{"id":13145,"date":"2023-12-22T15:05:51","date_gmt":"2023-12-22T07:05:51","guid":{"rendered":"https:\/\/docquity.com\/?post_type=articles&p=13145"},"modified":"2025-02-11T13:38:40","modified_gmt":"2025-02-11T05:38:40","slug":"idsa-2023-kiem-soat-nhiem-khuan-do-gram-am-da-khang-thuoc","status":"publish","type":"articles","link":"https:\/\/docquity.com\/vi\/articles\/idsa-2023-kiem-soat-nhiem-khuan-do-gram-am-da-khang-thuoc\/","title":{"rendered":"IDSA 2023: Ki\u1ec3m so\u00e1t nhi\u1ec5m khu\u1ea9n do gram \u00e2m \u0111a kh\u00e1ng thu\u1ed1c"},"content":{"rendered":"\n

Trong th\u1eadp k\u1ef7 v\u1eeba qua, t\u1ef7 l\u1ec7 nhi\u1ec5m khu\u1ea9n do vi khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng thu\u1ed1c \u0111\u00e3 t\u0103ng l\u00ean nhanh ch\u00f3ng v\u1edbi t\u1ef7 l\u1ec7 t\u1ef7 vong cao. \u0110i\u1ec1u tr\u1ecb c\u00e1c t\u00ecnh tr\u1ea1ng nhi\u1ec5m khu\u1ea9n n\u00e0y g\u1eb7p nhi\u1ec1u th\u00e1ch th\u1ee9c, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong vi\u1ec7c l\u1ef1a ch\u1ecdn ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh kinh nghi\u1ec7m ph\u00f9 h\u1ee3p cho b\u1ec7nh nh\u00e2n \u1ed1m n\u1eb7ng. M\u1eb7c d\u00f9 nhi\u1ec1u thu\u1ed1c m\u1edbi an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 \u0111\u00e3 c\u00f3 m\u1eb7t tr\u00ean th\u1ecb tr\u01b0\u1eddng nh\u1edd s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a l\u0129nh v\u1ef1c nghi\u00ean c\u1ee9u v\u00e0 ph\u00e1t tri\u1ec3n, tuy nhi\u00ean, v\u1eabn c\u00f3 nhi\u1ec1u r\u00e0o c\u1ea3n \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n nhi\u1ec5m khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng m\u1ed9t c\u00e1ch t\u1ed1i \u01b0u.<\/p>\n\n\n\n

\u0110\u1ed9i ng\u0169 Docquity h\u00e2n h\u1ea1nh m\u1eddi qu\u00fd v\u1ecb \u0111\u1ed3ng nghi\u1ec7p tham kh\u1ea3o b\u1ea3n l\u01b0\u1ee3c d\u1ecbch h\u01b0\u1edbng d\u1eabn ki\u1ec3m so\u00e1t nhi\u1ec5m khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng c\u1ee7a Hi\u1ec7p h\u1ed9i B\u1ec7nh nhi\u1ec5m Hoa K\u1ef3 (International Data Spaces Association \u2013 IDSA). C\u00e1c bi\u1ec7n ph\u00e1p ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c \u0111\u01b0a ra d\u1ef1a tr\u00ean m\u1ed9t v\u00ed d\u1ee5 ca l\u00e2m s\u00e0ng. B\u1ea3n l\u01b0\u1ee3c d\u1ecbch bao g\u1ed3m chi\u1ebfn l\u01b0\u1ee3c nh\u1eadn \u0111\u1ecbnh b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 nhi\u1ec5m khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng, ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh.<\/p>\n\n\n\n

T\u1ed5ng quan<\/strong><\/p>\n\n\n\n

Vi khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng thu\u1ed1c \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 vi khu\u1ea9n kh\u00f4ng nh\u1ea1y v\u1edbi \u2265 1 t\u00e1c nh\u1eadn trong s\u1ed1 \u2265 3 nh\u00f3m kh\u00e1ng sinh, g\u00e2y ra th\u00e1ch th\u1ee9c trong \u0111i\u1ec1u tr\u1ecb. Chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh hi\u1ec7u qu\u1ea3 v\u00e0 ph\u00f9 h\u1ee3p l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 l\u00e0m gi\u1ea3m g\u00e1nh n\u1eb7ng b\u1ec7nh t\u1eadt v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n nhi\u1ec5m khu\u1ea9n do vi khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng thu\u1ed1c.<\/p>\n\n\n\n

M\u1eb7c d\u00f9 \u0111\u00e3 c\u00f3 nhi\u1ec1u kh\u00e1ng sinh m\u1edbi tr\u00ean th\u1ecb tr\u01b0\u1eddng, tuy nhi\u00ean, theo th\u1eddi gian t\u1ef7 l\u1ec7 vi khu\u1ea9n \u0111\u1ec1 kh\u00e1ng c\u0169ng t\u0103ng l\u00ean. Ph\u00e2n t\u1ea7ng nguy c\u01a1 nhi\u1ec5m khu\u1ea9n vi khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng tr\u01b0\u1edbc khi kh\u1edfi \u0111\u1ea7u ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh kinh nghi\u1ec7m gi\u00fap t\u0103ng kh\u1ea3 n\u0103ng \u0111i\u1ec1u tr\u1ecb \u0111\u00fang, h\u1ea1n ch\u1ebf vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh c\u00f3 ph\u1ed5 r\u1ed9ng, t\u1eeb \u0111\u00f3 l\u00e0m gi\u1ea3m nguy c\u01a1 h\u00ecnh th\u00e0nh vi khu\u1ea9n \u0111\u1ec1 kh\u00e1ng kh\u00e1ng sinh.<\/p>\n\n\n\n

Ki\u1ec3m so\u00e1t nhi\u1ec5m khu\u1ea9n do vi khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng thu\u1ed1c \u0111\u00f2i h\u1ecfi ki\u1ebfn th\u1ee9c d\u1ecbch t\u1ec5 \u0111\u1ec1 kh\u00e1ng kh\u00e1ng sinh \u1edf \u0111\u1ecba ph\u01b0\u01a1ng n\u00f3i ri\u00eang v\u00e0 c\u1ea3 qu\u1ed1c gia n\u00f3i chung, c\u00e1c l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb, ph\u00e2n t\u00edch k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m nhanh, c\u00e1ch xu\u1ed1ng thang kh\u00e1ng sinh khi \u0111\u00e3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh. C\u00e1ch ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb h\u1ee3p t\u00e1c li\u00ean ng\u00e0nh c\u1ea3i thi\u1ec7n hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n\n\n\n

\"\"H\u00ecnh 1.<\/strong> Ki\u1ec3m so\u00e1t nhi\u1ec5m khu\u1ea9n do vi khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng<\/p>\n\n\n\n

Ca l\u00e2m s\u00e0ng<\/strong><\/p>\n\n\n\n

B\u1ec7nh nh\u00e2n n\u1eef, 82 tu\u1ed5i nh\u1eadp khoa c\u1ea5p c\u1ee9u do b\u1ecb h\u1ea1 huy\u1ebft \u00e1p v\u00e0 s\u1ed1t. B\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng ho, \u0111au do vi\u00eam m\u00e0ng ph\u1ed5i c\u00e1ch \u0111\u00e2y 1 tu\u1ea7n, b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng piperacillin \u2013 tazobactam trong v\u00f2ng 5 ng\u00e0y, tuy nhi\u00ean tri\u1ec7u ch\u1ee9ng kh\u00f4ng c\u1ea3i thi\u1ec7n. B\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed t\u0103ng huy\u1ebft \u00e1p, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 b\u1ec7nh th\u1eadn m\u1ea1n. C\u00e1ch \u0111\u00e2y kho\u1ea3ng 2 th\u00e1ng, b\u1ec7nh nh\u00e2n ph\u1ea3i nh\u1eadp vi\u1ec7n \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch n\u00e3o b\u1eb1ng bi\u1ec7n ph\u00e1p n\u00fat m\u1ea1ch. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u1ea1i \u0111\u01a1n v\u1ecb ch\u0103m s\u00f3c t\u00edch c\u1ef1c trong v\u00f2ng 10 ng\u00e0y. Th\u1eddi gian n\u1eb1m vi\u1ec7n t\u1ed5ng c\u1ed9ng 18 ng\u00e0y, trong th\u1eddi gian n\u00e0y, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng piperacillin-tazobactam do nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u do Escherichia coli<\/em> \u0111\u1ec1 kh\u00e1ng ceftriaxone trong v\u00f2ng 7 ng\u00e0y. Sau \u0111\u00f3 1 th\u00e1ng, b\u1ec7nh nh\u00e2n l\u1ea1i ph\u1ea3i nh\u1eadp vi\u1ec7n do nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1eddngt ti\u1ebft ni\u1ec7u v\u00e0 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi levofloxacin trong v\u00f2ng 7 ng\u00e0y.<\/p>\n\n\n\n

T\u1ea1i khoa c\u1ea5p c\u1ee9u, b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n kh\u00f3 th\u1edf, huy\u1ebft \u00e1p 80\/42 mmHg, m\u1ea1ch 120 nh\u1ecbp\/ph\u00fat, th\u00e2n nhi\u1ec7t 38.4o<\/sup>C, nh\u1ecbp th\u1edf 28 nh\u1ecbp\/ph\u00fat v\u00e0 \u0111\u1ed9 b\u00e3o h\u00f2a oxy l\u00e0 86%. Nghe ph\u1ed5i th\u1ea5y c\u00f3 ti\u1ebfng ran n\u1ed5 \u1edf \u0111\u00e1y ph\u1ed5i tr\u00e1i. K\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m: b\u1ea1ch c\u1ea7u 18×103<\/sup> t\u1ebf b\u00e0o\/\u00b5L, b\u1ea1ch c\u1ea7u trung t\u00ednh 96.9%, lactate 4 mmol\/L, creatinine 3 mg\/dL. K\u1ebft qu\u1ea3 x-quang ng\u1ef1c cho th\u1ea5y t\u00ecnh tr\u1ea1ng th\u00e2m nhi\u1ec5m \u1edf ph\u1ed5i tr\u00e1i. C\u00e1c bi\u1ec3u hi\u1ec7n h\u00f4 h\u1ea5p c\u1ee7a b\u1ec7nh nh\u00e2n ng\u00e0y c\u00e0ng tr\u1edf n\u1eb7ng t\u1ea1i khoa c\u1ea5p c\u1ee9u. Do v\u1eady, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n v\u00e0 \u0111i\u1ec1u tr\u1ecb v\u1edbi norepinephrine. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c c\u1ea5y m\u00e1u v\u00e0 m\u1eabu b\u1ec7nh ph\u1ea9m h\u00f4 h\u1ea5p.<\/p>\n\n\n\n

Ti\u1ebfp c\u1eadn x\u00e1c \u0111\u1ecbnh chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh kinh nghi\u1ec7m v\u00e0 ch\u1ea9n \u0111o\u00e1n<\/strong><\/p>\n\n\n\n

Khi x\u00e1c \u0111\u1ecbnh ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh kinh nghi\u1ec7m, vi\u1ec7c x\u00e1c \u0111\u1ecbnh \u1ed5 nhi\u1ec5m kh\u1ea3 d\u0129 l\u00e0 v\u00f4 c\u00f9ng quan tr\u1ecdng.<\/p>\n\n\n\n

Chi\u1ebfn l\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n<\/em><\/strong><\/p>\n\n\n\n

Chi\u1ebfn l\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m khu\u1ea9n do vi khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1c chi\u1ebfn l\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m khu\u1ea9n kh\u00e1c, nh\u01b0ng c\u1ea7n n\u1eafm b\u1eaft b\u1ec7nh s\u1ee7 li\u00ean quan c\u1ee7a b\u1ec7nh nh\u00e2n, bao g\u1ed3m ti\u1ec1n s\u1eed nhi\u1ec5m khu\u1ea9n, \u0111i\u1ec1u tr\u1ecb, l\u1ecbch s\u1eed du l\u1ecbch, k\u1ebft qu\u1ea3 c\u1ea5y v\u00e0 kh\u00e1ng sinh l\u1ef1a ch\u1ecdn.<\/p>\n\n\n\n

Y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a nhi\u1ec5m khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng<\/em><\/strong><\/p>\n\n\n\n

T\u1ed1i \u01b0u h\u00f3a ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh kinh nghi\u1ec7m bao g\u1ed3m \u0111\u00e1nh gi\u00e1 nguy c\u01a1 cho t\u1eebng t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh. Vi\u1ec7c l\u1ef1a ch\u1ecdn kh\u00e1ng sinh kinh nghi\u1ec7m ph\u00f9 h\u1ee3p n\u00ean c\u00e2n nh\u1eafc \u0111\u1ebfn d\u1ecbch t\u1ec5 \u0111\u1ec1 kh\u00e1ng t\u1ea1i \u0111\u1ecba ph\u01b0\u01a1ng, v\u1ecb tr\u00ed nhi\u1ec5m khu\u1ea9n, m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng v\u00e0 h\u1eadu qu\u1ea3 c\u00f3 th\u1ec3 c\u00f3 n\u1ebfu ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh kinh nghi\u1ec7m kh\u00f4ng hi\u1ec7u qu\u1ea3, bao g\u1ed3m c\u1ea3 t\u1eed vong. V\u1ecb tr\u00ed c\u1ee7a b\u1ec7nh nh\u00e2n khi c\u00e1c tri\u1ec7u ch\u1ee9ng nhi\u1ec5m khu\u1ea9n kh\u1edfi ph\u00e1t l\u00e0 th\u00f4ng tin quan tr\u1ecdng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ednh kh\u1ea3 d\u0129 c\u1ee7a t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh gram \u00e2m \u0111a kh\u00e1ng thu\u1ed1c. Kh\u00e1ng sinh \u0111\u1ed3 t\u1ea1i \u0111\u1ecba ph\u01b0\u01a1ng n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng n\u1ebfu c\u00f3 \u0111\u1ec3 h\u01b0\u1edbng d\u1eabn ph\u00e1c \u0111\u1ed3 kinh nghi\u1ec7m. Tuy nhi\u00ean, c\u1ea7n l\u01b0u \u00fd r\u1eb1ng nh\u1eefng kh\u00e1ng sinh \u0111\u1ed3 n\u00e0y c\u00f3 th\u1ec3 \u0111\u00e3 l\u1ed7i th\u1eddi, kh\u00f4ng bao g\u1ed3m th\u00f4ng tin c\u1ee7a c\u00e1c kh\u00e1ng sinh m\u1edbi.<\/p>\n\n\n\n

Y\u1ebfu t\u1ed1 nguy c\u01a1 th\u01b0\u1eddng \u0111\u01b0\u1ee3c ghi nh\u1eadn cho nhi\u1ec5m vi khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng l\u00e0 ph\u01a1i nhi\u1ec5m v\u1edbi kh\u00e1ng sinh trong v\u00f2ng 30 ng\u00e0y v\u00e0 nhi\u1ec5m khu\u1ea9n c\u00f3 li\u00ean quan \u0111\u1ebfn vi khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng thu\u1ed1c trong v\u00f2ng 6 th\u00e1ng v\u1eeba qua. Nhi\u1ec1u chuy\u00ean gia cho r\u1eb1ng n\u00ean l\u1ef1a ch\u1ecdn kh\u00e1ng sinh kinh nghi\u1ec7m c\u00f3 ph\u1ed5 tr\u00ean vi khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng thu\u1ed1c n\u1ebfu d\u1eef li\u1ec7u c\u1ee7a b\u1ec7nh vi\u1ec7n cho th\u1ea5y t\u1ef7 l\u1ec7 vi khu\u1ea9n \u0111\u1ec1 kh\u00e1ng v\u1edbi kh\u00e1ng sinh kinh nghi\u1ec7m l\u00ean t\u1edbi 20%. M\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c bao g\u1ed3m tu\u1ed5i, b\u1ec7nh m\u1eafc k\u00e8m (ch\u1eb3ng h\u1ea1n nh\u01b0 suy gi\u1ea3m mi\u1ec5n d\u1ecbch, t\u00ecnh tr\u1ea1ng n\u1eb1m li\u1ec7t gi\u01b0\u1eddng), l\u1ea7n nh\u1eadp vi\u1ec7n g\u1ea7n \u0111\u00e2y ho\u1eb7c k\u00e9o d\u00e0i, g\u1eafn thi\u1ebft b\u1ecb b\u00ean trong c\u01a1 th\u1ec3 v\u00e0 gh\u00e9 v\u00f9ng\/l\u00e3nh th\u1ed5 c\u00f3 t\u1ef7 l\u1ec7 l\u01b0u h\u00e0nh vi khu\u1ea9n gram \u00e2m \u0111a \u0111\u1ec1 kh\u00e1ng cao. Nhi\u1ec1u \u0111\u1ecba \u0111i\u1ec3m du l\u1ecbch tr\u00ean th\u1ebf gi\u1edbi \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 y\u1ebfu t\u1ed1 g\u00f3p ph\u1ea7n l\u00e0m lan r\u1ed9ng t\u00ecnh tr\u1ea1ng \u0111\u1ec1 kh\u00e1ng kh\u00e1ng sinh, ch\u1eb3ng h\u1ea1n nh\u01b0 t\u1ef7 l\u1ec7 E. coli<\/em> s\u1ea3n sinh metallo-\u03b2-lactamase New Delhi l\u1ea7n l\u01b0\u1ee3t l\u00e0 82.6%, 12.9%, 1.5%. 1.0% v\u00e0 2.0% Ch\u00e2u \u00c1, Ch\u00e2u \u00c2u, B\u1eafc M\u1ef9, Ch\u00e2u Phi v\u00e0 Ch\u00e2u \u0110\u1ea1i D\u01b0\u01a1ng.<\/p>\n\n\n\n

C\u00e1ch ti\u1ebfp c\u1eadn ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kinh nghi\u1ec7m s\u1edbm<\/em><\/strong><\/p>\n\n\n\n

Khi c\u00e2n nh\u1eafc ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh kinh nghi\u1ec7m, c\u1ea7n ti\u1ebfp c\u1eadn \u0111a ph\u01b0\u01a1ng di\u1ec7n, c\u00e2n nh\u1eafc th\u00f4ng tin d\u1ecbch t\u1ec5 \u0111\u1ecba ph\u01b0\u01a1ng, y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a b\u1ec7nh (h\u00ecnh 2).<\/p>\n\n\n\n

T\u1ea1i Hoa K\u1ef3, t\u1ef7 l\u1ec7 nhi\u1ec5m Pseudomonas aeruginosa <\/em>\u0111\u1ec1 kh\u00e1ng kh\u00f3 tr\u1ecb (DTRP), Enterobacterales<\/em> \u0111\u1ec1 kh\u00e1ng carbapenem (CRE) v\u00e0 Acinetobacter baummannii <\/em>\u0111\u1ec1 kh\u00e1ng carbepenem (CRAB) th\u01b0\u1eddng kh\u00e1 th\u1ea5p. Do v\u1eady, kh\u00e1ng sinh \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn trong ph\u00e1c \u0111\u1ed3 kinh nghi\u1ec7m th\u01b0\u1eddng kh\u00f4ng c\u00f3 ph\u1ed5 tr\u00ean nh\u1eefng vi khu\u1ea9n n\u00e0y. \u0110\u1ed1i v\u1edbi m\u1ed9t v\u00e0i b\u1ec7nh vi\u1ec7n, t\u1ef7 l\u1ec7 nhi\u1ec5m Enterobacterales<\/em> s\u1ea3n sinh \u03b2-lactamase ph\u1ed5 r\u1ed9ng v\u00e0 P. aeruginosa<\/em> (kh\u00f4ng thu\u1ed9c DTRP) th\u01b0\u1eddng kh\u00e1c cao . Do v\u1eady, \u1edf b\u1ec7nh nh\u00e2n \u1ed1m n\u1eb7ng c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1, ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh kinh nghi\u1ec7m c\u00f3 ph\u1ed5 tr\u00ean c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh n\u00e0y n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc. \u0110\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m khu\u1ea9n n\u1eb7ng v\u00e0 nghi ng\u1edd do vi khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng thu\u1ed1c, IDSA khuy\u1ebfn c\u00e1o n\u00ean \u0111i\u1ec1u tr\u1ecb kinh nghi\u1ec7m \u0111\u1ebfn v\u1edbi 2 kh\u00e1ng sinh (kh\u00e1c nh\u00f3m) c\u00f3 ph\u1ed5 tr\u00ean P. aeruginosa<\/em>. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 nhi\u1ec5m CRE, DTRP ho\u1eb7c CRAB, s\u1eed d\u1ee5ng t\u00e1c nh\u1eadn m\u1edbi c\u00f3 ph\u1ed5 tr\u00ean c\u00e1c vi khu\u1ea9n n\u00e0y n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc. Quy\u1ebft \u0111\u1ecbnh l\u1ef1a ch\u1ecdn kh\u00e1ng sinh c\u00f3 ph\u1ed5 bao ph\u1ee7 tr\u00ean vi sinh c\u1ee5 th\u1ec3 n\u00e0o n\u00ean \u0111\u01b0\u1ee3c \u0111\u01b0a ra d\u1ef1a tr\u00ean d\u1eef li\u1ec7u kh\u00e1ng sinh \u0111\u1ed3 t\u1ea1i \u0111\u1ecba ph\u01b0\u01a1ng v\u00e0 m\u1ed9t s\u1ed1 th\u00f4ng tin kh\u00e1c c\u1ee7a b\u1ec7nh nh\u00e2n ch\u1eb3ng h\u1ea1n nh\u01b0 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a b\u1ec7nh v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1.<\/p>\n\n\n\n

Sau khi l\u1ef1a ch\u1ecdn kh\u00e1ng sinh kinh nghi\u1ec7m, li\u1ec1u kh\u00e1ng sinh n\u00ean \u0111\u01b0\u1ee3c t\u1ed1i \u01b0u h\u00f3a d\u1ef1a tr\u00ean bi\u1ec3u hi\u1ec7n c\u1ee7a b\u1ec7nh nh\u00e2n, c\u00e1c y\u1ebfu t\u1ed1 vi sinh v\u00e0 \u0111\u1ec1 kh\u00e1ng.<\/p>\n\n\n\n

\"\"H\u00ecnh 2.<\/strong> Khuy\u1ebfn c\u00e1o cho chi\u1ebfn l\u01b0\u1ee3c ki\u1ec3m so\u00e1t b\u1ec7nh nh\u00e2n b\u1ecb nghi nh\u1edd nhi\u1ec5m vi khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng thu\u1ed1c<\/p>\n\n\n\n

Ki\u1ec3m so\u00e1t ca b\u1ec7nh li\u00ean quan<\/em><\/strong><\/p>\n\n\n\n

D\u1ef1a tr\u00ean nh\u1eefng bi\u1ec3u hi\u1ec7n v\u00e0 tri\u1ec7u ch\u1ee9ng, k\u1ebft qu\u1ea3 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh hi\u1ec7n t\u1ea1i v\u00e0 tr\u01b0\u1edbc \u0111\u00e2y c\u1ee7a b\u1ec7nh nh\u00e2n, \u1ed5 nhi\u1ec5m c\u00f3 th\u1ec3 l\u00e0 h\u1ec7 h\u00f4 h\u1ea5p c\u1ee7a b\u1ec7nh nh\u00e2n. B\u1ec7nh nh\u00e2n c\u00f3 m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 nhi\u1ec5m vi khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng ch\u1eb3ng h\u1ea1n nh\u01b0 \u0111i\u1ec1u tr\u1ecb v\u1edbi kh\u00e1ng sinh g\u1ea7n \u0111\u00e2y, \u0111\u00e3 t\u1eebng nhi\u1ec5m E.coli <\/em>ESBL v\u00e0 nh\u1eadp vi\u1ec7n g\u1ea7n \u0111\u00e2y. M\u1ed9t s\u1ed1 t\u00e1c nh\u00e2n gram \u00e2m \u0111a kh\u00e1ng thu\u1ed1c c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc \u1edf b\u1ec7nh nh\u00e2n ch\u1eb3ng h\u1ea1n nh\u01b0 ESBL v\u00e0 P. aeruginosa<\/em> kh\u00f4ng kh\u00f3 tr\u1ecb. T\u1ea1i b\u1ec7nh vi\u1ec7n b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb, kh\u00e1ng sinh \u0111\u1ed3 c\u1ee7a b\u1ec7nh vi\u1ec7n cho th\u1ea5y t\u1ef7 l\u1ec7 P. aeruginosa<\/em> nh\u1ea1y v\u1edbi meropenem t\u1ea1i \u0111\u01a1n v\u1ecb ch\u0103m s\u00f3c t\u00edch c\u1ef1c l\u00e0 75%. K\u1ebft h\u1ee3p c\u00f9ng v\u1edbi t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh nh\u00e2n, b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t v\u1edbi ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh kinh nghi\u1ec7m bao g\u1ed3m meropenem (c\u00f3 ph\u1ed5 tr\u00ean E. coli<\/em> ESBL v\u00e0 P. aeruginosa<\/em> nh\u1ea1y c\u1ea3m), tobramycin \u0111\u01b0\u1eddng ngo\u00e0i ru\u1ed9t (nh\u1eb1m b\u1ed5 sung th\u00eam kh\u00e1ng sinh c\u00f3 ph\u1ed5 tr\u00ean P. aeruginosa<\/em> nh\u1ea1y c\u1ea3m), vancomycin \u0111\u01b0\u1eddng ti\u00eam t\u0129nh m\u1ea1ch (do c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a b\u1ec7nh nh\u00e2n). Do b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed nhi\u1ec5m CRE, CTRP, CRAB, do v\u1eady kh\u00f4ng l\u1ef1a ch\u1ecdn kh\u00e1ng sinh c\u00f3 ph\u1ed5 tr\u00ean c\u00e1c t\u00e1c nh\u00e2n n\u00e0y trong ph\u00e1c \u0111\u1ed3 kinh nghi\u1ec7m.<\/p>\n\n\n\n

Chuy\u1ec3n d\u1ecbch t\u1eeb ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh kinh nghi\u1ec7m sang ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh x\u00e1c \u0111\u1ecbnh v\u00e0 theo d\u00f5i \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng<\/strong><\/p>\n\n\n\n

L\u1ef1a ch\u1ecdn kh\u00e1ng sinh x\u00e1c \u0111\u1ecbnh<\/em><\/strong><\/p>\n\n\n\n

Khi kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh kinh nghi\u1ec7m, c\u00e1c k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m bao g\u1ed3m k\u1ebft qu\u1ea3 c\u1ea5y, nhu\u1ed9m gram v\u00e0 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m nhanh (n\u1ebfu c\u00f3) n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u0111\u1ec3 xem x\u00e9t l\u1ea1i \u0111i\u1ec1u tr\u1ecb cho ph\u00f9 h\u1ee3p v\u1edbi vi sinh v\u1eadt g\u00e2y b\u1ec7nh \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh. \u1ede \u0111a s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, n\u00ean s\u1eed d\u1ee5ng m\u1ed9t kh\u00e1ng sinh duy nh\u1ea5t c\u00f3 ph\u1ed5 h\u1eb9p nh\u1ea5t bao ph\u1ee7 t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh v\u00e0 c\u00f3 \u00edt nguy c\u01a1 \u0111\u1ec1 kh\u00e1ng v\u00e0 g\u00e2y ra c\u00e1c t\u00e1c \u0111\u1ed9ng b\u1ea5t l\u1ee3i. C\u00e1c y\u1ebfu t\u1ed1 quan tr\u1ecdng kh\u00e1c c\u1ea7n ph\u1ea3i c\u00e2n nh\u1eafc khi \u0111\u01b0a ra ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh x\u00e1c \u0111\u1ecbnh cho b\u1ec7nh nh\u00e2n l\u00e0 c\u00e1c b\u1ec7nh m\u1eafc k\u00e8m, v\u1ecb tr\u00ed nhi\u1ec5m khu\u1ea9n, m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng, d\u1ecb \u1ee9ng\/kh\u00f4ng dung n\u1ea1p. Li\u1ec1u kh\u00e1ng sinh n\u00ean \u0111\u01b0\u1ee3c t\u1ed1i \u01b0u h\u00f3a d\u1ef1a tr\u00ean nguy\u00ean t\u1eafc d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc v\u00e0 c\u00e1c \u0111\u1eb7c th\u00f9 c\u1ee7a kh\u00e1ng sinh.<\/p>\n\n\n\n

\u0110\u00e1p \u1ee9ng l\u00e2m s\u00e0ng<\/em><\/strong><\/p>\n\n\n\n

Theo d\u00f5i \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb khi \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n nhi\u1ec5m vi khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng thu\u1ed1c r\u1ea5t quan tr\u1ecdng. X\u00e1c \u0111\u1ecbnh \u1ed5 nhi\u1ec5m c\u0169ng quan tr\u1ecdng v\u00ec \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u00e1ch theo d\u00f5i \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb. D\u1ea5u hi\u1ec7u sinh t\u1ed3n, thanh th\u1ea3i vi sinh, m\u1ee9c \u0111\u1ed9 \u1ed5n \u0111\u1ecbnh huy\u1ebft \u0111\u1ed9ng, thay \u0111\u1ed5i trong ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh li\u00ean quan v\u00e0 m\u1ee9c \u0111\u1ed9 th\u00e0nh c\u00f4ng trong ki\u1ec3m so\u00e1t \u1ed5 nhi\u1ec5m l\u00e0 nh\u1eefng y\u1ebfu t\u1ed1 c\u1ed1t l\u00f5i li\u00ean quan \u0111\u1ebfn \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb. M\u1ed9t s\u1ed1 d\u1ea5u ch\u1ec9 sinh h\u1ecdc ch\u1eb3ng h\u1ea1n nh\u01b0 lactate v\u00e0 procalcitonin c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng (tuy nhi\u00ean, vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c d\u1ea5u ch\u1ec9 sinh h\u1ecdc v\u1eabn \u0111ang l\u00e0 v\u1ea5n \u0111\u1ec1 g\u00e2y ra nhi\u1ec1u tranh lu\u1eadn).<\/p>\n\n\n\n

H\u00ecnh th\u00e0nh \u0111\u1ec1 kh\u00e1ng khi \u0111ang \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf b\u1ec7nh nh\u00e2n \u0111ang \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n do vi khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng. V\u1edbi tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 c\u1ea3i thi\u1ec7n v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng, c\u1ea7n \u0111\u1ea3m b\u1ea3o li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c t\u1ed1i \u01b0u h\u00f3a, c\u1ea5y l\u1ea1i b\u1ec7nh ph\u1ea9m, l\u1eb7p l\u1ea1i ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh v\u00e0 c\u00e1c \u1ed5 nhi\u1ec5m c\u00f3 ti\u1ec1m n\u0103ng \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1.<\/p>\n\n\n\n

Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb<\/em><\/strong><\/p>\n\n\n\n

Vi\u1ec7c x\u00e1c \u0111\u1ecbnh th\u1eddi gian c\u1ee7a \u0111\u1ee3t \u0111i\u1ec1u tr\u1ecb n\u00ean c\u00e2n nh\u1eafc d\u1ef1a tr\u00ean m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a t\u00ecnh tr\u1ea1ng nhi\u1ec5m khu\u1ea9n, \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb, m\u1ee9c \u0111\u1ed9 ch\u1eafc ch\u1eafn c\u1ee7a ch\u1ea9n \u0111o\u00e1n, lo\u1ea1i\/v\u1ecb tr\u00ed nhi\u1ec5m khu\u1ea9n, li\u1ec7u \u1ed5 nhi\u1ec5m \u0111\u00e3 \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t v\u00e0 c\u00e1c t\u00e1c \u0111\u1ed9ng b\u1ea5t l\u1ee3i. T\u00ecnh tr\u1ea1ng nhi\u1ec5m vi khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng thu\u1ed1c v\u00e0 \u0111\u1ec1 kh\u00e1ng kh\u00e1ng sinh kh\u00f4ng n\u00ean l\u00e0 y\u1ebfu t\u1ed1 g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn \u0111\u1ed9 d\u00e0i c\u1ee7a th\u1eddi gian \u0111i\u1ec1u tr\u1ecb.<\/p>\n\n\n\n

R\u00fat ng\u1eafn th\u1eddi gian \u0111i\u1ec1u tr\u1ecb l\u00e0 bi\u1ec7n ph\u00e1p hi\u1ec7u qu\u1ea3 \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 \u0111\u1ec1 kh\u00e1ng. M\u1ed9t s\u1ed1 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y r\u00fat ng\u1eafn th\u1eddi gian \u0111i\u1ec1u tr\u1ecb kh\u00f4ng l\u00e0m gia t\u0103ng nguy c\u01a1 th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb. M\u1ed9t s\u1ed1 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y procalcitonin c\u00f3 th\u1ec3 hi\u1ec7u qu\u1ea3 \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u1ed9 d\u00e0i th\u1eddi gian \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i.<\/p>\n\n\n\n

Ki\u1ec3m so\u00e1t ca b\u1ec7nh li\u00ean quan<\/em><\/strong><\/p>\n\n\n\n

Sau khi kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh, b\u1ec7nh nh\u00e2n v\u1eabn c\u00f3 bi\u1ec3u hi\u1ec7n s\u1ed1t. B\u1ec7nh nh\u00e2n v\u1eabn \u0111\u01b0\u1ee3c duy tr\u00ec \u0111i\u1ec1u tr\u1ecb v\u1edbi norepinephrine v\u00e0 th\u1edf m\u00e1y. Sau khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh \u0111\u01b0\u1ee3c 8 gi\u1edd, k\u1ebft qu\u1ea3 c\u1ea5y m\u00e1u cho th\u1ea5y b\u1ec7nh nh\u00e2n d\u01b0\u01a1ng t\u00ednh v\u1edbi bacilli. K\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m nhanh cho th\u1ea5y b\u1ec7nh nh\u00e2n nhi\u1ec5m K. pneumoniae<\/em> c\u00f3 gen KPC. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u1ed5i ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh v\u1edbi meropenem \u2013 vaborbactam (\u0111\u00e3 t\u1ed1i \u01b0u h\u00f3a li\u1ec1u). K\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3 thu \u0111\u01b0\u1ee3c 2 ng\u00e0y sau cho th\u1ea5y vi khu\u1ea9n \u0111\u1ec1 kh\u00e1ng v\u1edbi kh\u00e1ng sinh ti\u00eau hcuaanr (bao g\u1ed3m meropenem) nh\u01b0ng nh\u1ea1y c\u1ea3m v\u1edbi tobramycin. V\u00ec vi sinh \u0111\u1ec1 kh\u00e1ng v\u1edbi meropenem, kh\u00e1ng sinh \u0111\u1ed3 ph\u1ea3n x\u1ea1 (reflex) \u0111\u00e3 \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh, k\u1ebft qu\u1ea3 cho th\u1ea5y vi khu\u1ea9n nh\u1ea1y c\u1ea3m v\u1edbi ceftazidime \u2013 avibactam, imipenem \u2013 cilastin \u2013 relebactam v\u00e0 meropenem \u2013 vaborbactam. K\u1ebft qu\u1ea3 c\u1ea5y m\u1eabu b\u1ec7nh ph\u1ea9n h\u00f4 h\u1ea5p ph\u00e1t hi\u1ec7n K. pneumoniae<\/em> \u0111\u1ec1 kh\u00e1ng carbapenem.<\/p>\n\n\n\n

Sau 72 gi\u1edd, b\u1ec7nh nh\u00e2n h\u1ebft s\u1ed1t, \u0111\u01b0\u1ee3c r\u00fat n\u1ed9i kh\u00ed qu\u1ea3n, b\u1ea1ch c\u1ea7u \u0111\u1ea1t 11×103<\/sup> t\u1ebf b\u00e1o\/\u00b5L, kh\u00f4ng c\u00f2n suy th\u1eadn c\u1ea5p. \u0110\u1ed9 d\u00e0i th\u1eddi gian \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh c\u1ee7a b\u1ec7nh nh\u00e2n l\u00e0 7 ng\u00e0y (v\u1edbi meropenem \u2013 vaborbactam).<\/p>\n\n\n\n

K\u1ebft lu\u1eadn<\/em><\/strong><\/p>\n\n\n\n

\u0110i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n nhi\u1ec5m khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng thu\u1ed1c l\u00e0 v\u1ea5n \u0111\u1ec1 ph\u1ee9c t\u1ea1p, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5ng tr\u1ea1ng y\u1ebfu. V\u1edbi s\u1ef1 c\u00f3 m\u1eb7t c\u1ee7a nhi\u1ec1u kh\u00e1ng sinh m\u1edbi c\u00f3 ph\u1ed5 tr\u00ean vi khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng thu\u1ed1c, vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c t\u00e1c nh\u00e2n n\u00e0y c\u1ea7n \u0111\u01b0\u1ee3c t\u1ed1i \u01b0u h\u00f3a.<\/p>\n\n\n\n

Khi \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb, nhi\u1ec1u y\u1ebfu t\u1ed1 c\u1ea7n \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc, bao g\u1ed3m nh\u1eadn di\u1ec7n c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 nhi\u1ec5m vi khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng thu\u1ed1c, c\u1ea3i thi\u1ec7n ch\u1ea9n \u0111o\u00e1n b\u1eb1ng c\u00e1c k\u1ef9 thu\u1eadt m\u1edbi, thay \u0111\u1ed5i chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p v\u00e0 tr\u00e1nh li\u1ec7u tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh d\u00e0i ng\u00e0y kh\u00f4ng c\u1ea7n thi\u1ebft.<\/p>\n\n\n\n

\n\n\n\n

Ngu\u1ed3n<\/em><\/strong><\/p>\n\n\n\n

Yassin A, Huralska M, Pogue JM, Dixit D, Sawyer RG, Kaye KS. Executive Summary: State-of-the-Art Review: State of the Management of Infections Caused by Multidrug-Resistant Gram-Negative Organisms. Clin Infect Dis. 2023 Nov 11;77(9):1223-1225. doi: 10.1093\/cid\/ciad526. PMID: 37952120.<\/p>\n","protected":false},"excerpt":{"rendered":"

Trong th\u1eadp k\u1ef7 v\u1eeba qua, t\u1ef7 l\u1ec7 nhi\u1ec5m khu\u1ea9n do vi khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng thu\u1ed1c \u0111\u00e3 t\u0103ng l\u00ean nhanh ch\u00f3ng v\u1edbi t\u1ef7 l\u1ec7 t\u1ef7 vong cao. \u0110i\u1ec1u tr\u1ecb c\u00e1c t\u00ecnh tr\u1ea1ng nhi\u1ec5m khu\u1ea9n n\u00e0y g\u1eb7p nhi\u1ec1u th\u00e1ch th\u1ee9c, \u0111\u1eb7c bi\u1ec7t l\u00e0 trong vi\u1ec7c l\u1ef1a ch\u1ecdn ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh kinh nghi\u1ec7m ph\u00f9 h\u1ee3p …<\/p>\n

IDSA 2023: Ki\u1ec3m so\u00e1t nhi\u1ec5m khu\u1ea9n do gram \u00e2m \u0111a kh\u00e1ng thu\u1ed1c<\/span> Read More »<\/a><\/p>\n","protected":false},"author":123,"featured_media":13147,"comment_status":"closed","ping_status":"closed","template":"","meta":{"content-type":"","inline_featured_image":false,"site-sidebar-layout":"default","site-content-layout":"default","ast-global-header-display":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","footnotes":""},"articles_categories":[1370],"articles_tags":[],"articles_topics":[1440],"articles_languages":[1375],"articles_filters":[],"class_list":["post-13145","articles","type-articles","status-publish","has-post-thumbnail","hentry","articles_categories-medical-content-vi","articles_languages-vietnamese-vi"],"_links":{"self":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/13145","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles"}],"about":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/types\/articles"}],"author":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/users\/123"}],"replies":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/comments?post=13145"}],"version-history":[{"count":0,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/13145\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media\/13147"}],"wp:attachment":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media?parent=13145"}],"wp:term":[{"taxonomy":"articles_categories","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_categories?post=13145"},{"taxonomy":"articles_tags","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_tags?post=13145"},{"taxonomy":"articles_topics","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_topics?post=13145"},{"taxonomy":"articles_languages","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_languages?post=13145"},{"taxonomy":"articles_filters","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_filters?post=13145"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}