{"id":5675,"date":"2021-11-23T12:23:01","date_gmt":"2021-11-23T05:23:01","guid":{"rendered":"https:\/\/bvnguyentrai.org.vn\/vi-khuan-de-khang-carbapenem-va-cac-lua-chon-dieu-tri\/"},"modified":"2021-11-23T12:23:01","modified_gmt":"2021-11-23T05:23:01","slug":"vi-khuan-de-khang-carbapenem-va-cac-lua-chon-dieu-tri","status":"publish","type":"post","link":"https:\/\/bvnguyentrai.org.vn\/en\/vi-khuan-de-khang-carbapenem-va-cac-lua-chon-dieu-tri\/","title":{"rendered":"VI KHU\u1ea8N \u0110\u1ec0 KH\u00c1NG CARBAPENEM V\u00c0 C\u00c1C L\u1ef0A CH\u1eccN \u0110I\u1ec0U TR\u1eca"},"content":{"rendered":"<p align=\"center\"><strong>\u00a0<\/strong><\/p>\n<table cellspacing=\"0\" cellpadding=\"0\" align=\"left\">\n<tbody>\n<tr>\n<td width=\"258\" height=\"1\">\u00a0<\/td>\n<\/tr>\n<tr>\n<td>\u00a0<\/td>\n<td bgcolor=\"white\" width=\"417\" height=\"45\">\n<table style=\"width: 100%;\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td>\n<div class=\"shape\">\n<p><em>L\u01b0\u1ee3c d\u1ecbch v\u00e0 t\u1ed5ng h\u1ee3p: DS. L\u00ea \u0110\u1ee9c H\u1ea1nh Duy\u00ean, DS. Nguy\u1ec5n Th\u1ecb Th\u1ee5c Hi\u1ec1n<\/em><\/p>\n<p><em>Hi\u1ec7u \u0111\u00ednh: TS. DS. Nguy\u1ec5n Nh\u01b0 H\u1ed3<\/em><\/p>\n<\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>\u00a0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p>\u00a0<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>T\u1ed5ng quan<\/strong><\/p>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u0110\u1ec1 kh\u00e1ng kh\u00e1ng sinh \u0111\u00e3 tr\u1edf th\u00e0nh m\u1ed9t trong nh\u1eefng m\u1ed1i \u0111e d\u1ecda l\u1edbn nh\u1ea5t \u0111\u1ed1i v\u1edbi s\u1ee9c kh\u1ecfe c\u1ed9ng \u0111\u1ed3ng. Carbapenem t\u1eeb l\u00e2u \u0111\u01b0\u1ee3c coi l\u00e0 t\u00e1c nh\u00e2n m\u1ea1nh nh\u1ea5t ch\u1ed1ng l\u1ea1i c\u00e1c m\u1ea7m b\u1ec7nh Gram \u00e2m \u0111a kh\u00e1ng (MDR). Tuy nhi\u00ean, s\u1ef1 xu\u1ea5t hi\u1ec7n c\u00e1c ch\u1ee7ng c\u00f3 kh\u1ea3 n\u0103ng \u0111\u1ec1 kh\u00e1ng carbapenem khi\u1ebfn vi\u1ec7c \u0111i\u1ec1u tr\u1ecb kh\u00f3 kh\u0103n h\u01a1n do thi\u1ebfu c\u00e1c l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb thay th\u1ebf hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n. D\u01b0\u1edbi \u0111\u00e2y ch\u00fang t\u00f4i s\u1ebd tr\u00ecnh b\u00e0y v\u1ec1 c\u00e1c ch\u1ee7ng \u0111\u1ec1 kh\u00e1ng v\u1edbi carbapenem, ph\u00e2n t\u00edch l\u1ee3i \u00edch\/nguy c\u01a1 c\u1ee7a c\u00e1c l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb hi\u1ec7n c\u00f3 d\u1ef1a tr\u00ean y h\u1ecdc ch\u1ee9ng c\u1ee9 v\u00e0 gi\u1edbi thi\u1ec7u m\u1ed9t s\u1ed1 kh\u00e1ng sinh m\u1edbi \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn trong th\u1eddi gian g\u1ea7n \u0111\u00e2y.<\/p>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0<\/p>\n<p><strong>Vi khu\u1ea9n Gram \u00e2m kh\u00e1ng Carbapenem: M\u1ed1i \u0111e d\u1ecda s\u1ee9c kh\u1ecfe c\u1ed9ng \u0111\u1ed3ng nghi\u00eam tr\u1ecdng<\/strong><\/p>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ng\u00e0y nay, vi khu\u1ea9n Gram \u00e2m kh\u00e1ng carbapenem ng\u00e0y c\u00e0ng nhi\u1ec1u, th\u00f4ng qua c\u00e1c c\u01a1 ch\u1ebf nh\u01b0 s\u1ea3n xu\u1ea5t carbapenemase, \u0111\u1ed9t bi\u1ebfn porin, ho\u1eb7c \u0111i\u1ec1u ch\u1ec9nh b\u01a1m ng\u01b0\u1ee3c. Theo WHO n\u0103m 2017, 3 t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh \u0111\u01b0\u1ee3c \u01b0u ti\u00ean cho vi\u1ec7c nghi\u00ean c\u1ee9u v\u00e0 ph\u00e1t tri\u1ec3n kh\u00e1ng sinh m\u1edbi l\u00e0 c\u00e1c ch\u1ee7ng kh\u00e1ng carbapenem, bao g\u1ed3m <em>Enterobacteriaceae<\/em>), <em>Pseudomonas aeruginosa<\/em> v\u00e0 <em>Acinetobacter baumannii <\/em>kh\u00e1ng carbapenem. Ngo\u00e0i ra, ch\u1ee7ng <em>Stenotrophomonas maltophili<\/em>a c\u0169ng \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp nh\u01b0 l\u00e0 m\u1ed9t t\u00e1c nh\u00e2n c\u00f3 kh\u1ea3 n\u0103ng \u0111\u1ec1 kh\u00e1ng cao v\u1edbi carbapenem.<\/p>\n<ul>\n<li><strong><em>Enterobacteriales<\/em><\/strong><\/li>\n<\/ul>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kh\u1ea3 n\u0103ng kh\u00e1ng carbapenem m\u1eafc ph\u1ea3i th\u01b0\u1eddng g\u1eb7p h\u01a1n \u1edf <em>Enterobacteriaceae<\/em>, nh\u01b0 <em>Klebsiella pneumoniae<\/em> v\u00e0 <em>Escherichia coli<\/em>v\u1edbi kh\u1ea3 n\u0103ng ti\u1ebft metallo metallo-\u03b2-lactamase (MBL; t\u1ee9c l\u00e0, imipenemase metallo-\u03b2-lactamase [IMP] v\u00e0 Verona integron &#8211; encoded metallo-\u03b2-lactamase [VIM]) ho\u1eb7c KPC (<em>K. pneumoniae<\/em> carbapenemases). Ti\u1ebfp theo \u0111\u00f3 l\u00e0 s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a <em>K. pneumoniae<\/em> s\u1ea3n xu\u1ea5t oxacillinase (OXA) \u2013 48 carbapenemase \u1edf Th\u1ed5 Nh\u0129 K\u1ef3, c\u0169ng nh\u01b0 <em>E. coli<\/em> s\u1ea3n xu\u1ea5t MBL (metallo-\u03b2-lactamase) (NDM) \u1edf New Delhi \u1edf \u1ea4n \u0110\u1ed9. Hi\u1ec7n nay, c\u00e1c thu\u1ed1c kh\u00e1ng sinh m\u1edbi \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n v\u1edbi ph\u1ed5 bao ph\u1ee7 chuy\u00ean bi\u1ec7t cho c\u00e1c carbapenemase kh\u00e1c nhau do \u0111\u00f3 c\u1ea7n bi\u1ebft c\u1ee5 th\u1ec3 lo\u1ea1i carbapenemase n\u00e0o l\u00e0 c\u01a1 ch\u1ebf g\u00e2y \u0111\u1ec1 kh\u00e1ng \u0111\u1ec3 l\u1ef1a ch\u1ecdn kh\u00e1ng sinh ph\u00f9 h\u1ee3p.<\/p>\n<ul>\n<li><strong><em>Pseudomonas aeruginosa\u00a0\u00a0\u00a0\u00a0\u00a0 <\/em><\/strong><em>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/em>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/li>\n<\/ul>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <em>Pseudomonas aeruginosa<\/em> l\u00e0 lo\u00e0i \u0111\u1ea7u ti\u00ean kh\u00e1ng carbapenem xu\u1ea5t hi\u1ec7n sau khi carbapenem \u0111\u1ea7u ti\u00ean l\u00e0 imipenem ra \u0111\u1eddi, v\u00e0o gi\u1eefa nh\u1eefng n\u0103m 1980. S\u1ef1 kh\u00e1ng thu\u1ed1c c\u1ee7a <em>P. aeruginosa<\/em> l\u00e0 do thay \u0111\u1ed5i trong bi\u1ec3u hi\u1ec7n porin, khi\u1ebfn imipenem kh\u00f3 th\u00e2m nh\u1eadp qua m\u00e0ng t\u1ebf b\u00e0o vi khu\u1ea9n. T\u1ea1i Hoa K\u1ef3, 10% \u2013 20% c\u00e1c ch\u1ee7ng<em> P. aeruginosa<\/em> \u0111\u1ec1 kh\u00e1ng v\u1edbi \u00edt nh\u1ea5t 1 carbapenem. Tr\u00ean to\u00e0n c\u1ea7u, t\u00ecnh tr\u1ea1ng kh\u00e1ng carbapenem do s\u1ea3n xu\u1ea5t MBL (\u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u00f3m VIM) d\u01b0\u1eddng nh\u01b0 ph\u1ed5 bi\u1ebfn \u1edf <em>P. aeruginosa<\/em>. \u0110\u00e2y l\u00e0 v\u1ea5n \u0111\u1ec1 c\u1ea7n c\u00e2n nh\u1eafc v\u00ec \u0111a s\u1ed1 c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf \u03b2-lactamase kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng v\u1edbi c\u00e1c carbapenemase tr\u00ean.<\/p>\n<ul>\n<li><strong><em>Acinetobacter baumannii<\/em><\/strong><\/li>\n<\/ul>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <em>Acinetobacter baumannii <\/em>\u0111\u01b0\u1ee3c coi l\u00e0 vi khu\u1ea9n c\u01a1 h\u1ed9i \u00edt c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng cho \u0111\u1ebfn nh\u1eefng n\u0103m 1980. V\u00e0o nh\u1eefng n\u0103m 1990, quan ni\u1ec7m n\u00e0y thay \u0111\u1ed5i khi c\u00e1c ch\u1ee7ng <em>A. baumannii <\/em>\u0111a \u0111\u1ec1 kh\u00e1ng\u00a0 (MDR) v\u00e0 kh\u00e1ng carbapenem b\u1eaft \u0111\u1ea7u g\u00e2y c\u00e1c b\u1ec7nh nhi\u1ec5m khu\u1ea9n (v\u00ed d\u1ee5, vi\u00eam ph\u1ed5i li\u00ean quan \u0111\u1ebfn m\u00e1y th\u1edf [VAP]) \u1edf c\u00e1c \u0111\u01a1n v\u1ecb ch\u0103m s\u00f3c \u0111\u1eb7c bi\u1ec7t t\u1ea1i Ch\u00e2u \u00c2u, sau \u0111\u00f3 nhanh ch\u00f3ng lan r\u1ed9ng \u0111\u1ebfn c\u00e1c b\u1ec7nh vi\u1ec7n tr\u00ean to\u00e0n th\u1ebf gi\u1edbi. C\u00e1c ch\u1ee7ng kh\u00e1ng carbapenem n\u00e0y \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n t\u1ea1o ra c\u00e1c carbapenemase thu nh\u1eadn v\u00e0 \u0111\u1eb7c hi\u1ec7u cho <em>A. baumannii<\/em>. <em>A. baumannii<\/em> carbapenemase ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 OXA-23, OXA-40, OXA-58.<\/p>\n<ul>\n<li><strong><em>Stenotrophomonas maltophilia<\/em><\/strong><\/li>\n<\/ul>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <em>Stenotrophomonas maltophilia<\/em> kh\u00e1c v\u1edbi c\u00e1c m\u1ea7m b\u1ec7nh kh\u00e1ng carbapenem \u1edf tr\u00ean ch\u1ed7 t\u1ea1o ra MBL L1 c\u1ea3m \u1ee9ng n\u00ean c\u00f3 kh\u1ea3 n\u0103ng kh\u00e1ng carbapenem m\u1ed9t c\u00e1ch t\u1ef1 nhi\u00ean. <em>Stenotrophomonas maltophilia<\/em> l\u00e0 m\u1ed9t lo\u00e0i s\u1ed1ng trong m\u00f4i tr\u01b0\u1eddng c\u00f3 th\u1ec3 g\u00e2y nhi\u1ec5m tr\u00f9ng c\u01a1 h\u1ed9i \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p v\u00e0 \u0111\u01b0\u1eddng m\u00e1u \u1edf nh\u1eefng v\u1eadt ch\u1ee7 nh\u1ea1y c\u1ea3m, bao g\u1ed3m ng\u01b0\u1eddi b\u1ecb x\u01a1 ho\u00e1 nang, b\u1ec7nh \u00e1c t\u00ednh v\u00e0 b\u1ecb suy gi\u1ea3m mi\u1ec5n d\u1ecbch. M\u1eb7c d\u00f9 c\u00e1c ch\u1ee7ng n\u00e0y \u0111\u00e3 t\u1eebng nh\u1ea1y c\u1ea3m v\u1edbi m\u1ed9t s\u1ed1 t\u00e1c nh\u00e2n kh\u00e1c (v\u00ed d\u1ee5, ceftazidime, ticarcillin-clavulanate, trimethoprim-sulfamethoxazole, fluoroquinolone v\u00e0 tetracycline), t\u1ef7 l\u1ec7 nh\u1ea1y c\u1ea3m v\u1edbi c\u00e1c t\u00e1c nh\u00e2n n\u00e0y \u0111ang gi\u1ea3m.<\/p>\n<p><strong>C\u00c1CH TI\u1ebeP C\u1eacN \u0110I\u1ec0U TR\u1eca NHI\u1ec4M TR\u00d9NG GRAM \u00c2M KH\u00c1NG CARBAPENEM<\/strong><\/p>\n<p><strong>C\u00e2n<\/strong><strong> nh\u1eafc chung<\/strong><\/p>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vi\u1ec7c l\u1ef1a ch\u1ecdn m\u1ed9t ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh ph\u1ee5 thu\u1ed9c v\u00e0o t\u00ecnh hu\u1ed1ng l\u00e2m s\u00e0ng c\u1ee5 th\u1ec3, v\u00ed d\u1ee5 kh\u1ea3 n\u0103ng th\u00e2m nh\u1eadp m\u00f4 v\u00e0 n\u1ed3ng \u0111\u1ed9 kh\u00e1ng sinh t\u1ea1i v\u1ecb tr\u00ed nhi\u1ec5m tr\u00f9ng, \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh, \u0111\u1eb7c bi\u1ec7t l\u00e0 ch\u1ee9c n\u0103ng th\u1eadn, c\u0169ng c\u00f3 th\u1ec3 c\u00f3 t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn qu\u00e1 tr\u00ecnh ra quy\u1ebft \u0111\u1ecbnh.<\/p>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ngay c\u1ea3 khi t\u00ecnh tr\u1ea1ng kh\u00e1ng carbapenem c\u1ee7a m\u1ed9t t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh, m\u1ed9t s\u1ed1 kh\u00e1ng sinh kh\u00e1c nh\u00f3m carbapenem (ngo\u00e0i colistin, tigecycline v\u00e0 minocycline) c\u00f3 th\u1ec3 v\u1eabn hi\u1ec7u qu\u1ea3. Trong s\u1ed1 \u0111\u00f3, gentamicin c\u00f3 ho\u1ea1t t\u00ednh ch\u1ed1ng l\u1ea1i m\u1ed9t s\u1ed1 ch\u1ee7ng CRE, v\u00e0 m\u1ed9t s\u1ed1 quan s\u00e1t cho th\u1ea5y ph\u00e1c \u0111\u1ed3 ch\u1ee9a gentamicin c\u00f3 th\u1ec3 c\u00f3 hi\u1ec7u qu\u1ea3 h\u01a1n c\u00e1c ph\u00e1c \u0111\u1ed3 k\u1ebft h\u1ee3p kh\u00e1c \u0111\u1ed1i v\u1edbi nhi\u1ec5m tr\u00f9ng huy\u1ebft do CRE. Ampicillin-sulbactam \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng th\u00e0nh c\u00f4ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh nhi\u1ec5m tr\u00f9ng x\u00e2m l\u1ea5n do c\u00e1c ch\u1ee7ng <em>A. baumannii<\/em> g\u00e2y ra, v\u1edbi sulbactam l\u00e0 ch\u1ea5t c\u00f3 ho\u1ea1t t\u00ednh ch\u1ed1ng l\u1ea1i m\u1ed9t s\u1ed1 ch\u1ee7ng kh\u00e1ng carbapenem. Ch\u1ec9 m\u1ed9t t\u1ef7 l\u1ec7 nh\u1ecf c\u00e1c ch\u1ee7ng <em>P. aeruginosa<\/em> kh\u00e1ng carbapenem nh\u1ea1y c\u1ea3m v\u1edbi c\u00e1c t\u00e1c nh\u00e2n ngo\u00e0i carbapenem nh\u01b0 cefepime, ciprofloxacin v\u00e0 amikacin. Ph\u1ea7n l\u1edbn c\u00e1c ch\u1ee7ng <em>S. maltophilia<\/em> nh\u1ea1y c\u1ea3m v\u1edbi trimethoprim-sulfamethoxazole, v\u00e0 ch\u1ec9 m\u1ed9t s\u1ed1 ch\u1ee7ng nh\u1ea1y c\u1ea3m v\u1edbi minocycline, ticarcillin-clavulanate, ho\u1eb7c fluoroquinolone. M\u1eb7c d\u00f9 b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng c\u00f2n h\u1ea1n ch\u1ebf, fluoroquinolon c\u00f3 th\u1ec3 c\u00f3 hi\u1ec7u qu\u1ea3 nh\u01b0 trimethoprim-sulfamethoxazole trong \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng <em>S. maltophilia<\/em>. Tuy nhi\u00ean, m\u1ee9c \u0111\u1ed9 nh\u1ea1y c\u1ea3m c\u1ee7a c\u00e1c vi khu\u1ea9n Gram \u00e2m \u0111\u1ec1 kh\u00e1ng carbapenem kh\u00f3 d\u1ef1 \u0111o\u00e1n, do \u0111\u00f3 l\u1ef1a ch\u1ecdn c\u00e1c kh\u00e1ng sinh c\u0169 c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n d\u1ef1a tr\u00ean k\u1ebft qu\u1ea3 nh\u1ea1y c\u1ea3m v\u1edbi t\u1eebng kh\u00e1ng sinh chuy\u00ean bi\u1ec7t.<\/p>\n<p><strong>Polymyxin (Colistin v\u00e0 Polymyxin B)<\/strong><\/p>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Colistin (hay polymyxin E) l\u00e0 m\u1ed9t h\u1ed7n h\u1ee3p c\u00e1c kh\u00e1ng sinh polypeptid m\u1ea1ch v\u00f2ng. Polymyxin c\u00f3 ho\u1ea1t t\u00ednh ch\u1ed1ng l\u1ea1i h\u1ea7u h\u1ebft c\u00e1c <em>Enterobacteriaceae<\/em> (ngo\u1ea1i tr\u1eeb <em>Serratia marcescens<\/em> v\u00e0 <em>Proteus<\/em>, <em>Providencia, Morganella<\/em> v\u00e0 <em>Hafnia<\/em><em> spp<\/em>), <em>P. aeruginosa, A. baumannii<\/em>, v\u00e0 m\u1ed9t s\u1ed1 <em>S. maltophilia<\/em> spp..<\/p>\n<p>M\u1eb7c d\u00f9 colistin \u0111\u1ed9c tr\u00ean th\u1eadn v\u00e0 \u0111\u1ed9c th\u1ea7n kinh nh\u01b0ng do c\u00f3 ph\u1ed5 r\u1ed9ng, t\u00e1c \u0111\u1ed9ng \u0111\u01b0\u1ee3c tr\u00ean c\u00e1c ch\u1ee7ng kh\u00e1ng carbapenem n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh nhi\u1ec5m tr\u00f9ng do c\u00e1c m\u1ea7m b\u1ec7nh n\u00e0y g\u00e2y ra. Tuy nhi\u00ean, c\u00e1c nhi\u00ean c\u1ee9u quan s\u00e1t cho th\u1ea5y vi\u1ec7c s\u1eed d\u1ee5ng colistin \u0111\u01a1n tr\u1ecb cho k\u1ebft cu\u1ed9c l\u00e2m s\u00e0ng kh\u00f4ng t\u1ed1i \u01b0u\u00a0 so v\u1edbi k\u1ebft h\u1ee3p th\u00eam thu\u1ed1c kh\u00e1c.Ngo\u00e0i ra, colistin \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng d\u01b0\u1edbi d\u1ea1ng ti\u1ec1n ch\u1ea5t kh\u00f4ng ho\u1ea1t t\u00ednh &#8211; colistin methanesulfonate &#8211; d\u1eabn \u0111\u1ebfn n\u1ed3ng \u0111\u1ed9 thu\u1ed1c c\u00f3 ho\u1ea1t t\u00ednh th\u1ea5p trong m\u1ed9t th\u1eddi gian v\u00e0 v\u1ec1 m\u1eb7t l\u00fd thuy\u1ebft l\u00e0m t\u0103ng nguy c\u01a1 kh\u00e1ng thu\u1ed1c.<\/p>\n<p>Polymyxin B l\u00e0 thu\u1ed1c kh\u00e1c trong nh\u00f3m polymixin \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t. Thu\u1ed1c \u1edf d\u1ea1ng ho\u1ea1t ch\u1ea5t cho t\u00e1c d\u1ee5ng\u00a0 n\u00ean kh\u00f4ng b\u1ecb tr\u00ec ho\u00e3n th\u1eddi gian \u0111\u1ec3 \u0111\u1ea1t n\u1ed3ng \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb nh\u01b0 colistin. C\u00e1c khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb hi\u1ec7n nay \u0111\u1ec1u \u0111\u1ec1 ngh\u1ecb vi\u1ec7c s\u1eed d\u1ee5ng colistin ho\u1eb7c polymyxin B k\u1ebft h\u1ee3p v\u1edbi \u00edt nh\u1ea5t 1 t\u00e1c nh\u00e2n thu\u1ed9c nh\u00f3m kh\u00e1c \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o hi\u1ec7u qu\u1ea3.<\/p>\n<p><strong>Tigecycline v\u00e0 Minocycline<\/strong><\/p>\n<p>Tigecycline l\u00e0 m\u1ed9t t\u00e1c nh\u00e2n glycylcycline c\u00f3 t\u00e1c \u0111\u1ed9ng tr\u00ean c\u00e1c c\u01a1 ch\u1ebf c\u1ee7a ch\u1ee7ng \u0111\u1ec1 kh\u00e1ng tetracyclin , do \u0111\u00f3 c\u00f3 ph\u1ed5 kh\u00e1ng khu\u1ea9n r\u1ed9ng tr\u00ean c\u00e1c vi khu\u1ea9n Gram d\u01b0\u01a1ng v\u00e0 Gram \u00e2m, ngo\u1ea1i tr\u1eeb <em>P. aeruginosa<\/em>, <em>Proteus<\/em>spp, v\u00e0 <em>Providencia<\/em>spp. Trong s\u1ed1 c\u00e1c m\u1ea7m b\u1ec7nh Gram \u00e2m kh\u00e1ng carbapenem, tigecycline c\u00f3 ho\u1ea1t t\u00ednh in vitro ch\u1ed1ng l\u1ea1i ph\u1ea7n l\u1edbn c\u00e1c ch\u1ee7ng CRE, <em>A. baumannii<\/em> v\u00e0 <em>S. maltophilia<\/em>. Tuy nhi\u00ean c\u00e1c b\u1eb1ng ch\u1ee9ng v\u1ec1 hi\u1ec7u qu\u1ea3 tr\u00ean l\u00e2m s\u00e0ng ch\u01b0a th\u1ed1ng nh\u1ea5t v\u00e0 c\u00f3 nguy c\u01a1 t\u1eed vong cao h\u01a1n trong c\u00e1c th\u1eed ngh\u1ec7m l\u00e2m s\u00e0ng so s\u00e1nh. Tigecycline li\u1ec1u g\u1ea5p \u0111\u00f4i \u0111\u00e3 \u0111\u01b0\u1ee3c m\u1ed9t s\u1ed1 b\u00e1c s\u0129 l\u00e2m s\u00e0ng \u00e1p d\u1ee5ng cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m tr\u00f9ng n\u1eb7ng nh\u01b0 VAP, nh\u01b0ng d\u1eef li\u1ec7u l\u00e2m s\u00e0ng c\u00f2n h\u1ea1n ch\u1ebf v\u00e0 nhi\u1ec1u b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 ch\u1ecbu \u0111\u01b0\u1ee3c c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 tr\u00ean \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. C\u0169ng nh\u01b0 colistin, tigecycline ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong ph\u00e1c \u0111\u1ed3 ph\u1ed1i h\u1ee3p khi \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n Gram \u00e2m kh\u00e1ng carbapenem \u0111\u1ec3 kh\u1eafc ph\u1ee5c c\u00e1c v\u1ea5n \u0111\u1ec1 tr\u00ean. Ngo\u00e0i ra, tigecycline th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ed1i v\u1edbi nhi\u1ec5m khu\u1ea9n huy\u1ebft v\u00ec ch\u1ec9 c\u00f3 ho\u1ea1t t\u00ednh k\u00ecm khu\u1ea9n v\u00e0 n\u1ed3ng \u0111\u1ed9 \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh th\u1ea5p trong huy\u1ebft thanh \u1edf li\u1ec1u khuy\u1ebfn c\u00e1o.<\/p>\n<p>Minocycline, m\u1ed9t d\u1eabn xu\u1ea5t c\u1ee7a tetracycline, \u0111\u00e3 \u0111\u01b0\u1ee3c \u201ct\u00e1i kh\u00e1m ph\u00e1\u201d nh\u01b0 m\u1ed9t t\u00e1c nh\u00e2n c\u00f3 ho\u1ea1t t\u00ednh in vitro ch\u1ed1ng l\u1ea1i h\u1ea7u h\u1ebft c\u00e1c ch\u1ee7ng <em>A. baumannii<\/em> kh\u00e1ng carbapenem. Minocyclin kh\u00f4ng hi\u1ec7u qu\u1ea3 tr\u00ean CRE b\u1eb1ng tigecycline v\u00e0 kh\u00f4ng c\u00f3 ho\u1ea1t t\u00ednh ch\u1ed1ng l\u1ea1i <em>P. aeruginosa<\/em>. D\u1eef li\u1ec7u l\u00e2m s\u00e0ng v\u1ec1 hi\u1ec7u qu\u1ea3 c\u1ee7a thu\u1ed1c \u0111\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m <em>A. baumannii<\/em> kh\u00e1ng carbapenem hi\u1ec7n ch\u1ec9 gi\u1edbi h\u1ea1n trong c\u00e1c b\u00e1o cao ca.<\/p>\n<p><strong>C\u00e1c<\/strong><strong> kh\u00e1ng sinh m\u1edbi<\/strong><\/p>\n<p>G\u1ea7n \u0111\u00e2y h\u01a1n, ceftazidime-avibactam v\u00e0 meropenem-vaborbactam \u0111\u1ed1i v\u1edbi CRE v\u00e0 ceftolozane-tazobactam \u0111\u1ed1i v\u1edbi nhi\u1ec5m <em>P. aeruginosa <\/em>kh\u00e1ng carbapenem \u0111\u00e3 tr\u1edf th\u00e0nh c\u00e1c l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb quan tr\u1ecdng \u1edf c\u00e1c qu\u1ed1c gia n\u01a1i c\u00e1c thu\u1ed1c n\u00e0y \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong l\u00e2m s\u00e0ng. H\u01a1n n\u1eefa, m\u1ed9t s\u1ed1 t\u00e1c nh\u00e2n m\u1edbi kh\u00e1c \u0111ang \u0111\u1ea1t \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n v\u00e0 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng \u1edf c\u00e1c pha sau (B\u1ea3ng 1).<\/p>\n<p>Tuy nhi\u00ean, nh\u1eefng kh\u00e1ng sinh m\u1edbi \u0111\u1eb7t ra nhi\u1ec1u th\u00e1ch th\u1ee9c trong vi\u1ec7c qu\u1ea3n l\u00fd kh\u00e1ng sinh.<\/p>\n<ul>\n<li>Kh\u00f4ng \u0111\u1ee7 d\u1eef li\u1ec7u l\u00e2m s\u00e0ng ch\u1ea5t l\u01b0\u1ee3ng cao \u0111\u1ec3 h\u01b0\u1edbng d\u1eabn vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh cho nh\u00f3m b\u1ec7nh nh\u00e2n m\u1ee5c ti\u00eau<\/li>\n<\/ul>\n<p>C\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng \u0111\u0103ng k\u00ed thu\u1ed1c th\u01b0\u1eddng kh\u00f4ng tr\u1ef1c ti\u1ebfp tr\u00ean c\u00e1c t\u00e1c nh\u00e2n \u0111\u1ec1 kh\u00e1ng carbapenem.. M\u1eb7c d\u00f9 ng\u00e0y c\u00e0ng c\u00f3 nhi\u1ec1u th\u1eed nghi\u1ec7m tr\u00ean c\u00e1c tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m vi khu\u1ea9n Gram \u00e2m kh\u00e1ng carbapenem \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u0111\u1ec3 ch\u1ee9ng minh v\u00e0 xin \u0111\u01b0\u1ee3c c\u1ea5p ph\u00e9p l\u01b0u h\u00e0nh, nh\u1eefng nghi\u00ean c\u1ee9u n\u00e0y kh\u00f4ng \u0111\u1ee7 m\u1ea1nh \u0111\u1ec3 cho ph\u00e9p suy lu\u1eadn th\u1ed1ng k\u00ea v\u1ec1 t\u00ednh \u01b0u vi\u1ec7t c\u1ee7a thu\u1ed1c nghi\u00ean c\u1ee9u so v\u1edbi c\u00e1c thu\u1ed1c so s\u00e1nh. Do \u0111\u00f3 kinh nghi\u1ec7m l\u00e2m s\u00e0ng sau khi thu\u1ed1c ra th\u1ecb tr\u01b0\u1eddng c\u00f3 th\u1ec3 s\u1ebd \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c l\u1ef1a ch\u1ecdn c\u00e1c kh\u00e1ng sinh m\u1edbi m\u1ed9t c\u00e1ch th\u00edch h\u1ee3p.<\/p>\n<ul>\n<li>Thi\u1ebfu c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111\u00e1nh gi\u00e1 t\u00ednh nh\u1ea1y c\u1ea3m c\u1ee7a kh\u00e1ng sinh \u0111\u01b0\u1ee3c ph\u00ea chu\u1ea9n<\/li>\n<\/ul>\n<p>C\u00e1c \u0111i\u1ec3m g\u00e3y (clinical breakpoint) v\u00e0 ph\u01b0\u01a1ng ph\u00e1p x\u00e1c \u0111\u1ecbnh nh\u1ea1y c\u1ea3m tr\u00ean kh\u00e1ng sinh \u0111\u1ed3 ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh cho c\u00e1c thu\u1ed1c m\u1edbi. Do \u0111\u00f3, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng m\u1ed9t thu\u1ed1c m\u1edbi kh\u00f4ng c\u00f3 ho\u1ea1t t\u00ednh tr\u00ean in vitro, v\u00e0 d\u1eabn \u0111\u1ebfn nguy c\u01a1 th\u1ea5t b\u1ea1i trong \u0111i\u1ec1u tr\u1ecb.<\/p>\n<ul>\n<li>\u0110\u1ed9 ph\u1ee9c t\u1ea1p c\u1ee7a ph\u1ed5 kh\u00e1ng khu\u1ea9n c\u1ee7a m\u1ed7i lo\u1ea1i kh\u00e1ng sinh<\/li>\n<\/ul>\n<p>Ngo\u1ea1i tr\u1eeb t\u00e1c \u0111\u1ed9ng chung tr\u00ean vi khu\u1ea9n ti\u1ebft KPC, m\u1ed7i thu\u1ed1c c\u00f3 th\u1ec3 c\u00f3 ph\u1ed5 kh\u00e1c nhau. V\u00ed d\u1ee5, ceftazidime-avibactam c\u00f3 ho\u1ea1t t\u00ednh ch\u1ed1ng l\u1ea1i vi khu\u1ea9n s\u1ea3n xu\u1ea5t OXA-48 carbapenemase trong khi meropenem-vaborbactam v\u00e0 imipenem-relebactam kh\u00f4ng c\u00f3 ho\u1ea1t t\u00ednh.<\/p>\n<ul>\n<li>Chi ph\u00ed cao<\/li>\n<\/ul>\n<p>Chi ph\u00ed c\u1ee7a c\u00e1c thu\u1ed1c m\u1edbi s\u1ebd cao h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi c\u00e1c thu\u1ed1c \u0111\u00e3 c\u00f3 tr\u00ean th\u1ecb tr\u01b0\u1eddng v\u00e0 \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 s\u1ebd h\u1ea1n ch\u1ebf vi\u1ec7c s\u1eed d\u1ee5ng theo kinh nghi\u1ec7m trong h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p tr\u1eeb khi kh\u1ea3 n\u0103ng l\u00e2y nhi\u1ec5m t\u1eeb m\u1ea7m b\u1ec7nh kh\u00e1ng carbapenem l\u00e0 cao v\u00e0 t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng c\u1ea7n thi\u1ebft b\u1eaft bu\u1ed9c d\u00f9ng thu\u1ed1c.<\/p>\n<p>Do \u0111\u00f3 vai tr\u00f2 c\u1ee7a nh\u00e2n vi\u00ean y t\u1ebf bao g\u1ed3m b\u00e1c s\u0129 v\u00e0 d\u01b0\u1ee3c s\u0129 l\u00e2m s\u00e0ng r\u1ea5t c\u1ea7n thi\u1ebft \u0111\u1ec3 tham gia v\u00e0o qu\u1ea3n l\u00fd kh\u00e1ng sinh m\u1edbi, \u0111\u1ea3m b\u1ea3o l\u1ef1a ch\u1ecdn \u0111\u01b0\u1ee3c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u1ed1i \u01b0u v\u1ec1 hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n.<\/p>\n<p>\u00a0<\/p>\n<p><em>B\u1ea3ng 1: Ho\u1ea1t \u0111\u1ed9ng v\u00e0 ch\u1ec9 \u0111\u1ecbnh c\u1ee7a t\u00e1c nh\u00e2n m\u1edbi ch\u1ed1ng l\u1ea1i m\u1ea7m b\u1ec7nh Gram \u00e2m kh\u00e1ng Carbapenem<\/em><\/p>\n<table style=\"width: 737px;\" border=\"1\" cellspacing=\"0\" cellpadding=\"0\">\n<thead>\n<tr>\n<td valign=\"top\" width=\"87\">\n<p><span style=\"font-size: x-small;\">\u00a0<\/span><\/p>\n<\/td>\n<td colspan=\"9\" valign=\"top\" width=\"650\">\n<p align=\"center\"><span style=\"font-size: x-small;\">Ho\u1ea1t t\u00ednh<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"87\">\n<p><span style=\"font-size: x-small;\">\u00a0<\/span><\/p>\n<\/td>\n<td colspan=\"4\" valign=\"top\" width=\"288\">\n<p><span style=\"font-size: x-small;\">Enterobacteriaceae<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"78\">\n<p><span style=\"font-size: x-small;\">\u00a0<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"66\">\n<p><span style=\"font-size: x-small;\">\u00a0<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"73\">\n<p><span style=\"font-size: x-small;\">\u00a0<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"78\">\n<p><span style=\"font-size: x-small;\">\u00a0<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"66\">\n<p><span style=\"font-size: x-small;\">\u00a0<\/span><\/p>\n<\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td valign=\"top\" width=\"87\">\n<p><span style=\"font-size: x-small;\">Thu\u1ed1c<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">Class A Carbapenemase (KPC)<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">Class B<\/span><\/p>\n<p><span style=\"font-size: x-small;\">Carbapenemase (NDM)<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">Class D<\/span><\/p>\n<p><span style=\"font-size: x-small;\">Carbapenemase (OXA-48)<\/span><\/p>\n<\/td>\n<td colspan=\"2\" valign=\"top\" width=\"78\">\n<p><span style=\"font-size: x-small;\"><em>P. aeruginosa<\/em><\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"66\">\n<p><span style=\"font-size: x-small;\"><em>A. baumannii<\/em><\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"73\">\n<p><span style=\"font-size: x-small;\"><em>S. maltophilia<\/em><\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"78\">\n<p><span style=\"font-size: x-small;\">Ch\u1ec9 \u0111\u1ecbnh<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"66\">\n<p><span style=\"font-size: x-small;\">C\u00f3 nghi\u00ean c\u1ee9u th\u1eed nghi\u1ec7m<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"87\">\n<p><span style=\"font-size: x-small;\">Ceftazidime- avibactam<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td colspan=\"2\" valign=\"top\" width=\"78\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"66\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"73\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"78\">\n<p><span style=\"font-size: x-small;\">cNTT\/ VTBTC, cNTTH, VPBV\/ VPTM<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"66\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"87\">\n<p><span style=\"font-size: x-small;\">Ceftolozane<\/span><\/p>\n<p><span style=\"font-size: x-small;\">-tazobactam<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td colspan=\"2\" valign=\"top\" width=\"78\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"66\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"73\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"78\">\n<p><span style=\"font-size: x-small;\">cNTT\/ VTBTC, cNTTH, VPC\u0110<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"66\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"87\">\n<p><span style=\"font-size: x-small;\">Meropenem<\/span><\/p>\n<p><span style=\"font-size: x-small;\">-vaborbactam<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td colspan=\"2\" valign=\"top\" width=\"78\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<sup>a<\/sup><\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"66\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"73\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"78\">\n<p><span style=\"font-size: x-small;\">cNTT\/ VTBTC<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"66\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"87\">\n<p><span style=\"font-size: x-small;\">Imipenem<\/span><\/p>\n<p><span style=\"font-size: x-small;\">-cilastatin- relebactam<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td colspan=\"2\" valign=\"top\" width=\"78\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"66\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"73\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"78\">\n<p><span style=\"font-size: x-small;\">cNTT\/ VTBTC, cNTTH, VPBV\/ VPTM<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"66\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"87\">\n<p><span style=\"font-size: x-small;\">Cefiderocol<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td colspan=\"2\" valign=\"top\" width=\"78\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"66\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"73\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"78\">\n<p><span style=\"font-size: x-small;\">cNTT\/ VTBTC, VPBV\/ VPTM<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"66\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"87\">\n<p><span style=\"font-size: x-small;\">Plazomicin<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">Thay \u0111\u1ed5i<sup>b<\/sup><\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td colspan=\"2\" valign=\"top\" width=\"78\">\n<p><span style=\"font-size: x-small;\">Thay \u0111\u1ed5i<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"66\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"73\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"78\">\n<p><span style=\"font-size: x-small;\">cNTT\/ VTBTC<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"66\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"87\">\n<p><span style=\"font-size: x-small;\">Eravacyclin\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td colspan=\"2\" valign=\"top\" width=\"78\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"66\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"73\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"78\">\n<p><span style=\"font-size: x-small;\">cNTTH<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"66\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng\u00a0\u00a0\u00a0\u00a0<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"87\">\n<p><span style=\"font-size: x-small;\">Fosfomycin (ti\u00eam)<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"96\">\n<p><span style=\"font-size: x-small;\">C\u00f3<\/span><\/p>\n<\/td>\n<td colspan=\"2\" valign=\"top\" width=\"78\">\n<p><span style=\"font-size: x-small;\">Thay \u0111\u1ed5i<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"66\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"73\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"78\">\n<p><span style=\"font-size: x-small;\">cNTT\/ VTBTC<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"66\">\n<p><span style=\"font-size: x-small;\">Kh\u00f4ng<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"87\"><span style=\"font-size: x-small;\">\u00a0<\/span><\/td>\n<td width=\"96\"><span style=\"font-size: x-small;\">\u00a0<\/span><\/td>\n<td width=\"96\"><span style=\"font-size: x-small;\">\u00a0<\/span><\/td>\n<td width=\"96\"><span style=\"font-size: x-small;\">\u00a0<\/span><\/td>\n<td width=\"0\"><span style=\"font-size: x-small;\">\u00a0<\/span><\/td>\n<td width=\"78\"><span style=\"font-size: x-small;\">\u00a0<\/span><\/td>\n<td width=\"66\"><span style=\"font-size: x-small;\">\u00a0<\/span><\/td>\n<td width=\"73\"><span style=\"font-size: x-small;\">\u00a0<\/span><\/td>\n<td width=\"78\"><span style=\"font-size: x-small;\">\u00a0<\/span><\/td>\n<td width=\"66\"><span style=\"font-size: x-small;\">\u00a0<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>C\u00e1c t\u1eeb vi\u1ebft t\u1eaft: KPC: <em>Klebsiella pneumoniae<\/em> carbapenemase; NDM: New Delhi metallo-\u03b2-lactamase; NP: nosocomial pneumonia (VP c\u1ed9ng \u0111\u1ed3ng); OXA: oxacillinase<\/p>\n<p>VTBTC: vi\u00eam th\u1eadn b\u1ec3 th\u1eadn c\u1ea5p; cNTTH: nhi\u1ec5m tr\u00f9ng ti\u00eau ho\u00e1 c\u00f3 bi\u1ebfn ch\u1ee9ng; cNTT: nhi\u1ec5m tr\u00f9ng ti\u1ec3u c\u00f3 bi\u1ebfn ch\u1ee9ng; VPBV: vi\u00eam ph\u1ed5i b\u1ec7nh vi\u1ec7n; VPTM: vi\u00eam ph\u1ed5i th\u1edf m\u00e1y; VPC\u0110: vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng<\/p>\n<p><sup>a<\/sup>T\u00e1c d\u1ee5ng kh\u00f4ng v\u01b0\u1ee3t tr\u1ed9i so v\u1edbi meropenem \u0111\u01a1n \u0111\u1ed9c.<\/p>\n<p><sup>b<\/sup>Th\u01b0\u1eddng kh\u00f4ng c\u00f3 ho\u1ea1t t\u00ednh ch\u1ed1ng l\u1ea1i c\u00e1c ch\u1ee7ng ti\u1ebft metallo-\u03b2-lactamase lo\u1ea1i NDM.<\/p>\n<p><strong>K\u1ebeT LU\u1eacN<\/strong><\/p>\n<p>C\u00e1c m\u1ea7m b\u1ec7nh Gram \u00e2m kh\u00e1ng carbapenem \u0111\u00e3 tr\u1edf th\u00e0nh g\u00e1nh n\u1eb7ng ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe l\u1edbn trong th\u1ebf k\u1ef7 21, v\u00e0 c\u00e1c l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb b\u1ecb gi\u1edbi h\u1ea1n \u1edf c\u00e1c thu\u1ed1c c\u0169 nh\u01b0 colistin v\u00e0 tigecycline k\u1ebft h\u1ee3p v\u1edbi c\u00e1c kh\u00e1ng sinh kh\u00e1c. G\u1ea7n \u0111\u00e2y, m\u1ed9t s\u1ed1 t\u00e1c nh\u00e2n m\u1edbi c\u00f3 ho\u1ea1t t\u00ednh ch\u1ed1ng l\u1ea1i c\u00e1c m\u1ea7m b\u1ec7nh kh\u00e1ng carbapenem \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t ho\u1eb7c \u0111ang trong giai \u0111o\u1ea1n sau c\u1ee7a ph\u00e1t tri\u1ec3n l\u00e2m s\u00e0ng. Nh\u1eefng t\u00e1c nh\u00e2n m\u1edbi h\u01a1n n\u00e0y s\u1ebd tr\u1edf th\u00e0nh nh\u1eefng l\u1ef1a ch\u1ecdn quan tr\u1ecdng v\u00e0 \u0111\u01b0\u1ee3c k\u1ef3 v\u1ecdng s\u1ebd c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nhi\u1ec5m vi khu\u1ea9n kh\u00e1ng carbapenem. V\u00ec m\u1ed7i t\u00e1c nh\u00e2n m\u1edbi \u0111\u1ec1u c\u00f3 nh\u1eefng \u0111i\u1ec3m m\u1ea1nh v\u00e0 l\u01b0u \u00fd ri\u00eang, n\u00ean vi\u1ec7c qu\u1ea3n l\u00fd kh\u00e1ng khu\u1ea9n s\u1ebd \u0111\u00f3ng m\u1ed9t vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c \u0111\u1ea3m b\u1ea3o s\u1eed d\u1ee5ng h\u1ee3p l\u00fd v\u00e0 t\u1ed1i \u01b0u thu\u1ed1c.<\/p>\n<p>(L\u01b0\u1ee3c d\u1ecbch t\u1eeb: Doi Y. 2019. Treatment Options for Carbapenem-resistant Gram- negative Bacterial Infections. Clinical Infectious Diseases;69(S7):S565-75)<\/p>\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6853760\/\">Treatment Options for Carbapenem-resistant Gram-negative Bacterial Infections<\/a> <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6853760\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6853760\/<\/a><\/p>\n<p>\u00a0<\/p>","protected":false},"excerpt":{"rendered":"<p><strong>\u00a0<\/strong><\/p>\n<p align=\"center\"><span style=\"font-size: xx-large; color: #800000;\"><strong>VI<\/strong><strong> KHU\u1ea8N \u0110\u1ec0 KH\u00c1NG CARBAPENEM <br \/> V\u00c0 <\/strong><strong>C\u00c1C<\/strong><strong> L\u1ef0A CH\u1eccN \u0110I\u1ec0U TR\u1eca<\/strong><\/span><\/p>","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[16,7,9],"tags":[],"class_list":["post-5675","post","type-post","status-publish","format-standard","hentry","category-thong-tin-duoc","category-tin-tuc","category-tin-tuc-nganh"],"blocksy_meta":[],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v20.9 (Yoast SEO v20.9) - 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