eb7c n\u1ed9i tr\u00fa \u0111\u1ec1u c\u00f3 ch\u1ec9 \u0111\u1ecbnh d\u00f9ng thu\u1ed1c kh\u00e1ng virus. C\u00e1c thu\u1ed1c d\u00f9ng trong 48h \u0111\u1ea7u sau khi c\u00f3 tri\u1ec7u ch\u1ee9ng s\u1ebd l\u00e0m gi\u1ea3m m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh v\u00e0 tri\u1ec7u ch\u1ee9ng<\/p>\n<p>Thu\u1ed1c: Oslertamivir 75mg x 2 vi\u00ean\/ng\u00e0y u\u1ed1ng chia 2 l\u1ea7n. Tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng c\u00f3 th\u1ec3 d\u00f9ng li\u1ec1u g\u1ea5p \u0111\u00f4i.<\/p>\n<p>N\u00ean d\u00f9ng kh\u00e1ng sinh \u0111i k\u00e8m li\u1ec7u ph\u00e1p kh\u00e1ng virus v\u00ec b\u1ed9i nhi\u1ec5m vi khu\u1ea9n sau \u0111\u00f3 s\u1ebd l\u00e0m n\u1eb7ng h\u01a1n t\u00ecnh tr\u1ea1ng vi\u00eam ph\u1ed5i. <em>S. aureus\u00a0<\/em>l\u00e0 vi khu\u1ea9n th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n vi\u00eam ph\u1ed5i do c\u00fam, ti\u1ebfp \u0111\u1ebfn l\u00e0\u00a0<em>H. influenza, Streptococcus\u00a0<\/em>nh\u00f3m A.<\/p>\n<p><strong><em>3.9. <\/em><\/strong><strong>Vi\u00eam ph\u1ed5i do SARS-CoV2:\u00a0<\/strong>Tham kh\u1ea3o h\u01b0\u1edbng d\u1eabn Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb SARS- COV-2 c\u1ee7a B\u1ed9 Y t\u1ebf 2020.<\/p>\n<p><strong>4. Xu\u1ea5t vi\u1ec7n theo h\u01b0\u1edbng d\u1eabn c\u1ee7a B\u1ed9 Y t\u1ebf<\/strong><\/p>\n<p>&#8211; B\u1ec7nh nh\u00e2n h\u1ebft s\u1ed1t, d\u1ea5u hi\u1ec7u sinh t\u1ed3n \u1ed5n \u0111\u1ecbnh trong 48 gi\u1edd, \u0103n, u\u1ed1ng \u0111\u01b0\u1ee3c, kh\u00f4ng c\u00f3 b\u1ec7nh l\u00fd kh\u00e1c ho\u1eb7c t\u00ecnh tr\u1ea1ng t\u00e2m th\u1ea7n c\u1ea7n theo d\u00f5i t\u1ea1i b\u1ec7nh vi\u1ec7n.<\/p>\n<p>&#8211; Ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh sau xu\u1ea5t vi\u1ec7n \u0111\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam ph\u1ed5i do\u00a0<em>S.pneumoniae\u00a0<\/em>bi\u1ebfn ch\u1ee9ng nhi\u1ec5m khu\u1ea9n huy\u1ebft,\u00a0<em>S.aureus<\/em>, vi khu\u1ea9n gram \u00e2m, legionella, vi\u00eam ph\u1ed5i bi\u1ebfn ch\u1ee9ng t\u1eeb vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c, \u00e1p xe ph\u1ed5i, m\u1ee7 m\u00e0ng ph\u1ed5i<\/p>\n<p>&#8211; Chuy\u1ec3n kh\u00e1ng sinh sang \u0111\u01b0\u1eddng u\u1ed1ng<\/p>\n<p><strong>5<\/strong><strong>. X\u1eed tr\u00ed khi b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb<\/strong><\/p>\n<p>&#8211; Xem l\u1ea1i ch\u1ea9n \u0111o\u00e1n: c\u1ea7n lo\u1ea1i tr\u1eeb c\u00e1c c\u0103n nguy\u00ean kh\u00e1c c\u00f3 tri\u1ec7u ch\u1ee9ng gi\u1ed1ng vi\u00eam ph\u1ed5i nh\u01b0ng kh\u00f4ng ph\u1ea3i vi\u00eam ph\u1ed5i: Ung th\u01b0 ph\u1ed5i, t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, d\u1ecb v\u1eadt \u0111\u01b0\u1eddng th\u1edf, x\u1eb9p ph\u1ed5i, \u2026<\/p>\n<p>&#8211; L\u01b0u \u00fd bi\u1ebfn ch\u1ee9ng c\u1ee7a vi\u00eam ph\u1ed5i nh\u01b0 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i bi\u1ebfn ch\u1ee9ng, m\u1ee7 m\u00e0ng ph\u1ed5i, nhi\u1ec5m khu\u1ea9n huy\u1ebft\u2026<\/p>\n<p>&#8211; \u0110i\u1ec1u tr\u1ecb sai t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh, vi khu\u1ea9n kh\u00e1ng thu\u1ed1c, kh\u00f4ng bao ph\u1ee7 h\u1ebft c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh \u2026<\/p>\n<p>&#8211; Nhu\u1ed9m Gram v\u00e0 c\u1ea5y vi khu\u1ea9n l\u1ea1i + KS\u0110, c\u1ea5y m\u00e1u, c\u1ea5y d\u1ecbch vi\u00eam (m\u00e0ng ph\u1ed5i, m\u00e0ng n\u00e3o, d\u1ecbch kh\u1edbp\u2026), x\u00e9t nghi\u1ec7m t\u00ecm VK lao, c\u1ea5y n\u1ea5m \u2026<\/p>\n<figure id=\"attachment_17488\" aria-describedby=\"caption-attachment-17488\" style=\"width: 768px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-17488 size-full\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/3-2.png\" alt=\"\" width=\"768\" height=\"480\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/3-2.png 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/3-2-300x188.png 300w\" sizes=\"(max-width: 768px) 100vw, 768px\" \/><figcaption id=\"caption-attachment-17488\" class=\"wp-caption-text\">L\u01b0u \u0111\u1ed3 h\u01b0\u1edbng d\u1eabn khi \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi \u0111i\u1ec1u tr\u1ecb<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<p><strong>Nh\u1eefng \u0111i\u1ec3m c\u1ea7n nh\u1edb trong h\u01b0\u1edbng d\u1eabn c\u1ee7a B\u1ed9 Y t\u1ebf<\/strong><\/p>\n<p>&#8211;\u00a0M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb VPMPC\u0110: \u0110\u1ea1t hi\u1ec7u qu\u1ea3 l\u00e2m s\u00e0ng, gi\u1ea3m t\u1eed vong v\u00e0 tr\u00e1nh kh\u00e1ng thu\u1ed1c<\/p>\n<p>&#8211;\u00a0\u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh s\u1edbm trong 4 gi\u1edd \u0111\u1ea7u nh\u1eadp vi\u1ec7n theo kinh nghi\u1ec7m, \u0111i\u1ec1u ch\u1ec9nh kh\u00e1ng sinh d\u1ef1a v\u00e0o \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng, k\u1ebft qu\u1ea3 nu\u00f4i c\u1ea5y v\u00e0 kh\u00e1ng sinh \u0111\u1ed3. S\u1eed d\u1ee5ng kh\u00e1ng sinh theo d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc, d\u01b0\u1ee3c l\u1ef1c h\u1ecdc v\u00e0 hi\u1ec7u ch\u1ec9nh li\u1ec1u theo m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn.<\/p>\n<p>&#8211; \u0110i\u1ec1u tr\u1ecb VPC\u0110 m\u1ee9c \u0111\u1ed9 nh\u1eb9, ngo\u1ea1i tr\u00fa: h\u01b0\u1edbng t\u1edbi c\u0103n nguy\u00ean <em>S.pneumoniae, M.pneumoniae, C.pneumoniae, H.influenzae<\/em>, Virus h\u00f4 h\u1ea5p.<\/p>\n<p>* Amoxicillin \u0111\u01a1n thu\u1ea7n hay k\u1ebft h\u1ee3p v\u1edbi \u1ee9c ch\u1ebf betalactamase (n\u1ebfu nghi ng\u1edd H. influenzae, M. catarrhalis): ampicillin-sulbactam, amoxicillin-clavulanic acid\/sulbactam. N\u1ebfu nhi\u1ec1u kh\u1ea3 n\u0103ng VK kh\u00f4ng \u0111i\u1ec3n h\u00ecnh th\u00ec ch\u1ecdn azithromycin hay clarithromycin .<\/p>\n<p>*\u00a0Quinolone h\u00f4 h\u1ea5p (levofloxacin, moxifloxacin) n\u1ebfu d\u1ecb \u1ee9ng v\u1edbi betalactam<\/p>\n<p>*\u00a0N\u1ebfu nghi ng\u1edd S. pneumoniae kh\u00e1ng thu\u1ed1c: amoxicillin li\u1ec1u cao ho\u1eb7c quinolone h\u00f4 h\u1ea5p.<\/p>\n<p>*\u00a0BN l\u1edbn tu\u1ed5i c\u00f3 b\u1ec7nh \u0111\u1ed3ng m\u1eafc, suy gi\u1ea3m mi\u1ec5n d\u1ecbch: k\u1ebft h\u1ee3p betalactam\/\u1ee9c ch\u1ebf betalactamase v\u00e0 macrolid hay quinolone h\u00f4 h\u1ea5p \u0111\u01a1n tr\u1ecb, Cefdinir, Cefpodoxime.<\/p>\n<p>&#8211; \u0110i\u1ec1u tr\u1ecb VPC\u0110 m\u1ee9c \u0111\u1ed9 trung b\u00ecnh, nh\u1eadp vi\u1ec7n khoa n\u1ed9i\/h\u00f4 h\u1ea5p\/truy\u1ec1n nhi\u1ec5m: h\u01b0\u1edbng t\u1edbi c\u0103n nguy\u00ean: S.pneumoniae, H.influenzae, M.pneumiae, C. pneumoniae, Nhi\u1ec5m tr\u00f9ng k\u1ebft h\u1ee3p, Gram \u00e2m \u0111\u01b0\u1eddng ru\u1ed9t, Vi khu\u1ea9n y\u1ebfm kh\u00ed do h\u00edt, Virus, Legionella. \u0110i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p betalactam +\/- \u1ee9c ch\u1ebf betalactamase k\u1ebft h\u1ee3p macrolide (Azithromycin, Clarithromycin) TM ho\u1eb7c quinolone h\u00f4 h\u1ea5p (levofloxacin, moxifloxacin) TM (khi \u0111\u00e3 lo\u1ea1i tr\u1eeb lao khi nh\u1eadp vi\u1ec7n).<\/p>\n<p>&#8211; \u0110i\u1ec1u tr\u1ecb VPC\u0110 m\u1ee9c \u0111\u1ed9 n\u1eb7ng, n\u1eb1m ICU:<\/p>\n<p>*\u00a0Betalactam ph\u1ed5 r\u1ed9ng +\/- \u1ee9c ch\u1ebf betalactamase, ertapenem, ceftazidime, ceftriaxone, cefepim \u2026 k\u1ebft h\u1ee3p quinolone hay macrolide TTM.<\/p>\n<p>*N\u1ebfu c\u00f3 nguy c\u01a1 nhi\u1ec5m Pseudomonas:<\/p>\n<p>+ 1 \u03b2-lactam ch\u1ed1ng Pseudomonas [piperacillin\/tazobactam, ceftazidim, cefepime, imipenem, meropenem, doripenem] + ciprofloxacin ho\u1eb7c levofloxacin.<\/p>\n<p>+ \u03b2-lactams k\u1ec3 tr\u00ean + 1 aminoglycoside v\u00e0 azithromycin\/clarithromycin<\/p>\n<p>+ \u03b2-lactams k\u1ec3 tr\u00ean + quinolone (levofloxacin hay ciprofloxacin)<\/p>\n<p>*\u00a0N\u1ebfu c\u00f3 nguy c\u01a1 nhi\u1ec5m S. aureus kh\u00e1ng methicillin c\u1ed9ng \u0111\u1ed3ng (CA-MRSA): Th\u00eam Vancomycin, Teicoplanin, hay Linezolid.<\/p>\n<p>&#8211;\u00a0\u0110i\u1ec1u tr\u1ecb Burkholderia pseudomallei:<\/p>\n<p>*\u00a0Giai \u0111o\u1ea1n t\u1ea5n c\u00f4ng: \u00edt nh\u1ea5t 2 tu\u1ea7n, \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch: Ceftazidime (50 mg\/kg \u0111\u1ebfn 2g t\u0129nh m\u1ea1ch m\u1ed7i 6h) ho\u1eb7c Meropenem (25 mg\/kg \u0111\u1ebfn 1g t\u0129nh m\u1ea1ch m\u1ed7i 8h) ho\u1eb7c Imipenem (25 mg\/kg \u0111\u1ebfn 1g t\u0129nh m\u1ea1ch m\u1ed7i 6h).<\/p>\n<p>*\u00a0Pha th\u1ea3i s\u1ea1ch: ngay sau pha t\u1ea5n c\u00f4ng, k\u00e9o d\u00e0i 3 th\u00e1ng, n\u1ebfu c\u00f3 vi\u00eam t\u1ee7y x\u01b0\u01a1ng, th\u1ea7n kinh th\u00ec k\u00e9o d\u00e0i 6 th\u00e1ng; \u0111\u01b0\u1eddng u\u1ed1ng: Biseptol ho\u1eb7c Doxycycline ho\u1eb7c Amoxicillin- clavulanate.<\/p>\n<p>&#8211;\u00a0Xu\u1ea5t vi\u1ec7n khi: h\u1ebft s\u1ed1t, d\u1ea5u hi\u1ec7u sinh t\u1ed3n \u1ed5n \u0111\u1ecbnh trong 48 gi\u1edd, \u0103n u\u1ed1ng \u0111\u01b0\u1ee3c, kh\u00f4ng c\u00f3 b\u1ec7nh l\u00fd kh\u00e1c ho\u1eb7c t\u00ecnh tr\u1ea1ng t\u00e2m th\u1ea7n c\u1ea7n theo d\u00f5i t\u1ea1i b\u1ec7nh vi\u1ec7n; chuy\u1ec3n kh\u00e1ng sinh \u0111\u01b0\u1eddng u\u1ed1ng \u0111\u1ee7 li\u1ec7u tr\u00ecnh.<\/p>\n<p><strong>Ngu\u1ed3n<\/strong>: B\u1ed9 Y T\u1ebf<\/p>\n","protected":false},"excerpt":{"rendered":"<p>B\u1ed9 Y t\u1ebf \u0111\u00e3 ban h\u00e0nh Quy\u1ebft \u0111\u1ecbnh s\u1ed1 4815\/Q\u0110-BYT v\u00e0o 22\/11\/2020 v\u1ec1 vi\u1ec7c ban h\u00e0nh t\u00e0i li\u1ec7u chuy\u00ean m\u00f4n \u201cH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng \u1edf ng\u01b0\u1eddi l\u1edbn\u201d. H\u01b0\u1edbng d\u1eabn nh\u1ea5n m\u1ea1nh, Ti\u00eam ph\u00f2ng c\u00fam \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c ph\u00f2ng b\u1ec7nh vi\u00eam ph\u1ed5i, \u0111\u1eb7c [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng \u1edf ng\u01b0\u1eddi l\u1edbn theo B\u1ed9 Y t\u1ebf<\/title>\n<meta name=\"description\" content=\"B\u1ed9 Y t\u1ebf \u0111\u00e3 ban h\u00e0nh Quy\u1ebft \u0111\u1ecbnh s\u1ed1 4815\/Q\u0110-BYT v\u00e0o 22\/11\/2020 v\u1ec1 vi\u1ec7c ban h\u00e0nh t\u00e0i li\u1ec7u chuy\u00ean m\u00f4n \u201cH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u 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