{"id":17796,"date":"2023-04-11T18:03:08","date_gmt":"2023-04-11T11:03:08","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=17796"},"modified":"2023-04-17T16:36:07","modified_gmt":"2023-04-17T09:36:07","slug":"toi-uu-hoa","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/11\/toi-uu-hoa\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn t\u1ed1i \u01b0u h\u00f3a kh\u00e1ng sinh trong vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng"},"content":{"rendered":"

T\u1ed1i \u01b0u h\u00f3a kh\u00e1ng sinh trong vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng l\u00e0 m\u1ed9t ch\u1ee7 \u0111\u1ec1 \u0111\u01b0\u1ee3c quan t\u00e2m r\u1ea5t nhi\u1ec1u trong l\u00e2m s\u00e0ng v\u00e0 nghi\u00ean c\u1ee9u y h\u1ecdc hi\u1ec7n \u0111\u1ea1i.\u00a0B\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 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…<\/strong><\/p>\n

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 \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 c\u00e1ch s\u1eed d\u1ee5ng kh\u00e1ng sinh trong 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

1. L\u1ef1a ch\u1ecdn t\u1ed1i \u01b0u h\u00f3a kh\u00e1ng sinh d\u1ef1a tr\u00ean ph\u1ed5 kh\u00e1ng khu\u1ea9n<\/strong><\/p>\n

Vi\u1ec7c l\u1ef1a ch\u1ecdn kh\u00e1ng sinh, c\u1ea7n d\u1ef1a tr\u00ean t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh k\u1ebft h\u1ee3p v\u1edbi ph\u1ed5 kh\u00e1ng khu\u1ea9n c\u1ee7a c\u00e1c lo\u1ea1i kh\u00e1ng sinh, t\u1eeb \u0111\u00f3 \u0111\u1ecbnh h\u01b0\u1edbng ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh theo kinh nghi\u1ec7m. Do c\u00e1c t\u00e1c nh\u00e2n vi khu\u1ea9n g\u00e2y ra VPC\u0110 th\u01b0\u1eddng \u0111\u1ed3ng m\u1eafc v\u1edbi virus v\u00e0 hi\u1ec7n kh\u00f4ng c\u00f3 c\u00e1c test ch\u1ea9n \u0111o\u00e1n nhanh v\u00e0 ch\u00ednh x\u00e1c b\u1ec7nh c\u00f3 nguy\u00ean nh\u00e2n \u0111\u01a1n \u0111\u1ed9c do virus hay kh\u00f4ng, n\u00ean b\u1eaft \u0111\u1ea7u ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh theo kinh nghi\u1ec7m s\u1edbm ngay khi nghi ng\u1edd t\u00e1c nh\u00e2n vi khu\u1ea9n ho\u1eb7c vi khu\u1ea9n \u0111\u1ed3ng m\u1eafc v\u1edbi virus.<\/p>\n

C\u00e1c vi khu\u1ea9n g\u00e2y b\u1ec7nh VPC\u0110 th\u01b0\u1eddng g\u1eb7p bao g\u1ed3m Streptococcus pneumoniae<\/em>,\u00a0Haemophilus influenzae<\/em>,\u00a0Moraxella catarrhalis\u00a0<\/em>v\u00e0 c\u00e1c vi khu\u1ea9n n\u1ed9i b\u00e0o, trong \u0111\u00f3, th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0\u00a0Streptococcus pneumoniae<\/em>. T\u01b0\u01a1ng \u1ee9ng, ba nh\u00f3m kh\u00e1ng sinh ph\u1ed5 bi\u1ebfn trong \u0111i\u1ec1u tr\u1ecb VPC\u0110 bao g\u1ed3m: \u03b2-lactam, macrolide v\u00e0 fluoroquinolon (FQ). T\u00ecnh tr\u1ea1ng gia t\u0103ng \u0111\u1ec1 kh\u00e1ng l\u00e0m ho\u1ea1t t\u00ednh c\u1ee7a \u03b2-lactam b\u1ecb suy gi\u1ea3m nh\u01b0ng \u0111\u00e2y v\u1eabn l\u00e0 nh\u00f3m kh\u00e1ng sinh th\u1ec3 hi\u1ec7n ho\u1ea1t t\u00ednh m\u1ea1nh v\u1edbi S. pneumoniae\u00a0<\/em>v\u00e0 ph\u1ea7n l\u1edbn c\u00e1c ph\u00e1c \u0111\u1ed3 VPC\u0110 theo kinh nghi\u1ec7m \u0111\u1ec1u bao ph\u1ee7 vi khu\u1ea9n n\u00e0y. Khi nghi ng\u1edd c\u0103n nguy\u00ean g\u00e2y b\u1ec7nh l\u00e0 c\u00e1c vi khu\u1ea9n n\u1ed9i b\u00e0o bao g\u1ed3m Mycoplasma pneumoniae<\/em>,\u00a0Chlamydia pneumoniae\u00a0<\/em>v\u00e0\u00a0Legionella\u00a0<\/em>spp., c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng kh\u00e1ng sinh macrolide (v\u00ed d\u1ee5: azithromycin, clarithromycin) ho\u1eb7c doxycyclin \u0111\u01a1n \u0111\u1ed9c c\u00f3 ho\u1ea1t t\u00ednh m\u1ea1nh tr\u00ean c\u00e1c vi khu\u1ea9n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh.<\/p>\n

Ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh penicilin ph\u1ed5 h\u1eb9p tr\u00ean\u00a0S.pneumoniae\u00a0<\/em>ho\u1eb7c vi khu\u1ea9n n\u1ed9i b\u00e0o kh\u00f4ng ph\u00f9 h\u1ee3p \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd \u0111\u1ed3ng m\u1eafc (b\u1ec7nh l\u00fd tim, ph\u1ed5i, gan, th\u1eadn m\u1ea1n t\u00ednh, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, nghi\u1ec7n r\u01b0\u1ee3u, b\u1ec7nh l\u00fd \u00e1c t\u00ednh) ho\u1eb7c c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1ng thu\u1ed1c. \u1ede nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng n\u00e0y,\u00a0H.influenzae\u00a0<\/em>v\u00e0\u00a0M.catarrhalis\u00a0<\/em>(th\u01b0\u1eddng sinh enzym \u03b2- lactamase), tr\u1ef1c khu\u1ea9n Gram \u00e2m v\u00e0\u00a0S. aureus\u00a0<\/em>l\u00e0 c\u00e1c nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p g\u00e2y ra VPC\u0110, v\u00ec v\u1eady, ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb VPC\u0110 theo kinh nghi\u1ec7m c\u1ea7n c\u00f3 ph\u1ed5 kh\u00e1ng khu\u1ea9n r\u1ed9ng h\u01a1n. Theo \u0111\u00f3, kh\u00e1ng sinh \u03b2-lactam k\u1ebft h\u1ee3p v\u1edbi ch\u1ea5t \u1ee9c ch\u1ebf \u03b2-lactamase (v\u00ed d\u1ee5: amoxicilin\/clavulanat, ampicilin\/sulbactam) ho\u1eb7c kh\u00e1ng sinh cephalosporin ph\u1ed5 r\u1ed9ng (cefpodoxim, cefdinir, cefotaxim, ceftriaxon) th\u01b0\u1eddng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o k\u1ebft h\u1ee3p v\u1edbi kh\u00e1ng sinh macrolide\/doxycyclin \u0111\u1ec3 bao ph\u1ee7 c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh kh\u00f4ng \u0111i\u1ec3n h\u00ecnh.<\/p>\n

Kh\u00e1ng sinh FQ h\u00f4 h\u1ea5p (levofloxacin, moxifloxacin) c\u00f3 ph\u1ed5 kh\u00e1ng khu\u1ea9n r\u1ed9ng bao ph\u1ee7 \u0111\u01b0\u1ee3c c\u1ea3\u00a0S.pneumoniae\u00a0<\/em>v\u00e0 vi khu\u1ea9n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh, tuy nhi\u00ean c\u1ea7n d\u1ef1 tr\u1eef nh\u00f3m kh\u00e1ng sinh n\u00e0y, kh\u00f4ng n\u00ean l\u1ef1a ch\u1ecdn cho c\u00e1c b\u1ec7nh nh\u00e2n ngo\u1ea1i tr\u00fa kh\u00f4ng c\u00f3 b\u1ec7nh n\u1ec1n m\u1eafc k\u00e8m, kh\u00f4ng c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 nhi\u1ec5m\u00a0S.pneumoniae\u00a0<\/em>kh\u00e1ng thu\u1ed1c ho\u1eb7c c\u00f3 ti\u1ec1n s\u1eed s\u1eed d\u1ee5ng kh\u00e1ng sinh trong th\u1eddi gian g\u1ea7n \u0111\u00e2y \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 kh\u00e1ng thu\u1ed1c.<\/p>\n

\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n VPC\u0110 n\u1eb7ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa, ngo\u00e0i c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh th\u01b0\u1eddng g\u1eb7p, c\u00f3 th\u1ec3 c\u1ea7n c\u00e2n nh\u1eafc \u0111\u1ebfn vai tr\u00f2 c\u1ee7a vi khu\u1ea9n \u0111a kh\u00e1ng thu\u1ed1c nh\u01b0 S.aureus\u00a0<\/em>(MRSA) v\u00e0\u00a0P.aeruginosae<\/em>. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb kinh nghi\u1ec7m c\u1ea7n b\u1ed5 sung kh\u00e1ng sinh c\u00f3 ph\u1ed5 t\u00e1c d\u1ee5ng tr\u00ean MRSA (vancomycin, teicoplanin ho\u1eb7c linezolid), kh\u00e1ng sinh \u03b2-lactam c\u00f3 ho\u1ea1t t\u00ednh tr\u00ean\u00a0P. aeruginosae\u00a0<\/em>(ceftazidim, cefepim, piperacilin\/tazobactam, imipenem, doripenem ho\u1eb7c meropenem) ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c kh\u00e1ng sinh nh\u00f3m kh\u00e1c c\u00f3 ho\u1ea1t t\u00ednh tr\u00ean vi khu\u1ea9n n\u00e0y (ciprofloxacin, levofloxacin, tobramycin ho\u1eb7c amikacin). C\u00e1c vi khu\u1ea9n \u0111a kh\u00e1ng thu\u1ed9c h\u1ecd\u00a0Enterobacteriaceae\u00a0<\/em>nh\u01b0\u00a0K.pneumoniae\u00a0<\/em>c\u0169ng c\u00f3 th\u1ec3 l\u00e0 c\u0103n nguy\u00ean trong m\u1ed9t s\u1ed1 \u00edt ca VPC\u0110, ph\u00e1c \u0111\u1ed3 h\u01b0\u1edbng \u0111\u1ebfn vi khu\u1ea9n Gram \u00e2m \u0111\u01b0\u1eddng ru\u1ed9t (ertapenem, imipenem ho\u1eb7c meropenem) ho\u1eb7c tr\u1ef1c khu\u1ea9n P.aeruginosae\u00a0<\/em>(carbapenem nh\u00f3m 2, aminoglycosid) th\u01b0\u1eddng c\u0169ng bao ph\u1ee7 \u0111\u01b0\u1ee3c c\u00e1c t\u00e1c nh\u00e2n n\u00e0y.<\/p>\n

\"\"<\/p>\n

2. L\u1ef1a ch\u1ecdn v\u00e0 t\u1ed1i \u01b0u h\u00f3a ch\u1ebf \u0111\u1ed9 li\u1ec1u d\u1ef1a tr\u00ean \u0111\u1eb7c \u0111i\u1ec3m d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc\/d\u01b0\u1ee3c l\u1ef1c h\u1ecdc v\u00e0 ch\u1ee9c n\u0103ng th\u1eadn c\u1ee7a b\u1ec7nh nh\u00e2n<\/strong><\/p>\n

T\u1ed1i \u01b0u h\u00f3a ch\u1ebf \u0111\u1ed9 li\u1ec1u kh\u00e1ng sinh d\u1ef1a tr\u00ean \u0111\u1eb7c \u0111i\u1ec3m d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc\/d\u01b0\u1ee3c l\u1ef1c h\u1ecdc (PK\/PD) g\u00f3p ph\u1ea7n t\u0103ng hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb v\u00e0 gi\u1ea3m nguy c\u01a1 kh\u00e1ng thu\u1ed1c. D\u1ef1a v\u00e0o c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m PK\/PD, c\u00e1c kh\u00e1ng sinh \u0111i\u1ec1u tr\u1ecb VPC\u0110 \u0111\u01b0\u1ee3c chia l\u00e0m ba nh\u00f3m: ph\u1ee5 thu\u1ed9c th\u1eddi gian, ph\u1ee5 thu\u1ed9c n\u1ed3ng \u0111\u1ed9 v\u00e0 ph\u1ee5 thu\u1ed9c v\u00e0o t\u1ed5ng l\u01b0\u1ee3ng thu\u1ed1c v\u00e0o c\u01a1 th\u1ec3.<\/p>\n

B\u1ea3ng 2.1. Ph\u00e2n lo\u1ea1i nh\u00f3m kh\u00e1ng sinh theo \u0111\u1eb7c \u0111i\u1ec3m PK\/PD v\u00e0 \u0111\u1ec1 xu\u1ea5t chi\u1ebfn l\u01b0\u1ee3c t\u1ed1i \u01b0u li\u1ec1u<\/strong><\/p>\n\n\n\n\n\n\n
Nh\u00f3m kh\u00e1ng sinh ph\u00e2n lo\u1ea1i theo \u0111\u1eb7c \u0111i\u1ec3m PK\/PD<\/strong><\/td>\nTh\u00f4ng s\u1ed1 PK\/PD \u0111\u1eb7c tr\u01b0ng<\/strong><\/td>\nNh\u00f3m kh\u00e1ng sinh ho\u1eb7c thu\u1ed1c c\u1ee5 th\u1ec3<\/strong><\/td>\nChi\u1ebfn l\u01b0\u1ee3c t\u1ed1i \u01b0u h\u00f3a s\u1eed d\u1ee5ng<\/strong><\/td>\n<\/tr>\n
Ph\u1ee5 thu\u1ed9c th\u1eddi gian<\/strong><\/td>\nT\u1ef7 l\u1ec7 % gi\u1eefa th\u1eddi gian kh\u00e1ng sinh c\u00f3 n\u1ed3ng \u0111\u1ed9 trong m\u00e1u v\u01b0\u1ee3t qu\u00e1 gi\u00e1 tr\u1ecb MIC so v\u1edbi kho\u1ea3ng th\u1eddi gian \u0111\u01b0a li\u1ec1u (%T>MIC)<\/td>\n\u03b2-lactam Linezolid<\/td>\nT\u0103ng li\u1ec1u<\/p>\n

T\u0103ng t\u1ea7n su\u1ea5t \u0111\u01b0a thu\u1ed1c trong ng\u00e0y<\/p>\n

C\u00e2n nh\u1eafc truy\u1ec1n li\u00ean t\u1ee5c trong tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m khu\u1ea9n n\u1eb7ng ho\u1eb7c tr\u00ean b\u1ec7nh nh\u00e2n n\u1eb7ng<\/td>\n<\/tr>\n

Ph\u1ee5 thu\u1ed9c n\u1ed3ng \u0111\u1ed9<\/strong><\/td>\nT\u1ef7 l\u1ec7 gi\u1eefa n\u1ed3ng \u0111\u1ed9 t\u1ed1i \u0111a c\u1ee7a thu\u1ed1c trong m\u00e1u so v\u1edbi gi\u00e1 tr\u1ecb MIC (Cmax\/MIC).<\/td>\nAminoglycosid<\/td>\nS\u1eed d\u1ee5ng li\u1ec1u t\u1ed1i \u0111a c\u00f3 hi\u1ec7u qu\u1ea3 v\u00e0 gi\u1ea3m thi\u1ec3u \u0111\u1ed9c t\u00ednh<\/td>\n<\/tr>\n
Ph\u1ee5 thu\u1ed9c v\u00e0o t\u1ed5ng l\u01b0\u1ee3ng thu\u1ed1c v\u00e0o c\u01a1 th\u1ec3<\/strong><\/td>\nT\u1ef7 l\u1ec7 gi\u1eefa t\u1ed5ng l\u01b0\u1ee3ng thu\u1ed1c trong c\u01a1 th\u1ec3 (t\u00ednh b\u1eb1ng AUC) so v\u1edbi gi\u00e1 tr\u1ecb MIC (AUC\/MIC)<\/td>\nFluoroquinolon<\/p>\n

Macrolid<\/p>\n

Vancomycin<\/td>\n

T\u0103ng li\u1ec1u<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Ch\u1ebf \u0111\u1ed9 li\u1ec1u kh\u00e1ng sinh c\u00f2n c\u1ea7n \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc d\u1ef1a tr\u00ean ch\u1ee9c n\u0103ng th\u1eadn c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

Vi\u1ec7c hi\u1ec7u ch\u1ec9nh li\u1ec1u \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng v\u1edbi c\u00e1c kh\u00e1ng sinh c\u00f3 kho\u1ea3ng \u0111i\u1ec1u tr\u1ecb h\u1eb9p, nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi c\u00e1c thu\u1ed1c kh\u00e1c c\u0169ng c\u00f3 \u0111\u1ed9c t\u00ednh tr\u00ean th\u1eadn ho\u1eb7c \u0111ang c\u00f3 c\u00e1c b\u1ec7nh l\u00fd th\u1eadn ho\u1eb7c b\u1ec7nh n\u1ec1n t\u0103ng nguy c\u01a1 \u0111\u1ed9c t\u00ednh tr\u00ean th\u1eadn. Th\u00f4ng tin chi ti\u1ebft v\u1ec1 li\u1ec1u d\u00f9ng v\u00e0 hi\u1ec7u ch\u1ec9nh li\u1ec1u \u1edf b\u1ec7nh nh\u00e2n suy th\u1eadn c\u1ee7a c\u00e1c kh\u00e1ng sinh s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb VPC\u0110 \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong.<\/p>\n

3. L\u1ef1a ch\u1ecdn t\u1ed1i \u01b0u h\u00f3a kh\u00e1ng sinh d\u1ef1a tr\u00ean kh\u1ea3 n\u0103ng x\u00e2m nh\u1eadp v\u00e0o c\u01a1 quan \u0111\u00edch<\/strong><\/p>\n

Kh\u1ea3 n\u0103ng x\u00e2m nh\u1eadp c\u1ee7a kh\u00e1ng sinh v\u00e0o c\u01a1 quan \u0111\u00edch c\u0169ng l\u00e0 y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn vi\u1ec7c l\u1ef1a ch\u1ecdn kh\u00e1ng sinh m\u1eb7c d\u00f9 th\u00f4ng s\u1ed1 n\u00e0y kh\u00f4ng d\u1ec5 d\u00e0ng x\u00e1c \u0111\u1ecbnh tr\u00ean b\u1ec7nh nh\u00e2n. Kh\u1ea3 n\u0103ng n\u00e0y ph\u1ee5 thu\u1ed9c v\u00e0o \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a kh\u00e1ng sinh (v\u00ed d\u1ee5: t\u00ednh th\u00e2n lipid, k\u00edch th\u01b0\u1edbc ph\u00e2n t\u1eed thu\u1ed1c) v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a m\u00f4 \u0111\u00edch (nh\u01b0 h\u1ec7 t\u01b0\u1edbi m\u00e1u t\u1ea1i m\u00f4 \u0111\u00edch, c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 t\u00ecnh tr\u1ea1ng vi\u00eam, \u00e1p xe). Trong VPMPC\u0110, c\u01a1 quan \u0111\u00edch kh\u00e1ng sinh c\u1ea7n x\u00e2m nh\u1eadp l\u00e0 d\u1ecbch l\u00f3t bi\u1ec3u m\u00f4 ph\u1ebf nang (ELF) (v\u1edbi vi khu\u1ea9n ngo\u1ea1i b\u00e0o) v\u00e0 \u0111\u1ea1i th\u1ef1c b\u00e0o ph\u1ebf nang (AM) (v\u1edbi vi khu\u1ea9n n\u1ed9i b\u00e0o). Chi ti\u1ebft t\u1ef7 l\u1ec7 n\u1ed3ng \u0111\u1ed9 kh\u00e1ng sinh trong ELF so v\u1edbi n\u1ed3ng \u0111\u1ed9 trong huy\u1ebft t\u01b0\u01a1ng.<\/p>\n

4. C\u00e2n nh\u1eafc v\u1ec1 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c khi l\u1ef1a ch\u1ecdn kh\u00e1ng sinh<\/strong><\/p>\n

Hai nh\u00f3m kh\u00e1ng sinh \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n ph\u1ed5 bi\u1ebfn trong \u0111i\u1ec1u tr\u1ecb VPC\u0110 l\u00e0 macrolide v\u00e0 FQ \u0111\u1ec1u ti\u1ec1m t\u00e0ng nguy c\u01a1 t\u01b0\u01a1ng t\u00e1c v\u1edbi nhi\u1ec1u nh\u00f3m thu\u1ed1c kh\u00e1c, th\u00f4ng qua c\u01a1 ch\u1ebf t\u01b0\u01a1ng t\u00e1c d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc v\u00e0 d\u01b0\u1ee3c l\u1ef1c h\u1ecdc. Linezolid l\u00e0 m\u1ed9t ch\u1ea5t \u1ee9c ch\u1ebf y\u1ebfu monoaminoxidase (MAO) c\u0169ng c\u00f3 kh\u1ea3 n\u0103ng cao g\u1eb7p t\u01b0\u01a1ng t\u00e1c khi k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c t\u00e1c \u0111\u1ed9ng tr\u00ean h\u1ec7 serotonergic, d\u1eabn \u0111\u1ebfn nguy c\u01a1 x\u1ea3y ra h\u1ed9i ch\u1ee9ng serotonin.<\/p>\n

Chi ti\u1ebft c\u00e1c c\u1eb7p t\u01b0\u01a1ng t\u00e1c thu\u1ed1c c\u1ea7n l\u01b0u \u00fd li\u00ean quan \u0111\u1ebfn kh\u00e1ng sinh \u0111i\u1ec1u tr\u1ecb VPC\u0110, c\u00f9ng h\u1eadu qu\u1ea3 v\u00e0 c\u00e1ch x\u1eed tr\u00ed c\u1ee7a c\u00e1c c\u1eb7p t\u01b0\u01a1ng t\u00e1c.<\/p>\n

5. Nguy\u00ean t\u1eafc chuy\u1ec3n \u0111\u1ed5i kh\u00e1ng sinh \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch sang \u0111\u01b0\u1eddng u\u1ed1ng<\/strong><\/p>\n

B\u1ec7nh nh\u00e2n VPC\u0110 \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa c\u00f3 th\u1ec3 chuy\u1ec3n \u0111\u1ed5i kh\u00e1ng sinh \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch sang c\u00e1c kh\u00e1ng sinh \u0111\u01b0\u1eddng u\u1ed1ng t\u01b0\u01a1ng \u0111\u01b0\u01a1ng sau khi c\u00f3 c\u1ea3i thi\u1ec7n v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng ho\u1eb7c c\u1eaft s\u1ed1t. Chuy\u1ec3n \u0111\u1ed5i \u0111\u01b0\u1eddng t\u00ednh m\u1ea1ch (IV) sang \u0111\u01b0\u1eddng u\u1ed1ng (PO) gi\u00fap g\u1ed3m gi\u1ea3m chi ph\u00ed \u0111i\u1ec1u tr\u1ecb, gi\u1ea3m th\u1eddi gian n\u1eb1m vi\u1ec7n, gi\u1ea3m c\u00e1c tai bi\u1ebfn li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch v\u00e0 d\u1ec5 s\u1eed d\u1ee5ng h\u01a1n cho b\u1ec7nh nh\u00e2n. C\u00e1c \u0111i\u1ec1u ki\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh nh\u00e2n cho ph\u00e9p chuy\u1ec3n \u0111\u1ed5i t\u1eeb \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch sang \u0111\u01b0\u1eddng u\u1ed1ng bao g\u1ed3m.<\/p>\n

    \n
  • Nhi\u1ec7t \u0111\u1ed9 \u2264 37,8o<\/sup>C<\/li>\n
  • Nh\u1ecbp tim \u2264 100 l\u1ea7n\/ph\u00fat<\/li>\n
  • Nh\u1ecbp th\u1edf \u2264 24 l\u1ea7n\/ph\u00fat<\/li>\n
  • Huy\u1ebft \u00e1p t\u00e2m thu \u2265 90 mmHg<\/li>\n
  • B\u00e3o h\u00f2a oxy m\u00e1u \u0111\u1ed9ng m\u1ea1ch (SaO2<\/sub>) \u2265 90 ho\u1eb7c PO2<\/sub>\u2265 60 mmHg \u1edf \u0111i\u1ec1u ki\u1ec7n kh\u00ed ph\u00f2ng<\/li>\n
  • C\u00f3 kh\u1ea3 n\u0103ng \u0103n u\u1ed1ng<\/li>\n
  • S\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n b\u00ecnh th\u01b0\u1eddng<\/li>\n<\/ul>\n

    H\u01b0\u1edbng d\u1eabn chi ti\u1ebft v\u1ec1 li\u1ec1u d\u00f9ng c\u1ee7a kh\u00e1ng sinh khi chuy\u1ec3n \u0111\u1ed5i \u0111\u01b0\u1eddng ti\u00eam\/\u0111\u01b0\u1eddng u\u1ed1ng<\/p>\n

    \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong\u00a0B\u1ea3ng <\/strong>5<\/strong>.<\/strong>1<\/strong>.<\/p>\n

    B\u1ea3ng 5.1. H\u01b0\u1edbng d\u1eabn chuy\u1ec3n \u0111\u1ed5i \u0111\u01b0\u1eddng ti\u00eam\/\u0111\u01b0\u1eddng u\u1ed1ng v\u1edbi m\u1ed9t s\u1ed1 kh\u00e1ng sinh<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    Kh\u00e1ng sinh t\u0129nh m\u1ea1ch<\/strong><\/td>\nKh\u00e1ng sinh \u0111\u01b0\u1eddng u\u1ed1ng<\/strong><\/td>\n<\/tr>\n
    Levofloxacin 500 m\u1ed7i 12 gi\u1edd ho\u1eb7c 750mg m\u1ed7i 24 gi\u1edd<\/td>\nLevofloxacin 500 m\u1ed7i 12 gi\u1edd ho\u1eb7c 750mg m\u1ed7i 24 gi\u1edd<\/td>\n<\/tr>\n
    Moxifloxacin 400mg m\u1ed7i 24 gi\u1edd<\/td>\nMoxifloxacin 400mg m\u1ed7i 24 gi\u1edd<\/td>\n<\/tr>\n
    Ciprofloxacin 400mg m\u1ed7i 12 gi\u1edd<\/td>\nCiprofloxacin 500mg m\u1ed7i 12 gi\u1edd<\/td>\n<\/tr>\n
    Linezolid 600mg m\u1ed7i 12 gi\u1edd<\/td>\nLinezolid 600mg m\u1ed7i 12 gi\u1edd<\/td>\n<\/tr>\n
    Clarithromycin 500 mg m\u1ed7i 12 gi\u1edd<\/td>\nClarithromycin 500 mg m\u1ed7i 12 gi\u1edd<\/td>\n<\/tr>\n
    Azithromycin 500mg m\u1ed7i 24 gi\u1edd<\/td>\nAzithromycin 500mg m\u1ed7i 24 gi\u1edd<\/td>\n<\/tr>\n
    Ampicillin 1-2g m\u1ed7i 6 gi\u1edd<\/p>\n

    Ampicillin\/sulbactam (li\u1ec1u theo ampicillin)<\/td>\n

    		Amoxicillin 500mg – 1000 mg m\u1ed7i 8 gi\u1edd<\/p>\n

    Amoxicillin\/acid clavulamic (li\u1ec1u theo amoxicillin)<\/td>\n<\/tr>\n

    Cefuroxim 750mg-1,5g m\u1ed7i 8 gi\u1edd<\/td>\nCefuroxim axetil 500mg-1g m\u1ed7i 12 gi\u1edd<\/td>\n<\/tr>\n
    Cloxacillin 1g m\u1ed7i 6 gi\u1edd<\/td>\nCloxacillin 500mg m\u1ed7i 6 gi\u1edd<\/td>\n<\/tr>\n
    Ceftazidim ho\u1eb7c cefepim<\/p>\n

    (2g m\u1ed7i 8 gi\u1edd)<\/td>\n

    		Ciprofloxacin (750 mg m\u1ed7i 12 gi\u1edd) ho\u1eb7c levofloxacin<\/p>\n

    (500 mg m\u1ed7i 12 gi\u1edd ho\u1eb7c 750mg m\u1ed7i 24 gi\u1edd)<\/td>\n<\/tr>\n

    Ceftriaxon 1 – 2 g m\u1ed7i 24 gi\u1edd<\/td>\nCiprofloxacin 500-750mg m\u1ed7i 12 gi\u1edd ho\u1eb7c amoxicillin\/acid clavulanic 875\/125 mg m\u1ed7i 12 gi\u1edd<\/td>\n<\/tr>\n
    Clindamycin 600mg m\u1ed7i 8 gi\u1edd<\/td>\nClindamycin 300 – 450 mg m\u1ed7i 6 gi\u1edd<\/td>\n<\/tr>\n
    Vancomycin (li\u1ec1u theo khuy\u1ebfn c\u00e1o)<\/td>\nLinezolid 600mg m\u1ed7i 12 gi\u1edd<\/td>\n<\/tr>\n
    Metronidazol 500 mg m\u1ed7i 12 gi\u1edd<\/td>\nMetronidazol 500 mg m\u1ed7i 12 gi\u1edd<\/td>\n<\/tr>\n
    Gentamicin 5 mg\/kg m\u1ed7i 24 gi\u1edd<\/td>\nCiprofloxacin 500 mg m\u1ed7i 12 gi\u1edd (750 mg m\u1ed7i 12 gi\u1edd cho\u00a0P. aeruginosa<\/em>)<\/td>\n<\/tr>\n
    Tobramycin 5 mg\/kg m\u1ed7i 2 4 gi\u1edd<\/td>\nCiprofloxacin 750 mg m\u1ed7i 12 gi\u1edd (cho\u00a0P. aeruginosa<\/em>)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    \u0110\u1ed1i v\u1edbi kh\u00e1ng sinh thu\u1ed9c nh\u00f3m 1, 2: c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng u\u1ed1ng v\u1edbi c\u00e1c nhi\u1ec5m khu\u1ea9n kh\u00f4ng \u0111e d\u1ecda t\u00ednh m\u1ea1ng, b\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh v\u00e0 kh\u00f4ng c\u00f3 v\u1ea5n \u0111\u1ec1 v\u1ec1 h\u1ea5p hu, m\u1eb7t kh\u00e1c c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng trong chuy\u1ec3n ti\u1ebfp \u0111\u01b0\u1eddng ti\u00eam\/\u0111\u01b0\u1eddng u\u1ed1ng n\u1ebfu \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u ki\u1ec7n l\u00e2m s\u00e0ng.<\/p>\n

    \u0110\u1ed1i v\u1edbi kh\u00e1ng sinh thu\u1ed9c nh\u00f3m 3, 4, c\u00f3 th\u1ec3 chuy\u1ec3n ti\u1ebfp \u0111\u01b0\u1eddng ti\u00eam\/\u0111\u01b0\u1eddng u\u1ed1ng theo nguy\u00ean t\u1eafc: nhi\u1ec5m khu\u1ea9n c\u01a1 b\u1ea3n \u0111\u00e3 \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft b\u1eb1ng kh\u00e1ng sinh \u0111\u01b0\u1eddng ti\u00eam ban \u0111\u1ea7u, do \u0111\u00f3 n\u1ed3ng \u0111\u1ed9 kh\u00e1ng sinh trong huy\u1ebft thanh khi d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng d\u00f9 th\u1ea5p h\u01a1n so v\u1edbi khi d\u00f9ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 ti\u1ebfp t\u1ee5c duy tr\u00ec hi\u1ec7u qu\u1ea3 c\u1ee7a li\u1ec7u ph\u00e1p kh\u00e1ng sinh.<\/p>\n

    Nh\u1eefng \u0111i\u1ec3m c\u1ea7n nh\u1edb:<\/strong><\/p>\n

    – L\u1ef1a ch\u1ecdn kh\u00e1ng sinh theo kinh nghi\u1ec7m d\u1ef1a tr\u00ean t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh k\u1ebft h\u1ee3p v\u1edbi ph\u1ed5 kh\u00e1ng khu\u1ea9n c\u1ee7a kh\u00e1ng sinh v\u00e0 kh\u1ea3 n\u0103ng x\u00e2m nh\u1eadp c\u01a1 quan \u0111\u00edch (d\u1ecbch l\u00f3t bi\u1ec3u m\u00f4 ph\u1ebf nang v\u00e0 \u0111\u1ea1i th\u1ef1c b\u00e0o ph\u1ebf nang).<\/p>\n

    – T\u1ed1i \u01b0u h\u00f3a ch\u1ebf \u0111\u1ed9 li\u1ec1u kh\u00e1ng sinh d\u1ef1a tr\u00ean \u0111\u1eb7c \u0111i\u1ec3m d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc\/d\u01b0\u1ee3c l\u1ef1c h\u1ecdc (PK\/PD). C\u00e1c kh\u00e1ng sinh \u0111\u01b0\u1ee3c chia l\u00e0m 3 nh\u00f3m: ph\u1ee5 thu\u1ed9c th\u1eddi gian (\u03b2-lactam, Linezolid), ph\u1ee5 thu\u1ed9c n\u1ed3ng \u0111\u1ed3 (Aminoglycoside) v\u00e0 ph\u1ee5 thu\u1ed9c t\u1ed5ng l\u01b0\u1ee3ng thu\u1ed1c v\u00e0o c\u01a1 th\u1ec3 (Fluoroquinolon, macrolide, vancomycin). Ch\u1ebf \u0111\u1ed9 li\u1ec1u c\u1ea7n hi\u1ec7u ch\u1ec9nh d\u1ef1a tr\u00ean ch\u1ee9c n\u0103ng th\u1eadn.<\/p>\n

    – L\u01b0u \u00fd c\u00e1c t\u01b0\u01a1ng t\u00e1c thu\u1ed1c c\u1ee7a kh\u00e1ng sinh v\u1edbi c\u00e1c nh\u00f3m kh\u00e1c khi d\u00f9ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 FQ v\u00e0 macrolide.<\/p>\n

    – Chuy\u1ec3n \u0111\u1ed5i kh\u00e1ng sinh \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch sang \u0111\u01b0\u1eddng u\u1ed1ng khi c\u00f3 c\u1ea3i thi\u1ec7n v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng ho\u1eb7c c\u1eaft s\u1ed1t.<\/p>\n

    Ngu\u1ed3n<\/strong>: H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng \u1edf ng\u01b0\u1eddi l\u1edbn c\u1ee7a B\u1ed9 Y t\u1ebf 2020<\/p>\n","protected":false},"excerpt":{"rendered":"

    T\u1ed1i \u01b0u h\u00f3a kh\u00e1ng sinh trong vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng l\u00e0 m\u1ed9t ch\u1ee7 \u0111\u1ec1 \u0111\u01b0\u1ee3c quan t\u00e2m r\u1ea5t nhi\u1ec1u trong l\u00e2m s\u00e0ng v\u00e0 nghi\u00ean c\u1ee9u y h\u1ecdc hi\u1ec7n \u0111\u1ea1i.\u00a0B\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 […]<\/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":"\nH\u01b0\u1edbng d\u1eabn t\u1ed1i \u01b0u h\u00f3a kh\u00e1ng sinh trong vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng<\/title>\n<meta name=\"description\" content=\"Vi\u1ec7c l\u1ef1a ch\u1ecdn kh\u00e1ng sinh, c\u1ea7n 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