{"id":12696,"date":"2023-11-22T22:18:11","date_gmt":"2023-11-22T14:18:11","guid":{"rendered":"https:\/\/docquity.com\/?post_type=articles&p=12696"},"modified":"2025-02-11T13:37:58","modified_gmt":"2025-02-11T05:37:58","slug":"idsa-2023-huong-dan-kiem-soat-nhiem-khuan-gram-am-khang-thuoc","status":"publish","type":"articles","link":"https:\/\/docquity.com\/vi\/articles\/idsa-2023-huong-dan-kiem-soat-nhiem-khuan-gram-am-khang-thuoc\/","title":{"rendered":"IDSA 2023: H\u01b0\u1edbng d\u1eabn ki\u1ec3m so\u00e1t nhi\u1ec5m khu\u1ea9n gram \u00e2m kh\u00e1ng thu\u1ed1c"},"content":{"rendered":"\n

C\u00f3 kho\u1ea3ng 1.3 tri\u1ec7u ng\u01b0\u1eddi t\u1eed vong do nhi\u1ec5m vi sinh v\u1eadt \u0111\u1ec1 kh\u00e1ng trong n\u0103m 2019. C\u00f3 th\u1ec3 th\u1ea5y vi khu\u1ea9n kh\u00e1ng thu\u1ed1c \u0111\u00e3 v\u00e0 \u0111ang tr\u1edf th\u00e0nh v\u1ea5n \u0111\u1ec1 y khoa to\u00e0n c\u1ea7u \u0111\u00e1ng \u0111\u01b0\u1ee3c quan t\u00e2m. Vi\u1ec7c gia t\u0103ng t\u1ef7 l\u1ec7 l\u01b0u h\u00e0nh c\u1ee7a vi khu\u1ea9n \u0111\u1ec1 kh\u00e1ng c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c nhanh ch\u00f3ng ki\u1ec3m so\u00e1t. Trong \u0111\u00f3, th\u1ef1c h\u00e0nh t\u1ed1t s\u1eed d\u1ee5ng kh\u00e1ng sinh l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n. IDSA \u0111\u00e3 \u0111\u01b0a ra khuy\u1ebfn c\u00e1o c\u1eadp nh\u1eadt 2023 v\u1ec1 vi\u1ec7c ki\u1ec3m so\u00e1t c\u00e1c t\u00ecnh tr\u1ea1ng nhi\u1ec5m khu\u1ea9n do Enterobacterales s\u1ea3n sinh men beta-lactamase AmpC (AmpC-E), Enterobacterales \u0111\u1ec1 kh\u00e1ng carbapenem (CRE), Pseudomonas aeruginosa<\/em> \u0111\u1ec1 kh\u00e1ng kh\u00f3 tr\u1ecb (DTR-P. aeruginosa<\/em>), Acinetobacter baumannii <\/em>\u0111\u1ec1 kh\u00e1ng carbapneme (CRAB) v\u00e0 Stenotrophomonas maltophilia.<\/em><\/p>\n\n\n\n

LI\u1ec0U KH\u00c1NG SINH G\u1ee2I \u00dd TRONG \u0110I\u1ec0U TR\u1eca NHI\u1ec4M KHU\u1ea8N \u1ede NG\u01af\u1edcI TR\u01af\u1edeNG TH\u00c0NH<\/strong><\/p>\n\n\n\n

<\/p>\n\n\n\n

B\u1ea3ng 1.<\/strong>\u00a0Li\u1ec1u kh\u00e1ng sinh g\u1ee3i \u00fd \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh, gi\u1ea3 s\u1eed ch\u1ee9c n\u0103ng gan th\u1eadn b\u00ecnh th\u01b0\u1eddng<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

\"\"KHUY\u1ebeN C\u00c1O CHUNG<\/strong><\/p>\n\n\n\n

Ph\u00e1c \u0111\u1ed3 kinh nghi\u1ec7m<\/strong><\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

<\/strong>Ph\u00e1c \u0111\u1ed3 kinh nghi\u1ec7m n\u00ean nh\u1eafm v\u00e0o t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh c\u00f3 kh\u1ea3 n\u0103ng nh\u1ea5t, m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a nhi\u1ec5m tr\u00f9ng, ngu\u1ed3n nhi\u1ec5m v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 kh\u00e1c c\u1ee7a b\u1ec7nh nh\u00e2n (ch\u1eb3ng h\u1ea1n nh\u01b0 d\u1ecb \u1ee9ng, c\u00e1c b\u1ec7nh m\u1ea1n t\u00ednh m\u1eafc k\u00e8m). Khi l\u1ef1a ch\u1ecdn kh\u00e1ng sinh \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n, c\u00e1c y\u1ebfu t\u1ed1 sau \u0111\u00e2y c\u0169ng c\u1ea7n \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc:<\/p>\n\n\n\n

    \n
  • Vi sinh v\u1eadt m\u00e0 b\u1ec7nh nh\u00e2n \u0111\u00e3 nhi\u1ec5m v\u00e0 kh\u00e1ng sinh \u0111\u1ed3 c\u1ee7a b\u1ec7nh nh\u00e2n trong 6 th\u00e1ng tr\u1edf l\u1ea1i \u0111\u00e2y<\/li>\n\n\n\n
  • Kh\u00e1ng sinh b\u1ec7nh nh\u00e2n \u0111\u00e3 s\u1eed d\u1ee5ng trong 30 ng\u00e0y tr\u1edf l\u1ea1i \u0111\u00e2y<\/li>\n\n\n\n
  • D\u1eef li\u1ec7u \u0111\u1ec1 kh\u00e1ng kh\u00e1ng sinh t\u1ea1i \u0111\u1ecba ph\u01b0\u01a1ng cho vi sinh v\u1eadt c\u00f3 kh\u1ea3 n\u0103ng l\u00e0 nguy\u00ean nh\u00e2n c\u1ee7a t\u00ecnh tr\u1ea1ng nhi\u1ec5m khu\u1ea9n<\/li>\n<\/ul>\n\n\n\n

    Ph\u00e1c \u0111\u1ed3 kinh nghi\u1ec7m n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh d\u1ef1a tr\u00ean s\u1ef1 \u0111\u1ecbnh danh c\u1ee7a vi sinh v\u1eadt v\u00e0 kh\u00e1ng sinh \u0111\u1ed3.<\/p>\n\n\n\n

    Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb v\u00e0 chuy\u1ec3n sang kh\u00e1ng sinh \u0111\u01b0\u1eddng u\u1ed1ng<\/strong><\/p>\n\n\n\n

    Khuy\u1ebfn c\u00e1o v\u1ec1 th\u1eddi gian \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh kh\u00f4ng \u0111\u01b0\u1ee3c \u0111\u01b0a ra c\u1ee5 th\u1ec3, tuy nhi\u00ean, c\u00e1c nh\u00e2n vi\u00ean y t\u1ebf n\u00ean l\u01b0u \u00fd r\u1eb1ng th\u1eddi gian \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa vi sinh v\u1eadt \u0111\u1ec1 kh\u00e1ng v\u00e0 vi sinh v\u1eadt nh\u1ea1y c\u1ea3m. Sau khi \u0111\u1ecbnh danh \u0111\u01b0\u1ee3c vi sinh v\u1eadt g\u00e2y b\u1ec7nh, c\u00f3 th\u1ec3 kh\u00e1ng sinh kinh nghi\u1ec7m \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn ban \u0111\u1ea7u kh\u00f4ng nh\u1ea1y c\u1ea3m, trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y th\u1eddi gian \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh c\u00f3 th\u1ec3 s\u1ebd b\u1ecb \u1ea3nh h\u01b0\u1edfng. Ngo\u00e0i ra, tr\u1ea1ng th\u00e1i mi\u1ec5n d\u1ecbch, kh\u1ea3 n\u0103ng ki\u1ec3m so\u00e1t ngu\u1ed3n nhi\u1ec5m v\u00e0 c\u00e1c \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u1ec7nh nh\u00e2n c\u0169ng n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc khi quy\u1ebft \u0111\u1ecbnh th\u1eddi gian \u0111i\u1ec1u tr\u1ecb.<\/p>\n\n\n\n

    \"\"<\/figure>\n\n\n\n

    \"\"N\u00ean c\u00e2n nh\u1eafc chuy\u1ec3n sang kh\u00e1ng sinh \u0111\u01b0\u1eddng u\u1ed1ng n\u1ebfu b\u1ec7nh nh\u00e2n \u0111\u00e1p \u1ee9ng c\u00e1c ti\u00eau ch\u00ed sau:<\/p>\n\n\n\n

      \n
    • Nh\u1ea1y v\u1edbi kh\u00e1ng sinh \u0111\u01b0\u1eddng u\u1ed1ng<\/li>\n\n\n\n
    • Huy\u1ebft \u0111\u1ed9ng h\u1ecdc \u1ed5n \u0111\u1ecbnh<\/li>\n\n\n\n
    • Ki\u1ec3m so\u00e1t t\u1ed1 ngu\u1ed3n nhi\u1ec5m tr\u00f9ng<\/li>\n\n\n\n
    • Kh\u00f4ng c\u00f3 v\u1ea5n \u0111\u1ec1 v\u1ec1 kh\u1ea3 n\u0103ng h\u1ea5p thu thu\u1ed1c \u1edf ru\u1ed9t<\/li>\n<\/ul>\n\n\n\n

      ENTEROBACTERALES S\u1ea2N SINH BETA-LACTAMASE PH\u1ed4 R\u1ed8NG (ESBL-E)<\/strong><\/p>\n\n\n\n

      ESBL l\u00e0 enzym b\u1ea5t ho\u1ea1t \u0111a s\u1ed1 penicillin, cephalosporin v\u00e0 aztreonam. Th\u01b0\u1eddng th\u00ec ESBL-E v\u1eabn c\u00f2n nh\u1ea1y v\u1edbi carbapenem. ESBL kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng b\u1ea5t ho\u1ea1t t\u00e1c nh\u00e2n kh\u00f4ng c\u00f3 c\u1ea5y tr\u00fac beta-lactam (ch\u1eb3ng h\u1ea1n nh\u01b0 ciprofloxacin, trimethoprim-sulfamethoxazole (TMP-SMX), gentamicin…). Tuy nhi\u00ean, ESBL-E l\u00e0 nh\u1eefng vi sinh v\u1eadt th\u01b0\u1eddng mang gene\/c\u00f3 \u0111\u1ed9t bi\u1ebfn gene d\u1eabn \u0111\u1ebfn \u0111\u1ec1 kh\u00e1ng kh\u00e1ng sinh v\u1edbi ph\u1ed5 r\u1ed9ng h\u01a1n.<\/p>\n\n\n\n

      C\u00e1c vi khu\u1ea9n gram (-) \u0111\u1ec1u c\u00f3 th\u1ec3 mang gene ESBL, tuy nhi\u00ean th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 \u1edf Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, <\/em>v\u00e0 Proteus mirabilis. <\/em>X\u00e9t nghi\u1ec7m ESBL kh\u00f4ng ph\u1ea3i l\u00e0 quy tr\u00ecnh th\u01b0\u1eddng quy \u1edf \u0111a s\u1ed1 c\u00e1c ph\u00f2ng th\u00ed nghi\u1ec7m vi sinh. MIC \u2265 2 \u00b5g\/ml \u0111\u1ed1i v\u1edbi ceftriaxone \u0111\u01b0\u1ee3c xem l\u00e0 ng\u01b0\u1ee1ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh vi khu\u1ea9n s\u1ea3n sinh ESBL, tuy nhi\u00ean c\u00e1c x\u00e1c \u0111\u1ecbnh n\u00e0y c\u00f3 h\u1ea1n ch\u1ebf \u0111\u1ed1 v\u1edbi nh\u1eefng vi khu\u1ea9n kh\u00f4ng nh\u1ea1y v\u1edbi ceftriaxone v\u00ec l\u00fd do kh\u00e1c ngo\u00e0i s\u1ea3n sinh ESBL. Trong h\u01b0\u1edbng d\u1eabn n\u00e0y ESBSL-E \u0111\u01b0\u1ee3c xem l\u00e0 E. coli, K. pneumoniae, K. oxytoca, <\/em>ho\u1eb7c P. mirabilis.<\/em><\/p>\n\n\n\n

      C\u00e2u h\u1ecfi 1: Kh\u00e1ng sinh n\u00e0o n\u00ean \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u00e0ng quang kh\u00f4ng ph\u1ee9c t\u1ea1p g\u00e2y ra b\u1edfi ESBL-E?<\/strong><\/p>\n\n\n\n

      Nitrofurantoin v\u00e0 TMP-SMX l\u00e0 nh\u1eefng kh\u00e1ng sinh \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn cho b\u1ec7nh nh\u00e2n vi\u00eam b\u00e0ng quang kh\u00f4ng ph\u1ee9c t\u1ea1p do nhi\u1ec5m ESBL-E. Ciprofloxacin, levofloxacin v\u00e0 carbapenem l\u00e0 nh\u1eefng t\u00e1c nh\u00e2n thay th\u1ebf cho b\u1ec7nh nh\u00e2n vi\u00eam b\u00e0ng quang kh\u00f4ng ph\u1ee9c t\u1ea1p do ESBL-E. M\u1eb7c d\u00f9 hi\u1ec7u qu\u1ea3, tuy nhi\u00ean ciprofloxacin v\u00e0 levofloxacin kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb n\u1ebfu nitrofuratoin v\u00e0 TMP-SMX v\u1eabn c\u00f2n hi\u1ec7u qu\u1ea3. Ngo\u00e0i ra, aminoglycosides li\u1ec1u \u0111\u01a1n v\u00e0 fosfomycin \u0111\u01b0\u1eddng u\u1ed1ng (ch\u1ec9 \u0111\u1ed1i v\u1edbi E. coli<\/em>) c\u0169ng l\u00e0 nh\u1eefng li\u1ec7u ph\u00e1p thay th\u1ebf cho vi\u00eam b\u00e0ng quang kh\u00f4ng ph\u1ee9c t\u1ea1p do ESBL-E.<\/p>\n\n\n\n

      C\u00e2u h\u1ecfi 2. Kh\u00e1ng sinh n\u00e0o \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn trong \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u1ec3 th\u1eadn v\u00e0 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u ph\u1ee9c t\u1ea1p do ESBL-E?<\/strong><\/p>\n\n\n\n

      TMP-SMX, ciprofloxacin ho\u1eb7c levofloxacin l\u00e0 nh\u1eefng kh\u00e1ng sinh \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn trong \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u1ec3 th\u1eadn v\u00e0 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u ph\u1ee9c t\u1ea1p g\u00e2y ra b\u1edfi ESBL-E. Ertapenem, meropenem v\u00e0 imipenem-cilastatin l\u00e0 nh\u1eefng kh\u00e1ng sinh ch\u1ec9 n\u00ean \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn trong tr\u01b0\u1eddng h\u1ee3p \u0111\u1ec1 kh\u00e1ng ho\u1eb7c c\u00f3 \u0111\u1ed9c t\u00ednh v\u1edbi TMP-SMX ho\u1eb7c kh\u00e1ng sinh nh\u00f3m fluoroquinolone. Aminoglycoside (v\u1edbi li\u1ec7u tr\u00ecnh \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7y \u0111\u1ee7) c\u0169ng l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn thay th\u1ebf trong \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u1ec3 th\u1eadn v\u00e0 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u ph\u1ee9c t\u1ea1p do ESBL-E.<\/p>\n\n\n\n

      C\u00e2u h\u1ecfi 3. Kh\u00e1ng sinh n\u00e0o n\u00ean \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng \u1edf v\u1ecb tr\u00ed kh\u00e1c ngo\u00e0i \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u g\u00e2y ra b\u1edfi ESBL-E?<\/strong><\/p>\n\n\n\n

      Meropenem, imipenem-cilastatin ho\u1eb7c ertapenem l\u00e0 nh\u1eefng kh\u00e1ng sinh \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng ngo\u00e0i \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u g\u00e2y ra b\u1edfi ESBL-E. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n b\u1ec7nh n\u1eb7ng ho\u1eb7c gi\u1ea3m albumin huy\u1ebft, meropenem ho\u1eb7c imipenem-cilastatin l\u00e0 kh\u00e1ng sinh nh\u00f3m carbapenem \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn. N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng t\u1ed1t, vi\u1ec7c chuy\u1ec3n sang TMP-SMX, ciprofloxacin ho\u1eb7c levofloxacin \u0111\u01b0\u1eddng u\u1ed1ng n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc (n\u1ebfu nh\u1ea1y c\u1ea3m tr\u00ean kh\u00e1ng sinh \u0111\u1ed3).<\/p>\n\n\n\n

      C\u00e2u h\u1ecfi 4. Li\u1ec7u piperacillin-tazobactam c\u00f3 vai tr\u00f2 n\u00e0o trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do ESBL-E?<\/strong><\/p>\n\n\n\n

      N\u1ebfu piperacillin-tazobactam l\u00e0 kh\u00e1ng sinh kinh nghi\u1ec7m \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn ban \u0111\u1ea7u \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u00e0ng quang kh\u00f4ng ph\u1ee9c t\u1ea1p do vi khu\u1ea9n v\u1ec1 sau \u0111\u01b0\u1ee3c \u0111\u1ecbnh danh l\u00e0 ESBL-E, tuy nhi\u00ean t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh nh\u00e2n c\u00f3 c\u1ea3i thi\u1ec7n th\u00ec kh\u00f4ng c\u1ea7n thi\u1ebft ph\u1ea3i thay \u0111\u1ed5i kh\u00e1ng sinh ho\u1eb7c k\u00e9o d\u00e0i th\u1eddi gian \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh. IDSA khuy\u1ebfn ngh\u1ecb l\u1ef1a ch\u1ecdn TMP-SMX, ciprofloxacin, levofloxacin ho\u1eb7c kh\u00e1ng sinh nh\u00f3m carbapenem h\u01a1n l\u00e0 piperacillin-tazobactam \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u1ec3 th\u1eadn ho\u1eb7c nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u ph\u1ee9c t\u1ea1p do ESBL-E. Piperacillin-tazobactam kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n ngo\u00e0i \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u do ESBL-E, ngay c\u1ea3 khi peperacillin-tazobactam nh\u1ea1y c\u1ea3m tr\u00ean kh\u00e1ng sinh \u0111\u1ed3.<\/p>\n\n\n\n

      C\u00e2u h\u1ecfi 5. Li\u1ec7u cefepime c\u00f3 vai tr\u00f2 n\u00e0o trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n g\u00e2y ra b\u1edfi ESBL-E?<\/strong><\/p>\n\n\n\n

      N\u1ebfu cefepime l\u00e0 kh\u00e1ng sinh kinh nghi\u1ec7m \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn ban \u0111\u1ea7u \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u00e0ng quang kh\u00f4ng ph\u1ee9c t\u1ea1p do vi khu\u1ea9n v\u1ec1 sau \u0111\u01b0\u1ee3c \u0111\u1ecbnh danh l\u00e0 ESBSL-E, tuy nhi\u00ean t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh nh\u00e2n c\u00f3 c\u1ec9a thi\u1ec7n, th\u00ec kh\u00f4ng c\u1ea7n thi\u1ebft ph\u1ea3i thay \u0111\u1ed5i kh\u00e1ng sinh hay k\u00e9o d\u00e0i th\u1eddi gian \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh. IDSA khuy\u1ebfn ngh\u1ecb kh\u00f4ng n\u00ean d\u00f9ng cefepime trong \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u1ec3 th\u1eadn v\u00e0 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u ph\u1ee9c t\u1ea1p. Cefepime c\u0169ng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n ngo\u00e0i \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u g\u00e2y ra b\u1edfi ESBL-E, ngay c\u1ea3 khi cefepime c\u00f2n nh\u1ea1y tr\u00ean kh\u00e1ng sinh \u0111\u1ed3.<\/p>\n\n\n\n

      C\u00e2u h\u1ecfi 6. Li\u1ec7u kh\u00e1ng sinh nh\u00f3m cephamycin c\u00f3 vai tr\u00f2 n\u00e0o trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do ESBL-E?<\/strong><\/p>\n\n\n\n

      Kh\u00e1ng sinh nh\u00f3m cephamycin kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do ESBL-E cho \u0111\u1ebfn khi c\u00f3 d\u1eef li\u1ec7u l\u00e2m s\u00e0ng c\u1ee7a cefoxitin ho\u1eb7c cefotetan v\u00e0 li\u1ec1u t\u1ed1i \u01b0u \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh.<\/p>\n\n\n\n

      C\u00e2u h\u1ecfi 7. Ph\u1ed1i h\u1ee3p beta-lactam v\u00e0 ch\u1ea5t \u1ee9c ch\u1ebf beta-lactamase c\u00f3 vai tr\u00f2 g\u00ec v\u00e0 vai tr\u00f2 c\u1ee7a cefiderocol trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do ESBL-E?<\/strong><\/p>\n\n\n\n

      IDSA khuy\u1ebfn ngh\u1ecb ceftazidime-avibactam, meropenem-vaborbactam, imipenem-cilastatin-relebactam v\u00e0 cefiderocol n\u00ean \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do vi sinh v\u1eadt \u0111\u1ec1 kh\u00e1ng carbapenem. IDSA kh\u00f4ng khuy\u1ebfn ngh\u1ecb ceftolozane-tazobactam trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tkhuaanr do ESBL-E, c\u00f3 th\u1ec3 ngo\u1ea1i tr\u1eeb tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m polymicrobial.<\/p>\n\n\n\n

      ENTEROBACTERALES S\u1ea2N SINH MEN BETA-LACTAMASE AMPC (AMPC-E)<\/strong><\/p>\n\n\n\n

      AmpC beta-lactamase l\u00e0 men beta-lactamase \u0111\u01b0\u1ee3c s\u1ea3n sinh v\u1edbi n\u1ed3ng \u0111\u1ed9 th\u1ea5p (basal) b\u1edfi m\u1ed9t s\u1ed1 vi khu\u1ea9n Enterobacterales v\u00e0 vi khu\u1ea9n gtam \u00e2m kh\u00f4ng l\u00ean men glucose. AmpC beta-lactamase c\u00f3 kh\u1ea3 n\u0103ng th\u1ee7y ph\u00e2n m\u1ed9t s\u1ed1 kh\u00e1ng sinh beta-lactam (\u1edf n\u1ed3ng \u0111\u1ed9 AmpC beta-lactamase n\u1ec1n ho\u1eb7c cao). Enterobacterales t\u0103ng s\u1ea3n sinh AmpC beta-lactamase nh\u1edd m\u1ed9t trong 3 c\u01a1 ch\u1ebf:<\/p>\n\n\n\n

        \n
      • C\u1ea3m \u1ee9ng bi\u1ec3u hi\u1ec7n gen trong nhi\u1ec5m s\u1eafc th\u1ec3<\/li>\n\n\n\n
      • K\u00edch ho\u1ea1t gen trong nhi\u1ec5m nhi\u1ec5m s\u1eafc th\u1ec3 \u1ed5n \u0111\u1ecbnh<\/li>\n\n\n\n
      • Gen ampC \u0111\u01b0\u1ee3c bi\u1ec3u hi\u1ec7n c\u1ea5u th\u00e0nh (th\u01b0\u1eddng \u0111\u01b0\u1ee3c mang tr\u00ean plasmid nh\u01b0ng thi tho\u1ea3ng c\u0169ng \u0111\u01b0\u1ee3c h\u1ee3p nh\u1ea5t v\u1edbi nhi\u1ec5m s\u1eafc th\u1ec3).<\/li>\n<\/ul>\n\n\n\n

        Trong h\u01b0\u1edbng d\u1eabn n\u00e0y, c\u00e1c khuy\u1ebfn c\u00e1o t\u1eadp trung v\u00e0o vi\u1ec7c ki\u1ec3m so\u00e1t nhi\u1ec5m khu\u1ea9n do Enterobacterales c\u00f3 c\u1ea3m \u1ee9ng bi\u1ec3u hi\u1ec7n gen ampC.<\/p>\n\n\n\n

        T\u0103ng s\u1ea3n sinh AmpC do c\u1ea3m \u1ee9ng bi\u1ec3u hi\u1ec7n ampC c\u00f3 th\u1ec3 x\u1ea3y ra khi c\u00f3 m\u1eb7t c\u1ee7a kh\u00e1ng sinh c\u1ee5 th\u1ec3, l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 enzyme trong khoang chu ch\u1ea5t, \u0111\u1ee7 \u0111\u1ec3 l\u00e0m t\u0103ng MIC \u0111\u1ed1i v\u1edbi m\u1ed9t s\u1ed1 kh\u00e1ng sinh nh\u01b0 ceftriaxone, cefotaxime v\u00e0 ceftazidime. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, th\u01b0\u1eddng th\u00ec Enterobacterales \u0111\u01b0\u1ee3c ph\u00e2n l\u1eadp v\u1eabn nh\u1ea1y v\u1edbi ceftriaxone \u1edf nh\u1eefng l\u1ea7n test \u0111\u1ea7u ti\u00ean, nh\u01b0ng l\u1ea1i bi\u1ec3u hi\u1ec7n kh\u00f4ng nh\u1ea1y v\u1edbi ceftriaxone sau khi b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi ceftriaxone. H\u01b0\u1edbng d\u1eabn c\u1ee7a IDSA m\u00f4 t\u1ea3 nh\u1eefng vi sinh v\u1eadt n\u00e0y c\u00f3 nguy c\u01a1 trung b\u00ecnh \u2013 cao s\u1ea3n sinh AmpC v\u1edbi n\u1ed3ng \u0111\u1ed9 g\u00e2y \u1ea3nh h\u01b0\u1edfng tr\u00ean l\u00e2m s\u00e0ng. \u0110\u1ec1 kh\u00e1ng do c\u1ea3m \u1ee9ng ampC c\u00f3 th\u1ec3 quan s\u00e1t th\u1ea5y sau m\u1ed9t v\u00e0i li\u1ec1u ceftriaxone, cefotaxime ho\u1eb7c ceftazidime.<\/p>\n\n\n\n

        \u0110\u1ed1i v\u1edbi 2 c\u01a1 ch\u1ebf c\u00f2n l\u1ea1i, AmpC lu\u00f4n \u0111\u01b0\u1ee3c t\u0103ng c\u01b0\u1eddng s\u1ea3n xu\u1ea5t. Do v\u1eady, vi sinh v\u1eadt t\u0103ng s\u1ea3n sinh AmpC do 2 ch\u1ebf c\u00f2n l\u1ea1i th\u01b0\u1eddng c\u00f3 k\u1ebft qu\u1ea3 kh\u00f4ng nh\u1ea1y v\u1edbi ceftriaxone, cefotaxime v\u00e0\/ho\u1eb7c ceftazidime ngay t\u1eeb nh\u1eefng l\u1ea7n test \u0111\u1ea7u ti\u00ea, do v\u1eady, vi sinh v\u1eadt v\u1edbi 2 c\u01a1 ch\u1ebf c\u00f2n l\u1ea1i \u00edt ph\u1ee9c t\u1ea1p h\u01a1n v\u1ec1 m\u1eb7t ki\u1ec3m so\u00e1t trong l\u00e2m s\u00e0ng.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 1. Enterobacterales n\u00e0o n\u00ean c\u00e2n nh\u1eafc l\u00e0 vi sinh v\u1eadt c\u00f3 nguy c\u01a1 trung b\u00ecnh \u2013 cao s\u1ea3n sinh AmpC v\u1edbi n\u1ed3ng \u0111\u1ed9 g\u00e2y \u1ea3nh h\u01b0\u1edfng tr\u00ean l\u00e2m s\u00e0ng do c\u01a1 ch\u1ebf gen ampC \u0111\u01b0\u1ee3c bi\u1ec3u hi\u1ec7n c\u1ea5u th\u00e0nh?<\/strong><\/p>\n\n\n\n

        Enterobacter cloacae<\/em> complex, Klebsiella aerogenes <\/em>v\u00e0 Citrobacter freundii<\/em> l\u00e0 nh\u1eefng Enterobacterales ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u00f3 nguy c\u01a1 trung b\u00ecnh \u2013 cao c\u00f3 th\u1ec3 s\u1ea3n sinh AmpC c\u00f3 \u00fd ngh\u0129a.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 2. \u0110\u1eb7c \u0111i\u1ec3m n\u00e0o n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc khi l\u1ef1a ch\u1ecdn kh\u00e1ng sinh \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n g\u00e2y ra b\u1edfi vi sinh v\u1eadt c\u00f3 nguy c\u01a1 trung b\u00ecnh \u2013 cao s\u1ea3n sinh AmpC c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng do c\u1ea3m \u1ee9ng gene ampC?<\/strong><\/p>\n\n\n\n

        Nhi\u1ec1u kh\u00e1ng ssinh beta-lactam c\u00f3 nguy c\u01a1 cao c\u1ea3m \u1ee9ng gene ampC. Kh\u1ea3 n\u0103ng c\u1ea3m \u1ee9ng gene ampC v\u00e0 kh\u00f4ng c\u00f3 kh\u1ea3 n\u0103ng ch\u1ed1ng l\u1ea1i s\u1ef1 th\u1ee7y ph\u00e2n ucar AmpC \u0111\u1ec1u c\u00f3 th\u1ec3 h\u00ecnh th\u00e0nh c\u01a1 ch\u1ebf \u0111\u1ec1 kh\u00e1ng kh\u00e1ng sinh.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 3. Vai tr\u00f2 c\u1ee7a cefepime trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n g\u00e2y ra b\u1edfi Enterobacterales c\u00f3 nguy c\u01a1 trung b\u00ecnh \u2013 cao s\u1ea3n sinh AmpC c\u00f3 \u00fd ngh\u0129a v\u1ec1 n\u1eb7t l\u00e2m s\u00e0ng do c\u1ea3m \u1ee9ng gene ampC?<\/strong><\/p>\n\n\n\n

        Cefepime l\u00e0 kh\u00e1ng sinh \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n g\u00e2y ra b\u1edfi vi sinh v\u1eadt c\u00f3 nguy c\u01a1 trung b\u00ecnh \u2013 cao s\u1ea3n sinh AmpC c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng (E. cloacae <\/em>complex, K. aerogenes, <\/em>v\u00e0 C. freundii). <\/em>C\u00f3 \u00edt d\u1eef li\u1ec7u g\u1ee3i \u00fd carbapenem c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do nh\u1eefng vi sinh v\u1eadt n\u00e0y n\u1ebfu MIC c\u1ee7a cefepim \u2265 4\u00b5g\/mL, gi\u1ea3 s\u1eed carbapenem nh\u1ea1y tr\u00ean kh\u00e1ng sinh \u0111\u1ed3 v\u00ec vi sinh v\u1eadt c\u00f3 th\u1ec3 \u0111\u1ed3ng s\u1ea3n sinh ESBL.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 4. Vai tr\u00f2 c\u1ee7a ceftriaxone trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do Enterbacterales c\u00f3 nguy c\u01a1 trung b\u00ecnh \u2013 cao s\u1ea3n sinh AmpC c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng do c\u1ea3m \u1ee9ng gene ampC?<\/strong><\/p>\n\n\n\n

        Ceftriaxone (ho\u1eb7c cefotaxime ho\u1eb7c ceftazidime) kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng x\u00e2m l\u1ea5n g\u00e2y ra b\u1edfi vi sinh v\u1eadt c\u00f3 nguy c\u01a1 trung b\u00ecnh \u2013 cao s\u1ea3n sinh AmpC c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng (ch\u1eb3ng h\u1ea1n nh\u01b0 E. cloacae <\/em>complex, K. aerogenes, <\/em>v\u00e0 C. freundi<\/em>). Ceftriaxone l\u00e0 l\u1ef1a ch\u1ecdn ph\u00f9 h\u1ee3p \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u00e0ng quang kh\u00f4ng ph\u1ee9c t\u1ea1p g\u00e2y ra b\u1edfi vi khu\u1ea9n nh\u1ea1y v\u1edbi ceftriaxone tr\u00ean kh\u00e1ng sinh \u0111\u1ed3.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 5. Vai tr\u00f2 c\u1ee7a piperacillin-tazobactam trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do Enterobacterales c\u00f3 nguy c\u01a1 trung b\u00ecnh \u2013 cao s\u1ea3n sinh AmpC c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng do c\u1ea3m \u1ee9ng gene ampC?<\/strong><\/p>\n\n\n\n

        Piperacillin-tazobactam kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n nghi\u00eam tr\u1ecdng do Enterobacterales c\u00f3 nguy c\u01a1 trung b\u00ecnh \u2013 cao s\u1ea3n \u1ee9ng AmpC c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng do c\u1ea3m \u1ee9ng gene ampC.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 6. Vai tr\u00f2 c\u1ee7a ph\u1ed1i h\u1ee3p beta-lactam v\u00e0 ch\u1ea5t \u1ee9c ch\u1ebf beta-lactamase v\u00e0 vai tr\u00f2 c\u1ee7a cefiderocol trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n g\u00e2y ra b\u1edfi Enterobacterales c\u00f3 nguy c\u01a1 trung b\u00ecnh \u2013 cao s\u1ea3n sinh AmpC c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng do cmar \u1ee9ng gene ampC?<\/strong><\/p>\n\n\n\n

        IDSA khuy\u1ebfn ngh\u1ecb ceftazidime-avibactam, meropenem-vaborbactam, imipenem-cilastatin-relebactam v\u00e0 cefiderocol c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc l\u1ef1a ch\u1ecdn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n g\u00e2y ra b\u1edfi vi sinh v\u1eadt \u0111\u1ec1 kh\u00e1ng carbapenem. IDSA kh\u00f4ng khuy\u1ebfn ngh\u1ecb l\u1ef1a ch\u1ecdn ceftolozane-tazobactam \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do AmpC-E, c\u00f3 th\u1ec3 ngo\u1ea1i tr\u1eeb tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m khu\u1ea9n polymicrobial.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 7. Vai tr\u00f2 c\u1ee7a kh\u00e1ng sinh kh\u00f4ng thu\u1ed9c nh\u00f3m beta-lactam trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n g\u00e2y ra b\u1edfi Enterobacterales c\u00f3 nguy c\u01a1 trung b\u00ecnh \u2013 cao s\u1ea3n sinh AmpC c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng do c\u1ea3m \u1ee9ng gene ampC?<\/strong><\/p>\n\n\n\n

        Nitrofuratoin ho\u1eb7c TMP-SMX l\u00e0 nh\u1eefng kh\u00e1ng sinh \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn trong \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u00e0ng quang kh\u00f4ng ph\u1ee9c t\u1ea1p do AmpC-E. Kh\u00e1ng sinh nh\u00f3m aminoglycoside l\u00e0 l\u1ef1a ch\u1ecdn thay th\u1ebf \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u00e0ng quang kh\u00f4ng ph\u1ee9c t\u1ea1p, vi\u00eam b\u1ec3 th\u1eadn v\u00e0 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u ph\u1ee9c t\u1ea1p g\u00e2y ra b\u1edfi AmpC-E. TMP-SMX ho\u1eb7c kh\u00e1ng sinh nh\u00f3m fluoroquinolone c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n x\u00e2m l\u1ea5n g\u00e2y ra b\u1edfi vi sinh v\u1eadt c\u00f3 nguy c\u01a1 trung b\u00ecnh \u2013 cao s\u1ea3n sinh AmpC c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng.<\/p>\n\n\n\n

        ENTEROBACTERALES \u0110\u1ec0 KH\u00c1NG CARBAPENEM (CRE)<\/strong><\/p>\n\n\n\n

        Vi khu\u1ea9n \u0110\u1ec1 kh\u00e1ng v\u1edbi t\u1ed1i thi\u1ec3u 1 kh\u00e1ng sinh nh\u00f3m carbapenem (ngo\u00e0i imipenem) th\u01b0\u1eddng l\u00e0 \u0111i\u1ec1u ki\u1ec7n c\u1ea7n thi\u1ebft \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh vi khu\u1ea9n kh\u00f4ng nh\u1ea1y c\u1ea3m v\u1edbi imipenem. \u0110\u1ed1i v\u1edbi h\u01b0\u1edbng d\u1eabn n\u00e0y, CRE \u0111\u01b0\u1ee3c xem l\u00e0 vi sinh v\u1eadt \u0111\u1ec1 kh\u00e1ng meropenem ho\u1eb7c imipenem ho\u1eb7c Enterobacterales c\u00f3 s\u1ea3n sinh carbapenemase.<\/p>\n\n\n\n

        CRE bao g\u1ed3m nhi\u1ec1u nh\u00f3m vi sinh v\u1eadt v\u1edbi nhi\u1ec1u c\u01a1 ch\u1ebf \u0111\u1ec1 kh\u00e1ng kh\u00e1ng sinh kh\u00e1c nhau, th\u01b0\u1eddng \u0111\u01b0\u1ee3c chia th\u00e0nh nh\u00f3m s\u1ea3n sinh carbapenemase v\u00e0 nh\u00f3m kh\u00f4ng s\u1ea3n sinh carbapenemase. Vi khu\u1ea9n s\u1ea3n sinh carbapenemase \u0111\u01b0\u1ee3c \u0111\u1ecbnh danh nhi\u1ec1u nh\u1ea5t \u1edf Hoa K\u1ef3 l\u00e0 K. pneumoniae <\/em>carbapenemase (KPC) nh\u01b0ng kh\u00f4ng ch\u1ec9 gi\u1edbi h\u1ea1n \u1edf K. pneumoniade<\/em>. M\u1ed9t s\u1ed1 carbapenemase \u0111\u01b0\u1ee3c \u0111\u1ecbnh danh \u1edf Hoa K\u1ef3 bao g\u1ed3m New Delhi metallo-\u03b2-lactamases (NDMs), Verona integron-encoded metallo-\u03b2-lactamases (VIMs), imipenem-hydrolyzing metallo-\u03b2-lactamases (IMPs), v\u00e0 oxacillinases (ch\u1eb3ng h\u1ea1n nh\u01b0 OXA-48-like).<\/p>\n\n\n\n

        M\u1ed9t s\u1ed1 x\u00e9t nghi\u1ec7m c\u00f3 th\u1ec3 ph\u00e2n bi\u1ec7t CRE s\u1ea3n sinh hay kh\u00f4ng s\u1ea3n sinh carbapenemase. X\u00e9t nghi\u1ec7m ph\u00e2n t\u1eed c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c ki\u1ec3u carbapenemase. Tuy nhi\u00ean nh\u1eefng x\u00e9t nghi\u1ec7m n\u00e0y kh\u00f4ng \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh th\u01b0\u1eddng quy \u1edf c\u00e1c ph\u00f2ng th\u00ed nghi\u1ec7m. Tuy nhi\u00ean IDSA cho r\u1eb1ng n\u00ean th\u1ef1c hi\u1ec7n nh\u1eefng x\u00e9t nghi\u1ec7m n\u00e0y \u0111\u1ec3 \u0111\u01b0a ra l\u1ef1a ch\u1ecdn kh\u00e1ng sinh t\u1ed1i \u01b0u nh\u1ea5t.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 1. L\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb n\u00e0o \u0111\u01b0\u1ee3c \u01b0u ti\u00ean \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do Enterobacterales kh\u00f4ng s\u1ea3n sinh carbapenemase v\u1eabn c\u00f2n nh\u1ea1y v\u1edbi meropenem v\u00e0 imipenem nh\u01b0ng kh\u00f4ng nh\u1ea1y v\u1edbi ertapenem?<\/strong><\/p>\n\n\n\n

        \u0110\u1ed1i v\u1edbi tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m khu\u1ea9n do Enterobacterales nh\u1ea1y c\u1ea3m v\u1edbi meropenem v\u00e0 imipenem (MIC \u2264 1 \u00b5g\/ml) nh\u01b0ng kh\u00f4ng nh\u1ea1y c\u1ea3m v\u1edbi ertapenem (MIC \u2265 1 \u00b5g\/ml), meropenem (ho\u1eb7c imipenem \u2013 cilastatin) truy\u1ec1n t\u0129nh m\u1ea1ch k\u00e9o d\u00e0i \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb, gi\u1ea3 s\u1eed \u0111\u00e3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c vi khu\u1ea9n kh\u00f4ng s\u1ea3n sinh carbapenemase.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 2. Kh\u00e1ng sinh n\u00e0o \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u00e0ng quang kh\u00f4ng ph\u1ee9c t\u1ea1p g\u00e2y ra b\u1edfi CRE?<\/strong><\/p>\n\n\n\n

        Nitrofuratoin, TMP-SMX, ciprofloxacin ho\u1eb7c levofloxacin l\u00e0 nh\u1eefng l\u1ef1a ch\u1ecdn \u0111\u01b0\u1ee3c \u01b0u ti\u00ean \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u00e0ng quang kh\u00f4ng ph\u1ee9c t\u1ea1p g\u00e2y ra b\u1edfi CRE, m\u1eafc d\u00f9 kh\u1ea3 n\u0103ng nh\u1ea1y c\u1ea3m v\u1edbi kh\u00e1ng sinh n\u00e0y l\u00e0 th\u1ea5p. Li\u1ec1u \u0111\u01a1n aminoglycoside, fosfomycin \u0111\u01b0\u1eddng u\u1ed1ng (ch\u1ec9 d\u00f9ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb E. coli<\/em>), colistin, ceftazidime-avibactam, meropenem-vaborbactam, imipenem-cilastatin-relebactam, cefiderocol l\u00e0 nh\u1eefng l\u1ef1a ch\u1ecdn thay th\u1ebf cho vi\u00eam b\u00e0ng quang kh\u00f4ng ph\u1ee9c t\u1ea1p do CRE.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 3. Kh\u00e1ng sinh n\u00e0o \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn trong \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u1ec3 th\u1eadn v\u00e0 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u ph\u1ee9c t\u1ea1p g\u00e2y ra b\u1edfi CRE?<\/strong><\/p>\n\n\n\n

        TMP-SMX, ciprofloxacin ho\u1eb7c levofloxacin l\u00e0 nh\u1eefng l\u1ef1a ch\u1ecdn \u0111\u01b0\u1ee3c \u01b0u ti\u00ean \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u1ec3 th\u1eadn ho\u1eb7c nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u ph\u1ee9c t\u1ea1p g\u00e2y ra b\u1edfi CRE (n\u1ebfu nh\u1ea1y c\u1ea3m tr\u00ean kh\u00e1ng sinh \u0111\u1ed3). Ceftazidime-avibactam, meropenem-vaborbactm, imipenem-cilastatin-relebactam v\u00e0 cefiderocol c\u0169ng l\u00e0 nh\u1eefng l\u1ef1a ch\u1ecdn \u0111\u01b0\u1ee3c \u01b0u ti\u00ean \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u1ec3 th\u1eadn ho\u1eb7c nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u ph\u1ee9c t\u1ea1p. Kh\u00e1ng sinh nh\u00f3m aminoglycoside c\u0169ng l\u00e0 nh\u1eefng l\u1ef1a ch\u1ecdn thay th\u1ebf.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 4. Kh\u00e1ng sinh n\u00e0o \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m khu\u1ea9n ngo\u00e0i \u0111\u01b0\u1eddng ti\u1ec3u g\u00e2y ra b\u1edfi CRE, n\u1ebfu kh\u00f4ng th\u1ec3 l\u00e0m x\u00e9t nghi\u1ec7m carbapenemase ho\u1eb7c k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m carbapenemase \u00e2m t\u00ednh?<\/strong><\/p>\n\n\n\n

        Ceftazidime-avibactam, meropenem-vaborbactam v\u00e0 imipenem-cilastatin-relebactam l\u00e0 nh\u1eefng l\u1ef1a ch\u1ecdn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng ngo\u00e0i \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u n\u1ebfu nh\u01b0 kh\u00f4ng th\u1ec3 l\u00e0m x\u00e9t nghi\u1ec7m carbapenemase ho\u1eb7c k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m carbapenemase \u00e2m t\u00ednh. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n nhi\u1ec5m tr\u00f9ng do CRE \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u0103m s\u00f3c y t\u1ebf trong v\u00f2ng 12 th\u00e1ng qua t\u1ea1i m\u1ed9t qu\u1ed1c gia c\u00f3 t\u1ef7 l\u1ec7 l\u01b0u h\u00e0nh vi khu\u1ea9n s\u1ea3n sinh metallo-\u03b2-lactamase cao ho\u1eb7c b\u1ec7nh nh\u00e2n c\u00f3 m\u1eabu b\u1ec7nh ph\u1ea9m c\u1ea5y d\u01b0\u01a1ng t\u00ednh v\u1edbi vi sinh v\u1eadt s\u1ea3n sinh metallo-\u03b2-lactamase th\u00ec l\u1ef1a ch\u1ecdn \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u00e0 ph\u1ed1i h\u1ee3p ceftazidime-avibactam v\u1edbi aztreonam ho\u1eb7c cefiderocol \u0111\u01a1n tr\u1ecb trong khi ch\u1edd \u0111\u1ee3i k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3 v\u1edbi nh\u1eefng t\u00e1c nh\u00e2n beta-lactam kh\u00e1c v\u00e0 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m carbapenemase.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 5. Kh\u00e1ng sinh n\u00e0o \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n ngo\u00e0i \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u do CRE trong \u0111\u00f3 c\u00f3 KPC?<\/strong><\/p>\n\n\n\n

        Meropenem-vaborbactam, ceftazidime-avibactam v\u00e0 imipenem-cilastatin-relebactam l\u00e0 nh\u1eefng l\u1ef1a ch\u1ecdn \u0111\u01b0\u1ee3c \u01b0u ti\u00ean \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do KPC. Cefiderocol l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn thay th\u1ebf.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 6. Kh\u00e1ng sinh n\u00e0o \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng ngo\u00e0i \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u g\u00e2y ra b\u1edfi CRE c\u00f3 s\u1ea3n sinh NDM?<\/strong><\/p>\n\n\n\n

        Ceftazidime-avibactam ph\u1ed1i h\u1ee3p v\u1edbi aztreonam ho\u1eb7c cefiderocol \u0111\u01a1n tr\u1ecb l\u00e0 nh\u1eefng li\u1ec7u ph\u00e1p \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn cho nhi\u1ec5m khu\u1ea9n do vi sinh v\u1eadt c\u00f3 s\u1ea3n sinh NDM v\u00e0 metallo-\u03b2-lactamase.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 7. Kh\u00e1ng sinh n\u00e0o \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn cho \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng ngo\u00e0i \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u g\u00e2y ra b\u1edfi CRE c\u00f3 s\u1ea3n sinh OXA-48-like?<\/strong><\/p>\n\n\n\n

        Ceftazidime-avibactam l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u01b0\u1ee3c \u01b0u ti\u00ean \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do vi sinh v\u1eadt s\u1ea3n sinh OXA-48-like. Cefiderocol l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn thay th\u1ebf.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 8. T\u00ednh kh\u1ea3 d\u0129 c\u1ee7a vi\u1ec7c xu\u1ea5t hi\u1ec7n CRE \u0111\u1ec1 kh\u00e1ng v\u1edbi nh\u1eefng kh\u00e1ng sinh beta-lactam m\u1edbi khi \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRE l\u00e0 nh\u01b0 th\u1ebf n\u00e0o?<\/strong><\/p>\n\n\n\n

        \u0110\u1ec1 kh\u00e1ng l\u00e0 m\u1ed1i lo ng\u1ea1i \u0111\u1ed1i v\u1edbi m\u1ecdi t\u00e1c nh\u00e2n beta-lactam s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRE. D\u1eef li\u1ec7u hi\u1ec7n c\u00f3 cho th\u1ea5y kh\u1ea3 n\u0103ng \u0111\u1ec1 kh\u00e1ng l\u00e0 cao nh\u1ea5t v\u1edbi ceftazidime-avibactam.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 9. Vai tr\u00f2 c\u1ee7a c\u00e1c d\u1eabn xu\u1ea5t tetracycline trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRE?<\/strong><\/p>\n\n\n\n

        M\u1eb7c d\u00f9 beta-lactam v\u1eabn l\u00e0 nh\u1eefng l\u1ef1a ch\u1ecdn \u0111\u01b0\u1ee3c \u01b0u ti\u00ean \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb CRE, tigecycline v\u00e0 eravacycline l\u00e0 nh\u1eefng l\u1ef1a ch\u1ecdn thay th\u1ebf khi beta-lactam kh\u00f4ng nh\u1ea1y ho\u1eb7c b\u1ec7nh nh\u00e2n kh\u00f4ng dung n\u1ea1p. C\u00e1c d\u1eabn xu\u1ea5t c\u1ee7a tetracycline kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u do CRE ho\u1eb7c nhi\u1ec5m khu\u1ea9n huy\u1ebft.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 10. Vai tr\u00f2 c\u1ee7a kh\u00e1ng sinh nh\u00f3m polymyxin trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRE?<\/strong><\/p>\n\n\n\n

        Polymyxin B v\u00e0 colistin kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRE. Colistin c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc l\u00e0 t\u00e1c nh\u00e2n thay th\u1ebf \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u00e0ng quang kh\u00f4ng ph\u1ee9c t\u1ea1p do CRE.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 11. Vai tr\u00f2 c\u1ee7a ph\u1ed1i h\u1ee3p kh\u00e1ng sinh trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRE?<\/strong><\/p>\n\n\n\n

        Ph\u1ed1i h\u1ee3p kh\u00e1ng sinh (beta-lactam v\u1edbi kh\u00e1ng sinh nh\u00f3m aminoglucoside, fluoroquinolone, tetracycline ho\u1eb7c polymyxin) kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRE.<\/p>\n\n\n\n

        PSEUDOMONAS AERUGINOSA<\/em><\/strong> \u0110\u1ec0 KH\u00c1NG KH\u00d3 TR\u1eca (DTR-P. AERUGINOSA<\/em>)<\/strong><\/p>\n\n\n\n

        P. aeruginosa <\/em>\u0111a kh\u00e1ng thu\u1ed1c (MDR-P. aeruginosa<\/em>) \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 P. aeruginosa<\/em> kh\u00f4ng nh\u1ea1y c\u1ea3m v\u1edbi t\u1ed1i thi\u1ec3u 1 kh\u00e1ng sinh c\u1ee7a t\u1ed1i thi\u1ec3u 3 nh\u00f3m kh\u00e1ng sinh c\u00f3 ph\u1ed5 tr\u00ean P. aeruginosa<\/em> (nh\u00f3m penicillin, cephalosporin, fluoroquinolone, aminoglycoside v\u00e0 carbapenem). K\u1ec3 t\u1eeb n\u0103m 2018, thu\u1eadt ng\u1eef kh\u00f3 tr\u1ecb \u201cdifficult-to-treat\u201d \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb. Trong h\u01b0\u1edbng d\u1eabn n\u00e0y, DTR P. aeruginosa<\/em> \u0111\u01b0\u1ee3c xem l\u00e0 P. aeruginosa<\/em> kh\u00f4ng nh\u1ea1y v\u1edbi t\u1ea5t c\u1ea3 c\u00e1c kh\u00e1ng sinh sau: piperacillin-tazobactam, ceftazidime, cefepime, aztreonam, meropenem, imipenem-cilastatin, ciprofloxacin v\u00e0 levofloxacin.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 1. Kh\u00e1ng sinhnaof \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do MDR P. aeruginosa<\/em>?<\/em><\/strong><\/p>\n\n\n\n

        Khi P. aeruginosa <\/em>nh\u1ea1y v\u1edbi c\u1ea3 nh\u1eefng kh\u00e1ng sinh beta-lactam kh\u00f4ng ph\u1ea3i carbapenem truy\u1ec1n th\u1ed1ng (ch\u1eb3ng \u1ea1n nh\u01b0 piperacillin-tazobactam, ceftazidime, cefepime, aztreonam) v\u00e0 kh\u00e1ng sinh nh\u00f3m carbapenem th\u00ec n\u00ean \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn beta-lactam truy\u1ec1n th\u1ed1ng h\u01a1n l\u00e0 carbapenem. \u0110\u1ed1i v\u1edbi nhi\u1ec5m kh\u1ea9n do P. aeruginosa<\/em> kh\u00f4ng nh\u1ea1y v\u1edbi b\u1ea5t k\u1ef3 kh\u00e1ng sinh nh\u00f3m carbapenem n\u00e0o nh\u01b0ng nh\u1ea1y v\u1edbi t\u00e1c nh\u00e2n beta-lactam truy\u1ec1n th\u1ed1ng, th\u00ec n\u00ean l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb v\u1edbi t\u00e1c nh\u00e2n truy\u1ec1n th\u1ed1ng li\u1ec1u cao truy\u1ec1n t\u0129nh m\u1ea1ch k\u00e9o d\u00e0i v\u00e0 l\u1eb7p l\u1ea1i kh\u00e1ng sinh \u0111\u1ed3. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n b\u1ec7nh n\u1eb7ng ho\u1eb7c ki\u1ec3m so\u00e1t ngu\u1ed3n nhi\u1ec5m k\u00e9m v\u00e0 ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c P. aeruginosa <\/em>kh\u00e1ng carbapenem nh\u01b0ng nh\u1ea1y v\u1edbi beta-lactam truy\u1ec1n th\u1ed1ng th\u00ec c\u00e1c kh\u00e1ng sinh beta-lactam m\u1edbi nh\u1ea1y c\u1ea3m (ch\u1eb3ng h\u1ea1n nh\u01b0 ceftolozane-tazobactam, ceftazidime-avibactam, imipenem-cilastatin-relebactam) l\u00e0 l\u1ef1a ch\u1ecdn ph\u00f9 h\u1ee3p.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 2. Kh\u00e1ng sinh n\u00e0o \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn trong \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u00e0ng quang kh\u00f4ng ph\u1ee9c t\u1ea1p do DTR-P. aeruginosa?<\/em><\/strong><\/p>\n\n\n\n

        Ceftolozane-tazobactam, ceftazidime-avibactam, imipenem-cilastatin-relebactam v\u00e0 cefiderocol l\u00e0 nh\u1eefng l\u1ef1a ch\u1ecdn \u0111\u01b0\u1ee3c \u01b0u ti\u00ean \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u00e0ng quang kh\u00f4ng ph\u1ee9c t\u1ea1p g\u00e2y ra b\u1edfi DTR-P. aeruginosa. <\/em>Tobramycin ho\u1eb7c amikacin li\u1ec1u \u0111\u01a1n l\u00e0 nh\u1eefng l\u1ef1a ch\u1ecdn thay th\u1ebf \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u00e0ng quang kh\u00f4ng ph\u1ee9c t\u1ea1p do DTR-P. aeruginosa.<\/em><\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 3. Kh\u00e1ng sinh n\u00e0o \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u1ec3 th\u1eadn v\u00e0 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u ph\u1ee9c t\u1ea1p do DTR-P. aeruginosa<\/em>?<\/em><\/strong><\/p>\n\n\n\n

        Ceftolozane-tazobactam, ceftazidime-avibactam, imipenem-cilastatin-relebactam v\u00e0 cefiderocol l\u00e0 nh\u1eefng l\u1ef1a ch\u1ecdn \u0111\u01b0\u1ee3c \u01b0u ti\u00ean \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam b\u1ec3 th\u1eadn v\u00e0 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ebft ni\u00eau ph\u1ee9c t\u1ea1p do DTR-P. aeruginosa.<\/em><\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 4. Kh\u00e1ng sinh n\u00e0o \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn trogn \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng ngo\u00e0i \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u do DTR-P. aeruginosa?<\/em><\/strong><\/p>\n\n\n\n

        Ceftolozane-tazobactam, ceftazidime-avibactam v\u00e0 imipenem-cilastatin-relebactam l\u00e0 nh\u1eefng l\u1ef1a ch\u1ecdn \u0111\u01b0\u1ee3c \u01b0u ti\u00ean \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng ngo\u00e0i \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u g\u00e2y ra b\u1edfi DTR – P. aeruginosa<\/em>. Cefiderocol c\u0169ng l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn thay th\u1ebf \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n ngo\u00e0i \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u do DTR – P. aeruginosa.<\/em><\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 5. Kh\u00e1ng sinh n\u00e0o \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb DTR \u2013 P. aeruginosa<\/em> s\u1ea3n sinh metallo-beta-lactamase?<\/strong><\/p>\n\n\n\n

        \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n nhi\u1ec5m khu\u1ea9n do DTR – P. aeruginosa <\/em>c\u00f3 s\u1ea3n sinh metallo-beta-lactamase, kh\u00e1ng sinh \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn l\u00e0 cefiderocol.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 6. M\u1ee9c \u0111\u1ed9 kh\u1ea3 d\u0129 c\u1ee7a t\u00ecnh tr\u1ea1ng DTR \u2013 P. aeruginosa<\/em> \u0111\u1ec1 kh\u00e1ng v\u1edbi kh\u00e1ng sinh beta-lactam m\u1edbi khi d\u00f9ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb DTR \u2013 P. aeruginosa<\/em> l\u00e0 nh\u01b0 th\u1ebf n\u00e0o?<\/strong><\/p>\n\n\n\n

        \u0110\u1ec1 kh\u00e1ng l\u00e0 v\u1ea5n \u0111\u1ec1 chung \u0111\u1ed1i v\u1edbi m\u1ecdi kh\u00e1ng sinh beta-lactam s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do DTR – P. aeruginosa<\/em>. D\u1eef li\u1ec7u hi\u1ec7n c\u00f3 cho th\u1ea5y ceftolozane-tazobactam v\u00e0 ceftazidime-avibactam l\u00e0 kh\u00e1ng sinh c\u00f3 kh\u1ea3 n\u0103ng \u0111\u1ec1 kh\u00e1ng cao nh\u1ea5t.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 7. Vai tr\u00f2 c\u1ee7a k\u1ebft h\u1ee3p kh\u00e1ng sinh trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do DTR – P. aeruginosa<\/em>?<\/em><\/strong><\/p>\n\n\n\n

        Ph\u1ed1i h\u1ee3p kh\u00e1ng sinh kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do DTR – P. aeruginosa<\/em> n\u1ebfu ceftolozane-tazobactam, ceftazidime-avibactam, imipenem-cilastatin-relebactam ho\u1eb7c cefiderocol \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh c\u00f2n nh\u1ea1y.<\/p>\n\n\n\n

        C\u00e2u h\u1ecfi 8. Vai tr\u00f2 c\u1ee7a kh\u00e1ng sinh trong m\u1eb7t n\u1ea1 th\u00f4ng kh\u00ed \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p do DTR – P. aeruginosa?<\/em><\/strong><\/p>\n\n\n\n

        IDSA kh\u00f4ng khuy\u1ebfn ngh\u1ecb s\u1eed d\u1ee5ng kh\u00e1ng sinh \u0111\u01b0\u1eddng m\u1eb7t n\u1ea1 th\u00f4ng kh\u00ed \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p do DTR – P. aeruginosa.<\/em><\/p>\n\n\n\n

        ACINETOBACTER BAUMANNII <\/em><\/strong>\u0110\u1ec0 KH\u00c1NG CARBAPNEME (CRAB)<\/strong><\/p>\n\n\n\n

        Ki\u1ec3m so\u00e1t nhi\u1ec5m khu\u1ea9n do CRAB g\u1eb7p kh\u00f3 kh\u0103n do nhi\u1ec1u l\u00fd do:<\/p>\n\n\n\n

          \n
        • CRAB th\u01b0\u1eddng \u0111\u01b0\u1ee3c ph\u00e2n l\u1eadp t\u1eeb m\u1eabu b\u1ec7nh ph\u1ea9m h\u00f4 h\u1ea5p ho\u1eb7c c\u00e1c v\u1ebft th\u01b0\u01a1ng. Do v\u1eady, th\u01b0\u1eddng kh\u00f4ng r\u00f5 r\u00e0ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh li\u1ec7u r\u1eb1ng t\u00ecnh tr\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c quy b\u1edfi vi sinh v\u1eadt ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c hay kh\u00f4ng ho\u1eb7c li\u1ec7u CRAB c\u00f3 l\u00e0 t\u00e1c nh\u00e2n d\u1eabn \u0111\u1ebfn vi\u1ec7c t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong, d\u1eabn \u0111\u1ebfn vi\u1ec7c kh\u00f4ng ch\u1eafc ch\u1eafn v\u1ec1 nhu c\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh. C\u0169ng v\u00ec l\u00fd do n\u00e0y, vi\u1ec7c x\u00e1c \u0111\u1ecbnh li\u1ec7u k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng x\u1ea5u c\u1ee7a b\u1ec7nh nh\u00e2n c\u00f3 ph\u1ea3i l\u00e0 do ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh kh\u00f4ng t\u1ed1i \u01b0u hay do nh\u1eefng y\u1ebfu t\u1ed1 n\u1ec1n c\u1ee7a b\u1ec7nh nh\u00e2n c\u0169ng l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c.<\/li>\n\n\n\n
        • Khi A. baumannii<\/em> <\/em>c\u00f3 bi\u1ec3u hi\u1ec7n \u0111\u1ec1 kh\u00e1ng carbapenem, th\u01b0\u1eddng s\u1ebd \u0111\u1ec1 kh\u00e1ng th\u00eam nh\u1eefng kh\u00e1ng sinh kh\u00e1c c\u00f3 ph\u1ed5 tr\u00ean A. baumannii.<\/em><\/li>\n\n\n\n
        • Ch\u01b0a c\u00f3 ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh ti\u00eau chu\u1ea9n \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRAB. Nh\u1eefng nghi\u00ean c\u1ee9u so s\u00e1nh hi\u1ec7u qu\u1ea3 gi\u1eefa c\u00e1c kh\u00e1ng sinh th\u01b0\u1eddng s\u1eed d\u1ee5ng c\u0169ng c\u00f2n h\u1ea1n ch\u1ebf. D\u1eef li\u1ec7u \u01b0u ti\u1ec7n l\u1ef1a ch\u1ecdn kh\u00e1ng sinh \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRAB c\u0169ng c\u00f2n h\u1ea1n ch\u1ebf.<\/li>\n<\/ul>\n\n\n\n

          H\u01b0\u1edbng d\u1eabn n\u00e0y t\u1eadp trung v\u00e0o vi\u1ec7c ki\u1ec3m so\u00e1t CRAB m\u1ee9c \u0111\u1ed9 trung b\u00ecnh \u2013 nghi\u00eam tr\u1ecdng.<\/p>\n\n\n\n

          C\u00e2u h\u1ecfi 1. C\u00e1ch ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRAB?<\/strong><\/p>\n\n\n\n

          S\u1eed d\u1ee5ng ampicillin-sulbactam li\u1ec1u cao (li\u1ec1u sulbactam t\u1ed5ng c\u1ed9ng 6-9 g\/ng\u00e0y) ph\u1ed1i h\u1ee3p v\u1edbi t\u1ed1i thi\u1ec3u 1 kh\u00e1ng sinh kh\u00e1c \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRAB.<\/p>\n\n\n\n

          C\u00e2u h\u1ecfi 2. Vai tr\u00f2 c\u1ee7a vi\u1ec7c ph\u1ed1i h\u1ee3p kh\u00e1ng sinh trong iddeuef tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRAB?<\/strong><\/p>\n\n\n\n

          \u0110i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p b\u1eb1ng t\u1ed1i thi\u1ec3u 2 kh\u00e1ng sinh c\u00f3 ho\u1ea1t t\u00ednh \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb CRAB, t\u1ed1i thi\u1ec3u cho \u0111\u1ebfn khi c\u00f3 c\u1ea3i thi\u1ec7n v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng, v\u00ec ch\u01b0a c\u00f3 nhi\u1ec1u d\u1eef li\u1ec7u l\u00e2m s\u00e0ng \u1ee7ng h\u1ed9 kh\u00e1ng sinh \u0111\u01a1n tr\u1ecb.<\/p>\n\n\n\n

          C\u00e2u h\u1ecfi 3. Vai tr\u00f2 c\u1ee7a ampicillin-sulbactam trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRAB?<\/strong><\/p>\n\n\n\n

          Ampicillin-sulbactam li\u1ec1u cao \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb l\u00e0 m\u1ed9t t\u00e1c nh\u00e2n trong ph\u1ed1i h\u1ee3p kh\u00e1ng sinh \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRAB, b\u1ea5t k\u1ec3 \u0111\u00e3 c\u00f3 k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3 hay ch\u01b0a.<\/p>\n\n\n\n

          C\u00e2u h\u1ecfi 4. Vai tr\u00f2 c\u1ee7a kh\u00e1ng sinh nh\u00f3m polymyxin trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRAB?<\/strong><\/p>\n\n\n\n

          Polymyxin B c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc l\u00e0m m\u1ed9t t\u00e1c nh\u00e2n trong ph\u1ed1i h\u1ee3p kh\u00e1ng sinh \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRAB.<\/p>\n\n\n\n

          C\u00e2u h\u1ecfi 5. Vai tr\u00f2 c\u1ee7a c\u00e1c d\u1eabn xu\u1ea5t tetracycline trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRAB?<\/strong><\/p>\n\n\n\n

          Minocycline li\u1ec1u cao ho\u1eb7c tigecycline li\u1ec1u cao c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc trong ph\u1ed1i h\u1ee3p kh\u00e1ng sinh \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRAB. IDSA khuy\u1ebfn ngh\u1ecb minocycline v\u00ec c\u00f3 nhi\u1ec1u d\u1eef li\u1ec7u l\u00e2m s\u00e0ng. Tuy nhi\u00ean, tigecycline c\u0169ng l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn ph\u00f9 h\u1ee3p.<\/p>\n\n\n\n

          C\u00e2u h\u1ecfi 6. Vai tr\u00f2 c\u1ee7a cefiderocol trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRAB?<\/strong><\/p>\n\n\n\n

          N\u00ean h\u1ea1n ch\u1ebf l\u1ef1a ch\u1ecdn cefiderocol trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n kh\u00f3 tr\u1ecb do CRAB ho\u1eb7c ch\u1ec9 n\u00ean l\u1ef1a ch\u1ecdn n\u1ebfu nh\u1eefng t\u00e1c nh\u00e2n kh\u00e1c k\u00e9m dung n\u1ea1p ho\u1eb7c kh\u00f4ng c\u00f2n nh\u1ea1y c\u1ea3m. Khi cefiderocol \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRAB, IDSA khuy\u1ebfn ngh\u1ecb l\u1ef1a ch\u1ecdn cefiderocol nh\u01b0 m\u1ed9t th\u00e0nh ph\u1ea7n trong ph\u1ed1i h\u1ee3p kh\u00e1ng sinh.<\/p>\n\n\n\n

          C\u00e2u h\u1ecfi 7. Vai tr\u00f2 c\u1ee7a meropenem t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i ho\u1eb7c imipenem-cilastatin trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRAB?<\/strong><\/p>\n\n\n\n

          Meropenem li\u1ec1u cao, truy\u1ec1n t\u00e1c \u0111\u1ed9ng k\u00e9o d\u00e0i ho\u1eb7c imipenem-cilastatin kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb l\u1ef1a ch\u1ecdn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRAB.<\/p>\n\n\n\n

          C\u00e2u h\u1ecfi 8. Vai tr\u00f2 c\u1ee7a kh\u00e1ng sinh nh\u00f3m rifamycin trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRAB?<\/strong><\/p>\n\n\n\n

          Rifabutin ho\u1eb7c nh\u1eefng rifamycin kh\u00e1c kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do CRAB.<\/p>\n\n\n\n

          C\u00e2u h\u1ecfi 9. Vai tr\u00f2 c\u1ee7a kh\u00e1ng sinh \u0111\u01b0\u1eddng m\u1eb7t h\u1ea1 x\u00f4ng h\u00edt trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p do CRAB?<\/strong><\/p>\n\n\n\n

          Kh\u00e1ng sinh \u0111\u01b0\u1eddng m\u1eb7t n\u1ea1 x\u00f4ng h\u00edt kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p do CRAB.<\/p>\n\n\n\n

          STENOTROPHOMONAS MALTOPHILIA<\/em><\/strong><\/p>\n\n\n\n

          Stenotrophomonas maltophilia<\/em> l\u00e0 vi khu\u1ea9n hi\u1ebfu khi, gram \u00e2m, c\u00f3 m\u1eb7t \u1edf m\u00f4i tr\u01b0\u1eddng n\u01b0\u1edbc. M\u1eb7c d\u00f9 Stenotrophomonas maltophilia <\/em>\u0111\u01b0\u1ee3c cho r\u1eb1ng \u00edt c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y b\u1ec7nh nh\u00e2n nh\u1eefng vi sinh v\u1eadt th\u01b0\u1eddng g\u00e2y nhi\u1ec5m khu\u1ea9n b\u1ec7nh vi\u1ec7n kh\u00e1c, nh\u01b0ng Stenotrophomonas maltophilia<\/em> <\/em>l\u1ea1i c\u00f3 kh\u1ea3 n\u0103ng s\u1ea3n sinh biofilm v\u00e0 nh\u1eefng y\u1ebfu t\u1ed1 g\u00e2y \u0111\u1ed9c c\u00f3 th\u1ec3 g\u00e2y h\u1ea1i \u1edf nh\u1eefng v\u1eadt ch\u1ee7 d\u1ec5 b\u1ecb \u1ea3nh h\u01b0\u1edfng, ch\u1eb3ng h\u1ea1n nh\u1eefng ng\u01b0\u1eddi c\u00f3 b\u1ec7nh n\u1ec1n h\u00f4 h\u1ea5p ho\u1eb7c huy\u1ebft h\u1ecdc.<\/p>\n\n\n\n

          Nh\u1eefng th\u00e1ch th\u1ee9c g\u1eb7p ph\u1ea3i do nhi\u1ec5m Stenotrophomonas maltophilia <\/em>c\u0169ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 CRAB.<\/p>\n\n\n\n

          C\u00e2u h\u1ecfi 1. C\u00e1ch ti\u1ebfp c\u1eadn chung trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do Stenotrophomonas maltophilia?<\/em><\/strong><\/p>\n\n\n\n

          C\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn 1 trong 2 c\u00e1ch ti\u1ebfp c\u1eadn \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb sau \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do Stenotrophomonas maltophilia:<\/em><\/p>\n\n\n\n