{"id":25144,"date":"2023-04-19T21:57:21","date_gmt":"2023-04-19T14:57:21","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25144"},"modified":"2023-04-22T12:57:27","modified_gmt":"2023-04-22T05:57:27","slug":"khang-sinh-du-phong-trong-viem-noi-tam-mac-nhiem-khuan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/khang-sinh-du-phong-trong-viem-noi-tam-mac-nhiem-khuan\/","title":{"rendered":"Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng \u00a0trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n"},"content":{"rendered":"

Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng \u00a0trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<\/a> l\u00e0 v\u1ea5n \u0111\u1ec1 \u0111\u01b0\u1ee3c quan t\u00e2m. B\u00e0i vi\u1ebft s\u1ebd \u0111\u01b0a ra c\u00e1c khuy\u1ebfn c\u00e1o t\u1eeb Ch\u00e2u \u00c2u trong v\u1ea5n \u0111\u1ec1 n\u00e0y trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p.<\/strong><\/p>\n

\"Vi\u00eam<\/p>\n

Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n t\u1ea1i v\u1ecb tr\u00ed vale 2 l\u00e1<\/strong><\/p>\n

1.D\u1ef1 ph\u00f2ng vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<\/h2>\n

Theo khuy\u1ebfn c\u00e1o c\u1ee7a ESC v\u1ec1 vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n c\u1eadp nh\u1eadt n\u0103m 2015, kh\u00e1ng sinh d\u1ef1 ph\u00f2ng ch\u1ec9 n\u00ean d\u00f9ng cho b\u1ec7nh nh\u00e2n \u1edf m\u1ee9c nguy c\u01a1 cao \u0111\u1ed1i v\u1edbi vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n, bao g\u1ed3m:<\/p>\n

    \n
  • B\u1ec7nh nh\u00e2n v\u1edbi b\u1ea5t k\u1ef3 van nh\u00e2n t\u1ea1o n\u00e0o, bao g\u1ed3m c\u1ea3 van nh\u00e2n t\u1ea1o \u0111\u1eb7t qua \u1ed1ng th\u00f4ng ho\u1eb7c \u0111\u01b0\u1ee3c s\u1eeda van v\u1edbi v\u1eadt li\u1ec7u nh\u00e2n t\u1ea1o.<\/li>\n
  • B\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n.<\/li>\n
  • B\u1ec7nh nh\u00e2n tim b\u1ea9m sinh: (1) tim b\u1ea9m sinh c\u00f3 t\u00edm; (2) tim b\u1ea9m sinh c\u00f3 v\u1eadt li\u1ec7u nh\u00e2n t\u1ea1o, c\u00f3 th\u1ec3 qua ph\u1eabu thu\u1eadt ho\u1eb7c can thi\u1ec7p qua da. Li\u1ec7u tr\u00ecnh kh\u00e1ng sinh d\u1ef1 ph\u00f2ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho \u0111\u1ebfn 6 th\u00e1ng sau th\u1ee7 thu\u1eadt, ho\u1eb7c su\u1ed1t \u0111\u1eddi n\u1ebfu c\u00f2n shunt t\u1ed3n l\u01b0u ho\u1eb7c h\u1edf van tim.<\/li>\n<\/ul>\n

    1.1. Th\u1ee7 thu\u1eadt c\u1ea7n c\u00f3 kh\u00e1ng sinh d\u1ef1 ph\u00f2ng theo h\u01b0\u1edbng d\u1eabn ESC 2015<\/h3>\n

    1.1.1<\/strong>. C\u00e1c th\u1ee7 thu\u1eadt r\u0103ng mi\u1ec7ng<\/strong><\/h4>\n
      \n
    • Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho c\u00e1c th\u1ee7 thu\u1eadt nha khoa \u0111\u00f2i h\u1ecfi c\u00e1c thao t\u00e1c qua v\u00f9ng l\u1ee3i ho\u1eb7c v\u00f9ng quanh ch\u00f3p r\u0103ng ho\u1eb7c g\u00e2y t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c mi\u1ec7ng.<\/li>\n
    • Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p: Ti\u00eam g\u00e2y t\u00ea t\u1ea1i ch\u1ed7 \u1edf v\u00f9ng kh\u00f4ng b\u1ecb nhi\u1ec5m khu\u1ea9n, \u0111i\u1ec1u tr\u1ecb s\u00e2u r\u0103ng tr\u00ean b\u1ec1 m\u1eb7t, c\u1eaft b\u1ecf ch\u1ec9 kh\u00e2u, x\u1ea1 tr\u1ecb r\u0103ng, thay \u0111\u1ed5i ho\u1eb7c s\u1eeda ch\u1eefa c\u00e1c v\u1eadt li\u1ec7u ph\u1ee5c h\u00ecnh, ch\u1ec9nh h\u00ecnh r\u0103ng mi\u1ec7ng, ni\u1ec1ng r\u0103ng, sau nh\u1ed5 r\u0103ng ho\u1eb7c ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ebfn m\u00f4i hay ni\u00eam m\u1ea1c mi\u1ec7ng.<\/li>\n
    • Kh\u00e1ng sinh \u0111\u01b0\u1ee3c cho m\u1ed9t li\u1ec1u duy nh\u1ea5t t\u1eeb 30 \u2013 60 ph\u00fat tr\u01b0\u1edbc th\u1ee7 thu\u1eadt v\u00e0 kh\u00f4ng c\u1ea7n s\u1eed d\u1ee5ng nh\u1eafc l\u1ea1i li\u1ec1u sau th\u1ee7 thu\u1eadt.<\/li>\n<\/ul>\n

      1.1.2<\/strong>. C\u00e1c th\u1ee7 thu\u1eadt li\u00ean quan \u0111\u1ebfn \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p<\/strong><\/h3>\n
        \n
      • Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho c\u00e1c th\u1ee7 thu\u1eadt li\u00ean quan \u0111\u1ebfn \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p, bao g\u1ed3m c\u1ea3: n\u1ed9i soi ph\u1ebf qu\u1ea3n, n\u1ed9i soi thanh qu\u1ea3n, \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n qua mi\u1ec7ng hay qua m\u0169i.<\/li>\n
      • Trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 vi\u00eam \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p n\u00ean \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh \u1ed5n \u0111\u1ecbnh tr\u01b0\u1edbc th\u1ee7 thu\u1eadt.<\/li>\n
      • Nh\u1eefng b\u1ec7nh nh\u00e2n n\u1eb1m trong nh\u00f3m nguy c\u01a1 cao b\u1ecb vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n khi tr\u1ea3i qua c\u00e1c th\u1ee7 thu\u1eadt \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p c\u00f3 x\u00e2m l\u1ea5n v\u1edbi m\u1ee5c \u0111\u00edch \u0111i\u1ec1u tr\u1ecb c\u00e1c nhi\u1ec5m tr\u00f9ng hi\u1ec7n t\u1ea1i (v\u00ed d\u1ee5: d\u1eabn l\u01b0u \u1ed5 \u00e1p xe) n\u00ean d\u00f9ng kh\u00e1ng sinh t\u00e1c d\u1ee5ng tr\u00ean t\u1ee5 c\u1ea7u.<\/li>\n<\/ul>\n

        1.1.3<\/strong>. Th\u1ee7 thu\u1eadt li\u00ean quan \u0111\u1ebfn d\u1ea1 d\u00e0y \u2013 ru\u1ed9t ho\u1eb7c ni\u1ec7u \u2013 sinh d\u1ee5c ho\u1eb7c<\/strong> si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n<\/strong><\/h4>\n
          \n
        • Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho c\u00e1c th\u1ee7 thu\u1eadt nh\u01b0: n\u1ed9i soi d\u1ea1 d\u00e0y, n\u1ed9i soi \u0111\u1ea1i tr\u00e0ng, n\u1ed9i soi b\u00e0ng quang, \u0111\u1ee1 \u0111\u1ebb t\u1ef1 nhi\u00ean qua \u0111\u01b0\u1eddng \u00e2m \u0111\u1ea1o ho\u1eb7c ph\u1eabu thu\u1eadt l\u1ea5y thai ho\u1eb7c si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n.<\/li>\n
        • Nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang c\u00f3 t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng li\u00ean quan \u0111\u1ebfn h\u1ec7 d\u1ea1 d\u00e0y- ru\u1ed9t, sinh d\u1ee5c \u2013 ti\u1ebft ni\u1ec7u \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n nguy c\u01a1 cao n\u00ean s\u1eed d\u1ee5ng kh\u00e1ng sinh c\u00f3 t\u00e1c d\u1ee5ng tr\u00ean c\u00e1c ch\u1ee7ng enterococcus (V\u00ed d\u1ee5: ampicillin, amoxicillin ho\u1eb7c vancomycin n\u1ebfu kh\u00f4ng dung n\u1ea1p v\u1edbi nh\u00f3m beta-lactam).<\/li>\n<\/ul>\n

          1.1.4<\/strong>. C\u00e1c th\u1ee7 thu\u1eadt \u1edf da v\u00e0 m\u00f4 m\u1ec1m<\/strong><\/h4>\n

          Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho b\u1ea5t c\u1ee9 th\u1ee7 thu\u1eadt n\u00e0o (ngo\u1ea1i tr\u1eeb b\u1ec7nh nh\u00e2n n\u1eb1m trong nh\u00f3m nguy c\u01a1 cao b\u1ecb vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1ee3c l\u00e0m th\u1ee7 thu\u1eadt do c\u00e1c nhi\u1ec5m tr\u00f9ng da, m\u00f4 m\u1ec1m, c\u01a1 x\u01b0\u01a1ng kh\u1edbp (V\u00ed d\u1ee5: \u00c1p xe) th\u00ec n\u00ean s\u1eed d\u1ee5ng kh\u00e1ng sinh c\u00f3 t\u00e1c d\u1ee5ng tr\u00ean t\u1ee5 c\u1ea7u v\u00e0 li\u00ean c\u1ea7u tan huy\u1ebft nh\u00f3m \u03b2).<\/p>\n

          1.2. Khuy\u1ebfn c\u00e1o d\u00f9ng kh\u00e1ng sinh ph\u00f2ng ng\u1eeba nhi\u1ec5m khu\u1ea9n khu tr\u00fa<\/strong> v\u00e0 to\u00e0n th\u00e2n tr\u01b0\u1edbc c\u00e1c th\u1ee7 thu\u1eadt can thi\u1ec7p tim v\u00e0 m\u1ea1ch m\u00e1u<\/strong><\/h3>\n
            \n
          • Khuy\u1ebfn c\u00e1o s\u00e0ng l\u1ecdc t\u1ee5 c\u1ea7u v\u00e0ng v\u00f9ng m\u0169i h\u1ecdng \u1edf nh\u1eefng ng\u01b0\u1eddi mang m\u1ea7m b\u1ec7nh, v\u1edbi c\u00e1c ph\u1eabu thu\u1eadt tim m\u1ea1ch c\u00f3 chu\u1ea9n b\u1ecb.<\/li>\n
          • D\u1ef1 ph\u00f2ng tr\u01b0\u1edbc th\u1ee7 thu\u1eadt \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho \u0111\u1eb7t m\u00e1y t\u1ea1o nh\u1ecbp ho\u1eb7c m\u00e1y ph\u00e1 rung t\u1ef1 \u0111\u1ed9ng (ICD).<\/li>\n<\/ul>\n

            C\u00e1c \u1ed5 nhi\u1ec5m khu\u1ea9n ti\u1ec1m t\u00e0ng c\u1ea7n \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb tr\u01b0\u1edbc ph\u1eabu thu\u1eadt \u00edt nh\u1ea5t 2 tu\u1ea7n:<\/p>\n

              \n
            • Ph\u1eabu thu\u1eadt van nh\u00e2n t\u1ea1o, c\u00e1c thi\u1ebft b\u1ecb nh\u00e2n t\u1ea1o trong tim ho\u1eb7c trong m\u1ea1ch m\u00e1u, ngo\u1ea1i tr\u1eeb ph\u1eabu thu\u1eadt c\u1ea5p c\u1ee9u.<\/li>\n
            • Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u1edf b\u1ec7nh nh\u00e2n tr\u1ea3i qua ph\u1eabu thu\u1eadt thay van ho\u1eb7c \u0111\u1eb7t thi\u1ebft b\u1ecb nh\u00e2n t\u1ea1o trong l\u00f2ng m\u1ea1ch (ho\u1eb7c th\u1ee7 thu\u1eadt qua da).<\/li>\n
            • \u0110i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n m\u1ed9t c\u00e1ch h\u1ec7 th\u1ed1ng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o khi kh\u00f4ng c\u00f3 s\u00e0ng l\u1ecdc nhi\u1ec5m t\u1ee5 c\u1ea7u.<\/li>\n
            • Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng n\u00ean \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u ngay l\u1eadp t\u1ee9c tr\u01b0\u1edbc th\u1ee7 thu\u1eadt v\u00e0 l\u1eb7p l\u1ea1i n\u1ebfu th\u1ee7 thu\u1eadt k\u00e9o d\u00e0i tr\u00ean 48h.<\/li>\n<\/ul>\n

              1.3. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p d\u1ef1 ph\u00f2ng vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n kh\u00f4ng \u0111\u1eb7c hi\u1ec7u<\/strong><\/h3>\n
                \n
              • C\u00e1c ph\u01b0\u01a1ng ph\u00e1p n\u00e0y n\u00ean \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng cho t\u1ea5t c\u1ea3 m\u1ecdi ng\u01b0\u1eddi n\u00f3i chung, \u0111\u1eb7c bi\u1ec7t c\u1ea7n \u0111\u01b0\u1ee3c t\u0103ng c\u01b0\u1eddng h\u01a1n n\u1eefa \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n.<\/li>\n
              • V\u1ec7 sinh da v\u00e0 r\u0103ng mi\u1ec7ng th\u01b0\u1eddng xuy\u00ean. Theo d\u00f5i r\u0103ng mi\u1ec7ng n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh 2 l\u1ea7n m\u1ed7i n\u0103m \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 m\u1eafc b\u1ec7nh cao v\u00e0 h\u1eb1ng n\u0103m \u0111\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f2n l\u1ea1i.<\/li>\n
              • Tr\u00e1nh nhi\u1ec5m khu\u1ea9n v\u1ebft th\u01b0\u01a1ng.<\/li>\n
              • Lo\u1ea1i b\u1ecf ho\u1eb7c l\u00e0m gi\u1ea3m c\u00e1c \u1ed5 mang vi khu\u1ea9n m\u1ea1n t\u00ednh: ngo\u00e0i da, \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u, \u0111\u01b0\u1eddng r\u0103ng mi\u1ec7ng.<\/li>\n
              • \u0110i\u1ec1u tr\u1ecb kh\u1ecfi c\u00e1c \u1ed5 nhi\u1ec5m khu\u1ea9n (b\u1eb1ng kh\u00e1ng sinh).<\/li>\n
              • B\u1ec7nh nh\u00e2n kh\u00f4ng t\u1ef1 \u00fd d\u00f9ng thu\u1ed1c kh\u00e1ng sinh.<\/li>\n
              • Ki\u1ec3m so\u00e1t nhi\u1ec5m khu\u1ea9n ch\u1eb7t ch\u1ebd khi ti\u1ebfn h\u00e0nh b\u1ea5t k\u1ef3 th\u1ee7 thu\u1eadt n\u00e0o c\u00f3 nguy c\u01a1.<\/li>\n
              • Kh\u00f4ng khuy\u1ebfn kh\u00edch x\u1ecf l\u1ed7 tai hay x\u0103m tr\u1ed5.<\/li>\n
              • H\u1ea1n ch\u1ebf t\u1ed1i \u0111a vi\u1ec7c \u0111\u1eb7t \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch v\u00e0 c\u00e1c th\u1ee7 thu\u1eadt x\u00e2m l\u1ea5n. N\u1ebfu c\u1ea7n \u0111\u1eb7t \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch, \u01b0u ti\u00ean s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch ngo\u1ea1i bi\u00ean h\u01a1n l\u00e0 t\u0129nh m\u1ea1ch trung t\u00e2m v\u00e0 thay \u0111\u01b0\u1eddng truy\u1ec1n ngo\u1ea1i bi\u00ean m\u1ed7i 3 \u2013 4 ng\u00e0y.<\/li>\n<\/ul>\n

                2.Kh\u00e1ng sinh \u0111i\u1ec1u tr\u1ecb vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n do vi khu\u1ea9n gram \u00e2m<\/strong><\/h2>\n

                2.2.1 <\/strong>Hacker<\/b><\/h3>\n

                Ceftriaxone 2 g\/24h \u0111\u01b0\u1eddng TM 1 l\u1ea7n x 4 tu\u1ea7n (van t\u1ef1 nhi\u00ean) ho\u1eb7c trong 6 tu\u1ea7n (van nh\u00e2n t\u1ea1o).
                \nN\u1ebfu vi khu\u1ea9n kh\u00f4ng ti\u1ebft beta-lactamase th\u00ec c\u00f3 th\u1ec3 d\u00f9ng ph\u00e1c \u0111\u1ed3:
                \nAmpicillin 12 g\/24h TM chia 4 \u2013 6 l\u1ea7n k\u1ebft h\u1ee3p v\u1edbi gentamycin 3 mg\/kg\/24h chia 2 \u2013 3 l\u1ea7n (k\u00e9o d\u00e0i trong v\u00f2ng 4 \u2013 6 tu\u1ea7n).
                \nKh\u00f4ng HACEK (\u00edt g\u1eb7p): Khuy\u1ebfn c\u00e1o n\u00ean ph\u1eabu thu\u1eadt s\u1edbm h\u01a1n l\u00e0 ch\u1edd \u0111i\u1ec1u tr\u1ecb \u0111\u1ee7 ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh beta-lactam + aminoglycoside trong 4 \u2013 6 tu\u1ea7n.<\/p>\n

                2.<\/strong>2<\/strong>. \u0110i\u1ec1u tr\u1ecb vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n do n\u1ea5m<\/strong><\/p>\n

                Th\u01b0\u1eddng g\u1eb7p vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n do n\u1ea5m \u1edf b\u1ec7nh nh\u00e2n mang van nh\u00e2n t\u1ea1o, l\u1ea1m d\u1ee5ng thu\u1ed1c \u0111\u01b0\u1eddng TM v\u00e0 tr\u00ean ng\u01b0\u1eddi suy gi\u1ea3m mi\u1ec5n d\u1ecbch; t\u1ef7 l\u1ec7 t\u1eed vong t\u01b0\u01a1ng \u0111\u1ed1i cao (> 50%).
                \n\u0110i\u1ec1u tr\u1ecb ch\u1ee7 y\u1ebfu b\u1eb1ng amphotericin B truy\u1ec1n TM ph\u1ed1i h\u1ee3p v\u1edbi ph\u1eabu thu\u1eadt thay van. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng tr\u00ean 6 tu\u1ea7n. Sau ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb c\u01a1 b\u1ea3n ban \u0111\u1ea7u n\u00ean duy tr\u00ec l\u00e2u d\u00e0i b\u1eb1ng thu\u1ed1c kh\u00e1ng n\u1ea5m \u0111\u01b0\u1eddng u\u1ed1ng (\u0080uconazole v\u1edbi Candida v\u00e0 voriconazole v\u1edbi Aspergillus).<\/p>\n

                3. <\/strong>M<\/strong>\u1ed9t s\u1ed1 l\u01b0u \u00fd<\/strong><\/h2>\n

                Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n l\u00e0 b\u1ec7nh nhi\u1ec5m khu\u1ea9n \u0111\u1eb7c bi\u1ec7t t\u1eeb tim lan r\u1ed9ng to\u00e0n th\u00e2n c\u1ea7n \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh nhanh, m\u1ea1nh v\u00e0 k\u00e9o d\u00e0i \u0111\u1ec3 h\u1ea1n ch\u1ebf th\u1ea5p nh\u1ea5t t\u1ed5n th\u01b0\u01a1ng c\u00e1c c\u01a1 quan \u0111\u00edch v\u00e0 kh\u00f4ng \u0111\u1ec3 b\u1ec7nh t\u00e1i ph\u00e1t.
                \nKh\u00e1ng sinh \u0111\u1ea7u tay \u0111i\u1ec1u tr\u1ecb vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n l\u00e0 c\u00e1c beta-lactam, vancomycin v\u00e0 aminoglycoside. M\u1ecdi m\u1ea7m b\u1ec7nh \u0111\u1ec1u c\u00f3 th\u1ec3 l\u00e0 t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3, v\u1edbi nh\u1eefng m\u1ea7m b\u1ec7nh \u00edt g\u1eb7p c\u1ea7n t\u00edch c\u1ef1c thu th\u1eadp th\u00f4ng tin v\u1ec1 ho\u00e0n c\u1ea3nh ph\u00e1t sinh b\u1ec7nh, di\u1ec5n bi\u1ebfn l\u00e2m s\u00e0ng, \u0111\u1eb7c \u0111i\u1ec3m m\u1ea7m b\u1ec7nh ph\u00e2n l\u1eadp c\u00f9ng v\u1edbi m\u1ee9c \u0111\u1ed9 nh\u1ea1y c\u1ea3m thu\u1ed1c kh\u00e1ng sinh \u0111\u1ec3 chuy\u00ean khoa Tim m\u1ea1ch ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c \u0111\u01a1n v\u1ecb Vi sinh l\u00e2m s\u00e0ng, D\u01b0\u1ee3c l\u00e2m s\u00e0ng v\u00e0 Truy\u1ec1n nhi\u1ec5m \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n cho hi\u1ec7u qu\u1ea3.
                \nTh\u1eed nghi\u1ec7m POET (Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis) tr\u00ean 400 b\u1ec7nh nh\u00e2n vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n ng\u01b0\u1eddi l\u1edbn van tim b\u00ean tr\u00e1i do m\u1ed9t trong c\u00e1c vi khu\u1ea9n sau Streptococcus, Enterococcus faecalis, Staphylococcus aureus, t\u1ee5 c\u1ea7u coagulase \u00e2m t\u00ednh, t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng \u1ed5n \u0111\u1ecbnh, th\u1ea5y r\u1eb1ng tr\u00ean nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y, vi\u1ec7c chuy\u1ec3n sang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh \u0111\u01b0\u1eddng u\u1ed1ng \u0111em l\u1ea1i k\u1ebft qu\u1ea3 kh\u00f4ng k\u00e9m h\u01a1n so v\u1edbi \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. Tuy nhi\u00ean, hi\u1ec7n nay vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh \u0111\u01b0\u1eddng u\u1ed1ng trong \u0111i\u1ec1u tr\u1ecb vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n ch\u01b0a \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o trong khuy\u1ebfn c\u00e1o.<\/p>\n

                 <\/p>\n","protected":false},"excerpt":{"rendered":"

                Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng \u00a0trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n l\u00e0 v\u1ea5n \u0111\u1ec1 \u0111\u01b0\u1ee3c quan t\u00e2m. B\u00e0i vi\u1ebft s\u1ebd \u0111\u01b0a ra c\u00e1c khuy\u1ebfn c\u00e1o t\u1eeb Ch\u00e2u \u00c2u trong v\u1ea5n \u0111\u1ec1 n\u00e0y trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p. Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n t\u1ea1i v\u1ecb tr\u00ed vale 2 l\u00e1 1.D\u1ef1 ph\u00f2ng vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"\nKh\u00e1ng sinh d\u1ef1 ph\u00f2ng \u00a0trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<\/title>\n<meta name=\"description\" content=\"Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng \u00a0trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n l\u00e0 v\u1ea5n \u0111\u1ec1 \u0111\u01b0\u1ee3c quan t\u00e2m khi \u0111i\u1ec1u tr\u1ecb. 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