{"id":26386,"date":"2023-04-22T13:08:07","date_gmt":"2023-04-22T06:08:07","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26386"},"modified":"2023-04-22T13:08:07","modified_gmt":"2023-04-22T06:08:07","slug":"tong-quan-ve-khang-sinh-trong-viem-noi-tam-mac-nhiem-khuan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/tong-quan-ve-khang-sinh-trong-viem-noi-tam-mac-nhiem-khuan\/","title":{"rendered":"T\u1ed5ng quan v\u1ec1 kh\u00e1ng sinh trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n"},"content":{"rendered":"

K<\/strong>h\u00e1ng sinh \u0111\u01b0\u1ee3c chia th\u00e0nh: kh\u00e1ng sinh di\u1ec7t khu\u1ea9n ph\u1ee5<\/strong> thu\u1ed9c n\u1ed3ng \u0111\u1ed9 <\/strong>F<\/strong>uoroquinolone, aminoglycoside, kh\u00e1ng sinh di\u1ec7t khu\u1ea9n ph\u1ee5 thu\u1ed9c th\u1eddi<\/strong> gian kh\u00f4ng c\u00f3 ho\u1eb7c c\u00f3 t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i ng\u1eafn (h\u1ea7u h\u1ebft c\u00e1c <\/strong>\u03b2<\/strong>-lactam), kh\u00e1ng sinh di\u1ec7t<\/strong> khu\u1ea9n ph\u1ee5 thu\u1ed9c th\u1eddi gian c\u00f3 t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i trung b\u00ecnh ho\u1eb7c d\u00e0i nh\u01b0 azithromycin<\/strong> d\u1ef1a tr\u00ean \u0111\u1eb7c \u0111i\u1ec3m PK\/PD.<\/strong><\/p>\n

1. Ph\u00e2n lo\u1ea1i kh\u00e1ng sinh<\/h2>\n

Kh\u00e1ng sinh \u0111\u01b0\u1ee3c chia th\u00e0nh: kh\u00e1ng sinh di\u1ec7t khu\u1ea9n ph\u1ee5 thu\u1ed9c n\u1ed3ng \u0111\u1ed9 Fuoroquinolone, aminoglycoside, kh\u00e1ng sinh di\u1ec7t khu\u1ea9n ph\u1ee5 thu\u1ed9c th\u1eddi gian kh\u00f4ng c\u00f3 ho\u1eb7c c\u00f3 t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i ng\u1eafn (h\u1ea7u h\u1ebft c\u00e1c \u03b2-lactam), kh\u00e1ng sinh di\u1ec7t khu\u1ea9n ph\u1ee5 thu\u1ed9c th\u1eddi gian c\u00f3 t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i trung b\u00ecnh ho\u1eb7c d\u00e0i nh\u01b0 azithromycin d\u1ef1a tr\u00ean \u0111\u1eb7c \u0111i\u1ec3m PK\/PD.<\/p>\n

1.1<\/strong>. Kh\u00e1ng sinh di\u1ec7t khu\u1ea9n ph\u1ee5 thu\u1ed9c n\u1ed3ng \u0111\u1ed9<\/strong><\/h3>\n

V\u1edbi kh\u00e1ng sinh ph\u1ee5 thu\u1ed9c n\u1ed3ng \u0111\u1ed9, t\u1ed5ng l\u01b0\u1ee3ng thu\u1ed1c \u0111\u01b0\u1ee3c d\u00f9ng l\u00e0 y\u1ebfu t\u1ed1 x\u00e1c \u0111\u1ecbnh hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb. Khi m\u1ed9t kh\u00e1ng sinh ph\u1ee5 thu\u1ed9c n\u1ed3ng \u0111\u1ed9 c\u00f3 kh\u1ea3 n\u0103ng \u0111\u1ea1t t\u1ef7 s\u1ed1 Cpeak\/MIC t\u1ed1i \u01b0u (v\u00ed d\u1ee5 10:1), th\u00ec y\u1ebfu t\u1ed1 th\u1eddi gian l\u00fac n\u00e0y kh\u00f4ng c\u00f3 \u00fd ngh\u0129a, ch\u1ec9 s\u1ed1 Cpeak\/MIC ch\u00ednh l\u00e0 y\u1ebfu t\u1ed1 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb. N\u1ebfu kh\u00e1ng sinh \u0111\u00f3 kh\u00f4ng th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c Cpeak\/MIC t\u1ed1i \u01b0u, l\u00fac n\u00e0y c\u1ea7n ph\u1ea3i xem x\u00e9t \u0111\u1ebfn c\u1ea3 y\u1ebfu t\u1ed1 v\u1ec1 th\u1eddi gian, v\u00e0 t\u1ef7 s\u1ed1 AUC\/MIC l\u00e0 y\u1ebfu t\u1ed1 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, v\u00ec AUC = n\u1ed3ng \u0111\u1ed9 \u00d7 th\u1eddi gian. V\u00ec v\u1eady, \u0111\u1ed1i v\u1edbi nhi\u1ec1u kh\u00e1ng sinh kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng \u0111\u1ea1t Cpeak\/MIC t\u1ed1i \u01b0u, AUC\/MIC l\u00e0 ch\u1ec9 s\u1ed1 t\u1ed1t nh\u1ea5t \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb. C\u00e1c lo\u1ea1i kh\u00e1ng sinh ph\u1ee5 thu\u1ed9c n\u1ed3ng \u0111\u1ed9 th\u01b0\u1eddng d\u00f9ng g\u1ed3m:fuoroquinolone, aminoglycoside.<\/p>\n

1.2<\/strong>. Kh\u00e1ng sinh di\u1ec7t khu\u1ea9n ph\u1ee5 thu\u1ed9c th\u1eddi gian<\/strong><\/h3>\n

V\u1edbi kh\u00e1ng sinh ph\u1ee5 thu\u1ed9c th\u1eddi gian (nh\u00f3m kh\u00e1ng sinh \u03b2-lactam bao g\u1ed3m penicillin, cephalosporine, v\u00e0 carbapenem, macrolide), y\u1ebfu t\u1ed1 x\u00e1c \u0111\u1ecbnh hi\u1ec7u qu\u1ea3 l\u00e0 th\u1eddi gian duy tr\u00ec n\u1ed3ng \u0111\u1ed9 tr\u00ean MIC. M\u1ed9t s\u1ed1 kh\u00e1ng sinh ph\u1ee5 thu\u1ed9c th\u1eddi gian nh\u01b0 \u03b2-lactam kh\u00f4ng c\u00f3 ho\u1eb7c c\u00f3 PAE r\u1ea5t ng\u1eafn, trong khi m\u1ed9t s\u1ed1 kh\u00e1ng sinh ph\u1ee5 thu\u1ed9c th\u1eddi gian kh\u00e1c l\u1ea1i c\u00f3 PAE trung b\u00ecnh ho\u1eb7c d\u00e0i. C\u00e1c \u03b2-lactam c\u00f3 ho\u1ea1t ph\u1ed5 r\u1ed9ng tr\u00ean c\u1ea3 vi khu\u1ea9n Gram \u00e2m v\u00e0 Gram d\u01b0\u01a1ng, \u0111\u1ea1t hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb cao nh\u1ea5t khi \u0111\u1ea1t n\u1ed3ng \u0111\u1ed9 kho\u1ea3ng tr\u00ean 4 l\u1ea7n MIC. N\u1ed3ng \u0111\u1ed9 cao h\u01a1n gi\u00e1 tr\u1ecb n\u00e0y s\u1ebd kh\u00f4ng l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng di\u1ec7t khu\u1ea9n. V\u00ec v\u1eady, T > MIC l\u00e0 ch\u1ec9 s\u1ed1 t\u1ed1i \u01b0u \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb c\u1ee7a nh\u00f3m n\u00e0y. V\u1edbi h\u1ea7u h\u1ebft c\u00e1c \u03b2-lactam, T > MIC \u0111\u1ea1t \u2265 40 \u2013 50% so v\u1edbi kho\u1ea3ng \u0111\u01b0a li\u1ec1u \u0111\u01b0\u1ee3c xem l\u00e0 \u0111\u1ea1t hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb. Carbapenem l\u00e0 m\u1ed9t ph\u00e2n nh\u00f3m c\u1ee7a \u03b2-lactam (ertapenem, imipenem, meropenem) c\u00f3 m\u1ed9t s\u1ed1 \u0111i\u1ec3m kh\u00e1c v\u1edbi c\u00e1c \u03b2-lactam kh\u00e1c. V\u1edbi c\u00e1c kh\u00e1ng sinh n\u00e0y, gi\u00e1 tr\u1ecb T > MIC c\u00f3 th\u1ec3 th\u1ea5p h\u01a1n \u0111\u1ed1i v\u1edbi vi khu\u1ea9n Gram \u00e2m, T > MIC \u0111\u1ea1t 20% \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 c\u00f3 t\u00e1c d\u1ee5ng k\u00ecm khu\u1ea9n, \u0111\u1ea1t 40% \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 c\u00f3 t\u00e1c d\u1ee5ng di\u1ec7t khu\u1ea9n. \u0110\u1ec3 \u0111\u1ea1t T > MIC \u0111\u1ea1t hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 t\u0103ng li\u1ec1u d\u00f9ng, r\u00fat ng\u1eafn kho\u1ea3ng \u0111\u01b0a li\u1ec1u, d\u00f9ng c\u00f4ng th\u1ee9c gi\u1ea3i ph\u00f3ng thu\u1ed1c k\u00e9o d\u00e0i ho\u1eb7c truy\u1ec1n li\u00ean t\u1ee5c. \u0110\u1eb7c bi\u1ec7t, truy\u1ec1n li\u00ean t\u1ee5c c\u00f3 t\u00e1c d\u1ee5ng t\u1ed1i \u01b0u h\u00f3a th\u1eddi gian \u0111i\u1ec1u tr\u1ecb, gi\u1ea3m thi\u1ec3u s\u1ef1 dao \u0111\u1ed9ng n\u1ed3ng \u0111\u1ed9 thu\u1ed1c trong huy\u1ebft t\u01b0\u01a1ng. V\u1edbi nh\u1eefng kh\u00e1ng sinh c\u00f3 PAE d\u00e0i, th\u01b0\u1eddng g\u1eb7p \u1edf c\u00e1c thu\u1ed1c c\u00f3 kh\u1ea3 n\u0103ng di\u1ec7t khu\u1ea9n b\u1eb1ng c\u00e1ch \u1ee9c ch\u1ebf ADN ho\u1eb7c \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p protein nh\u01b0 fuoroquinolone v\u00e0 clindamycin, s\u1ed1 l\u1ea7n \u0111\u01b0a thu\u1ed1c s\u1ebd \u00edt h\u01a1n so v\u1edbi s\u1ed1 l\u1ea7n \u0111\u01b0\u1ee3c \u01b0\u1edbc t\u00ednh d\u1ef1a tr\u00ean th\u1eddi gian b\u00e1n th\u1ea3i.<\/p>\n

2. T\u00e1c nh\u00e2n th\u01b0\u1eddng g\u1eb7p g\u00e2y vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<\/h2>\n

C\u00f3 r\u1ea5t nhi\u1ec1u lo\u1ea1i vi khu\u1ea9n c\u00f3 th\u1ec3 g\u00e2y vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<\/a> VNTMNK, t\u1ef7 l\u1ec7 thay \u0111\u1ed5i theo c\u00e1c qu\u1ea7n th\u1ec3 kh\u00e1c
\nnhau.
\nBa nguy\u00ean nh\u00e2n<\/strong> g\u00e2y VNTMNK ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 staphylococcus, streptococcus v\u00e0 enterococcus<\/strong>. Streptococcus l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n cao tu\u1ed5i v\u00e0 VNTMNK m\u1eafc ph\u1ea3i \u1edf c\u1ed9ng \u0111\u1ed3ng, trong khi staphylococcus l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t g\u00e2y VNTMNK \u1edf c\u00e1c n\u01b0\u1edbc ph\u00e1t tri\u1ec3n v\u00e0 VNTMNK li\u00ean quan \u0111\u1ebfn ch\u0103m s\u00f3c y t\u1ebf.<\/p>\n

C\u00e1c tr\u01b0\u1eddng h\u1ee3p VNTMNK c\u1ea5y m\u00e1u \u00e2m t\u00ednh chi\u1ebfm kho\u1ea3ng 10%, bao g\u1ed3m hai tr\u01b0\u1eddng h\u1ee3p: VNTMNK \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e3 s\u1eed d\u1ee5ng kh\u00e1ng sinh tr\u01b0\u1edbc khi ch\u1ea9n \u0111o\u00e1n ho\u1eb7c VNTMNK do ch\u1ee7ng vi khu\u1ea9n kh\u00f3 nu\u00f4i c\u1ea5y. Trong tr\u01b0\u1eddng h\u1ee3p th\u1ee9 2, x\u00e9t nghi\u1ec7m huy\u1ebft thanh h\u1ecdc, PCR t\u1ed5 ch\u1ee9c van ho\u1eb7c m\u00e1u\u2026 c\u00f3 th\u1ec3 gi\u00fap x\u00e1c \u0111\u1ecbnh c\u0103n nguy\u00ean trong 60% tr\u01b0\u1eddng h\u1ee3p, ph\u1ea7n l\u1edbn l\u00e0 do c\u00e1c ch\u1ee7ng Bartonella, c\u00e1c ch\u1ee7ng Brucella, Coxiella burnetii (s\u1ed1t Q), nh\u00f3m HACEK v\u00e0 Tropheryma whipplei.<\/p>\n

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

Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n tr\u00ean si\u00eau \u00e2m<\/strong><\/p>\n

2<\/strong>.1. Streptococcus<\/strong><\/h3>\n

Vi khu\u1ea9n Gram d\u01b0\u01a1ng, x\u1ebfp chu\u1ed7i, k\u1ef5 kh\u00ed t\u00f9y \u00fd.
\nPh\u00e2n lo\u1ea1i:
\nTheo kh\u1ea3 n\u0103ng tan m\u00e1u: g\u1ed3m ba nh\u00f3m alpha (tan m\u00e1u m\u1ed9t ph\u1ea7n), beta (tan m\u00e1u ho\u00e0n to\u00e0n), gama (kh\u00f4ng g\u00e2y tan m\u00e1u). Theo kh\u00e1ng nguy\u00ean Lancefeld \u1edf v\u00e1ch t\u1ebf b\u00e0o: t\u1eeb A, B, C, D, E, t\u1edbi S.
\nNg\u00e0y nay vi\u1ec7c ph\u00e2n lo\u1ea1i li\u00ean c\u1ea7u theo kh\u00e1ng nguy\u00ean Lancefeld \u00edt \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng h\u01a1n, m\u00e0 ch\u1ee7 y\u1ebfu d\u1ef1a v\u00e0o t\u00ednh ch\u1ea5t tan m\u00e1u, c\u00e1c th\u00e0nh ph\u1ea7n kh\u00e1ng nguy\u00ean, \u0111\u1eb7c \u0111i\u1ec3m ph\u00e1t tri\u1ec3n, gen.
\nC\u00f3 tr\u00ean 30 ch\u1ee7ng li\u00ean c\u1ea7u, tuy nhi\u00ean 5 ch\u1ee7ng ch\u00ednh g\u00e2y b\u1ec7nh \u1edf ng\u01b0\u1eddi g\u1ed3m: 3 ch\u1ee7ng thu\u1ed9c nh\u00f3m A, B v\u00e0 D; 2 ch\u1ee7ng c\u00f2n l\u1ea1i kh\u00f4ng c\u00f3 kh\u00e1ng nguy\u00ean Lancefeld l\u00e0 Streptococcus pneumoniae v\u00e0 c\u00e1c streptococcus nh\u00f3m viridan.
\nC\u00e1c streptococcus nh\u00f3m viridan, streptococcus bovis l\u00e0 hai nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong nh\u00f3m li\u00ean c\u1ea7u g\u00e2y VNTMNK.
\nViridans group streptococci: th\u1ef1c ch\u1ea5t l\u00e0 m\u1ed9t nh\u00f3m g\u1ed3m nhi\u1ec1u ch\u1ee7ng li\u00ean c\u1ea7u, \u0111\u1ea1i \u0111a s\u1ed1 thu\u1ed9c nh\u00f3m tan m\u00e1u alpha. G\u1ed3m: S. salivarius, S. sanguis, S. mitis, S. intermedius, S. mutans\u2026 \u0110\u00e2y l\u00e0 c\u00e1c ch\u1ee7ng vi khu\u1ea9n b\u00ecnh th\u01b0\u1eddng trong h\u1ec7 vi khu\u1ea9n ch\u00ed c\u1ee7a ng\u01b0\u1eddi \u1edf \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, v\u00f9ng h\u1ea7u h\u1ecdng v\u00e0 khoang mi\u1ec7ng.
\nC\u00e1c t\u1ed5n th\u01b0\u01a1ng trong khoang mi\u1ec7ng c\u00f3 th\u1ec3 khi\u1ebfn c\u00e1c vi khu\u1ea9n n\u00e0y \u0111i v\u00e0o trong m\u00e1u, b\u00e1m tr\u00ean b\u1ec1 m\u1eb7t n\u1ed9i t\u00e2m m\u1ea1c \u0111\u1eb7c bi\u1ec7t nh\u1eefng v\u1ecb tr\u00ed n\u1ed9i m\u1ea1c \u0111\u00e3 c\u00f3 t\u1ed5n th\u01b0\u01a1ng tr\u01b0\u1edbc \u0111\u00f3. L\u00e2m s\u00e0ng th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n di\u1ec5n bi\u1ebfn b\u00e1n c\u1ea5p, s\u1ed1t nh\u1eb9, m\u1ec7t m\u1ecfi, thi\u1ebfu m\u00e1u, ti\u1ebfng th\u1ed5i m\u1edbi \u1edf tim.
\nStreptococcus bovis: Thu\u1ed9c nh\u00f3m li\u00ean c\u1ea7u nh\u00f3m D, tan m\u00e1u alpha. Bao g\u1ed3m: S. equinus, S. gallolyticus, S. infantarius\u2026 Sinh s\u1ed1ng trong \u0111\u01b0\u1eddng ti\u00eau h\u00f3a c\u1ee7a ng\u01b0\u1eddi th\u01b0\u1eddng g\u00e2y nhi\u1ec5m khu\u1ea9n ti\u1ebft ni\u1ec7u, nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng m\u1eadt v\u00e0 VNTMNK di\u1ec5n bi\u1ebfn b\u00e1n c\u1ea5p. L\u01b0u \u00fd 50% b\u1ec7nh nh\u00e2n nhi\u1ec5m S. bovis c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u0111\u1ea1i tr\u00e0ng \u00e1c t\u00ednh.<\/p>\n

2<\/strong>.2. Staphylococcus<\/strong><\/h3>\n

G\u1ed3m ba ch\u1ee7ng ch\u00ednh: Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus. Staphylococci sinh s\u1ed1ng tr\u00ean da v\u00e0 v\u00f9ng h\u1ea7u h\u1ecdng \u1edf 50% s\u1ed1 ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng. \u0110\u00e2y l\u00e0 nh\u00f3m c\u1ea7u khu\u1ea9n Gram d\u01b0\u01a1ng x\u1ebfp ch\u00f9m, k\u1ef5 kh\u00ed t\u00f9y \u00fd.
\nStaphylococcus aureus:
\nC\u00f3 l\u1edbp v\u1ecf bao ngo\u00e0i th\u00e0nh peptidoglycan, c\u00f3 ch\u1ee9a protein g\u1eafn penicillin.S. aureus c\u00f3 nhi\u1ec1u protein l\u00e0m v\u00f4 hi\u1ec7u h\u00f3a h\u1ec7 mi\u1ec5n d\u1ecbch c\u1ee7a con ng\u01b0\u1eddi:Protein A (ng\u0103n c\u1ea3n qu\u00e1 tr\u00ecnh opsonin h\u00f3a v\u00e0 th\u1ef1c b\u00e0o), coagulase (enzyme n\u00e0y gi\u00fap t\u1ea1o l\u1edbp fibrin xung quanh vi khu\u1ea9n, b\u1ea3o v\u1ec7 S. aureus kh\u1ecfi s\u1ef1 th\u1ef1c b\u00e0o), hemolysins (ph\u00e1 h\u1ee7y t\u1ebf b\u00e0o h\u1ed3ng c\u1ea7u, b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh, \u0111\u1ea1i th\u1ef1c b\u00e0o, ti\u1ec3u c\u1ea7u), leukocidins (ph\u00e1 h\u1ee7y b\u1ea1ch c\u1ea7u), penicillinase (l\u00e0 m\u1ed9t d\u1ea1ng c\u1ee7a beta \u2013 lactamase, ph\u00e1 h\u1ee7y v\u00f2ng beta \u2013 lactam l\u00e0m v\u00f4 hi\u1ec7u h\u00f3a penicillin. C\u00e1c protein gi\u00fap S. aureus \u0111\u00e2m xuy\u00ean m\u00f4: hyaluronidase (gi\u00e1ng h\u00f3a proteoglycan trong m\u00f4 li\u00ean k\u1ebft, staphylokinase (ph\u00e2n h\u1ee7y fibrin), lipase (gi\u00e1ng h\u00f3a m\u1ee1), protease (ph\u00e2n h\u1ee7y protein m\u00f4).
\nC\u00e1c ngo\u1ea1i \u0111\u1ed9c t\u1ed1: exfoliatin (g\u00e2y bong da), enterotoxin (g\u00e2y ng\u1ed9 \u0111\u1ed9c th\u1ef1c ph\u1ea9m: n\u00f4n, ti\u00eau ch\u1ea3y), TSST \u2013 1 (g\u00e2y h\u1ed9i ch\u1ee9ng s\u1ed1c nhi\u1ec5m \u0111\u1ed9c, 20% S. aureus c\u00f3 \u0111\u1ed9c t\u1ed1 n\u00e0y). S. aureus c\u00f3 th\u1ec3 g\u00e2y b\u1ec7nh \u1edf h\u1ea7u h\u1ebft c\u00e1c c\u01a1 quan trong c\u01a1 th\u1ec3: B\u1ec7nh do ngo\u1ea1i \u0111\u1ed9c t\u1ed1: ng\u1ed9 \u0111\u1ed9c th\u1ef1c ph\u1ea9m, t\u1ed5n th\u01b0\u01a1ng da (nh\u1ecdt k\u00e8m bong da), h\u1ed9i ch\u1ee9ng s\u1ed1c nhi\u1ec5m \u0111\u1ed9c. B\u1ec7nh do vi khu\u1ea9n x\u00e2m nh\u1eadp tr\u1ef1c ti\u1ebfp: vi\u00eam ph\u1ed5i, vi\u00eam m\u00e0ng n\u00e3o, vi\u00eam x\u01b0\u01a1ng kh\u1edbp, VNTMNK, nhi\u1ec5m khu\u1ea9n ti\u1ebft ni\u1ec7u.
\nMSSA (Methicillin \u2013 susceptible Staphylococcus aureus) v\u00e0 MRSA(Methicillin \u2013 resistant Staphylococcus aureus): Staphylococci ti\u1ebft ra penicillinase do \u0111\u00f3 ch\u00fang kh\u00e1ng penicillin. Methicillin, nafcillin, oxacillin, cloxacillin, dicloxacillin l\u00e0 c\u00e1c penicillin kh\u00e1ng penicillinase, kh\u00f4ng b\u1ecb gi\u00e1ng h\u00f3a b\u1edfi penicillinase, do \u0111\u00f3 ch\u00fang c\u00f3 kh\u1ea3 n\u0103ng di\u1ec7t S. aureus. Nh\u1eefng S. aureus nh\u1ea1y c\u1ea3m v\u1edbi c\u00e1c penicillin kh\u00e1ng penicillinase \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 MSSA, nh\u1eefng S. aureus kh\u00e1ng v\u1edbi c\u00e1c penicillin kh\u00e1ng penicillinase g\u1ecdi l\u00e0 MRSA. MRSA l\u00e0 ch\u1ee7ng vi khu\u1ea9n \u0111a kh\u00e1ng kh\u00e1ng sinh, l\u00e0 m\u1ed9t trong nh\u1eefng c\u0103n nguy\u00ean nhi\u1ec5m khu\u1ea9n b\u1ec7nh vi\u1ec7n h\u00e0ng \u0111\u1ea7u. VNTMNK do S. aureus: Kh\u1edfi ph\u00e1t \u0111\u1ed9t ng\u1ed9t, BN s\u1ed1t cao, r\u00e9t run, t\u1ed5n th\u01b0\u01a1ng van tim ti\u1ebfn tri\u1ec3n nhanh, c\u00f3 th\u1ec3 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 b\u1ec7nh van tim tr\u01b0\u1edbc \u0111\u00f3. Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed nghi\u1ec7n ch\u00edch ma t\u00fay th\u01b0\u1eddng g\u1eb7p t\u1ed5n th\u01b0\u01a1ng van tim b\u00ean ph\u1ea3i.
\nStaphylococcus epidermidis: Lo\u1ea1i vi khu\u1ea9n n\u00e0y l\u00e0 m\u1ed9t ph\u1ea7n trong h\u1ec7 vi khu\u1ea9n ch\u00ed b\u00ecnh th\u01b0\u1eddng \u1edf ng\u01b0\u1eddi v\u00e0 th\u01b0\u1eddng chung s\u1ed1ng h\u00f2a b\u00ecnh tr\u00ean da kh\u00f4ng g\u00e2y b\u1ec7nh. Tuy nhi\u00ean, \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u1eb7t \u1ed1ng th\u00f4ng ti\u1ec3u, \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch \u2026 vi khu\u1ea9n c\u00f3 th\u1ec3 x\u00e2m nh\u1eadp qua c\u00e1c \u0111\u01b0\u1eddng v\u00e0o tr\u00ean v\u00e0 g\u00e2y b\u1ec7nh. Kh\u00e1c v\u1edbi S. aureus, S. epidermidis kh\u00f4ng c\u00f3 men coagulase. S. epidermidis l\u00e0 m\u1ed9t trong c\u00e1c lo\u1ea1i vi khu\u1ea9n \u0111\u00f4i khi b\u1ecb t\u1ea1p nhi\u1ec5m khi c\u1ea5y m\u00e1u. Do \u0111\u00f3, n\u1ebfu ch\u1ec9 c\u00f3 m\u1ed9t trong c\u00e1c m\u1eabu m\u00e1u c\u1ea5y d\u01b0\u01a1ng t\u00ednh v\u1edbi S. epidermidis, c\u1ea7n nghi ng\u1edd \u0111\u00e2y ch\u1ec9 l\u00e0 t\u1ea1p nhi\u1ec5m tr\u00ean da b\u1ec7nh nh\u00e2n. N\u1ebfu c\u00f3 t\u1eeb hai m\u1eabu m\u00e1u tr\u1edf l\u00ean d\u01b0\u01a1ng t\u00ednh, th\u00ec kh\u1ea3 n\u0103ng cao b\u1ec7nh nh\u00e2n c\u00f3 nhi\u1ec5m khu\u1ea9n huy\u1ebft do S. epidermidis. Tr\u00ean th\u1ef1c t\u1ebf, \u0111\u00e2y l\u00e0 ch\u1ee7ng vi khu\u1ea9n g\u00e2y nhi\u1ec5m khu\u1ea9n tr\u00ean thi\u1ebft b\u1ecb nh\u00e2n t\u1ea1o th\u01b0\u1eddng g\u1eb7p nh\u1ea5t. Nguy\u00ean nh\u00e2n l\u00e0 do S. epidermidis c\u00f3 l\u1edbp v\u1ecf
\npolysaccharide, cho ph\u00e9p vi khu\u1ea9n b\u00e1m d\u00ednh v\u00e0o v\u1eadt li\u1ec7u nh\u00e2n t\u1ea1o.Staphylococcus saprophyticus:
\nTh\u01b0\u1eddng g\u00e2y nhi\u1ec5m tr\u00f9ng ti\u1ebft ni\u1ec7u \u1edf n\u1eef gi\u1edbi c\u00f3 quan h\u1ec7 t\u00ecnh d\u1ee5c, trong c\u1ed9ng\u00a0 \u0111\u1ed3ng. Kh\u00f4ng c\u00f3 men coagulase.<\/p>\n

2<\/strong>.3. Enterococcus<\/strong><\/h3>\n

Tr\u01b0\u1edbc \u0111\u00e2y, Enterococcus \u0111\u01b0\u1ee3c x\u1ebfp v\u00e0o Streptococcus nh\u00f3m D, tan huy\u1ebft alpha. Tuy nhi\u00ean, ng\u00e0y nay Enterococcus \u0111\u01b0\u1ee3c t\u00e1ch th\u00e0nh nh\u00f3m ri\u00eang do c\u00f3 qu\u00e1 nhi\u1ec1u \u0111i\u1ec3m kh\u00e1c bi\u1ec7t v\u1edbi Streptococcus. \u0110\u00e2y l\u00e0 nh\u00f3m c\u1ea7u khu\u1ea9n, Gram d\u01b0\u01a1ng, th\u01b0\u1eddng x\u1ebfp \u0111\u00f4i, k\u1ef5 kh\u00ed t\u00f9y \u00fd. Enterococcus l\u00e0 th\u00e0nh ph\u1ea7n c\u1ee7a h\u1ec7 vi khu\u1ea9n ch\u00ed trong \u0111\u01b0\u1eddng ti\u00eau h\u00f3a c\u1ee7a ng\u01b0\u1eddi. Hai ch\u1ee7ng ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf ng\u01b0\u1eddi l\u00e0 E. faecalis v\u00e0 E. faecium. Th\u01b0\u1eddng g\u00e2y vi\u00eam \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u, \u0111\u01b0\u1eddng m\u1eadt, VNTMNK. Th\u1ef1c t\u1ebf enterococcus l\u00e0 m\u1ed9t trong nh\u1eefng nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y nhi\u1ec5m tr\u00f9ng b\u1ec7nh vi\u1ec7n ng\u00e0y nay.<\/p>\n

2<\/strong>.4. HACEK<\/strong><\/h3>\n

HACEK l\u00e0 nh\u00f3m tr\u1ef1c khu\u1ea9n ho\u1eb7c h\u00ecnh d\u1ea1ng lai gi\u1eefa c\u1ea7u khu\u1ea9n v\u00e0 tr\u1ef1c khu\u1ea9n, gram \u00e2m, kh\u00f3 nu\u00f4i c\u1ea5y, g\u1ed3m c\u00e1c tr\u1ef1c khu\u1ea9n: Haemophilus species (H. parainfuenzae, H. aphrophilus, H. paraphrophilus, H. infuenzae) Actinobacillus actinomycetemcomitans ;Cardiobacterium hominis;Eikenella corrodens;Kingella species (K. kingae, K. denitrifcans)
\nHACEK l\u00e0 vi khu\u1ea9n s\u1ed1ng h\u1ed9i sinh \u1edf v\u00f9ng h\u1ea7u h\u1ecdng. Eikenella v\u00e0 Cardiobacterium \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y c\u1ea3 \u1edf \u0111\u01b0\u1eddng ti\u00eau h\u00f3a v\u00e0 \u0111\u01b0\u1eddng sinh d\u1ee5c n\u1eef. VNTMNK do HACEK th\u01b0\u1eddng di\u1ec5n bi\u1ebfn b\u00e1n c\u1ea5p trong nhi\u1ec1u tu\u1ea7n. 60% c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 li\u00ean quan v\u1edbi b\u1ec7nh l\u00fd r\u0103ng mi\u1ec7ng. B\u00ean c\u1ea1nh VNTMNK, nh\u1eefng vi khu\u1ea9n n\u00e0y c\u00f2n g\u00e2y nhi\u1ec5m tr\u00f9ng v\u1ebft th\u01b0\u01a1ng (\u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng v\u1ebft th\u01b0\u01a1ng do b\u1ecb c\u1eafn), \u00e1p xe ph\u1ea7n m\u1ec1m, \u00e1p xe n\u00e3o, vi\u00eam quanh r\u0103ng\u2026<\/p>\n

2<\/strong>.5. N\u1ea5m<\/strong><\/h3>\n

VNTMNK do n\u1ea5m r\u1ea5t hi\u1ebfm ch\u1ee7 y\u1ebfu \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c thi\u1ebft b\u1ecb c\u1ea5y gh\u00e9p nh\u00e2n t\u1ea1o v\u00e0 ti\u1ec1n s\u1eed d\u00f9ng thu\u1ed1c \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. Candida spp, Aspergillus spp l\u00e0 nh\u1eefng nguy\u00ean nh\u00e2n ch\u1ee7 y\u1ebfu g\u00e2y VNTMNK do n\u1ea5m.C\u1ea7n ngh\u0129 \u0111\u1ebfn nhi\u1ec5m n\u1ea5m \u1edf b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng s\u00f9i l\u1edbn.<\/p>\n","protected":false},"excerpt":{"rendered":"

Kh\u00e1ng sinh \u0111\u01b0\u1ee3c chia th\u00e0nh: kh\u00e1ng sinh di\u1ec7t khu\u1ea9n ph\u1ee5 thu\u1ed9c n\u1ed3ng \u0111\u1ed9 Fuoroquinolone, aminoglycoside, kh\u00e1ng sinh di\u1ec7t khu\u1ea9n ph\u1ee5 thu\u1ed9c th\u1eddi gian kh\u00f4ng c\u00f3 ho\u1eb7c c\u00f3 t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i ng\u1eafn (h\u1ea7u h\u1ebft c\u00e1c \u03b2-lactam), kh\u00e1ng sinh di\u1ec7t khu\u1ea9n ph\u1ee5 thu\u1ed9c th\u1eddi gian c\u00f3 t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i trung b\u00ecnh ho\u1eb7c d\u00e0i nh\u01b0 azithromycin […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[],"yoast_head":"\nT\u1ed5ng quan v\u1ec1 kh\u00e1ng sinh trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<\/title>\n<meta name=\"description\" content=\"Kh\u00e1ng sinh d\u00f9ng trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n l\u00e0 v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p v\u00e0 c\u1ea7n thi\u1ebft. 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