{"id":22022,"date":"2023-04-17T12:34:45","date_gmt":"2023-04-17T05:34:45","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22022"},"modified":"2023-04-17T12:36:06","modified_gmt":"2023-04-17T05:36:06","slug":"nhiem-khuan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/nhiem-khuan\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n b\u1eb1ng kh\u00e1ng sinh \u1edf b\u1ec7nh nh\u00e2n COVID 19"},"content":{"rendered":"

Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, b\u1ec7nh nh\u00e2n COVID-19 c\u00f3 th\u1ec3 b\u1ecb nhi\u1ec5m\u00a0 khu\u1ea9n th\u1ee9 ph\u00e1t do vi khu\u1ea9n ho\u1eb7c n\u1ea5m, v\u00e0 trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, s\u1eed d\u1ee5ng kh\u00e1ng sinh c\u00f3 th\u1ec3 l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng. Tuy nhi\u00ean, vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n COVID-19, v\u00ec n\u00f3 c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 kh\u00e1ng thu\u1ed1c v\u00e0 l\u00e0m suy gi\u1ea3m h\u1ec7 mi\u1ec5n d\u1ecbch c\u1ee7a c\u01a1 th\u1ec3.Do \u0111\u00f3, vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u01b0a ra d\u1ef1a tr\u00ean t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a t\u1eebng b\u1ec7nh nh\u00e2n v\u00e0 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 nhi\u1ec5m tr\u00f9ng.<\/strong><\/p>\n

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Ngu\u1ed3n<\/strong>: COVID-19 Antibiotic Overuse Puts Stewardship Efforts at Risk<\/em><\/figcaption><\/figure>\n

1. \u0110i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n<\/strong><\/h1>\n

1.1. \u0110i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n theo ph\u00e2n t\u1ea7ng ng\u01b0\u1eddi b\u1ec7nh COVID-19<\/strong><\/h3>\n

1.1.1. Ng\u01b0\u1eddi nhi\u1ec5m kh\u00f4ng tri\u1ec7u ch\u1ee9ng, m\u1ee9c \u0111\u1ed9 nh\u1eb9<\/em><\/strong><\/p>\n

Kh\u00f4ng s\u1eed d\u1ee5ng kh\u00e1ng sinh (KS), kh\u00e1ng n\u1ea5m n\u1ebfu kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng nhi\u1ec5m tr\u00f9ng.<\/p>\n

1.1.2.<\/strong> M\u1ee9c \u0111\u1ed9 trung b\u00ecnh<\/em><\/strong><\/p>\n

Ch\u1ec9 \u0111i\u1ec1u tr\u1ecb KS khi nghi ng\u1edd c\u00f3 b\u1eb1ng ch\u1ee9ng nhi\u1ec5m tr\u00f9ng.<\/p>\n

1.1.3. M\u1ee9c \u0111\u1ed9 n\u1eb7ng<\/em><\/strong><\/p>\n

– D\u00f9ng kh\u00e1ng sinh theo kinh nghi\u1ec7m ph\u1ee5 thu\u1ed9c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh ho\u1eb7c theo kh\u00e1ng sinh \u0111\u1ed3 n\u1ebfu c\u00f3.<\/p>\n

1.1.4. M\u1ee9c \u0111\u1ed9 nguy k\u1ecbch c\u00f3 nhi\u1ec1u k\u1ef9 thu\u1eadt-th\u1ee7 thu\u1eadt x\u00e2m l\u1ea5n<\/em><\/strong><\/p>\n

– D\u00f9ng kh\u00e1ng sinh theo kinh nghi\u1ec7m ph\u1ee5 thu\u1ed9c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh ho\u1eb7c theo kh\u00e1ng sinh \u0111\u1ed3 n\u1ebfu c\u00f3.<\/p>\n

1.2. Nguy\u00ean t\u1eafc s\u1eed d\u1ee5ng kh\u00e1ng sinh<\/strong><\/h3>\n

– Khi c\u00f3 bi\u1ec3u hi\u1ec7n nghi ng\u1edd nhi\u1ec5m khu\u1ea9n, c\u1ea7n l\u00e0m x\u00e9t nghi\u1ec7m c\u00f4ng th\u1ee9c m\u00e1u, bilan vi\u00eam (CRP ho\u1eb7c t\u1ed1t h\u01a1n l\u00e0 procalcitonin, PCT), ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh (X-quang) tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng kh\u00e1ng sinh.<\/p>\n

– Khuy\u1ebfn kh\u00edch l\u1ea5y m\u1eabu b\u1ec7nh ph\u1ea9m (m\u00e1u, \u0111\u1eddm, d\u1ecbch ti\u1ebft ph\u1ebf qu\u1ea3n, v\u00e0\/ho\u1eb7c c\u00e1c b\u1ec7nh ph\u1ea9m kh\u00e1c t\u00f9y theo v\u1ecb tr\u00ed nhi\u1ec5m tr\u00f9ng nghi ng\u1edd theo h\u01b0\u1edbng d\u1eabn c\u1ee7a Khoa X\u00e9t nghi\u1ec7m) \u0111\u1ec3 t\u00ecm t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh\u00a0tr\u01b0\u1edbc ho\u1eb7c trong v\u00f2ng 24 h\u00a0<\/strong>sau khi s\u1eed d\u1ee5ng kh\u00e1ng sinh nh\u01b0ng tr\u00e1nh l\u00e0m tr\u00ec ho\u00e3n vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh, nu\u00f4i c\u1ea5y, \u0111\u1ecbnh danh v\u00e0 l\u00e0m kh\u00e1ng sinh \u0111\u1ed3.<\/p>\n

– K\u1ebft qu\u1ea3 CRP > 10 mg\/dl ho\u1eb7c PCT > 0,5 ng\/ml k\u1ebft h\u1ee3p v\u1edbi t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng \u0111\u1ec3 s\u1eed d\u1ee5ng kh\u00e1ng sinh.<\/p>\n

– Ch\u1ecdn ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh ph\u00f9 h\u1ee3p nh\u1ea5t ph\u00f9 h\u1ee3p nh\u1ea5t d\u1ef1a tr\u00ean v\u1ecb tr\u00ed nhi\u1ec5m khu\u1ea9n, vi sinh v\u1eadt c\u00f3 th\u1ec3 li\u00ean quan (Gram d\u01b0\u01a1ng, Gram \u00e2m, k\u1ef5 kh\u00ed ho\u1eb7c vi khu\u1ea9n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh), m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh v\u00e0 nguy c\u01a1 kh\u00e1ng thu\u1ed1c c\u1ee7a vi sinh v\u1eadt g\u00e2y b\u1ec7nh (\u0111\u00e1nh gi\u00e1 th\u00f4ng tin ch\u0103m s\u00f3c y t\u1ebf, s\u1eed d\u1ee5ng kh\u00e1ng sinh, c\u00e1c y\u1ebfu t\u1ed1 b\u1ec7nh n\u1ec1n v\u00e0 c\u00e1c can thi\u1ec7p x\u00e2m l\u1ea5n th\u1ef1c hi\u1ec7n tr\u00ean ng\u01b0\u1eddi b\u1ec7nh).<\/p>\n

– Ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh kinh nghi\u1ec7m v\u1edbi c\u00e1c t\u00ecnh tr\u1ea1ng nhi\u1ec5m khu\u1ea9n c\u00f3 s\u1eb5n t\u1eeb c\u00e1c ca b\u1ec7nh trong c\u1ed9ng \u0111\u1ed3ng v\u00e0o th\u1eb3ng Trung t\u00e2m (ch\u1ea9n \u0111o\u00e1n trong v\u00f2ng 48 gi\u1edd sau khi nh\u1eadp Trung t\u00e2m) c\u1ea7n \u01b0u ti\u00ean kh\u00e1ng sinh ph\u1ed5 h\u1eb9p tr\u00ean c\u00e1c vi khu\u1ea9n g\u00e2y nhi\u1ec5m tr\u00f9ng c\u1ed9ng \u0111\u1ed3ng. Ch\u1ec9 s\u1eed d\u1ee5ng kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng ho\u1eb7c ph\u1ed1i h\u1ee3p kh\u00e1ng sinh cho nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh c\u00f3 nguy c\u01a1 nhi\u1ec5m vi khu\u1ea9n kh\u00e1ng thu\u1ed1c.<\/p>\n

– Ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh cho nhi\u1ec5m khu\u1ea9n n\u1eb7ng, th\u1ee9 ph\u00e1t trong \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa \u1edf b\u1ec7nh vi\u1ec7n tuy\u1ebfn d\u01b0\u1edbi ho\u1eb7c t\u1ea1i Trung t\u00e2m (\u0111\u1eb7c bi\u1ec7t tr\u00ean ng\u01b0\u1eddi b\u1ec7nh th\u1edf m\u00e1y) c\u1ea7n \u01b0u ti\u00ean ph\u1ed1i h\u1ee3p kh\u00e1ng sinh c\u00f3 ph\u1ed5 tr\u00ean vi khu\u1ea9n Gram \u00e2m, c\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p th\u00eam kh\u00e1ng sinh t\u00e1c d\u1ee5ng tr\u00ean vi khu\u1ea9n Gram d\u01b0\u01a1ng (t\u1ee5 c\u1ea7u ho\u1eb7c\u00a0Enterococcus<\/em>) nh\u01b0 vancomycin hay linezolid khi c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1, ho\u1eb7c trong nhi\u1ec5m khu\u1ea9n n\u1eb7ng, vi\u00eam ph\u1ed5i li\u00ean quan \u0111\u1ebfn th\u1edf m\u00e1y, s\u1ed1c nhi\u1ec5m tr\u00f9ng. Ch\u1ec9 c\u00e2n nh\u1eafc ph\u1ed1i h\u1ee3p th\u00eam c\u00e1c kh\u00e1ng sinh v\u1edbi m\u1ee5c \u0111\u00edch bao ph\u1ee7 tr\u00ean vi khu\u1ea9n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh (nh\u01b0 azithromycin, fluoroquinolon) khi c\u00f3 b\u1eb1ng ch\u1ee9ng x\u00e9t nghi\u1ec7m ho\u1eb7c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng r\u1ea5t g\u1ee3i \u00fd.<\/p>\n

– Ch\u1ec9 c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng kh\u00e1ng n\u1ea5m trong c\u00e1c t\u00ecnh hu\u1ed1ng l\u00e2m s\u00e0ng \u0111\u1eb7c bi\u1ec7t sau khi \u0111\u00e3 \u0111\u00e1nh gi\u00e1 c\u00e1c y\u1ebfu t\u1ed1 li\u00ean quan \u0111\u1ebfn nhi\u1ec5m n\u1ea5m x\u00e2m l\u1ea5n v\u00e0 l\u00e2m s\u00e0ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

– Kh\u00e1ng sinh c\u1ea7n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t sau khi c\u00f3 ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m khu\u1ea9n (t\u1ed1t nh\u1ea5t trong v\u00f2ng 6 gi\u1edd). Trong c\u00e1c nhi\u1ec5m khu\u1ea9n n\u1eb7ng v\u00e0 s\u1ed1c nhi\u1ec5m khu\u1ea9n, kh\u00e1ng sinh kinh nghi\u1ec7m n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong v\u00f2ng 1 gi\u1edd sau khi c\u00f3 ch\u1ea9n \u0111o\u00e1n.<\/p>\n

– \u00c1p d\u1ee5ng nguy\u00ean t\u1eafc D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc – D\u01b0\u1ee3c l\u1ef1c h\u1ecdc trong hi\u1ec7u ch\u1ec9nh li\u1ec1u \u0111\u1ec3 t\u0103ng hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb, gi\u1ea3m \u0111\u1ed9c t\u00ednh c\u1ee7a kh\u00e1ng sinh. Ch\u00fa \u00fd c\u00e1c ng\u01b0\u1eddi b\u1ec7nh th\u1eeba c\u00e2n, b\u00e9o ph\u00ec, gi\u1ea3m albumin m\u00e1u, s\u1ed1c nhi\u1ec5m tr\u00f9ng ph\u1ee5 thu\u1ed1c v\u1eadn m\u1ea1ch, t\u0103ng thanh th\u1ea3i th\u1eadn (\u1edf ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i, ph\u1ee5 n\u1eef c\u00f3 thai), suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn (\u1edf ng\u01b0\u1eddi b\u1ec7nh cao tu\u1ed5i ho\u1eb7c c\u00f3 b\u1ec7nh n\u1ec1n) hay th\u1ef1c hi\u1ec7n can thi\u1ec7p \u0111i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn (ng\u1eaft qu\u00e3ng ho\u1eb7c li\u00ean t\u1ee5c), l\u1ecdc m\u00e1u h\u1ea5p ph\u1ee5, ECMO c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a kh\u00e1ng sinh v\u00e0 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb, do \u0111\u00f3 c\u1ea7n tham kh\u1ea3o li\u1ec1u cho ph\u00f9 h\u1ee3p.<\/em><\/p>\n

– \u0110\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng xuy\u00ean (quan tr\u1ecdng nh\u1ea5t sau 48 – 72 h sau khi kh\u1edfi \u0111\u1ea7u ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb), \u0111i\u1ec1u ch\u1ec9nh kh\u00e1ng sinh sau khi c\u00f3 k\u1ebft qu\u1ea3 vi sinh v\u00e0 \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh. C\u00e2n nh\u1eafc ng\u1eebng kh\u00e1ng sinh khi \u0111\u1ee7 li\u1ec7u tr\u00ecnh \u0111i\u1ec1u tr\u1ecb, bilan vi\u00eam (s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u, b\u1ea1ch c\u1ea7u trung t\u00ednh, CRP ho\u1eb7c PCT tr\u1edf v\u1ec1 b\u00ecnh th\u01b0\u1eddng ho\u1eb7c gi\u1ea3m \u00edt nh\u1ea5t 80% so v\u1edbi th\u1eddi \u0111i\u1ec3m tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb) v\u00e0 ch\u1ec9 \u0111\u1ecbnh l\u00e2m s\u00e0ng cho ph\u00e9p. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh th\u00f4ng th\u01b0\u1eddng t\u1eeb 5 – 7 ng\u00e0y. C\u00f3 th\u1ec3 k\u00e9o d\u00e0i h\u01a1n (10 – 14 ng\u00e0y) trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb ch\u1eadm, nhi\u1ec5m khu\u1ea9n nghi ng\u1edd ho\u1eb7c x\u00e1c \u0111\u1ecbnh do c\u0103n nguy\u00ean kh\u00e1ng thu\u1ed1c, \u1ed5 nhi\u1ec5m tr\u00f9ng s\u00e2u, kh\u00f4ng th\u1ec3 x\u1eed l\u00fd tri\u1ec7t \u0111\u1ec3 \u1ed5 nhi\u1ec5m; ho\u1eb7c tr\u00ean ng\u01b0\u1eddi b\u1ec7nh suy gi\u1ea3m mi\u1ec5n d\u1ecbch.<\/p>\n

– C\u00e2n nh\u1eafc xu\u1ed1ng thang: c\u1eaft vancomycin ho\u1eb7c linezolid sau 5 ng\u00e0y n\u1ebfu c\u1ea5y vi sinh \u00e2m t\u00ednh v\u1edbi t\u1ee5 c\u1ea7u ho\u1eb7c l\u00e2m s\u00e0ng kh\u00f4ng c\u00f2n nghi ng\u1edd nhi\u1ec5m khu\u1ea9n do vi khu\u1ea9n Gram d\u01b0\u01a1ng; c\u00e2n nh\u1eafc ng\u1eebng kh\u00e1ng sinh n\u1ebfu kh\u00f4ng c\u00f2n d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m nghi ng\u1edd nhi\u1ec5m khu\u1ea9n (c\u1ea5y vi sinh \u00e2m t\u00ednh, PCT < 0,5 ng\/ml), chuy\u1ec3n kh\u00e1ng sinh u\u1ed1ng c\u00f3 ph\u1ed5 t\u00e1c d\u1ee5ng t\u01b0\u01a1ng t\u1ef1 n\u1ebfu \u0111i\u1ec1u ki\u1ec7n l\u00e2m s\u00e0ng cho ph\u00e9p (c\u1eaft s\u1ed1t \u00edt nh\u1ea5t 48 gi\u1edd, x\u00e9t nghi\u1ec7m b\u1ea1ch c\u1ea7u tr\u1edf v\u1ec1 b\u00ecnh th\u01b0\u1eddng, ng\u01b0\u1eddi b\u1ec7nh t\u1ec9nh t\u00e1o, kh\u00f4ng c\u00f3 r\u1ed1i lo\u1ea1n nu\u1ed1t, kh\u00f4ng c\u00f2n \u0103n qua sonde hay c\u00e1c t\u00ecnh tr\u1ea1ng kh\u00e1c \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn h\u1ea5p thu thu\u1ed1c qua \u0111\u01b0\u1eddng ti\u00eau h\u00f3a).<\/p>\n

1.3. \u0110\u00e1nh gi\u00e1 y\u1ebfu t\u1ed1 nguy c\u01a1 nhi\u1ec5m vi khu\u1ea9n \u0111a kh\u00e1ng thu\u1ed1c<\/strong><\/h3>\n

1.3.1. Nguy c\u01a1 chung<\/em><\/strong><\/p>\n

– C\u00f3 \u0111i\u1ec1u tr\u1ecb \u2265 5 ng\u00e0y t\u1ea1i c\u00e1c c\u01a1 s\u1edf y t\u1ebf trong v\u00f2ng 90 ng\u00e0y ho\u1eb7c c\u00f3 \u0111i\u1ec1u tr\u1ecb t\u1ea1i h\u1ed3i s\u1ee9c > 2 ng\u00e0y.<\/p>\n

– \u0110ang c\u00f3 \u0111\u1eb7t d\u1ee5ng c\u1ee5 x\u00e2m l\u1ea5n l\u01b0u > 7 ng\u00e0y ho\u1eb7c th\u1ee7 thu\u1eadt, ph\u1eabu thu\u1eadt.<\/p>\n

– C\u00f3 d\u00f9ng KS t\u0129nh m\u1ea1ch trong 30 ng\u00e0y.<\/p>\n

– D\u00f9ng corticoid k\u00e9o d\u00e0i (prednisolon 0,2 mg\/kg\/ng\u00e0y > 3 th\u00e1ng ho\u1eb7c 1 mg\/kg\/ng\u00e0y trong 1 tu\u1ea7n trong v\u00f2ng 3 th\u00e1ng tr\u01b0\u1edbc nh\u1eadp vi\u1ec7n).<\/p>\n

– B\u1ec7nh l\u00fd m\u1ea1n t\u00ednh k\u00e8m theo (\u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, x\u01a1 gan, suy th\u1eadn m\u1ea1n giai \u0111o\u1ea1n cu\u1ed1i c\u00f3 ch\u1ea1y th\u1eadn, b\u1ec7nh c\u1ea5u tr\u00fac ph\u1ed5i, gi\u1ea3m b\u1ea1ch c\u1ea7u h\u1ea1t, suy gi\u1ea3m mi\u1ec5n d\u1ecbch, x\u01a1 gan).<\/p>\n

– Ng\u01b0\u1eddi b\u1ec7nh gh\u00e9p t\u1ee7y x\u01b0\u01a1ng, gh\u00e9p t\u1ea1ng, gi\u1ea3m b\u1ea1ch c\u1ea7u h\u1ea1t do h\u00f3a tr\u1ecb.<\/p>\n

– Tu\u1ed5i > 60.<\/p>\n

– C\u00f3 ti\u1ebfp x\u00fac ng\u01b0\u1eddi nhi\u1ec5m vi khu\u1ea9n \u0111a kh\u00e1ng thu\u1ed1c.<\/p>\n

1.3.2. Nguy c\u01a1 nhi\u1ec5m T\u1ee5 c\u1ea7u v\u00e0ng kh\u00e1ng methicilin (MRSA)<\/em><\/strong><\/p>\n

– C\u00f3 d\u00f9ng fluoroquinolon \u0111\u01a1n tr\u1ecb li\u1ec7u trong 90 ng\u00e0y.<\/p>\n

– HIV\/AIDS ch\u01b0a \u0111i\u1ec1u tr\u1ecb ho\u1eb7c CD4 < 50 t\u1ebf b\u00e0o\/uL.<\/p>\n

– \u0110\u1eb7t catheter t\u0129nh m\u1ea1ch trung t\u00e2m ho\u1eb7c th\u00f4ng ti\u1ec3u l\u01b0u.<\/p>\n

– Ti\u1ec1n c\u0103n nhi\u1ec5m ho\u1eb7c ph\u01a1i nhi\u1ec5m MRSA.<\/p>\n

– S\u1eed d\u1ee5ng ma t\u00fay \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch.<\/p>\n

– Quan h\u1ec7 t\u00ecnh d\u1ee5c kh\u00f4ng an to\u00e0n.<\/p>\n

\u2192 S\u1eed d\u1ee5ng KS: vancomycin, linezolid ho\u1eb7c teicoplanin.<\/p>\n

1.3.3. Nguy c\u01a1 nhi\u1ec5m vi khu\u1ea9n gram \u00e2m \u0111\u01b0\u1eddng ru\u1ed9t sinh men Betalactamase ph\u1ed5 r\u1ed9ng (ESBL)<\/em><\/strong><\/p>\n

– S\u1eed d\u1ee5ng corticoid k\u00e9o d\u00e0i.<\/p>\n

– \u0110\u1eb7t th\u00f4ng d\u1ea1 d\u00e0y nu\u00f4i \u0103n, th\u00f4ng ti\u1ec3u l\u01b0u.<\/p>\n

– Ti\u1ec1n c\u0103n nhi\u1ec5m\/ ph\u01a1i nhi\u1ec5m tr\u1ef1c khu\u1ea9n gram \u00e2m \u0111\u01b0\u1eddng ru\u1ed9t sinh ESBL.<\/p>\n

– \u0110i\u1ec1u tr\u1ecb t\u1ea1i c\u01a1 s\u1edf y t\u1ebf d\u00e0i h\u1ea1n.<\/p>\n

– Ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o.<\/p>\n

– \u0110\u1eb7t catheter t\u0129nh m\u1ea1ch trung t\u00e2m.<\/p>\n

\u2192 S\u1eed d\u1ee5ng KS: piperacillin\/tazobactam, imipenem\/cilastatin, meropenem, ceftolozan\/tazobactam ho\u1eb7c ceftazidime\/avibactam.<\/p>\n

1.3.4. Nguy c\u01a1 nhi\u1ec5m Pseudomonas spp. ho\u1eb7c Acinetobacter baumanni \u0111a kh\u00e1ng thu\u1ed1c<\/em><\/strong><\/p>\n

– \u0110ang \u0111i\u1ec1u tr\u1ecb t\u1ea1i ICU > 5 ng\u00e0y.<\/p>\n

– C\u00f3 thi\u1ebft b\u1ecb x\u00e2m l\u1ea5n.<\/p>\n

– N\u1eb1m li\u1ec7t gi\u01b0\u1eddng trong c\u01a1 s\u1edf y t\u1ebf.<\/p>\n

– C\u00f3 d\u00f9ng cephalosporin ph\u1ed5 r\u1ed9ng, aminoglycosid, carbapenem, fluoroquinolon ho\u1eb7c d\u00f9ng nhi\u1ec1u lo\u1ea1i KS.<\/p>\n

– \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/p>\n

– C\u00f3 ph\u1eabu thu\u1eadt, th\u1ee7 thu\u1eadt x\u00e2m l\u1ea5n.<\/p>\n

\u2192 S\u1eed d\u1ee5ng KS: piperacillin\/tazobactam, ampicillin\/sulbactam, cefoperazone\/sulbactam, ceftazidim, cefepim, imipenem\/cilastatin, meropenem, ceftolozan\/tazobactam ho\u1eb7c ceftazidim\/avibactam. Xem x\u00e9t ph\u1ed1i h\u1ee3p colistin.<\/p>\n

1.3.5. Nguy c\u01a1 nhi\u1ec5m c\u00e1c vi khu\u1ea9n kh\u00e1c<\/em><\/strong><\/p>\n

– Nghi ng\u1edd nhi\u1ec5m Stenotrophomonas maltophilia: cotrimoxazol, levofloxacin ho\u1eb7c ceftazidim.<\/p>\n

– Nghi ng\u1edd nhi\u1ec5m Burkholderia cepacia: meropenem, ceftazidim ho\u1eb7c cotrimoxazol.<\/p>\n

1.3.6. Nguy c\u01a1 nhi\u1ec5m n\u1ea5m Candida x\u00e2m l\u1ea5n<\/em><\/strong><\/p>\n

* Ch\u1ea9n \u0111o\u00e1n<\/em><\/strong><\/p>\n

Nguy c\u01a1 nhi\u1ec5m n\u1ea5m Candida theo thang Candida index (xem\u00a0Ph\u1ee5 l\u1ee5c 6<\/strong>,\u00a0B\u1ea3ng<\/strong>)\u00a0<\/em>\u2265 3 \u0111i\u1ec3m\u00a0V\u00c0\u00a0<\/strong>nhi\u1ec5m tr\u00f9ng huy\u1ebft c\u00f3 gi\u1ea3m b\u1ea1ch c\u1ea7u h\u1ea1t ho\u1eb7c s\u1eed d\u1ee5ng KS ph\u1ed5 r\u1ed9ng > 7 ng\u00e0y m\u00e0 c\u00f2n s\u1ed1t\/s\u1ed1c kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c nguy\u00ean nh\u00e2n.<\/p>\n

* \u0110i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng n\u1ea5m<\/em><\/strong><\/p>\n

– Giai \u0111o\u1ea1n t\u1ea5n c\u00f4ng:<\/em><\/p>\n

+ D\u00f9ng kh\u00e1ng n\u1ea5m t\u0129nh m\u1ea1ch.<\/p>\n

+ Echinocandins:\u00a0caspofugin\u00a0<\/strong>ho\u1eb7c\u00a0micafungin\u00a0<\/strong>l\u00e0 \u01b0u ti\u00ean h\u00e0ng \u0111\u1ea7u.<\/p>\n

+ N\u1ebfu kh\u00f4ng c\u00f3\u00a0caspofugin\u00a0<\/strong>ho\u1eb7c\u00a0micafungin<\/strong>: fluconazol, amphotericin ho\u1eb7c voriconazol.<\/p>\n

+ Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb \u00edt nh\u1ea5t l\u00e0 7 ng\u00e0y v\u00e0 \u0111\u1ebfn khi c\u00f3 k\u1ebft qu\u1ea3 2 m\u1eabu c\u1ea5y b\u1ec7nh ph\u1ea9m li\u00ean ti\u1ebfp \u00e2m t\u00ednh.<\/p>\n

– Giai \u0111o\u1ea1n duy tr\u00ec:<\/em><\/p>\n

+ D\u00f9ng kh\u00e1ng n\u1ea5m u\u1ed1ng fluconazol ho\u1eb7c voriconazol, \u00edt nh\u1ea5t 2 tu\u1ea7n.<\/p>\n

+ C\u1ea5y t\u00ecm n\u1ea5m m\u1ed7i ng\u00e0y hay c\u00e1ch ng\u00e0y li\u00ean t\u1ee5c \u0111\u1ec3 theo d\u00f5i hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb v\u00e0 quy\u1ebft \u0111\u1ecbnh th\u1eddi gian ng\u1eebng kh\u00e1ng n\u1ea5m.<\/p>\n

+ Th\u1eddi \u0111i\u1ec3m ng\u1eebng c\u1ea5y t\u00ecm n\u1ea5m khi ng\u01b0\u1eddi b\u1ec7nh l\u00e2m s\u00e0ng \u1ed5n \u0111\u1ecbnh v\u00e0 2 m\u1eabu c\u1ea5y li\u00ean ti\u1ebfp \u00e2m t\u00ednh.<\/p>\n

2. M\u1ed9t s\u1ed1 ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh kinh nghi\u1ec7m \u0111i\u1ec1u tr\u1ecb c\u00e1c nhi\u1ec5m khu\u1ea9n th\u01b0\u1eddng g\u1eb7p tr\u00ean ng\u01b0\u1eddi b\u1ec7nh COVID-19<\/strong><\/h2>\n

– K\u1ebft qu\u1ea3 CRP (< 10 mg\/dl) ho\u1eb7c PCT (< 0,5 ng\/ml) th\u1ea5p g\u1ee3i \u00fd \u00edt c\u00f3 nguy c\u01a1 \u0111\u1ed3ng nhi\u1ec5m vi khu\u1ea9n. K\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m cao (> 20 mg\/dl v\u1edbi CRP ho\u1eb7c > 10 ng\/ml v\u1edbi PCT) ho\u1eb7c t\u0103ng b\u1ea5t th\u01b0\u1eddng trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb l\u00e0 d\u1ea5u hi\u1ec7u g\u1ee3i \u00fd t\u00ecnh tr\u1ea1ng nhi\u1ec5m khu\u1ea9n th\u1ee9 ph\u00e1t.<\/p>\n

– Ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh kinh nghi\u1ec7m g\u1ee3i \u00fd cho m\u1ed9t s\u1ed1 nhi\u1ec5m khu\u1ea9n th\u01b0\u1eddng g\u1eb7p tr\u00ean ng\u01b0\u1eddi b\u1ec7nh nhi\u1ec5m COVID-19:<\/p>\n

+ Nhi\u1ec5m khu\u1ea9n huy\u1ebft<\/p>\n

+ Vi\u00eam ph\u1ed5i<\/p>\n

+ Nhi\u1ec5m khu\u1ea9n ti\u1ebft ni\u1ec7u<\/p>\n

+ Nhi\u1ec5m khu\u1ea9n da – m\u00f4 m\u1ec1m<\/p>\n

Ngu\u1ed3n<\/strong>: H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb COVID 19 c\u1ee7a B\u1ed9 Y t\u1ebf 2022<\/p>\n","protected":false},"excerpt":{"rendered":"

Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, b\u1ec7nh nh\u00e2n COVID-19 c\u00f3 th\u1ec3 b\u1ecb nhi\u1ec5m\u00a0 khu\u1ea9n th\u1ee9 ph\u00e1t do vi khu\u1ea9n ho\u1eb7c n\u1ea5m, v\u00e0 trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, s\u1eed d\u1ee5ng kh\u00e1ng sinh c\u00f3 th\u1ec3 l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng. Tuy nhi\u00ean, vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh […]<\/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":"\n\u0110i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n b\u1eb1ng kh\u00e1ng sinh \u1edf b\u1ec7nh nh\u00e2n COVID 19<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh nh\u00e2n COVID-19 c\u00f3 th\u1ec3 b\u1ecb b\u1ed9i nhi\u1ec5m th\u1ee9 ph\u00e1t do vi khu\u1ea9n ho\u1eb7c n\u1ea5m, v\u00e0 trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, s\u1eed d\u1ee5ng kh\u00e1ng sinh c\u00f3 th\u1ec3 l\u00e0 c\u1ea7n thi\u1ebft\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" 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