{"id":160673,"date":"2026-07-24T15:35:04","date_gmt":"2026-07-24T08:35:04","guid":{"rendered":"https:\/\/vnras.com\/drug\/?p=160673"},"modified":"2026-07-24T15:35:04","modified_gmt":"2026-07-24T08:35:04","slug":"huong-dan-chan-doan-va-dieu-tri-viem-phoi-mac-phai-cong-dong-o-nguoi-lon","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/huong-dan-chan-doan-va-dieu-tri-viem-phoi-mac-phai-cong-dong-o-nguoi-lon\/","title":{"rendered":"H\u01af\u1edaNG D\u1eaaN CH\u1ea8N \u0110O\u00c1N V\u00c0 \u0110I\u1ec0U TR\u1eca VI\u00caM PH\u1ed4I M\u1eaeC PH\u1ea2I C\u1ed8NG \u0110\u1ed2NG \u1ede NG\u01af\u1edcI L\u1edaN N\u0102M 2026"},"content":{"rendered":"<table style=\"border-collapse: collapse; width: 100%;\">\n<tbody>\n<tr>\n<td style=\"width: 35.8223%; text-align: center;\"><strong>B\u1ed8 Y T\u1ebe<\/strong><\/p>\n<p>S\u1ed1: 2147\/Q\u0110-BYT<\/td>\n<td style=\"width: 64.1777%; text-align: center;\"><strong>C\u1ed8NG HO\u00c0 X\u00c3 H\u1ed8I CH\u1ee6 NGH\u0128A VI\u1ec6T NAM<\/strong><\/p>\n<p><strong>\u0110\u1ed9c l\u1eadp &#8211; T\u1ef1 do &#8211; H\u1ea1nh ph\u00fac<\/strong><\/p>\n<p><em>H\u00e0 N\u1ed9i, ng\u00e0y 15 th\u00e1ng 7 n\u0103m 2026<\/em><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: center;\"><strong>QUY\u1ebeT \u0110\u1ecaNH<\/strong><\/p>\n<p style=\"text-align: center;\"><strong>V\u1ec1 vi\u1ec7c ban h\u00e0nh t\u00e0i li\u1ec7u chuy\u00ean m\u00f4n \u201cH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng \u1edf ng\u01b0\u1eddi l\u1edbn\u201d<\/strong><\/p>\n<p style=\"text-align: center;\"><strong>B\u1ed8 TR\u01af\u1edeNG B\u1ed8 Y T\u1ebe<\/strong><\/p>\n<p style=\"text-align: justify;\"><em>C\u0103n c\u1ee9 Lu\u1eadt Kh\u00e1m b\u1ec7nh, ch\u1eefa b\u1ec7nh n\u0103m 2023;<\/em><\/p>\n<p style=\"text-align: justify;\"><em>C\u0103n c\u1ee9 Ngh\u1ecb \u0111\u1ecbnh s\u1ed1 42\/2025\/N\u0110-CP ng\u00e0y 27 th\u00e1ng 02 n\u0103m 2025 c\u1ee7a Ch\u00ednh ph\u1ee7 quy \u0111\u1ecbnh ch\u1ee9c n\u0103ng, nhi\u1ec7m v\u1ee5, quy\u1ec1n h\u1ea1n v\u00e0 c\u01a1 c\u1ea5u t\u1ed5 ch\u1ee9c c\u1ee7a B\u1ed9 Y t\u1ebf;<\/em><\/p>\n<p style=\"text-align: justify;\"><em>Theo \u0111\u1ec1 ngh\u1ecb c\u1ee7a C\u1ee5c tr\u01b0\u1edfng C\u1ee5c Qu\u1ea3n l\u00fd kh\u00e1m, ch\u1eefa b\u1ec7nh.<\/em><\/p>\n<p style=\"text-align: justify;\"><strong>QUY\u1ebeT \u0110\u1ecaNH:<\/strong><\/p>\n<p style=\"text-align: justify;\"><strong>\u0110i\u1ec1u 1.<\/strong> Ban h\u00e0nh k\u00e8m theo Quy\u1ebft \u0111\u1ecbnh n\u00e0y t\u00e0i li\u1ec7u chuy\u00ean m\u00f4n \u201cH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng \u1edf ng\u01b0\u1eddi l\u1edbn\u201d.<\/p>\n<p style=\"text-align: justify;\"><strong>\u0110i\u1ec1u 2.<\/strong> T\u00e0i li\u1ec7u chuy\u00ean m\u00f4n \u201cH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng \u1edf ng\u01b0\u1eddi l\u1edbn\u201d \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng t\u1ea1i c\u00e1c c\u01a1 s\u1edf kh\u00e1m b\u1ec7nh, ch\u1eefa b\u1ec7nh trong c\u1ea3 n\u01b0\u1edbc.<\/p>\n<p style=\"text-align: justify;\"><strong>\u0110i\u1ec1u 3.<\/strong> Quy\u1ebft \u0111\u1ecbnh n\u00e0y c\u00f3 hi\u1ec7u l\u1ef1c k\u1ec3 t\u1eeb ng\u00e0y k\u00fd, ban h\u00e0nh v\u00e0 thay th\u1ebf Quy\u1ebft \u0111\u1ecbnh s\u1ed1 4815\/Q\u0110-BYT ng\u00e0y 20 th\u00e1ng 11 n\u0103m 2020 c\u1ee7a B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf v\u1ec1 vi\u1ec7c ban h\u00e0nh t\u00e0i li\u1ec7u chuy\u00ean m\u00f4n \u201cH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng \u1edf ng\u01b0\u1eddi l\u1edbn\u201d.<\/p>\n<p style=\"text-align: justify;\"><strong>\u0110i\u1ec1u 4.<\/strong> C\u00e1c \u00f4ng, b\u00e0: Ch\u00e1nh V\u0103n ph\u00f2ng B\u1ed9, C\u1ee5c tr\u01b0\u1edfng v\u00e0 V\u1ee5 tr\u01b0\u1edfng c\u00e1c C\u1ee5c, V\u1ee5 thu\u1ed9c B\u1ed9 Y t\u1ebf, Gi\u00e1m \u0111\u1ed1c S\u1edf Y t\u1ebf c\u00e1c t\u1ec9nh, th\u00e0nh ph\u1ed1 tr\u1ef1c thu\u1ed9c trung \u01b0\u01a1ng, Gi\u00e1m \u0111\u1ed1c c\u00e1c B\u1ec7nh vi\u1ec7n tr\u1ef1c thu\u1ed9c B\u1ed9 Y t\u1ebf, Th\u1ee7 tr\u01b0\u1edfng Y t\u1ebf c\u00e1c ng\u00e0nh ch\u1ecbu tr\u00e1ch nhi\u1ec7m thi h\u00e0nh Quy\u1ebft \u0111\u1ecbnh n\u00e0y.\/.<\/p>\n<table style=\"width: 100%; border-collapse: collapse; border-color: #ffffff; background-color: #ffffff;\">\n<tbody>\n<tr>\n<td style=\"width: 50%;\"><em><strong><span style=\"font-size: 10px;\">N\u01a1i nh\u1eadn:<\/span><\/strong><\/em><\/p>\n<p><span style=\"font-size: 10px;\">&#8211; Nh\u01b0 \u0110i\u1ec1u 4;<\/span><\/p>\n<p><span style=\"font-size: 10px;\">&#8211; B\u1ed9 tr\u01b0\u1edfng (\u0111\u1ec3 b\/c);<\/span><\/p>\n<p><span style=\"font-size: 10px;\">&#8211; C\u00e1c Th\u1ee9 tr\u01b0\u1edfng;<\/span><\/p>\n<p><span style=\"font-size: 10px;\">&#8211; H\u1ed9i H\u00f4 h\u1ea5p Vi\u1ec7t Nam;<\/span><\/p>\n<p><span style=\"font-size: 10px;\">&#8211; C\u1ed5ng th\u00f4ng tin \u0111i\u1ec7n t\u1eed B\u1ed9 Y t\u1ebf; Website C\u1ee5c KCB;<\/span><\/p>\n<p><span style=\"font-size: 10px;\">&#8211; L\u01b0u: VT, KCB.<\/span><\/td>\n<td style=\"width: 50%;\">\n<p style=\"text-align: center;\"><strong>KT. B\u1ed8 TR\u01af\u1edeNG<\/strong><\/p>\n<p style=\"text-align: center;\"><strong>TH\u1ee8 TR\u01af\u1edeNG<\/strong><\/p>\n<p style=\"text-align: center;\"><strong>Tr\u1ea7n V\u0103n Thu\u1ea5n<\/strong><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: center;\"><strong>H\u01af\u1edaNG D\u1eaaN CH\u1ea8N \u0110O\u00c1N V\u00c0 \u0110I\u1ec0U TR\u1eca VI\u00caM PH\u1ed4I M\u1eaeC PH\u1ea2I C\u1ed8NG \u0110\u1ed2NG \u1ede NG\u01af\u1edcI L\u1edaN<\/strong><\/p>\n<p style=\"text-align: center;\"><em>(Ban h\u00e0nh k\u00e8m theo Quy\u1ebft \u0111\u1ecbnh s\u1ed1 2147\/Q\u0110-BYT ng\u00e0y 15 th\u00e1ng 7 n\u0103m 2026 c\u1ee7a B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf)<\/em><\/p>\n<p style=\"text-align: justify;\"><strong>CH\u1ec8 \u0110\u1ea0O BI\u00caN SO\u1ea0N<\/strong><\/p>\n<p style=\"text-align: justify;\">GS.TS. Tr\u1ea7n V\u0103n Thu\u1ea5n \u2013 Th\u1ee9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf, Ch\u1ee7 t\u1ecbch H\u1ed9i \u0111\u1ed3ng Y khoa Qu\u1ed1c gia<\/p>\n<p style=\"text-align: justify;\">TS. H\u00e0 Anh \u0110\u1ee9c \u2013 Ph\u00f3 Ch\u1ee7 t\u1ecbch H\u1ed9i \u0111\u1ed3ng Y khoa Qu\u1ed1c gia, C\u1ee5c tr\u01b0\u1edfng C\u1ee5c Qu\u1ea3n l\u00fd Kh\u00e1m, ch\u1eefa b\u1ec7nh (QLKCB), B\u1ed9 Y t\u1ebf.<\/p>\n<p style=\"text-align: justify;\"><strong>CH\u1ee6 BI\u00caN<\/strong><\/p>\n<p style=\"text-align: justify;\">GS.TS. Ng\u00f4 Qu\u00fd Ch\u00e2u &#8211; Ch\u1ee7 t\u1ecbch H\u1ed9i H\u00f4 H\u1ea5p Vi\u1ec7t Nam<\/p>\n<p style=\"text-align: justify;\">PGS.TS. Nguy\u1ec5n Vi\u1ebft Nhung \u2013 Ph\u00f3 Ch\u1ee7 t\u1ecbch T\u1ed5ng H\u1ed9i Y h\u1ecdc Vi\u1ec7t Nam<\/p>\n<p style=\"text-align: justify;\">TS. Nguy\u1ec5n Tr\u1ecdng Khoa \u2013 Ph\u00f3 C\u1ee5c tr\u01b0\u1edfng C\u1ee5c QLKCB, B\u1ed9 Y t\u1ebf.<\/p>\n<p style=\"text-align: justify;\"><strong>THAM GIA BI\u00caN SO\u1ea0N V\u00c0 TH\u1ea8M \u0110\u1ecaNH<\/strong><\/p>\n<p style=\"text-align: justify;\">PGS.TS. Nguy\u1ec5n Ho\u00e0ng Anh \u2013 Ph\u00f3 Tr\u01b0\u1edfng khoa D\u01b0\u1ee3c, B\u1ec7nh vi\u1ec7n B\u1ea1ch Mai, Gi\u00e1m \u0111\u1ed1c Trung t\u00e2m theo d\u00f5i ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i c\u1ee7a thu\u1ed1c \u2013 Tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc D\u01b0\u1ee3c H\u00e0 N\u1ed9i<\/p>\n<p style=\"text-align: justify;\">PGS.TS. L\u00ea Kh\u1eafc B\u1ea3o \u2013 Ph\u00f3 Gi\u00e1m \u0111\u1ed1c B\u1ec7nh vi\u1ec7n \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c TP. H\u1ed3 Ch\u00ed Minh<\/p>\n<p style=\"text-align: justify;\">TS. \u0110\u00e0o Ng\u1ecdc B\u1eb1ng \u2013 Ch\u1ee7 nhi\u1ec7m Khoa B\u1ec7nh ph\u1ed5i, B\u1ec7nh vi\u1ec7n Qu\u00e2n y 103<\/p>\n<p style=\"text-align: justify;\">GS.TS. Ng\u00f4 Qu\u00fd Ch\u00e2u &#8211; Ch\u1ee7 t\u1ecbch H\u1ed9i H\u00f4 H\u1ea5p Vi\u1ec7t Nam<\/p>\n<p style=\"text-align: justify;\">TS. Ph\u1ea1m Minh Ch\u00e2u &#8211; Khoa Vi Sinh \u2013 B\u1ec7nh vi\u1ec7n \u0110\u1ea1i h\u1ecdc Y H\u00e0 N\u1ed9i<\/p>\n<p style=\"text-align: justify;\">PGS.TS. L\u00ea Ti\u1ebfn D\u0169ng \u2013 Ph\u00f3 Ch\u1ee7 t\u1ecbch H\u1ed9i H\u00f4 h\u1ea5p TP. H\u1ed3 Ch\u00ed Minh<\/p>\n<p style=\"text-align: justify;\">TS. Nguy\u1ec5n Quang \u0110\u1ee3i \u2013 Ph\u00f3 Tr\u01b0\u1edfng khoa H\u00f4 H\u1ea5p, B\u1ec7nh vi\u1ec7n \u0110a khoa T\u00e2m Anh<\/p>\n<p style=\"text-align: justify;\">ThS. Ho\u00e0ng Anh \u0110\u1ee9c &#8211; Vi\u1ec7n H\u00f4 h\u1ea5p B\u1ea1ch Mai, B\u1ec7nh vi\u1ec7n B\u1ea1ch Mai<\/p>\n<p style=\"text-align: justify;\">PGS.TS. V\u0169 V\u0103n Gi\u00e1p \u2013 Ph\u00f3 Gi\u00e1m \u0111\u1ed1c B\u1ec7nh vi\u1ec7n B\u1ea1ch Mai<\/p>\n<p style=\"text-align: justify;\">PGS.TS. Chu Th\u1ecb H\u1ea1nh \u2013 Ph\u00f3 Ch\u1ee7 t\u1ecbch H\u1ed9i H\u00f4 H\u1ea5p Vi\u1ec7t Nam, Tr\u01b0\u1edfng khoa H\u00f4 H\u1ea5p B\u1ec7nh vi\u1ec7n \u0110a khoa T\u00e2m Anh<\/p>\n<p style=\"text-align: justify;\">PGS.TS. L\u00ea Ho\u00e0n \u2013 Tr\u01b0\u1edfng khoa H\u00f4 h\u1ea5p, B\u1ec7nh vi\u1ec7n \u0110\u1ea1i h\u1ecdc Y H\u00e0 N\u1ed9i<\/p>\n<p style=\"text-align: justify;\">PGS.TS. Nguy\u1ec5n Thanh H\u1ed3i \u2013 Tr\u01b0\u1edfng khoa Y, Tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc Phenikaa<\/p>\n<p style=\"text-align: justify;\">TS. L\u00ea Qu\u1ed1c H\u00f9ng \u2013 Tr\u01b0\u1edfng khoa B\u1ec7nh nhi\u1ec7t \u0111\u1edbi, B\u1ec7nh vi\u1ec7n Ch\u1ee3 R\u1eaby<\/p>\n<p style=\"text-align: justify;\">TS. Nguy\u1ec5n Th\u1ecb Thanh Huy\u1ec1n \u2013 Ph\u00f3 Vi\u1ec7n tr\u01b0\u1edfng Vi\u1ec7n H\u00f4 H\u1ea5p B\u1ea1ch Mai, B\u1ec7nh vi\u1ec7n B\u1ea1ch Mai<\/p>\n<p style=\"text-align: justify;\">TS. L\u00ea Th\u1ecb Thu H\u01b0\u01a1ng \u2013 Tr\u01b0\u1edfng khoa N\u1ed9i H\u00f4 h\u1ea5p, B\u1ec7nh vi\u1ec7n Nh\u00e2n d\u00e2n Gia \u0110\u1ecbnh<\/p>\n<p style=\"text-align: justify;\">BSCKII. Tr\u1ea7n Th\u1ecb Thanh Nga &#8211; Gi\u00e1m \u0111\u1ed1c Trung t\u00e2m X\u00e9t nghi\u1ec7m, B\u1ec7nh vi\u1ec7n \u0110a khoa T\u00e2m Anh TP. H\u1ed3 Ch\u00ed Minh<\/p>\n<p style=\"text-align: justify;\">PGS.TS. Tr\u1ea7n V\u0103n Ng\u1ecdc \u2013 Ph\u00f3 Ch\u1ee7 t\u1ecbch H\u1ed9i Ph\u1ed5i Vi\u1ec7t Nam<\/p>\n<p style=\"text-align: justify;\">TS. Nguy\u1ec5n Th\u1ecb B\u00edch Ng\u1ecdc &#8211; Gi\u00e1m \u0111\u1ed1c Trung t\u00e2m \u0110i\u1ec1u tr\u1ecb b\u1ec7nh ph\u1ed5i hi\u1ebfm v\u00e0 c\u00e1c b\u1ec7nh nhi\u1ec5m khu\u1ea9n h\u00f4 h\u1ea5p, B\u1ec7nh vi\u1ec7n Ph\u1ed5i Trung \u01b0\u01a1ng<\/p>\n<p style=\"text-align: justify;\">ThS. Tr\u01b0\u01a1ng L\u00ea V\u00e2n Ng\u1ecdc &#8211; Tr\u01b0\u1edfng ph\u00f2ng Nghi\u1ec7p v\u1ee5 C\u1ee5c QLKCB, B\u1ed9 Y t\u1ebf<\/p>\n<p style=\"text-align: justify;\">PGS.TS. Ph\u1ea1m H\u1ed3ng Nhung \u2013 Ph\u00f3 Tr\u01b0\u1edfng khoa Vi sinh, B\u1ec7nh vi\u1ec7n B\u1ea1ch Mai<\/p>\n<p style=\"text-align: justify;\">PGS.TS. Nguy\u1ec5n Vi\u1ebft Nhung \u2013 Ph\u00f3 ch\u1ee7 t\u1ecbch T\u1ed5ng H\u1ed9i Y h\u1ecdc Vi\u1ec7t Nam<\/p>\n<p style=\"text-align: justify;\">TS. \u0110o\u00e0n Th\u1ecb Ph\u01b0\u01a1ng Lan \u2013 Ph\u00f3 Vi\u1ec7n tr\u01b0\u1edfng Vi\u1ec7n H\u00f4 h\u1ea5p B\u1ea1ch Mai, B\u1ec7nh vi\u1ec7n B\u1ea1ch Mai<\/p>\n<p style=\"text-align: justify;\">PGS.TS. L\u00ea Th\u1ecb Tuy\u1ebft Lan \u2013 Ph\u00f3 Ch\u1ee7 t\u1ecbch H\u1ed9i H\u00f4 h\u1ea5p Vi\u1ec7t Nam<\/p>\n<p style=\"text-align: justify;\">TS. Tr\u01b0\u01a1ng Th\u00e1i Ph\u01b0\u01a1ng \u2013 Ph\u00f3 Vi\u1ec7n tr\u01b0\u1edfng Vi\u1ec7n X\u00e9t nghi\u1ec7m, B\u1ec7nh vi\u1ec7n B\u1ea1ch Mai<\/p>\n<p style=\"text-align: justify;\">PGS.TS. Phan Thu Ph\u01b0\u01a1ng \u2013 Vi\u1ec7n tr\u01b0\u1edfng Vi\u1ec7n H\u00f4 h\u1ea5p B\u1ea1ch Mai, B\u1ec7nh vi\u1ec7n B\u1ea1ch Mai<\/p>\n<p style=\"text-align: justify;\">TS. Tr\u01b0\u01a1ng Thi\u00ean Ph\u00fa \u2013 Tr\u01b0\u1edfng khoa Vi sinh, B\u1ec7nh vi\u1ec7n Ch\u1ee3 R\u1eaby<\/p>\n<p style=\"text-align: justify;\">TS. Ph\u1ea1m Th\u1ecb L\u1ec7 Quy\u00ean \u2013 Ph\u00f3 Tr\u01b0\u1edfng khoa H\u00f4 H\u1ea5p B\u1ec7nh vi\u1ec7n \u0110a khoa T\u00e2m Anh<\/p>\n<p style=\"text-align: justify;\">TS. Nguy\u1ec5n V\u0103n Th\u00e0nh \u2013 Ph\u00f3 Ch\u1ee7 t\u1ecbch H\u1ed9i Ph\u1ed5i Vi\u1ec7t Nam<\/p>\n<p style=\"text-align: justify;\">TS. V\u0169 V\u0103n Th\u00e0nh \u2013 Tr\u01b0\u1edfng khoa B\u1ec7nh ph\u1ed5i m\u1ea1n t\u00ednh, B\u1ec7nh vi\u1ec7n Ph\u1ed5i Trung \u01b0\u01a1ng<\/p>\n<p style=\"text-align: justify;\">PGS.TS. Nguy\u1ec5n V\u0103n Th\u1ecd &#8211; Tr\u01b0\u1edfng B\u1ed9 m\u00f4n Lao &amp; B\u1ec7nh Ph\u1ed5i, Tr\u01b0\u1eddng Y, \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c TP. H\u1ed3 Ch\u00ed Minh<\/p>\n<p style=\"text-align: justify;\">TS. Nguy\u1ec5n Thanh Th\u1ee7y &#8211; B\u1ed9 m\u00f4n N\u1ed9i \u0110\u1ea1i h\u1ecdc Y H\u00e0 N\u1ed9i<\/p>\n<p style=\"text-align: justify;\">TS. Phan Thanh Th\u1ee7y &#8211; Vi\u1ec7n H\u00f4 h\u1ea5p B\u1ea1ch Mai, B\u1ec7nh vi\u1ec7n B\u1ea1ch Mai<\/p>\n<p style=\"text-align: justify;\">BSCKII. \u0110\u1eb7ng V\u0169 Th\u00f4ng \u2013 Tr\u01b0\u1edfng khoa N\u1ed9i Ph\u1ed5i, B\u1ec7nh vi\u1ec7n Ch\u1ee3 R\u1eaby<\/p>\n<p style=\"text-align: justify;\">PGS.TS. Nguy\u1ec5n \u0110\u00ecnh Ti\u1ebfn \u2013 Nguy\u00ean Tr\u01b0\u1edfng khoa H\u00f4 h\u1ea5p, B\u1ec7nh vi\u1ec7n Trung \u01b0\u01a1ng Qu\u00e2n \u0111\u1ed9i 108<\/p>\n<p style=\"text-align: justify;\">TS. \u0110o\u00e0n Thu Tr\u00e0 &#8211; Quy\u1ec1n Vi\u1ec7n tr\u01b0\u1edfng Vi\u1ec7n Y h\u1ecdc nhi\u1ec7t \u0111\u1edbi B\u1ea1ch Mai, B\u1ec7nh vi\u1ec7n B\u1ea1ch Mai<\/p>\n<p style=\"text-align: justify;\">TS. V\u0169 Th\u1ecb Thu Trang &#8211; B\u1ed9 m\u00f4n N\u1ed9i \u0110\u1ea1i h\u1ecdc Y H\u00e0 N\u1ed9i<\/p>\n<p style=\"text-align: justify;\">TS. Ph\u1ea1m H\u00f9ng V\u00e2n &#8211; Ch\u1ee7 t\u1ecbch H\u1ed9i Vi sinh l\u00e2m s\u00e0ng th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh<\/p>\n<p style=\"text-align: justify;\">PGS.TS. L\u00ea Th\u01b0\u1ee3ng V\u0169 \u2013 Tr\u01b0\u1edfng khoa H\u00f4 h\u1ea5p, B\u1ec7nh vi\u1ec7n \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c TP. H\u1ed3 Ch\u00ed Minh<\/p>\n<p style=\"text-align: justify;\"><strong>TH\u01af K\u00dd<\/strong><\/p>\n<p style=\"text-align: justify;\">ThS. \u0110\u1eb7ng Th\u00e0nh \u0110\u00f4 &#8211; Vi\u1ec7n H\u00f4 h\u1ea5p B\u1ea1ch Mai, B\u1ec7nh vi\u1ec7n B\u1ea1ch Mai<\/p>\n<p style=\"text-align: justify;\">ThS. Ho\u00e0ng Anh \u0110\u1ee9c &#8211; Vi\u1ec7n H\u00f4 h\u1ea5p B\u1ea1ch Mai, B\u1ec7nh vi\u1ec7n B\u1ea1ch Mai<\/p>\n<p style=\"text-align: justify;\">TS. Phan Thanh Th\u1ee7y &#8211; Vi\u1ec7n H\u00f4 h\u1ea5p B\u1ea1ch Mai, B\u1ec7nh vi\u1ec7n B\u1ea1ch Mai<\/p>\n<p style=\"text-align: justify;\">ThS. Tr\u01b0\u01a1ng L\u00ea V\u00e2n Ng\u1ecdc &#8211; Tr\u01b0\u1edfng ph\u00f2ng Nghi\u1ec7p v\u1ee5 C\u1ee5c QLKCB, B\u1ed9 Y t\u1ebf<\/p>\n<p style=\"text-align: justify;\">DS. \u0110\u1ed7 Th\u1ecb Ng\u00e1t &#8211; Chuy\u00ean vi\u00ean ph\u00f2ng Nghi\u1ec7p v\u1ee5, C\u1ee5c QLKCB, B\u1ed9 Y t\u1ebf<\/p>\n<p style=\"text-align: justify;\">CN. \u0110\u1ed7 Th\u1ecb Th\u01b0 &#8211; C\u1ee5c QLKCB, B\u1ed9 Y t\u1ebf.<\/p>\n<p style=\"text-align: center;\"><strong>L\u1edcI N\u00d3I \u0110\u1ea6U<\/strong><\/p>\n<p style=\"text-align: justify;\">Vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng (VPMPC\u0110) l\u00e0 b\u1ec7nh l\u00fd h\u00f4 h\u1ea5p th\u01b0\u1eddng g\u1eb7p, n\u1eb1m trong nh\u00f3m nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y b\u1ec7nh t\u1eadt v\u00e0 t\u1eed vong tr\u00ean to\u00e0n th\u1ebf gi\u1edbi. B\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng VPMPC\u0110 \u1edf nhi\u1ec1u m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau, t\u1eeb nh\u1eefng ca b\u1ec7nh nh\u1eb9 c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa \u0111\u1ebfn c\u00e1c ca b\u1ec7nh n\u1eb7ng v\u1edbi suy h\u00f4 h\u1ea5p, nhi\u1ec5m khu\u1ea9n huy\u1ebft, s\u1ed1c nhi\u1ec5m khu\u1ea9n, g\u00e2y t\u1eed vong.<\/p>\n<p style=\"text-align: justify;\">VPMPC\u0110 c\u00f3 nhi\u1ec1u tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng t\u01b0\u01a1ng \u0111\u1ed3ng v\u1edbi c\u00e1c b\u1ec7nh l\u00fd h\u00f4 h\u1ea5p kh\u00e1c n\u00ean b\u1ec7nh c\u1ea7n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi nhi\u1ec1u b\u1ec7nh l\u00fd h\u00f4 h\u1ea5p kh\u00e1c nhau. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n s\u1edbm v\u00e0 ch\u00ednh x\u00e1c gi\u00fap t\u0103ng hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb cho ng\u01b0\u1eddi b\u1ec7nh. M\u1eb7c d\u00f9 ng\u00e0y nay \u0111\u00e3 c\u00f3 nhi\u1ec1u ti\u1ebfn b\u1ed9 trong ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb VPMPC\u0110, nh\u01b0ng t\u1ef7 l\u1ec7 t\u1eed vong c\u00f2n cao.<\/p>\n<p style=\"text-align: justify;\">\u201cH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng \u1edf ng\u01b0\u1eddi l\u1edbn\u201d (B\u1ea3n c\u1eadp nh\u1eadt n\u0103m 2026) \u0111\u01b0\u1ee3c x\u00e2y d\u1ef1ng v\u1edbi s\u1ef1 t\u00e2m huy\u1ebft v\u00e0 n\u1ed7 l\u1ef1c c\u1ee7a c\u00e1c chuy\u00ean gia h\u00e0ng \u0111\u1ea7u c\u00f3 kinh nghi\u1ec7m v\u1ec1 qu\u1ea3n l\u00fd, l\u00e2m s\u00e0ng, gi\u1ea3ng d\u1ea1y c\u1ee7a c\u1ea3 3 mi\u1ec1n B\u1eafc, Trung, Nam.<\/p>\n<p style=\"text-align: justify;\">V\u1ec1 nguy\u00ean t\u1eafc \u00e1p d\u1ee5ng: C\u00e1c thu\u1ed1c, v\u1eafc xin, sinh ph\u1ea9m \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp trong H\u01b0\u1edbng d\u1eabn n\u00e0y ph\u1ea3i l\u00e0 thu\u1ed1c \u0111\u01b0\u1ee3c ph\u00e9p l\u01b0u h\u00e0nh t\u1ea1i Vi\u1ec7t Nam theo quy \u0111\u1ecbnh c\u1ee7a ph\u00e1p lu\u1eadt v\u1ec1 D\u01b0\u1ee3c. Vi\u1ec7c ch\u1ec9 \u0111\u1ecbnh, k\u00ea \u0111\u01a1n, s\u1eed d\u1ee5ng thu\u1ed1c ph\u1ea3i ph\u00f9 h\u1ee3p v\u1edbi ch\u1ec9 \u0111\u1ecbnh, li\u1ec1u d\u00f9ng, \u0111\u01b0\u1eddng d\u00f9ng, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 c\u00e1c n\u1ed9i dung kh\u00e1c \u0111\u01b0\u1ee3c B\u1ed9 Y t\u1ebf ph\u00ea duy\u1ec7t.<\/p>\n<p style=\"text-align: justify;\">C\u1ee5c Qu\u1ea3n l\u00fd Kh\u00e1m, ch\u1eefa b\u1ec7nh tr\u00e2n tr\u1ecdng c\u1ea3m \u01a1n s\u1ef1 \u0111\u00f3ng g\u00f3p c\u00f4ng s\u1ee9c v\u00e0 tr\u00ed tu\u1ec7 c\u1ee7a l\u00e3nh \u0111\u1ea1o c\u00e1c b\u1ec7nh vi\u1ec7n, c\u00e1c gi\u00e1o s\u01b0, ph\u00f3 gi\u00e1o s\u01b0, ti\u1ebfn s\u0129, b\u00e1c s\u0129 chuy\u00ean khoa \u0111\u00e3 tham gia g\u00f3p \u00fd cho t\u00e0i li\u1ec7u n\u00e0y. Trong qu\u00e1 tr\u00ecnh bi\u00ean t\u1eadp, in \u1ea5n t\u00e0i li\u1ec7u kh\u00f3 c\u00f3 th\u1ec3 tr\u00e1nh \u0111\u01b0\u1ee3c c\u00e1c sai s\u00f3t, ch\u00fang t\u00f4i r\u1ea5t mong nh\u1eadn \u0111\u01b0\u1ee3c s\u1ef1 \u0111\u00f3ng g\u00f3p t\u1eeb qu\u00fd \u0111\u1ed9c gi\u1ea3 v\u00e0 \u0111\u1ed3ng nghi\u1ec7p \u0111\u1ec3 t\u00e0i li\u1ec7u ng\u00e0y m\u1ed9t ho\u00e0n thi\u1ec7n h\u01a1n. M\u1ecdi \u00fd ki\u1ebfn g\u00f3p \u00fd xin g\u1eedi v\u1ec1 C\u1ee5c Qu\u1ea3n l\u00fd Kh\u00e1m, ch\u1eefa b\u1ec7nh \u2013 B\u1ed9 Y t\u1ebf, 138A Gi\u1ea3ng V\u00f5, ph\u01b0\u1eddng Gi\u1ea3ng V\u00f5, H\u00e0 N\u1ed9i.<\/p>\n<p style=\"text-align: justify;\">Tr\u00e2n tr\u1ecdng c\u1ea3m \u01a1n!<\/p>\n<h2 style=\"text-align: center;\">CH\u01af\u01a0NG 1. T\u1ed4NG QUAN VI\u00caM PH\u1ed4I M\u1eaeC PH\u1ea2I C\u1ed8NG \u0110\u1ed2NG<\/h2>\n<h3 style=\"text-align: justify;\">1.1. \u0110\u1ecbnh ngh\u0129a<\/h3>\n<p style=\"text-align: justify;\">Vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng (VPMPC\u0110) \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng ph\u1ed5i c\u1ea5p t\u00ednh x\u1ea3y ra \u1edf ng\u01b0\u1eddi \u0111ang s\u1ed1ng trong c\u1ed9ng \u0111\u1ed3ng [1]. Bi\u1ec3u hi\u1ec7n c\u1ee7a vi\u00eam ph\u1ed5i t\u1eeb nh\u1eb9 v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng s\u1ed1t, ho kh\u1ea1c \u0111\u1eddm \u0111\u1ebfn r\u1ea5t n\u1eb7ng nh\u01b0 suy h\u00f4 h\u1ea5p c\u1ea5p ti\u1ebfn tri\u1ec3n, nhi\u1ec5m khu\u1ea9n huy\u1ebft [2, 3].<\/p>\n<p style=\"text-align: justify;\">\u0110\u00e2y l\u00e0 b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. Trong h\u01b0\u1edbng d\u1eabn n\u00e0y ch\u00fang t\u00f4i ch\u1ec9 \u0111\u1ec1 c\u1eadp t\u1edbi vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng \u1edf ng\u01b0\u1eddi l\u1edbn.<\/p>\n<h3 style=\"text-align: justify;\">1.2. D\u1ecbch t\u1ec5 h\u1ecdc VPMPC\u0110<\/h3>\n<p style=\"text-align: justify;\">VPMPC\u0110 l\u00e0 m\u1ed9t b\u1ec7nh ph\u1ed5 bi\u1ebfn \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kho\u1ea3ng 450 tri\u1ec7u ng\u01b0\u1eddi m\u1ed7i n\u0103m v\u00e0 x\u1ea3y ra tr\u00ean to\u00e0n th\u1ebf gi\u1edbi. \u0110\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y ra 4 tri\u1ec7u ca t\u1eed vong h\u00e0ng n\u0103m (7% t\u1ed5ng s\u1ed1 t\u1eed vong tr\u00ean th\u1ebf gi\u1edbi) [4]. T\u1ef7 l\u1ec7 t\u1eed vong cao nh\u1ea5t \u1edf tr\u1ebb d\u01b0\u1edbi 5 tu\u1ed5i v\u00e0 ng\u01b0\u1eddi l\u1edbn tr\u00ean 75 tu\u1ed5i. Theo WHO (2015) vi\u00eam ph\u1ed5i l\u00e0 c\u0103n nguy\u00ean g\u00e2y t\u1eed vong \u0111\u1ee9ng h\u00e0ng th\u1ee9 3 sau \u0111\u1ed9t qu\u1ef5 v\u00e0 nh\u1ed3i m\u00e1u c\u01a1 tim. T\u1ef7 l\u1ec7 m\u1eafc VPMPC\u0110 \u1edf c\u00e1c n\u01b0\u1edbc \u0111ang ph\u00e1t tri\u1ec3n cao h\u01a1n g\u1ea5p 5 l\u1ea7n so v\u1edbi c\u00e1c n\u01b0\u1edbc ph\u00e1t tri\u1ec3n [5].<\/p>\n<p style=\"text-align: justify;\">N\u0103m 2005, vi\u00eam ph\u1ed5i v\u00e0 c\u00fam k\u1ebft h\u1ee3p l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u1eed vong ph\u1ed5 bi\u1ebfn th\u1ee9 8 \u1edf Hoa K\u1ef3 v\u00e0 l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u1eed vong ph\u1ed5 bi\u1ebfn th\u1ee9 b\u1ea3y \u1edf Canada [5]. T\u1ef7 l\u1ec7 t\u1eed vong do VPMPC\u0110 cao nh\u1ea5t trong nh\u00f3m c\u1ea7n nh\u1eadp vi\u1ec7n. T\u1ef7 l\u1ec7 t\u1eed vong c\u00f3 th\u1ec3 thay \u0111\u1ed5i t\u00f9y theo v\u1ecb tr\u00ed \u0111\u1ecba l\u00fd (Hoa K\u1ef3\/Canada 7,3%; Ch\u00e2u \u00c2u 9,1%; Ch\u00e2u M\u1ef9 Latinh 13,3%). Nh\u00ecn chung, t\u1ef7 l\u1ec7 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n \u1edf ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 kho\u1ea3ng 28% trong v\u00f2ng m\u1ed9t n\u0103m [6].<\/p>\n<p style=\"text-align: justify;\">\u1ede Vi\u1ec7t Nam, VPMPC\u0110 l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd nhi\u1ec5m khu\u1ea9n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong c\u00e1c b\u1ec7nh nhi\u1ec5m khu\u1ea9n tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, chi\u1ebfm 12% c\u00e1c b\u1ec7nh ph\u1ed5i. T\u1ea1i Trung t\u00e2m H\u00f4 H\u1ea5p, B\u1ec7nh vi\u1ec7n B\u1ea1ch Mai theo th\u1ed1ng k\u00ea t\u1eeb 1996-2000: vi\u00eam ph\u1ed5i chi\u1ebfm 9,57%, \u0111\u1ee9ng h\u00e0ng th\u1ee9 t\u01b0 sau: b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh, lao, ung th\u01b0 ph\u1ed5i [7]. N\u0103m 2014, t\u1ef7 l\u1ec7 m\u1eafc vi\u00eam ph\u1ed5i \u1edf n\u01b0\u1edbc ta l\u00e0 561\/100.000 ng\u01b0\u1eddi d\u00e2n, \u0111\u1ee9ng h\u00e0ng th\u1ee9 hai sau t\u0103ng huy\u1ebft \u00e1p, t\u1ef7 l\u1ec7 t\u1eed vong do vi\u00eam ph\u1ed5i l\u00e0 1,32\/100.000 ng\u01b0\u1eddi d\u00e2n, \u0111\u1ee9ng h\u00e0ng \u0111\u1ea7u trong c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y t\u1eed vong [8].<\/p>\n<h3 style=\"text-align: justify;\">1.3. Nguy\u00ean nh\u00e2n v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1<\/h3>\n<h4 style=\"text-align: justify;\">1.3.1. Nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p<\/h4>\n<p style=\"text-align: justify;\">Vi khu\u1ea9n Gram d\u01b0\u01a1ng: Streptococcus pneumoniae, methicillin susceptible Staphylococcus aureus, Streptococcus pyogenes, v\u00e0 c\u00e1c Streptococci kh\u00e1c. Vi khu\u1ea9n Gram \u00e2m: Haemophilus influenzae, Moraxella catarrhalis, Enterobacterales (v\u00ed d\u1ee5 Klebsiella pneumoniae). Vi khu\u1ea9n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh: Legionella pneumophila, Mycoplasma pneumoniae, Chlamydophila pneumoniae. C\u00e1c virus h\u00f4 h\u1ea5p: Influenza virus, SARS-CoV-2, respiratory syncytial virus, parainfluenza virus, human meta pneumovirus, rhinoviruses, common human coronaviruses [1].<\/p>\n<h4 style=\"text-align: justify;\">1.3.2. Nguy\u00ean nh\u00e2n \u00edt g\u1eb7p<\/h4>\n<p style=\"text-align: justify;\">Vi khu\u1ea9n Gram d\u01b0\u01a1ng: S. aureus kh\u00e1ng methicillin, Nocardia species, Rhodococcus equi. Vi khu\u1ea9n Gram \u00e2m: Enterobacterales, bao g\u1ed3m vi khu\u1ea9n ti\u1ebft beta-lactamases ph\u1ed5 r\u1ed9ng ho\u1eb7c Enterobacterales kh\u00e1ng carbapenem; c\u00e1c vi khu\u1ea9n kh\u00f4ng l\u00ean men (v\u00ed d\u1ee5 Pseudomonas ho\u1eb7c Acinetobacter); Francisella tularensis. Vi khu\u1ea9n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh: Chlamydia psittaci, Coxiella burnetii. Virus: Cytomegalovirus, Herpes simplex virus, Varicella zoster virus, MERS-CoV. N\u1ea5m: Pneumocystis jirovecii, Aspergillus spp.Mucorales, Histoplasma spp., Cryptococcusspp., Blastomyces spp., Coccidioides spp.. K\u00fd sinh tr\u00f9ng: Strongyloides stercoralis, Toxoplasma gondii [1].<\/p>\n<h4 style=\"text-align: justify;\">1.3.3. Y\u1ebfu t\u1ed1 nguy c\u01a1 v\u00e0 y\u1ebfu t\u1ed1 thu\u1eadn l\u1ee3i c\u1ee7a VPMPC\u0110 C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1:<\/h4>\n<p style=\"text-align: justify;\">C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 d\u1eabn \u0111\u1ebfn VPMPC\u0110 bao g\u1ed3m nh\u1eefng y\u1ebfu t\u1ed1 sau:[2, 9]\n<p style=\"text-align: justify;\">&#8211; Tu\u1ed5i cao: nguy c\u01a1 m\u1eafc VPMPC\u0110 t\u0103ng theo tu\u1ed5i. T\u1ef7 l\u1ec7 nh\u1eadp vi\u1ec7n h\u00e0ng n\u0103m do VPMPC\u0110 \u1edf ng\u01b0\u1eddi \u2265 65 tu\u1ed5i kho\u1ea3ng 2000\/100.000 t\u1ea1i Hoa K\u1ef3, cao h\u01a1n kho\u1ea3ng 3 l\u1ea7n so v\u1edbi d\u00e2n s\u1ed1 chung v\u00e0 kho\u1ea3ng 2% ng\u01b0\u1eddi cao tu\u1ed5i s\u1ebd ph\u1ea3i nh\u1eadp vi\u1ec7n v\u00ec VPMPC\u0110 h\u00e0ng n\u0103m.<\/p>\n<p style=\"text-align: justify;\">&#8211; B\u1ec7nh m\u1eafc k\u00e8m m\u1ea1n t\u00ednh nh\u01b0 b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh (COPD), hen ph\u1ebf qu\u1ea3n, x\u01a1 h\u00f3a k\u00e9n, gi\u00e3n ph\u1ebf qu\u1ea3n, suy tim, t\u1eafc ngh\u1ebdn ph\u1ebf qu\u1ea3n (do h\u1eb9p ph\u1ebf qu\u1ea3n, u ho\u1eb7c d\u1ecb v\u1eadt), ung th\u01b0 ph\u1ed5i, ti\u1ec1n s\u1eed vi\u00eam ph\u1ed5i, h\u1ed9i ch\u1ee9ng b\u1ea5t \u0111\u1ed9ng nhung mao v\u00e0 h\u1ed9i ch\u1ee9ng Kartagener. B\u1ec7nh m\u1eafc k\u00e8m g\u00f3p ph\u1ea7n l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 m\u1eafc v\u00e0 nh\u1eadp vi\u1ec7n do VPMPC\u0110, cao nh\u1ea5t l\u00e0 COPD v\u1edbi t\u1ef7 l\u1ec7 5.832\/100.000\/n\u0103m \u1edf Hoa K\u1ef3. C\u00e1c b\u1ec7nh m\u1eafc k\u00e8m kh\u00e1c li\u00ean quan \u0111\u1ebfn t\u0103ng t\u1ef7 l\u1ec7 m\u1eafc VPMPC\u0110 bao g\u1ed3m \u0111\u1ed9t qu\u1ef5, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, suy dinh d\u01b0\u1ee1ng v\u00e0 t\u00ecnh tr\u1ea1ng suy gi\u1ea3m mi\u1ec5n d\u1ecbch (HIV, gh\u00e9p t\u1ea1ng ho\u1eb7c gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c, s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, c\u00e1c r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a (suy dinh d\u01b0\u1ee1ng, t\u0103ng ure m\u00e1u, nhi\u1ec5m toan\u2026).<\/p>\n<p style=\"text-align: justify;\">&#8211; Nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p do virus<\/p>\n<p style=\"text-align: justify;\">&#8211; Gi\u1ea3m kh\u1ea3 n\u0103ng b\u1ea3o v\u1ec7 \u0111\u01b0\u1eddng th\u1edf, d\u1eabn \u0111\u1ebfn t\u0103ng nguy c\u01a1 vi\u00eam ph\u1ed5i h\u00edt (h\u00edt ph\u1ea3i d\u1ecbch d\u1ea1 d\u00e0y ho\u1eb7c c\u00e1c ch\u1ea5t ti\u1ebft \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean): \u0111\u1ed9t qu\u1ef5, co gi\u1eadt, h\u00f4n m\u00ea, g\u00e2y m\u00ea, s\u1eed d\u1ee5ng ma t\u00fay ho\u1eb7c r\u01b0\u1ee3u, ho\u1eb7c kh\u00f3 nu\u1ed1t do t\u1ed5n th\u01b0\u01a1ng th\u1ef1c qu\u1ea3n ho\u1eb7c r\u1ed1i lo\u1ea1n nhu \u0111\u1ed9ng th\u1ef1c qu\u1ea3n.<br \/>\nC\u00e1c y\u1ebfu t\u1ed1 thu\u1eadn l\u1ee3i:<\/p>\n<p style=\"text-align: justify;\">&#8211; C\u00e1c y\u1ebfu t\u1ed1 l\u1ed1i s\u1ed1ng v\u00e0 m\u00f4i tr\u01b0\u1eddng: h\u00fat thu\u1ed1c, l\u1ea1m d\u1ee5ng r\u01b0\u1ee3u, s\u1eed d\u1ee5ng ch\u1ea5t g\u00e2y nghi\u1ec7n (opioid), h\u00edt ph\u1ea3i ch\u1ea5t \u0111\u1ed9c, \u0111i\u1ec1u ki\u1ec7n s\u1ed1ng \u0111\u00f4ng \u0111\u00fac (v\u00ed d\u1ee5: nh\u00e0 t\u00f9, n\u01a1i t\u1ea1m tr\u00fa cho ng\u01b0\u1eddi v\u00f4 gia c\u01b0), thu nh\u1eadp th\u1ea5p v\u00e0 ti\u1ebfp x\u00fac v\u1edbi c\u00e1c ch\u1ea5t \u0111\u1ed9c h\u1ea1i t\u1eeb m\u00f4i tr\u01b0\u1eddng (v\u00ed d\u1ee5: dung m\u00f4i, s\u01a1n ho\u1eb7c x\u0103ng).<\/p>\n<p style=\"text-align: justify;\">&#8211; S\u1ef1 k\u1ebft h\u1ee3p nhi\u1ec1u y\u1ebfu t\u1ed1 nguy c\u01a1, ch\u1eb3ng h\u1ea1n h\u00fat thu\u1ed1c, COPD v\u00e0 suy tim sung huy\u1ebft g\u00f3p ph\u1ea7n l\u00e0m t\u0103ng nguy c\u01a1 VPMPC\u0110.<\/p>\n<h3 style=\"text-align: justify;\">1.4. C\u01a1 ch\u1ebf b\u1ec7nh sinh<\/h3>\n<p style=\"text-align: justify;\">C\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng kh\u00e1 ph\u1ee9c t\u1ea1p v\u00e0 li\u00ean quan \u0111\u1ebfn s\u1ef1 t\u01b0\u01a1ng t\u00e1c gi\u1eefa t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh, kh\u1ea3 n\u0103ng b\u1ea3o v\u1ec7 c\u1ee7a c\u01a1 th\u1ec3 v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 t\u1eeb m\u00f4i tr\u01b0\u1eddng. Vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n khi c\u00f3 s\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a ba y\u1ebfu t\u1ed1 ch\u00ednh: s\u1ef1 suy gi\u1ea3m kh\u1ea3 n\u0103ng \u0111\u1ec1 kh\u00e1ng c\u1ee7a v\u1eadt ch\u1ee7, s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a vi sinh v\u1eadt c\u00f3 \u0111\u1ed9c l\u1ef1c cao v\u00e0\/ho\u1eb7c s\u1ef1 x\u00e2m nh\u1eadp c\u1ee7a m\u1ed9t l\u01b0\u1ee3ng l\u1edbn t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh. Nh\u1eefng y\u1ebfu t\u1ed1 n\u00e0y k\u00edch ho\u1ea1t ph\u1ea3n \u1ee9ng vi\u00eam t\u1ea1i ph\u1ebf nang, l\u00e0m t\u00edch t\u1ee5 d\u1ecbch vi\u00eam v\u00e0 t\u1ebf b\u00e0o vi\u00eam trong nhu m\u00f4 ph\u1ed5i, t\u1eeb \u0111\u00f3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng m\u00f4 ph\u1ed5i v\u00e0 l\u00e0m gi\u1ea3m hi\u1ec7u qu\u1ea3 trao \u0111\u1ed5i kh\u00ed c\u1ee7a h\u1ec7 h\u00f4 h\u1ea5p.<\/p>\n<h4 style=\"text-align: justify;\">1.4.1. \u0110\u01b0\u1eddng l\u00e2y nhi\u1ec5m<\/h4>\n<p style=\"text-align: justify;\">C\u00e1c t\u00e1c nh\u00e2n g\u00e2y vi\u00eam ph\u1ed5i c\u00f3 th\u1ec3 x\u00e2m nh\u1eadp v\u00e0o ph\u1ed5i theo nh\u1eefng \u0111\u01b0\u1eddng sau \u0111\u00e2y:<\/p>\n<p style=\"text-align: justify;\">&#8211; \u0110\u01b0\u1eddng h\u00f4 h\u1ea5p: H\u00edt ph\u1ea3i vi khu\u1ea9n \u1edf m\u00f4i tr\u01b0\u1eddng b\u00ean ngo\u00e0i. H\u00edt ph\u1ea3i vi khu\u1ea9n t\u1eeb \u1ed5 nhi\u1ec5m khu\u1ea9n c\u1ee7a \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean. \u0110\u00e2y l\u00e0 con \u0111\u01b0\u1eddng l\u00e2y nhi\u1ec5m ph\u1ed5 bi\u1ebfn nh\u1ea5t.<\/p>\n<p style=\"text-align: justify;\">&#8211; \u0110\u01b0\u1eddng m\u00e1u: th\u01b0\u1eddng g\u1eb7p sau nhi\u1ec5m khu\u1ea9n huy\u1ebft do S. aureus, vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n, vi\u00eam t\u0129nh m\u1ea1ch nhi\u1ec5m khu\u1ea9n&#8230;<\/p>\n<p style=\"text-align: justify;\">&#8211; Nhi\u1ec5m khu\u1ea9n theo \u0111\u01b0\u1eddng k\u1ebf c\u1eadn ph\u1ed5i: m\u00e0ng ngo\u00e0i tim, trung th\u1ea5t\u2026 tuy nhi\u00ean hi\u1ebfm g\u1eb7p.<\/p>\n<p style=\"text-align: justify;\">&#8211; \u0110\u01b0\u1eddng b\u1ea1ch huy\u1ebft: m\u1ed9t s\u1ed1 vi khu\u1ea9n (P. aeruginosa, Klebsiella pneumoniae, S. aureus) c\u00f3 th\u1ec3 t\u1edbi ph\u1ed5i theo \u0111\u01b0\u1eddng b\u1ea1ch huy\u1ebft, ch\u00fang th\u01b0\u1eddng g\u00e2y vi\u00eam ph\u1ed5i ho\u1ea1i t\u1eed v\u00e0 \u00e1p xe ph\u1ed5i, v\u1edbi nhi\u1ec1u \u1ed5 nh\u1ecf \u0111\u01b0\u1eddng k\u00ednh d\u01b0\u1edbi 2 cm.<\/p>\n<h4 style=\"text-align: justify;\">1.4.2. Qu\u00e1 tr\u00ecnh g\u00e2y b\u1ec7nh<\/h4>\n<p style=\"text-align: justify;\">Khi c\u00e1c vi sinh v\u1eadt x\u00e2m nh\u1eadp v\u00e0o ph\u1ed5i, \u0111\u1ea1i th\u1ef1c b\u00e0o ph\u1ebf nang v\u00e0 s\u1ef1 c\u00f3 m\u1eb7t c\u1ee7a vi h\u1ec7 khu tr\u00fa trong \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p c\u00f3 vai tr\u00f2 ng\u0103n ch\u1eb7n s\u1ef1 nh\u00e2n l\u00ean c\u1ee7a vi sinh v\u1eadt g\u00e2y b\u1ec7nh. Khi c\u01a1 ch\u1ebf n\u00e0y kh\u00f4ng th\u1ec3 ng\u0103n ch\u1eb7n \u0111\u01b0\u1ee3c, \u0111\u1ea1i th\u1ef1c b\u00e0o ph\u1ebf nang ti\u1ebft ra c\u00e1c ch\u1ea5t h\u00f3a h\u1ecdc trung gian g\u00e2y vi\u00eam, kh\u1edfi \u0111\u1ed9ng ph\u1ea3n \u1ee9ng vi\u00eam t\u1ea1i ch\u1ed7, d\u1eabn \u0111\u1ebfn s\u1ef1 l\u1ea5p \u0111\u1ea7y c\u00e1c ph\u1ebf nang b\u1edfi c\u00e1c t\u1ebf b\u00e0o vi\u00eam, d\u1ecbch r\u1ec9 vi\u00eam, h\u00ecnh th\u00e0nh t\u1ed5n th\u01b0\u01a1ng c\u01a1 b\u1ea3n v\u1ec1 vi\u00eam ph\u1ed5i \u201c\u0111\u00f4ng \u0111\u1eb7c ph\u1ebf nang\u201d. T\u1ed5n th\u01b0\u01a1ng t\u1ea1i m\u1ed9t th\u00f9y ph\u1ed5i c\u00f3 th\u1ec3 lan ra nhi\u1ec1u thu\u1ef3 khi vi khu\u1ea9n theo d\u1ecbch vi\u00eam lan \u0111\u1ebfn thu\u1ef3 ph\u1ed5i kh\u00e1c theo \u0111\u01b0\u1eddng ph\u1ebf qu\u1ea3n. Vi\u00eam c\u00f3 th\u1ec3 lan tr\u1ef1c ti\u1ebfp \u0111\u1ebfn m\u00e0ng ph\u1ed5i, m\u00e0ng tim g\u00e2y m\u1ee7 m\u00e0ng ph\u1ed5i, m\u00e0ng ngo\u00e0i tim.<\/p>\n<p style=\"text-align: justify;\">M\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a vi\u00eam ph\u1ed5i ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ea7m b\u1ec7nh v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 li\u00ean quan \u0111\u1ebfn c\u01a1 \u0111\u1ecba ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n<p style=\"text-align: justify;\"><strong>Nh\u1eefng \u0111i\u1ec3m c\u1ea7n nh\u1edb:<\/strong><\/p>\n<p style=\"text-align: justify;\">&#8211; Vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng l\u00e0 t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng c\u1ee7a nhu m\u00f4 ph\u1ed5i x\u1ea3y ra trong c\u1ed9ng \u0111\u1ed3ng b\u00ean ngo\u00e0i b\u1ec7nh vi\u1ec7n. Bi\u1ec3u hi\u1ec7n c\u1ee7a vi\u00eam ph\u1ed5i t\u1eeb nh\u1eb9 v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng s\u1ed1t, ho kh\u1ea1c \u0111\u1eddm \u0111\u1ebfn r\u1ea5t n\u1eb7ng nh\u01b0 suy h\u00f4 h\u1ea5p c\u1ea5p ti\u1ebfn tri\u1ec3n, nhi\u1ec5m khu\u1ea9n huy\u1ebft.<\/p>\n<p style=\"text-align: justify;\">&#8211; C\u0103n nguy\u00ean g\u00e2y b\u1ec7nh th\u01b0\u1eddng do vi khu\u1ea9n (Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis, Legionella pneumophila, Chlamydia pneumoniae, Mycoplasma pneumoniae, tr\u1ef1c khu\u1ea9n Gram \u00e2m (P. aeruginosae, E. coli\u2026)), virus v\u00e0 m\u1ed9t s\u1ed1 t\u00e1c nh\u00e2n kh\u00e1c, nh\u01b0ng kh\u00f4ng do tr\u1ef1c khu\u1ea9n lao.<\/p>\n<p style=\"text-align: justify;\">&#8211; C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1, y\u1ebfu t\u1ed1 thu\u1eadn l\u1ee3i: tu\u1ed5i cao, suy gi\u1ea3m mi\u1ec5n d\u1ecbch, nghi\u1ec7n r\u01b0\u1ee3u bia, h\u00fat thu\u1ed1c, b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh\u2026<\/p>\n<p style=\"text-align: justify;\">&#8211; T\u00e1c nh\u00e2n g\u00e2y vi\u00eam ph\u1ed5i qua c\u00e1c \u0111\u01b0\u1eddng: h\u00f4 h\u1ea5p, m\u00e1u, b\u1ea1ch huy\u1ebft, k\u1ebf c\u1eadn ph\u1ed5i.<\/p>\n<p style=\"text-align: justify;\">&#8211; C\u01a1 ch\u1ebf b\u1ec7nh sinh bao g\u1ed3m s\u1ef1 suy gi\u1ea3m kh\u1ea3 n\u0103ng \u0111\u1ec1 kh\u00e1ng c\u1ee7a v\u1eadt ch\u1ee7, ti\u1ebfp x\u00fac v\u1edbi vi sinh v\u1eadt c\u00f3 \u0111\u1ed9c l\u1ef1c m\u1ea1nh ho\u1eb7c ti\u1ebfp x\u00fac v\u1edbi m\u1ed9t l\u01b0\u1ee3ng l\u1edbn vi sinh v\u1eadt g\u00e2y b\u1ec7nh.<\/p>\n<h2 style=\"text-align: center;\">CH\u01af\u01a0NG 2. C\u00c1C C\u0102N NGUY\u00caN G\u00c2Y B\u1ec6NH V\u00c0 C\u00c1C PH\u01af\u01a0NG PH\u00c1P CH\u1ea8N \u0110O\u00c1N VI SINH<\/h2>\n<h3 style=\"text-align: justify;\">2.1. \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a c\u00e1c c\u0103n nguy\u00ean g\u00e2y VPMPC\u0110<\/h3>\n<p style=\"text-align: justify;\">C\u00e1c nghi\u00ean c\u1ee9u t\u1ed5ng quan g\u1ea7n \u0111\u00e2y v\u1ec1 t\u00e1c nh\u00e2n g\u00e2y VPMPC\u0110 cho th\u1ea5y Streptococcus pneumoniae v\u1eabn \u0111\u01b0\u1ee3c coi l\u00e0 c\u0103n nguy\u00ean VPMPC\u0110 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t, ti\u1ebfp \u0111\u1ebfn l\u00e0 Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis, Pseudomonas aeruginosa v\u00e0 c\u00e1c Enterobacterales [10]. C\u00e1c t\u00e1c nh\u00e2n vi khu\u1ea9n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh nh\u01b0 Mycoplasma pneumoniae, Chlamydophila pneumoniae v\u00e0 Legionella pneumophila chi\u1ebfm kho\u1ea3ng 3-11% t\u1ed5ng s\u1ed1 c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh [11]. Influenza A virus, Influenza B virus, RSV, Adenovirus v\u00e0 c\u00e1c Coronavirus bao g\u1ed3m c\u1ea3 SARS-CoV-2 l\u00e0 c\u00e1c c\u0103n nguy\u00ean virus h\u00e0ng \u0111\u1ea7u g\u00e2y VPMPC\u0110 [12]. Do c\u00e1c d\u1eef li\u1ec7u v\u1ec1 c\u0103n nguy\u00ean g\u00e2y VPMPC\u0110 tr\u01b0\u1edbc kia ch\u1ec9 d\u1ef1a v\u00e0o nu\u00f4i c\u1ea5y kinh \u0111i\u1ec3n c\u00f3 ho\u1eb7c kh\u00f4ng k\u1ebft h\u1ee3p v\u1edbi ph\u01b0\u01a1ng ph\u00e1p huy\u1ebft thanh h\u1ecdc n\u00ean c\u00f2n nh\u1eefng \u0111i\u1ec3m h\u1ea1n ch\u1ebf trong vi\u1ec7c ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh. C\u00e1c nghi\u00ean c\u1ee9u trong h\u01a1n m\u1ed9t th\u1eadp k\u1ef7 qua \u1ee9ng d\u1ee5ng nhi\u1ec1u ti\u1ebfn b\u1ed9 c\u1ee7a k\u1ef9 thu\u1eadt sinh h\u1ecdc ph\u00e2n t\u1eed, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c x\u00e9t nghi\u1ec7m \u0111a t\u00e1c nh\u00e2n v\u1edbi \u0111\u1ed9 nh\u1ea1y, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao, c\u00f9ng v\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng v\u1eafc xin ph\u00f2ng S. pneumoniae r\u1ed9ng r\u00e3i \u0111\u00e3 l\u00e0m thay \u0111\u1ed5i s\u1ef1 hi\u1ec3u bi\u1ebft v\u1ec1 c\u00e1c c\u0103n nguy\u00ean g\u00e2y VPMPC\u0110 [5, 13]. Do v\u1eady, khi n\u00f3i v\u1ec1 c\u0103n nguy\u00ean g\u00e2y vi\u00eam ph\u1ed5i c\u1ea7n \u0111\u1ec1 c\u1eadp \u0111\u1ebfn k\u1ef9 thu\u1eadt s\u1eed d\u1ee5ng cho ch\u1ea9n \u0111o\u00e1n.<\/p>\n<h4 style=\"text-align: justify;\">2.1.1. C\u0103n nguy\u00ean vi khu\u1ea9n<\/h4>\n<p style=\"text-align: justify;\">Nhi\u1ec1u nghi\u00ean c\u1ee9u v\u1ec1 c\u00e1c ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 cho th\u1ea5y h\u1ea7u h\u1ebft c\u0103n nguy\u00ean ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c l\u00e0 vi khu\u1ea9n.<\/p>\n<p style=\"text-align: justify;\">&#8211; S. pneumoniae chi\u1ebfm 75% trong s\u1ed1 c\u00e1c t\u00e1c nh\u00e2n g\u00e2y VPMPC\u0110 \u1edf th\u1eddi k\u1ef3 ti\u1ec1n kh\u00e1ng sinh [14, 15]. G\u1ea7n \u0111\u00e2y ch\u1ec9 c\u00f2n chi\u1ebfm kho\u1ea3ng 5-15% c\u0103n nguy\u00ean ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c \u1edf Hoa K\u1ef3 [16, 17], nh\u01b0ng c\u00f3 th\u1ec3 cao h\u01a1n \u1edf m\u1ed9t s\u1ed1 n\u01b0\u1edbc kh\u00e1c [18]. Th\u1ef1c t\u1ebf, t\u1ef7 l\u1ec7 VPMPC\u0110 do S. pneumoniae \u0111\u01b0\u1ee3c cho l\u00e0 cao h\u01a1n c\u00e1c s\u1ed1 li\u1ec7u c\u00f3 t\u1eeb nghi\u00ean c\u1ee9u v\u00ec ng\u01b0\u1eddi ta cho r\u1eb1ng c\u00f3 nhi\u1ec1u ca VPMPC\u0110 do S. pneumoniae c\u00f3 k\u1ebft qu\u1ea3 nu\u00f4i c\u1ea5y \u00e2m t\u00ednh. L\u00fd do m\u00e0 S. pneumoniae v\u1eabn \u0111\u01b0\u1ee3c cho l\u00e0 t\u00e1c nh\u00e2n g\u00e2y VPMPC\u0110 th\u01b0\u1eddng g\u1eb7p v\u00ec \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 c\u00f3 c\u1ea5y m\u00e1u d\u01b0\u01a1ng t\u00ednh th\u00ec \u0111\u1ebfn 58-81% ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c S. pneumoniae [19, 20]. Theo \u01b0\u1edbc t\u00ednh trong nghi\u00ean c\u1ee9u ph\u00e2n t\u00edch g\u1ed9p th\u00ec c\u1ee9 m\u1ed7i ca vi\u00eam ph\u1ed5i c\u00f3 nhi\u1ec5m tr\u00f9ng huy\u1ebft do S. pneumoniae s\u1ebd c\u00f3 \u00edt nh\u1ea5t th\u00eam ba ca vi\u00eam ph\u1ed5i do S. pneumoniae m\u00e0 kh\u00f4ng k\u00e8m theo c\u00f3 nhi\u1ec5m tr\u00f9ng huy\u1ebft [21].<\/p>\n<p style=\"text-align: justify;\">&#8211; H. influenzae l\u00e0 m\u1ed9t t\u00e1c nh\u00e2n quan tr\u1ecdng g\u00e2y vi\u00eam ph\u1ed5i \u1edf ng\u01b0\u1eddi gi\u00e0 v\u00e0 \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh c\u00f3 b\u1ec7nh l\u00fd n\u1ec1n \u1edf ph\u1ed5i nh\u01b0 b\u1ec7nh l\u00fd x\u01a1 nang ph\u1ed5i, b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh.<\/p>\n<p style=\"text-align: justify;\">&#8211; M. pneumoniae l\u00e0 c\u0103n nguy\u00ean g\u00e2y vi\u00eam ph\u1ed5i kh\u00f4ng \u0111i\u1ec3n h\u00ecnh ph\u1ed5 bi\u1ebfn nh\u1ea5t, chi\u1ebfm kho\u1ea3ng 15% c\u00e1c ca vi\u00eam ph\u1ed5i \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u1ea1i c\u00e1c c\u01a1 s\u1edf c\u1ea5p c\u1ee9u nh\u01b0ng ch\u1ea9n \u0111o\u00e1n ch\u1ee7 y\u1ebfu d\u1ef1a tr\u00ean ph\u01b0\u01a1ng ph\u00e1p huy\u1ebft thanh h\u1ecdc. Tuy nhi\u00ean, c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 huy\u1ebft thanh h\u1ecdc c\u00f3 th\u1ec3 \u01b0\u1edbc t\u00ednh t\u1ef7 l\u1ec7 m\u1eafc cao h\u01a1n so v\u1edbi th\u1ef1c t\u1ebf. T\u1ef7 l\u1ec7 nhi\u1ec5m M. pneumoniae cao nh\u1ea5t \u1edf tr\u1ebb em l\u1ee9a tu\u1ed5i \u0111\u1ebfn tr\u01b0\u1eddng, \u1edf nh\u00f3m t\u00e2n binh v\u00e0 sinh vi\u00ean [22].<\/p>\n<p style=\"text-align: justify;\">&#8211; T\u1ef7 l\u1ec7 VPMPC\u0110 do C. pneumoniae kh\u00e1c nhau \u1edf c\u00e1c nghi\u00ean c\u1ee9u kh\u00e1c nhau, t\u1eeb 0-20% [23-25]. Ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n huy\u1ebft thanh h\u1ecdc kh\u00f4ng ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng \u0111\u00e3 nhi\u1ec5m hay \u0111ang nhi\u1ec5m C. pneumoniae. C\u00e1c nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y s\u1eed d\u1ee5ng k\u1ef9 thu\u1eadt sinh h\u1ecdc ph\u00e2n t\u1eed ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c C. pneumoniae d\u01b0\u1edbi 1% c\u00e1c ca VPMPC\u0110 [8, 10]. Kh\u00f4ng nh\u01b0 c\u00e1c nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p kh\u00e1c c\u00f3 \u0111\u1ec9nh m\u1eafc v\u00e0o c\u00e1c th\u00e1ng m\u00f9a \u0111\u00f4ng, nhi\u1ec5m tr\u00f9ng C. pneumoniae kh\u00f4ng kh\u00e1c bi\u1ec7t theo m\u00f9a.<\/p>\n<p style=\"text-align: justify;\">&#8211; Legionella chi\u1ebfm kho\u1ea3ng 1-10% c\u00e1c c\u0103n nguy\u00ean g\u00e2y VPMPC\u0110. Nhi\u1ec5m tr\u00f9ng Legionella th\u01b0\u1eddng x\u1ea3y ra do ti\u1ebfp x\u00fac v\u1edbi c\u00e1c d\u1ee5ng c\u1ee5 ch\u1ee9a c\u00e1c gi\u1ecdt nh\u1ecf mang vi khu\u1ea9n nh\u01b0 v\u00f2i hoa sen, m\u00e1y phun s\u01b0\u01a1ng, th\u00e1p gi\u1ea3i nhi\u1ec7t c\u1ee7a h\u1ec7 th\u1ed1ng \u0111i\u1ec1u ho\u00e0, v\u00f9ng xo\u00e1y n\u01b0\u1edbc, v\u00f2i phun [26].<\/p>\n<p style=\"text-align: justify;\">&#8211; Tr\u1ef1c khu\u1ea9n Gram \u00e2m, \u0111\u1eb7c bi\u1ec7t l\u00e0 K. pneumoniae, E. coli, Enterobacter spp., Serratia spp., Proteus spp., P. aeruginosa v\u00e0 Acinetobacter spp. l\u00e0 c\u00e1c c\u0103n nguy\u00ean g\u00e2y VPMPC\u0110 hi\u1ebfm g\u1eb7p ngo\u1ea1i tr\u1eeb \u1edf nh\u00f3m ng\u01b0\u1eddi b\u1ec7nh vi\u00eam ph\u1ed5i n\u1eb7ng c\u1ea7n nh\u1eadp vi\u1ec7n \u0111i\u1ec1u tr\u1ecb t\u1ea1i khoa \u0110i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c (ICU). K. pneumoniae chi\u1ebfm kho\u1ea3ng 6% c\u0103n nguy\u00ean VPMPC\u0110 t\u1ea1i c\u00e1c n\u01b0\u1edbc ch\u00e2u \u00c1 nh\u01b0ng hi\u1ebfm g\u1eb7p h\u01a1n \u1edf c\u00e1c khu v\u1ef1c kh\u00e1c [27]. Ch\u1ec9 n\u00ean ngh\u0129 \u0111\u1ebfn c\u0103n nguy\u00ean K. pneumoniae \u1edf ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 c\u00f3 k\u00e8m c\u00e1c b\u1ec7nh l\u00fd n\u1ec1n nh\u01b0 COPD, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 nghi\u1ec7n r\u01b0\u1ee3u [28]. Y\u1ebfu t\u1ed1 nguy c\u01a1 VPMPC\u0110 do P. aeruginosa bao g\u1ed3m t\u00ecnh tr\u1ea1ng gi\u00e3n ph\u1ebf qu\u1ea3n v\u00e0 s\u1eed d\u1ee5ng kh\u00e1ng sinh nhi\u1ec1u l\u1ea7n ho\u1eb7c s\u1eed d\u1ee5ng corticosteroid k\u00e9o d\u00e0i \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh c\u00f3 c\u1ea5u tr\u00fac ph\u1ed5i b\u1ea5t th\u01b0\u1eddng kh\u00e1c nh\u01b0 COPD, x\u01a1 ph\u1ed5i, t\u00ecnh tr\u1ea1ng suy gi\u1ea3m mi\u1ec5n d\u1ecbch nh\u01b0 gi\u1ea3m b\u1ea1ch c\u1ea7u, nhi\u1ec5m tr\u00f9ng HIV, gh\u00e9p t\u1ea1ng v\u00e0 c\u1ea5y gh\u00e9p t\u1ebf b\u00e0o g\u1ed1c [17, 29].<\/p>\n<p style=\"text-align: justify;\">&#8211; M. catarrhalis g\u00e2y vi\u00eam \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p d\u01b0\u1edbi \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh COPD v\u00e0 \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh suy gi\u1ea3m mi\u1ec5n d\u1ecbch. Nhi\u1ec1u ng\u01b0\u1eddi b\u1ec7nh nhi\u1ec5m M. catarrhalis b\u1ecb suy dinh d\u01b0\u1ee1ng. M. catarrhalis th\u01b0\u1eddng g\u1eb7p l\u00e0 \u0111\u1ed3ng t\u00e1c nh\u00e2n g\u00e2y vi\u00eam ph\u1ed5i [30].<\/p>\n<p style=\"text-align: justify;\">&#8211; S. aureus chi\u1ebfm kho\u1ea3ng 3% trong s\u1ed1 c\u00e1c c\u0103n nguy\u00ean g\u00e2y VPMPC\u0110 \u1edf ng\u01b0\u1eddi b\u1ec7nh n\u1ed9i tr\u00fa v\u1edbi t\u1ef7 l\u1ec7 m\u1eafc kh\u00e1c nhau \u1edf c\u00e1c qu\u1ed1c gia v\u00e0 c\u00e1c l\u1ee5c \u0111\u1ecba kh\u00e1c nhau [31].<\/p>\n<p style=\"text-align: justify;\">Trong \u0111\u00f3, MRSA chi\u1ebfm \u0111\u1ebfn 51%. VPMPC\u0110 do S. aureus th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi gi\u00e0, nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh sau nhi\u1ec5m c\u00fam v\u00e0 th\u01b0\u1eddng c\u00f3 bi\u1ec3u hi\u1ec7n vi\u00eam ph\u1ed5i ho\u1ea1i t\u1eed n\u1eb7ng. M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u cho th\u1ea5y xu h\u01b0\u1edbng d\u1eabn \u0111\u1ebfn vi\u00eam ph\u1ed5i ho\u1ea1i t\u1eed do S. aureus c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn \u0111\u1ed9c t\u1ed1 PVL (Panton Valentine leukocidin) l\u00e0 m\u1ed9t \u0111\u1ed9c t\u1ed1 g\u00e2y ph\u00e1 hu\u1ef7 t\u1ebf b\u00e0o b\u1ea1ch c\u1ea7u v\u00e0 ho\u1ea1i t\u1eed m\u00f4. S\u1ef1 c\u00f3 m\u1eb7t c\u1ee7a gen m\u00e3 ho\u00e1 cho \u0111\u1ed9c t\u1ed1 PVL l\u00e0 m\u1ed9t \u0111\u1eb7c \u0111i\u1ec3m \u0111\u1eb7c tr\u01b0ng c\u1ee7a c\u00e1c ch\u1ee7ng MRSA m\u1eafc ph\u1ea3i t\u1ea1i c\u1ed9ng \u0111\u1ed3ng [32, 33].<\/p>\n<p style=\"text-align: justify;\">&#8211; C\u00e1c vi khu\u1ea9n kh\u00e1c:<\/p>\n<p style=\"text-align: justify;\">+ S. pyogenes c\u00f3 th\u1ec3 g\u00e2y vi\u00eam ph\u1ed5i k\u1ecbch ph\u00e1t ho\u00e1 m\u1ee7 s\u1edbm \u1edf ng\u01b0\u1eddi b\u1ec7nh tr\u1ebb, mi\u1ec5n d\u1ecbch b\u00ecnh th\u01b0\u1eddng [34].<\/p>\n<p style=\"text-align: justify;\">+ Vi khu\u1ea9n k\u1ef5 kh\u00ed g\u00e2y vi\u00eam ph\u1ed5i c\u00f3 th\u1ec3 do h\u00edt ph\u1ea3i v\u00e0 th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn c\u00e1c nhi\u1ec5m tr\u00f9ng ho\u1ea1i t\u1eed \u0111a c\u0103n nguy\u00ean. N\u00ean ngh\u0129 \u0111\u1ebfn c\u00e1c c\u0103n nguy\u00ean k\u1ef5 kh\u00ed khi th\u1ea5y \u0111\u1eddm c\u00f3 m\u00f9i th\u1ed1i ho\u1eb7c d\u1ecbch m\u1ee7 th\u1ed1i, nhi\u1ec5m tr\u00f9ng c\u00f3 li\u00ean quan \u0111\u1ebfn h\u00edt ph\u1ea3i ho\u1eb7c nhi\u1ec5m tr\u00f9ng ho\u1ea1i t\u1eed. H\u1ea7u h\u1ebft c\u00e1c nhi\u1ec5m tr\u00f9ng \u0111\u1ec1u do \u0111a c\u0103n nguy\u00ean trong \u0111\u00f3 ch\u1ee7 y\u1ebfu l\u00e0 c\u00e1c vi khu\u1ea9n k\u1ef5 kh\u00ed nh\u01b0 Bacteroides melaninogenicus, Fusobacterium spp., Peptostreptococcus spp.) v\u00e0\/ho\u1eb7c Streptococcus \u1edf mi\u1ec7ng (Streptococcus milleri) [35].<\/p>\n<p style=\"text-align: justify;\">+ Neisseria meningitidis l\u00e0 c\u0103n nguy\u00ean g\u00e2y VPMPC\u0110 kh\u00f4ng ph\u1ed5 bi\u1ebfn. Vi\u00eam ph\u1ed5i do N. meningitidis kh\u00f4ng c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng kh\u00e1c bi\u1ec7t nh\u01b0ng c\u1ea7n \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u00e0 d\u1ef1 ph\u00f2ng nhi\u1ec5m tr\u00f9ng huy\u1ebft ho\u1eb7c vi\u00eam m\u00e0ng n\u00e3o.<\/p>\n<p style=\"text-align: justify;\">+ Burkholderia pseudomallei l\u00e0 m\u1ed9t c\u0103n nguy\u00ean VPMPC\u0110 quan tr\u1ecdng \u1edf c\u00e1c n\u01b0\u1edbc thu\u1ed9c v\u00f9ng d\u1ecbch t\u1ec5 nh\u01b0 \u0110\u00f4ng Nam \u00c1 v\u00e0 B\u1eafc \u00dac. R\u1ea5t kh\u00f3 c\u00f3 th\u1ec3 ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c VPMPC\u0110 do B. pseudomallei v\u1edbi VPMPC\u0110 do c\u00e1c t\u00e1c nh\u00e2n kh\u00e1c v\u1ec1 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 h\u00ecnh \u1ea3nh ch\u1ee5p ph\u1ed5i. T\u1ef7 l\u1ec7 t\u1eed vong r\u1ea5t cao (46,7%) n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi. Vi khu\u1ea9n c\u00f3 m\u1eb7t ph\u1ed5 bi\u1ebfn trong \u0111\u1ea5t v\u00e0 n\u01b0\u1edbc b\u1ec1 m\u1eb7t \u1edf c\u00e1c v\u00f9ng d\u1ecbch t\u1ec5 l\u01b0u h\u00e0nh cho n\u00ean c\u00e1c n\u01b0\u1edbc trong khu v\u1ef1c d\u1ecbch t\u1ec5 c\u1ea7n \u0111\u1eb7c bi\u1ec7t l\u01b0u \u00fd \u0111\u1ebfn c\u0103n nguy\u00ean B. pseudomallei [36].<\/p>\n<h4 style=\"text-align: justify;\">2.1.2. C\u0103n nguy\u00ean virus<\/h4>\n<p style=\"text-align: justify;\">T\u1ef7 l\u1ec7 c\u00e1c c\u0103n nguy\u00ean virus \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf c\u00e1c nghi\u00ean c\u1ee9u kh\u00e1c nhau r\u1ea5t kh\u00e1c nhau, ph\u1ee5 thu\u1ed9c v\u00e0o k\u1ef9 thu\u1eadt ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng. C\u00e1c nghi\u00ean c\u1ee9u s\u1eed d\u1ee5ng k\u1ef9 thu\u1eadt PCR, \u0111\u1eb7c bi\u1ec7t l\u00e0 multiplex PCR c\u00f3 th\u1ec3 \u0111\u01b0a ra t\u1ef7 l\u1ec7 virus g\u00e2y VPMPC\u0110 cao h\u01a1n so v\u1edbi th\u1ef1c t\u1ebf v\u00ec c\u00e1c virus h\u00f4 h\u1ea5p c\u00f3 th\u1ec3 c\u00f3 m\u1eb7t \u1edf \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean nh\u01b0ng kh\u00f4ng g\u00e2y b\u1ec7nh. T\u0103m b\u00f4ng ngo\u00e1y d\u1ecbch t\u1ef5 h\u1ea7u c\u1ee7a ng\u01b0\u1eddi kho\u1ebb m\u1ea1nh cho k\u1ebft qu\u1ea3 20-30% d\u01b0\u01a1ng t\u00ednh v\u1edbi c\u00e1c virus \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p khi s\u1eed d\u1ee5ng k\u1ef9 thu\u1eadt PCR [37].<br \/>\nInfluenza virus, RSV, Parainfluenza virus v\u00e0 Adenovirus v\u1eabn l\u00e0 c\u00e1c c\u0103n nguy\u00ean virus ph\u1ed5 bi\u1ebfn nh\u1ea5t g\u00e2y VPMPC\u0110 \u1edf ng\u01b0\u1eddi l\u1edbn. C\u00e1c virus kh\u00e1c c\u00f3 th\u1ec3 g\u1eb7p nh\u01b0 Rhinovirus, Coronavirus v\u00e0 Metapneumovirus ng\u01b0\u1eddi (HMPV). VPMPC\u0110 do virus c\u00f3 \u0111\u1ed3ng nhi\u1ec5m vi khu\u1ea9n chi\u1ebfm kho\u1ea3ng 20-40% v\u00e0 th\u01b0\u1eddng n\u1eb7ng h\u01a1n, ph\u1ea3i n\u1eb1m vi\u1ec7n l\u00e2u h\u01a1n nh\u1eefng ca b\u1ec7nh ch\u1ec9 do vi khu\u1ea9n [40, 41].<\/p>\n<p style=\"text-align: justify;\">&#8211; Influenza A virus v\u00e0 Influenza B virus c\u00f3 th\u1ec3 g\u00e2y vi\u00eam ph\u1ed5i c\u1ea5p t\u00ednh v\u00e0 g\u00e2y d\u1ecbch tr\u00ean to\u00e0n th\u1ebf gi\u1edbi, ch\u1ee7 y\u1ebfu trong m\u00f9a \u0111\u00f4ng. C\u00e1c virus c\u00fam gia c\u1ea7m nh\u01b0 H5N1 v\u00e0 H7N9 Avian Influenza l\u00e0 c\u00e1c t\u00e1c nh\u00e2n m\u1edbi n\u1ed5i g\u00e2y b\u1ec7nh cho ng\u01b0\u1eddi. C\u00e1c virus c\u00fam th\u01b0\u1eddng g\u00e2y nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean nh\u01b0ng c\u00f3 th\u1ec3 g\u00e2y vi\u00eam ph\u1ed5i ti\u00ean ph\u00e1t v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0a \u0111\u1ebfn vi\u00eam ph\u1ed5i th\u1ee9 ph\u00e1t do vi khu\u1ea9n. Vi\u00eam ph\u1ed5i ti\u00ean ph\u00e1t do virus c\u00fam l\u00e0 t\u00ecnh tr\u1ea1ng virus c\u00fam tr\u1ef1c ti\u1ebfp g\u00e2y nhi\u1ec5m tr\u00f9ng v\u00e0 t\u1ed5n th\u01b0\u01a1ng nhu m\u00f4 ph\u1ed5i, d\u1eabn \u0111\u1ebfn b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng n\u1eb7ng. Th\u1ec3 b\u1ec7nh n\u00e0y th\u01b0\u1eddng g\u1eb7p \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh c\u00f3 b\u1ec7nh l\u00fd n\u1ec1n m\u1ea1n t\u00ednh nh\u01b0 hen ph\u1ebf qu\u1ea3n, b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh (COPD), b\u1ec7nh tim b\u1ea9m sinh, b\u1ec7nh m\u1ea1ch v\u00e0nh, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng ho\u1eb7c c\u00e1c t\u00ecnh tr\u1ea1ng suy gi\u1ea3m mi\u1ec5n d\u1ecbch. \u1ede c\u00e1c tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m virus c\u00fam n\u1eb7ng, t\u1ed5n th\u01b0\u01a1ng bi\u1ec3u m\u00f4 \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p v\u00e0 suy gi\u1ea3m c\u01a1 ch\u1ebf b\u1ea3o v\u1ec7 t\u1ea1i ph\u1ed5i t\u1ea1o \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i cho vi khu\u1ea9n x\u00e2m nh\u1eadp v\u00e0 g\u00e2y b\u1ed9i nhi\u1ec5m vi khu\u1ea9n. C\u00e1c t\u00e1c nh\u00e2n vi khu\u1ea9n th\u01b0\u1eddng g\u1eb7p trong b\u1ed9i nhi\u1ec5m sau c\u00fam bao g\u1ed3m Streptococcus pneumoniae, Staphylococcus aureus v\u00e0 Streptococcus pyogenes.<\/p>\n<p style=\"text-align: justify;\">&#8211; Parainfluenza virus l\u00e0 t\u00e1c nh\u00e2n quan tr\u1ecdng \u1edf ng\u01b0\u1eddi b\u1ec7nh suy gi\u1ea3m mi\u1ec5n d\u1ecbch, c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p d\u01b0\u1edbi nguy hi\u1ec3m, \u0111e do\u1ea1 \u0111\u1ebfn t\u00ednh m\u1ea1ng.<\/p>\n<p style=\"text-align: justify;\">&#8211; RSV c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c b\u1ec7nh l\u00fd \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p c\u1ea5p t\u00ednh m\u1ecdi l\u1ee9a tu\u1ed5i nh\u01b0ng \u0111\u1eb7c bi\u1ec7t g\u00e2y VPMPC\u0110 n\u1eb7ng \u1edf ng\u01b0\u1eddi gi\u00e0 v\u00e0 nh\u1eefng ng\u01b0\u1eddi suy gi\u1ea3m mi\u1ec5n d\u1ecbch (ng\u01b0\u1eddi c\u1ea5y gh\u00e9p t\u1ee7y\u2026)<\/p>\n<p style=\"text-align: justify;\">&#8211; HMPV (Human Metapneumovirus) c\u00f3 th\u1ec3 g\u00e2y nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p tr\u00ean v\u00e0 h\u00f4 h\u1ea5p d\u01b0\u1edbi \u1edf m\u1ecdi l\u1ee9a tu\u1ed5i nh\u01b0ng bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb em ho\u1eb7c ng\u01b0\u1eddi gi\u00e0. \u0110\u00e2y l\u00e0 m\u1ed9t c\u0103n nguy\u00ean m\u1edbi n\u1ed5i g\u00e2y VPMPC\u0110 \u1edf ng\u01b0\u1eddi l\u1edbn.<\/p>\n<p style=\"text-align: justify;\">&#8211; MERS-CoV l\u00e0 m\u1ed9t Coronavirus m\u1edbi n\u1ed5i g\u00e2y nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p n\u1eb7ng \u1edf Saudi Arabia n\u0103m 2012. H\u1ea7u h\u1ebft c\u00e1c MERS-CoV c\u00f3 \u0111\u1eb7c t\u00ednh l\u00e2y truy\u1ec1n tr\u1ef1c ti\u1ebfp t\u1eeb ng\u01b0\u1eddi sang ng\u01b0\u1eddi r\u1ea5t h\u1ea1n ch\u1ebf nh\u01b0ng c\u0169ng c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng si\u00eau l\u00e2y truy\u1ec1n \u0111\u01b0\u1ee3c ghi nh\u1eadn trong v\u1ee5 d\u1ecbch MERS \u1edf H\u00e0n Qu\u1ed1c n\u0103m 2015. Th\u00e1ng 12 n\u0103m 2019, Coronavirus m\u1edbi c\u00f3 t\u00ean g\u1ecdi SARS-CoV-2 l\u1ea7n \u0111\u1ea7u ti\u00ean xu\u1ea5t hi\u1ec7n t\u1ea1i V\u0169 H\u00e1n, Trung Qu\u1ed1c. V\u1edbi kh\u1ea3 n\u0103ng l\u00e2y nhi\u1ec5m cao, th\u1eddi gian \u1ee7 b\u1ec7nh k\u00e9o d\u00e0i, SARS-CoV-2 \u0111\u00e3 g\u00e2y \u0111\u1ea1i d\u1ecbch tr\u00ean to\u00e0n th\u1ebf gi\u1edbi, g\u00e2y \u1ea3nh h\u01b0\u1edfng n\u1eb7ng n\u1ec1 v\u1ec1 y t\u1ebf v\u00e0 kinh t\u1ebf c\u1ee7a c\u00e1c qu\u1ed1c gia tr\u00ean to\u00e0n th\u1ebf gi\u1edbi [42]. (Tham kh\u1ea3o chi ti\u1ebft t\u1ea1i \u201cH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p c\u1ea5p do SARS-CoV-2 (COVID-19)\u201d c\u1ee7a B\u1ed9 Y t\u1ebf).<\/p>\n<p style=\"text-align: justify;\">&#8211; Rhinovirus l\u00e0 m\u1ed9t trong s\u1ed1 c\u00e1c t\u00e1c nh\u00e2n ph\u1ed5 bi\u1ebfn g\u00e2y nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p (35-50%). Ng\u00e0y c\u00e0ng c\u00f3 nhi\u1ec1u b\u1eb1ng ch\u1ee9ng nghi\u00ean c\u1ee9u cho th\u1ea5y vai tr\u00f2 g\u00e2y VPMPC\u0110 c\u1ee7a virus n\u00e0y [39, 43].<\/p>\n<p style=\"text-align: justify;\">&#8211; C\u00e1c virus kh\u00e1c c\u0169ng c\u00f3 th\u1ec3 g\u1eb7p nh\u01b0 c\u00e1c Coronavirus kh\u00e1c (HcoV &#8211; Human Coronavirus), Hantavirus, Varicella-zoster virus.<\/p>\n<h4 style=\"text-align: justify;\">2.1.3. C\u0103n nguy\u00ean n\u1ea5m<\/h4>\n<p style=\"text-align: justify;\">N\u1ea5m r\u1ea5t hi\u1ebfm khi g\u00e2y VPMPC\u0110 \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f3 h\u1ec7 mi\u1ec5n d\u1ecbch b\u00ecnh th\u01b0\u1eddng nh\u01b0ng c\u00f3 m\u1ed9t s\u1ed1 lo\u00e0i n\u1ea5m nh\u01b0 Histoplasma capsulatum, Coccidioides spp.,<\/p>\n<p style=\"text-align: justify;\">Blastomyces dermatitidis c\u00f3 th\u1ec3 g\u00e2y vi\u00eam ph\u1ed5i cho c\u1ea3 ng\u01b0\u1eddi b\u1ec7nh suy gi\u1ea3m mi\u1ec5n d\u1ecbch v\u00e0 c\u1ea3 ng\u01b0\u1eddi c\u00f3 h\u1ec7 mi\u1ec5n d\u1ecbch b\u00ecnh th\u01b0\u1eddng s\u1ed1ng ho\u1eb7c \u0111\u1ebfn c\u00e1c khu v\u1ef1c d\u1ecbch t\u1ec5 c\u1ee7a c\u00e1c lo\u00e0i n\u1ea5m \u0111\u00f3 [44]. (Tham kh\u1ea3o t\u00e0i li\u1ec7u \u201cH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m n\u1ea5m x\u00e2m l\u1ea5n c\u1ee7a B\u1ed9 Y t\u1ebf\u201d).<\/p>\n<h4 style=\"text-align: justify;\">2.1.4. T\u00ecnh h\u00ecnh kh\u00e1ng thu\u1ed1c c\u1ee7a m\u1ed9t s\u1ed1 vi khu\u1ea9n g\u00e2y VPMPC\u0110<\/h4>\n<p style=\"text-align: justify;\">Trong c\u00e1c t\u00e1c nh\u00e2n g\u00e2y VPMPC\u0110, c\u00f3 kho\u1ea3ng 6% l\u00e0 c\u00e1c vi khu\u1ea9n \u0111a kh\u00e1ng thu\u1ed1c. Vi khu\u1ea9n \u0111a kh\u00e1ng thu\u1ed1c th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 S. aureus v\u00e0 P. aeruginosa. Nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y c\u1ee7a ch\u00e2u \u00c2u cho th\u1ea5y c\u00f3 \u0111\u1ebfn 3,3 \u2013 7,6% c\u0103n nguy\u00ean \u0111a kh\u00e1ng ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c t\u1eeb c\u00e1c ca VPMPC\u0110, trong \u0111\u00f3 ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 MRSA. V\u00ec khuy\u1ebfn c\u00e1o hi\u1ec7n nay \u0111i\u1ec1u tr\u1ecb VPMPC\u0110 theo kinh nghi\u1ec7m l\u00e0 s\u1eed d\u1ee5ng \u00df-lactam c\u00f9ng nh\u00f3m thu\u1ed1c macrolid-ho\u1eb7c quinolon nh\u01b0ng v\u1edbi MRSA th\u00ec kh\u00f4ng ph\u00f9 h\u1ee3p n\u00ean c\u00e1c ch\u1ea9n \u0111o\u00e1n vi sinh v\u1ec1 c\u0103n nguy\u00ean g\u00e2y b\u1ec7nh l\u00e0 r\u1ea5t quan tr\u1ecdng cho vi\u1ec7c ch\u1ecdn l\u1ef1a kh\u00e1ng sinh ph\u00f9 h\u1ee3p [45].<br \/>\nP. aeruginosa kh\u00f4ng ph\u1ea3i c\u0103n nguy\u00ean g\u00e2y VPMPC\u0110 th\u01b0\u1eddng g\u1eb7p nh\u01b0ng \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 ph\u1ea3i \u0111i\u1ec1u tr\u1ecb t\u1ea1i c\u00e1c khoa h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c P. aeruginosa chi\u1ebfm 1,8 &#8211; 8,3% v\u00e0 t\u1ef7 l\u1ec7 g\u00e2y t\u1eed vong l\u00ean \u0111\u1ebfn 50 &#8211; 100%. S\u1eed d\u1ee5ng kh\u00e1ng sinh t\u1eeb tr\u01b0\u1edbc \u0111\u01b0\u1ee3c cho l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u01b0a \u0111\u1ebfn VPMPC\u0110 do P. aeruginosa \u0111a kh\u00e1ng thu\u1ed1c [46].<\/p>\n<p style=\"text-align: justify;\">Khi v\u1eafc xin ph\u00f2ng S. pneumoniae \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o s\u1eed d\u1ee5ng d\u1eabn \u0111\u1ebfn s\u1ef1 l\u01b0u h\u00e0nh c\u1ee7a c\u00e1c serotype thay \u0111\u1ed5i. C\u00e1c serotype c\u00f3 v\u1eafc xin d\u1ef1 ph\u00f2ng gi\u1ea3m \u0111i nh\u01b0ng c\u00e1c serotype tr\u01b0\u1edbc kia hi\u1ebfm g\u1eb7p l\u1ea1i tr\u1edf n\u00ean ph\u1ed5 bi\u1ebfn. C\u00f9ng v\u1edbi s\u1ef1 thay \u0111\u1ed5i n\u00e0y l\u00e0 s\u1ef1 gia t\u0103ng \u0111\u1ec1 kh\u00e1ng c\u1ee7a S. pneumoniae v\u1edbi m\u1ed9t s\u1ed1 nh\u00f3m kh\u00e1ng sinh nh\u01b0 cephalosporin, macrolid v\u00e0 fluoroquinolon tr\u00ean to\u00e0n th\u1ebf gi\u1edbi trong hai th\u1eadp k\u1ef7 g\u1ea7n \u0111\u00e2y [5]. T\u1ef7 l\u1ec7 kh\u00e1ng macrolid kho\u1ea3ng 20 \u2013 40% nh\u01b0ng s\u1ef1 \u0111\u1ec1 kh\u00e1ng n\u00e0y \u00edt g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb v\u00ec macrolid \u0111\u01a1n tr\u1ecb li\u1ec7u th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o [13]. T\u1ef7 l\u1ec7 S. pneumoniae \u0111\u1ec1 kh\u00e1ng fluoroquinolon \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf ch\u00e2u \u00c2u (5,2%) cao h\u01a1n \u1edf Hoa K\u1ef3 (1,2%) v\u00e0 \u1edf ch\u00e2u \u00c1 (2,4%). \u0110\u1ec1 kh\u00e1ng fluoroquinolon hi\u1ebfm g\u1eb7p \u1edf c\u00e1c ch\u1ee7ng g\u00e2y b\u1ec7nh cho tr\u1ebb em nh\u01b0ng cao h\u01a1n \u1edf ng\u01b0\u1eddi l\u1edbn, \u0111\u1eb7c bi\u1ec7t cao \u1edf ng\u01b0\u1eddi tr\u00ean 64 tu\u1ed5i c\u00f3 k\u00e8m c\u00e1c b\u1ec7nh l\u00fd ph\u1ed5i t\u1eafc ngh\u1ebdn [5]. Trong nghi\u00ean c\u1ee9u \u0111a trung t\u00e2m SOAR cho th\u1ea5y S. pneumoniae c\u00f2n nh\u1ea1y c\u1ea3m cao (&gt;70%) v\u1edbi penicillin ti\u00eam [47-50]. Hi\u1ec7n nay, 20-30% c\u00e1c ch\u1ee7ng S. pneumoniae \u0111a kh\u00e1ng thu\u1ed1c, \u0111\u1eb7c bi\u1ec7t t\u0103ng nhanh \u1edf c\u00e1c serotype kh\u00f4ng c\u00f3 v\u1eafc xin. Trong s\u1ed1 c\u00e1c serotype \u0111a kh\u00e1ng, hay g\u1eb7p nh\u1ea5t l\u00e0 serotype 19A v\u00e0 m\u1edbi n\u1ed5i l\u00ean m\u1ed9t s\u1ed1 serotype kh\u00e1c n\u1eefa l\u00e0 6B, 6C, 14, 15B\/C, 19F v\u00e0 23A [51, 52].<\/p>\n<h4 style=\"text-align: justify;\">2.1.5. C\u0103n nguy\u00ean g\u00e2y VPMPC\u0110 \u1edf Vi\u1ec7t Nam<\/h4>\n<p style=\"text-align: justify;\">Nghi\u00ean c\u1ee9u t\u1ea1i b\u1ec7nh vi\u1ec7n Kh\u00e1nh Ho\u00e0 tr\u00ean 154 ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 ph\u1ea3i nh\u1eadp vi\u1ec7n b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p nu\u00f4i c\u1ea5y cho th\u1ea5y c\u00e1c c\u0103n nguy\u00ean vi khu\u1ea9n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 H. influenzae, S. pneumoniae, M. catarrhalis, P. aeruginosa, S. aureus v\u00e0 K. pneumoniae. B\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p PCR cho k\u1ebft qu\u1ea3 kh\u00f4ng nh\u01b0 nu\u00f4i c\u1ea5y, trong \u0111\u00f3 ch\u1ee7 y\u1ebfu ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c H. influenzae v\u00e0 S. pneumoniae. C\u00e1c c\u0103n nguy\u00ean virus ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c bao g\u1ed3m influenza A virus, Influenza B virus, Rhinovirus, Adenovirus v\u00e0 RSV [53].<\/p>\n<p style=\"text-align: justify;\">Nghi\u00ean c\u1ee9u ti\u1ebfn h\u00e0nh \u1edf 142 ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u1ea1i B\u1ec7nh vi\u1ec7n B\u1ec7nh Nhi\u1ec7t \u0111\u1edbi Trung \u01b0\u01a1ng, B\u1ec7nh vi\u1ec7n \u0110a khoa \u0110\u1ed1ng \u0110a v\u00e0 B\u1ec7nh vi\u1ec7n \u0110a khoa \u0110\u1ee9c Giang l\u1ea1i cho th\u1ea5y M. pneumoniae (16,2%), K. pneumoniae (14,8%), C. pneumoniae (10,6%) v\u00e0 S. pneumoniae (9.9%) l\u00e0 c\u00e1c c\u0103n nguy\u00ean chi\u1ebfm t\u1ef7 l\u1ec7 cao nh\u1ea5t [54].<br \/>\nM\u1ed9t nghi\u00ean c\u1ee9u \u0111a trung t\u00e2m thu th\u1eadp t\u1eeb 11 b\u1ec7nh vi\u1ec7n l\u1edbn tr\u00ean ph\u1ea1m vi to\u00e0n qu\u1ed1c ti\u1ebfn h\u00e0nh thu th\u1eadp 289 ch\u1ee7ng S. pneumoniae v\u00e0 195 ch\u1ee7ng H. influenzae trong v\u00f2ng 3 n\u0103m t\u1eeb 2009 \u0111\u1ebfn 2011, trong \u0111\u00f3 kho\u1ea3ng 60% ch\u1ee7ng \u0111\u01b0\u1ee3c thu th\u1eadp t\u1eeb ng\u01b0\u1eddi b\u1ec7nh nhi. C\u00e1c ch\u1ee7ng S. pneumoniae c\u00f2n nh\u1ea1y c\u1ea3m cao v\u1edbi penicillin ti\u00eam (86,9%) nh\u01b0ng \u0111\u00e3 \u0111\u1ec1 kh\u00e1ng cao v\u1edbi nh\u00f3m macrolid (&gt;90%) v\u00e0 tr\u00ean 95% c\u00e1c ch\u1ee7ng H. influenzae c\u00f2n nh\u1ea1y c\u1ea3m v\u1edbi amoxicillin\/acid clavulanic khi s\u1eed d\u1ee5ng ti\u00eau chu\u1ea9n phi\u00ean gi\u1ea3i CLSI c\u1ee7a Hoa K\u1ef3 nh\u01b0ng n\u1ebfu s\u1eed d\u1ee5ng ti\u00eau chu\u1ea9n phi\u00ean gi\u1ea3i EUCAST c\u1ee7a ch\u00e2u \u00c2u th\u00ec t\u1ef7 l\u1ec7 nh\u1ea1y c\u1ea3m v\u1edbi kh\u00e1ng sinh t\u01b0\u01a1ng \u1ee9ng c\u1ee7a c\u00e1c ch\u1ee7ng vi khu\u1ea9n n\u00e0y th\u1ea5p h\u01a1n [50]. Hi\u1ec7n nay, th\u1eed nghi\u1ec7m kh\u00e1ng sinh \u0111\u1ed3 c\u1ee7a H. influenzae v\u1edbi amoxicillin\/acid clavulanic ph\u1ea3i th\u1ef1c hi\u1ec7n b\u1eb1ng k\u1ef9 thu\u1eadt x\u00e1c \u0111\u1ecbnh MIC ch\u1ee9 kh\u00f4ng \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p khoanh gi\u1ea5y khu\u1ebfch t\u00e1n n\u1eefa n\u00ean c\u00e1c k\u1ebft qu\u1ea3 v\u1ec1 t\u1ef7 l\u1ec7 nh\u1ea1y\/kh\u00e1ng t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u tr\u01b0\u1edbc c\u1ea7n \u0111\u01b0\u1ee3c xem x\u00e9t k\u1ef9 l\u01b0\u1ee1ng. Trong b\u00e1o c\u00e1o m\u1edbi nh\u1ea5t c\u1ee7a B\u1ed9 Y t\u1ebf thu\u1ed9c ch\u01b0\u01a1ng tr\u00ecnh gi\u00e1m s\u00e1t kh\u00e1ng kh\u00e1ng sinh qu\u1ed1c gia, c\u00e1c ch\u1ee7ng S. pneumoniae ph\u00e2n l\u1eadp t\u1eeb b\u1ec7nh ph\u1ea9m h\u00f4 h\u1ea5p c\u00f2n nh\u1ea1y c\u1ea3m cao v\u1edbi penicillin v\u00e0 ceftriaxon (&gt;92%) [55].<\/p>\n<p style=\"text-align: justify;\">C\u00e1c nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n ch\u1ee7 y\u1ebfu d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng nu\u00f4i c\u1ea5y n\u00ean ch\u1ec9 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c c\u00e1c t\u00e1c nh\u00e2n c\u00f3 th\u1ec3 nu\u00f4i c\u1ea5y \u0111\u01b0\u1ee3c. C\u00f3 m\u1ed9t nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y s\u1eed d\u1ee5ng k\u1ef9 thu\u1eadt nu\u00f4i c\u1ea5y v\u00e0 real-time PCR ph\u00e1t hi\u1ec7n t\u00e1c nh\u00e2n g\u00e2y VPMPC\u0110 \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa t\u1ea1i 4 b\u1ec7nh vi\u1ec7n \u1edf th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh. K\u1ebft qu\u1ea3 cho th\u1ea5y H. influenzae (63,1%) v\u00e0 S. pneumoniae (25,5%) v\u1eabn l\u00e0 nh\u1eefng c\u0103n nguy\u00ean h\u00e0ng \u0111\u1ea7u ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c nh\u01b0ng v\u1edbi th\u1eed nghi\u1ec7m real-time PCR l\u1ea1i ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c S. pneumoniae chi\u1ebfm t\u1ef7 l\u1ec7 cao nh\u1ea5t (71,3%) v\u00e0 21,7% l\u00e0 c\u00e1c t\u00e1c nh\u00e2n virus nh\u01b0 Rhinovirus, Influenza virus v\u00e0 Parainfluenza virus. Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p VPMPC\u0110 trong nghi\u00ean c\u1ee9u n\u00e0y cho th\u1ea5y m\u1ed9t t\u1ef7 l\u1ec7 r\u1ea5t l\u1edbn c\u00e1c tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m \u0111a t\u00e1c nh\u00e2n (76,4%) [56].<\/p>\n<p style=\"text-align: justify;\">C\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 c\u0103n nguy\u00ean VPMPC\u0110 c\u0169ng nh\u01b0 m\u1ee9c \u0111\u1ed9 nh\u1ea1y c\u1ea3m v\u1edbi kh\u00e1ng sinh \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 h\u1ea7u nh\u01b0 l\u00e0 c\u00e1c nghi\u00ean c\u1ee9u thu th\u1eadp t\u1eeb c\u00e1c ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 nh\u01b0ng \u0111\u01b0\u1ee3c \u0111\u1ebfn kh\u00e1m v\u00e0 \u0111i\u1ec1u tr\u1ecb t\u1ea1i c\u00e1c b\u1ec7nh vi\u1ec7n trung \u01b0\u01a1ng ho\u1eb7c tuy\u1ebfn t\u1ec9nh l\u1edbn v\u00e0 s\u1ed1 l\u01b0\u1ee3ng ch\u1ee7ng thu th\u1eadp \u0111\u01b0\u1ee3c trong c\u00e1c nghi\u00ean c\u1ee9u kh\u00f4ng \u0111\u1ee7 l\u1edbn \u0111\u1ec3 \u0111\u1ea1i di\u1ec7n cho qu\u1ea7n th\u1ec3 c\u0103n nguy\u00ean g\u00e2y VPMPC\u0110 n\u00ean th\u1ef1c s\u1ef1 ch\u01b0a h\u1eb3n \u0111\u00e3 ph\u1ea3n \u00e1nh \u0111\u00fang v\u1ec1 th\u1ef1c tr\u1ea1ng c\u1ee7a c\u0103n nguy\u00ean g\u00e2y VPMPC\u0110. H\u01a1n n\u1eefa, c\u00e1c k\u1ebft qu\u1ea3 v\u1ec1 m\u1ee9c \u0111\u1ed9 nh\u1ea1y c\u1ea3m v\u1edbi kh\u00e1ng sinh ph\u1ee5 thu\u1ed9c nhi\u1ec1u v\u00e0o ph\u01b0\u01a1ng ph\u00e1p l\u00e0m kh\u00e1ng sinh \u0111\u1ed3 c\u0169ng nh\u01b0 ti\u00eau chu\u1ea9n l\u1ef1a ch\u1ecdn \u0111\u1ec3 phi\u00ean gi\u1ea3i k\u1ebft qu\u1ea3 n\u00ean c\u0169ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t kh\u00f4ng nh\u1ecf gi\u1eefa c\u00e1c nghi\u00ean c\u1ee9u. Do v\u1eady, r\u1ea5t c\u1ea7n c\u00f3 c\u00e1c nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c thi\u1ebft k\u1ebf ch\u1eb7t ch\u1ebd c\u0169ng nh\u01b0 th\u1ed1ng nh\u1ea5t v\u1ec1 ph\u01b0\u01a1ng ph\u00e1p \u0111\u1ec3 c\u00f3 \u0111\u01b0\u1ee3c h\u00ecnh \u1ea3nh c\u0103n nguy\u00ean VPMPC\u0110 ch\u00ednh x\u00e1c h\u01a1n.<\/p>\n<h3 style=\"text-align: justify;\">2.2. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n vi sinh VPMPC\u0110<\/h3>\n<p style=\"text-align: justify;\">M\u1eb7c d\u00f9 c\u00f3 s\u1ef1 \u0111\u1ed3ng thu\u1eadn cao v\u1ec1 l\u00fd thuy\u1ebft l\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1ebd t\u1ed1t nh\u1ea5t khi x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c c\u0103n nguy\u00ean g\u00e2y b\u1ec7nh nh\u01b0ng v\u1ec1 th\u1ef1c h\u00e0nh c\u00f2n nhi\u1ec1u tranh c\u00e3i v\u1ec1 gi\u00e1 tr\u1ecb c\u1ee7a c\u00e1c x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n c\u0103n nguy\u00ean VPMPC\u0110 do \u0111\u1ed9 nh\u1ea1y c\u1ee7a c\u00e1c x\u00e9t nghi\u1ec7m, t\u1ef7 l\u1ec7 l\u1ee3i \u00edch\/chi ph\u00ed x\u00e9t nghi\u1ec7m th\u1ea5p [58]. V\u00ec v\u1eady, trong khuy\u1ebfn c\u00e1o c\u1ee7a H\u1ed9i Truy\u1ec1n nhi\u1ec5m v\u00e0 H\u1ed9i L\u1ed3ng ng\u1ef1c M\u1ef9 th\u1ed1ng nh\u1ea5t kh\u00f4ng x\u00e9t nghi\u1ec7m vi sinh th\u01b0\u1eddng quy cho ch\u1ea9n \u0111o\u00e1n VPMPC\u0110 ng\u01b0\u1eddi b\u1ec7nh \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa. V\u1edbi nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 ph\u1ea3i nh\u1eadp vi\u1ec7n v\u00e0 nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh ngo\u1ea1i tr\u00fa m\u00e0 k\u1ebft qu\u1ea3 ch\u1ea9n \u0111o\u00e1n c\u00f3 thay \u0111\u1ed5i ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb th\u00ec c\u1ea7n l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m vi sinh ch\u1ea9n \u0111o\u00e1n [29, 59].<br \/>\n2.2.1. Ch\u1ecdn l\u1ef1a x\u00e9t nghi\u1ec7m d\u1ef1a tr\u00ean \u0111\u1eb7c \u0111i\u1ec3m ng\u01b0\u1eddi b\u1ec7nh<\/p>\n<p style=\"text-align: justify;\">&#8211; V\u1edbi nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i l\u00e0 (i) ng\u01b0\u1eddi b\u1ec7nh c\u00f3 VPMPC\u0110 n\u1eb7ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi ng\u01b0\u1eddi b\u1ec7nh c\u00f3 \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n; ho\u1eb7c (ii) ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb theo kinh nghi\u1ec7m theo h\u01b0\u1edbng MRSA ho\u1eb7c P. aeruginosa; ho\u1eb7c (iii) ng\u01b0\u1eddi b\u1ec7nh tr\u01b0\u1edbc \u0111\u00f3 \u0111\u00e3 nhi\u1ec5m tr\u00f9ng MRSA ho\u1eb7c P. aeruginosa, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111\u00e3 nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p v\u1edbi c\u00e1c c\u0103n nguy\u00ean n\u00e0y tr\u01b0\u1edbc \u0111\u00f3; ho\u1eb7c (iv) ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e3 n\u1eb1m vi\u1ec7n v\u00e0 d\u00f9ng kh\u00e1ng sinh \u0111\u01b0\u1eddng ti\u00eam c\u00f3 th\u1ec3 trong giai \u0111o\u1ea1n n\u1eb1m vi\u1ec7n ho\u1eb7c kh\u00f4ng trong v\u00f2ng 90 ng\u00e0y g\u1ea7n \u0111\u00e2y n\u00ean l\u1ea5y \u0111\u1eddm nhu\u1ed9m Gram v\u00e0 c\u1ea5y, c\u1ea5y m\u00e1u tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh.<\/p>\n<p style=\"text-align: justify;\">&#8211; Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 c\u00f3 y\u1ebfu t\u1ed1 d\u1ecbch t\u1ec5 nghi ng\u1edd nhi\u1ec5m tr\u00f9ng Legionella nh\u01b0 li\u00ean quan \u0111\u1ebfn v\u1ee5 d\u1ecbch Legionella ho\u1eb7c m\u1edbi \u0111i du l\u1ecbch ho\u1eb7c \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 n\u1eb7ng n\u00ean l\u00e0m th\u1eed nghi\u1ec7m t\u00ecm kh\u00e1ng nguy\u00ean Legionella trong n\u01b0\u1edbc ti\u1ec3u v\u00e0 c\u1ea5y ho\u1eb7c l\u00e0m x\u00e9t nghi\u1ec7m sinh h\u1ecdc ph\u00e2n t\u1eed t\u00ecm Legionella t\u1eeb c\u00e1c b\u1ec7nh ph\u1ea9m d\u1ecbch ti\u1ebft \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p.<\/p>\n<p style=\"text-align: justify;\">&#8211; \u1ede nh\u1eefng c\u1ed9ng \u0111\u1ed3ng c\u00f3 Influenza virus, SARS-CoV-2 v\u00e0 RSV l\u01b0u h\u00e0nh, n\u00ean th\u1ef1c hi\u1ec7n x\u00e9t nghi\u1ec7m ph\u00e1t hi\u1ec7n c\u00e1c virus n\u00e0y cho c\u1ea3 ng\u01b0\u1eddi b\u1ec7nh ngo\u1ea1i tr\u00fa v\u00e0 ng\u01b0\u1eddi b\u1ec7nh n\u1ed9i tr\u00fa v\u00ec k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m c\u00f3 \u00fd ngh\u0129a cho vi\u1ec7c l\u1ef1a ch\u1ecdn ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb t\u1ed1i \u01b0u. X\u00e9t nghi\u1ec7m sinh h\u1ecdc ph\u00e2n t\u1eed c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n t\u1ed1t h\u01a1n c\u00e1c x\u00e9t nghi\u1ec7m test nhanh ph\u00e1t hi\u1ec7n kh\u00e1ng nguy\u00ean virus.<\/p>\n<h4 style=\"text-align: justify;\">2.2.2. C\u00e1c k\u1ef9 thu\u1eadt x\u00e9t nghi\u1ec7m<\/h4>\n<p style=\"text-align: justify;\"><strong>a. C\u1ea5y m\u00e1u<\/strong><\/p>\n<p style=\"text-align: justify;\">C\u1ea5y m\u00e1u \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho c\u00e1c ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 ph\u1ea3i nh\u1eadp vi\u1ec7n \u0111i\u1ec1u tr\u1ecb. M\u1eb7c d\u00f9 t\u1ef7 l\u1ec7 c\u1ea5y m\u00e1u d\u01b0\u01a1ng t\u00ednh kh\u00e1 th\u1ea5p \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 ph\u1ea3i nh\u1eadp vi\u1ec7n (4,7 \u2013 16%) nh\u01b0ng k\u1ebft qu\u1ea3 c\u1ea5y m\u00e1u c\u00f3 th\u1ec3 h\u1ed7 tr\u1ee3 tr\u1ef1c ti\u1ebfp cho vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb ng\u01b0\u1eddi b\u1ec7nh c\u0169ng nh\u01b0 g\u00f3p ph\u1ea7n cung c\u1ea5p th\u00eam d\u1eef li\u1ec7u quan tr\u1ecdng cho c\u00e1c ch\u01b0\u01a1ng tr\u00ecnh v\u1ec1 s\u1ee9c kh\u1ecfe c\u1ed9ng \u0111\u1ed3ng nh\u01b0 xu h\u01b0\u1edbng \u0111\u1ec1 kh\u00e1ng kh\u00e1ng sinh, hi\u1ec7u qu\u1ea3 c\u1ee7a v\u1eafc xin\u2026<\/p>\n<p style=\"text-align: justify;\">C\u1ea5y m\u00e1u l\u00fd t\u01b0\u1edfng nh\u1ea5t l\u00e0 l\u1ea5y \u0111\u01b0\u1ee3c m\u00e1u tr\u01b0\u1edbc khi ng\u01b0\u1eddi b\u1ec7nh d\u00f9ng kh\u00e1ng sinh. N\u1ebfu ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e3 d\u00f9ng kh\u00e1ng sinh, n\u00ean l\u1ea5y ngay tr\u01b0\u1edbc khi d\u00f9ng li\u1ec1u kh\u00e1ng sinh ti\u1ebfp theo. Th\u1eddi \u0111i\u1ec3m t\u1ed1t nh\u1ea5t \u0111\u1ec3 l\u1ea5y m\u00e1u l\u00e0 khi ng\u01b0\u1eddi b\u1ec7nh c\u00f3 c\u01a1n gai r\u00e9t ho\u1eb7c \u1edf \u0111\u1ec9nh s\u1ed1t. M\u1ed7i l\u1ea7n c\u1ea5y m\u00e1u, t\u1ed1i thi\u1ec3u c\u1ea7n c\u1ea5y 2 v\u1ecb tr\u00ed v\u00e0 c\u1ea5y v\u00e0o 2 chai (m\u1ed9t chai hi\u1ebfu kh\u00ed, m\u1ed9t chai k\u1ef5 kh\u00ed), m\u1ed7i chai c\u1ea5y 8-10 ml m\u00e1u v\u1edbi ng\u01b0\u1eddi l\u1edbn, th\u1ec3 t\u00edch m\u00e1u l\u1ea5y \u1edf tr\u1ebb em tu\u1ef3 theo c\u00e2n n\u1eb7ng [60]. C\u00f3 th\u1ec3 c\u1ea5y m\u00e1u nhi\u1ec1u l\u1ea7n t\u00f9y theo di\u1ec5n bi\u1ebfn l\u00e2m s\u00e0ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n<p style=\"text-align: justify;\"><strong>b. Nhu\u1ed9m Gram v\u00e0 nu\u00f4i c\u1ea5y \u0111\u1eddm\/d\u1ecbch ti\u1ebft \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p<\/strong><\/p>\n<p style=\"text-align: justify;\">B\u1ec7nh ph\u1ea9m \u0111\u1eddm c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh nhu\u1ed9m Gram v\u00e0 nu\u00f4i c\u1ea5y nh\u01b0ng t\u1ef7 l\u1ec7 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c c\u0103n nguy\u00ean g\u00e2y b\u1ec7nh (10-86%) r\u1ea5t kh\u00e1c nhau \u1edf c\u00e1c nghi\u00ean c\u1ee9u kh\u00e1c nhau [50]. Ph\u1ea3i l\u1ea5y \u0111\u01b0\u1ee3c t\u1ed1i thi\u1ec3u 1-2 ml \u0111\u1eddm c\u00f3 nh\u1ea7y &#8211; m\u1ee7 ho\u1eb7c nh\u1ea7y m\u00e1u, n\u00ean l\u1ea5y \u0111\u1eddm tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh ho\u1eb7c trong v\u00f2ng 24 gi\u1edd sau khi nh\u1eadp vi\u1ec7n, t\u1ed1t nh\u1ea5t l\u00e0 l\u1ea5y v\u00e0o bu\u1ed5i s\u00e1ng s\u1edbm. B\u1ec7nh ph\u1ea9m \u0111\u1eddm \u0111\u1ea1t ch\u1ea5t l\u01b0\u1ee3ng cho nu\u00f4i c\u1ea5y khi kh\u00f4ng ho\u1eb7c \u00edt t\u1ea1p nhi\u1ec5m vi h\u1ec7 h\u1ecdng mi\u1ec7ng (\u0111\u00e1nh gi\u00e1 ch\u1ea5t l\u01b0\u1ee3ng b\u1ec7nh ph\u1ea9m \u0111\u1eddm d\u1ef1a tr\u00ean ti\u00eau chu\u1ea9n \u0111\u1eddm soi c\u00f3 \u00edt h\u01a1n 10 t\u1ebf b\u00e0o bi\u1ec3u m\u00f4\/1 vi tr\u01b0\u1eddng ho\u1eb7c c\u00f3 nhi\u1ec1u h\u01a1n 25 t\u1ebf b\u00e0o b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n\/1 vi tr\u01b0\u1eddng). T\u1ef7 l\u1ec7 c\u1ea5y ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh \u1edf nh\u1eefng b\u1ec7nh ph\u1ea9m \u0111\u1eddm \u0111\u1ea1t ti\u00eau chu\u1ea9n c\u00f3 th\u1ec3 \u0111\u1ebfn 73% nh\u01b0ng ch\u1ec9 \u0111\u01b0\u1ee3c 36% \u1edf nh\u1eefng m\u1eabu \u0111\u1eddm ch\u1ea5t l\u01b0\u1ee3ng th\u1ea5p. C\u00e1c b\u1ec7nh ph\u1ea9m sau khi l\u1ea5y ph\u1ea3i \u0111\u01b0\u1ee3c v\u1eadn chuy\u1ec3n \u0111\u1ebfn ph\u00f2ng x\u00e9t nghi\u1ec7m c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t, kh\u00f4ng mu\u1ed9n h\u01a1n 2 ti\u1ebfng [60]. \u0110\u1ed9 nh\u1ea1y c\u1ee7a nhu\u1ed9m Gram kh\u00e1c nhau tu\u1ef3 thu\u1ed9c c\u0103n nguy\u00ean vi khu\u1ea9n v\u00e0 c\u00e1c nghi\u00ean c\u1ee9u (15-100%). K\u1ebft qu\u1ea3 nu\u00f4i c\u1ea5y \u0111\u1eddm \u0111\u01b0\u1ee3c phi\u00ean gi\u1ea3i d\u1ef1a tr\u00ean m\u1ee9c \u0111\u1ed9 vi khu\u1ea9n m\u1ecdc (\u00edt, trung b\u00ecnh, nhi\u1ec1u, r\u1ea5t nhi\u1ec1u t\u01b0\u01a1ng \u1ee9ng v\u1edbi gi\u00e1 tr\u1ecb c\u1ea5y b\u00e1n \u0111\u1ecbnh l\u01b0\u1ee3ng 1+, 2+, 3+ v\u00e0 4+), s\u1ef1 ph\u00f9 h\u1ee3p v\u1edbi l\u00e2m s\u00e0ng v\u00e0 m\u1ed1i li\u00ean quan v\u1edbi k\u1ebft qu\u1ea3 nhu\u1ed9m Gram. Nh\u1eefng vi khu\u1ea9n \u0111\u01b0\u1ee3c coi l\u00e0 c\u0103n nguy\u00ean g\u00e2y b\u1ec7nh th\u01b0\u1eddng c\u00f3 m\u1eb7t \u1edf m\u1ee9c trung b\u00ecnh ho\u1eb7c nhi\u1ec1u tr\u00ean \u0111\u0129a nu\u00f4i c\u1ea5y v\u00e0 tr\u00ean ti\u00eau b\u1ea3n nhu\u1ed9m Gram. Tuy nhi\u00ean, Legionella spp., B. anthracis, B. pseudomallei, M. pneumoniae, C. pneumoniae v\u00e0 C. psittaci cho d\u00f9 s\u1ed1 l\u01b0\u1ee3ng bao nhi\u00eau c\u0169ng l\u00e0 c\u0103n nguy\u00ean g\u00e2y b\u1ec7nh v\u00ec kh\u00f4ng bao gi\u1edd c\u00f3 s\u1ef1 c\u01b0 tr\u00fa tr\u00ean \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p c\u1ee7a c\u00e1c c\u0103n nguy\u00ean n\u00e0y [50]. Nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh n\u1ed9i tr\u00fa c\u00f3 \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n th\u00ec s\u1eed d\u1ee5ng b\u1ec7nh ph\u1ea9m d\u1ecbch h\u00fat kh\u00ed qu\u1ea3n ho\u1eb7c d\u1ecbch r\u1eeda ph\u1ebf qu\u1ea3n ph\u1ebf nang s\u1ebd c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n t\u1ed1t h\u01a1n b\u1ec7nh ph\u1ea9m \u0111\u1eddm.<\/p>\n<p style=\"text-align: justify;\"><strong>c. X\u00e9t nghi\u1ec7m kh\u00e1ng nguy\u00ean trong n\u01b0\u1edbc ti\u1ec3u<\/strong><\/p>\n<p style=\"text-align: justify;\">X\u00e9t nghi\u1ec7m kh\u00e1ng nguy\u00ean trong n\u01b0\u1edbc ti\u1ec3u c\u00f3 th\u1ec3 l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n b\u1ed5 sung ho\u1eb7c thay th\u1ebf \u0111\u1ec3 ph\u00e1t hi\u1ec7n S. pneumoniae v\u00e0 Legionella pneumophila. So v\u1edbi nu\u00f4i c\u1ea5y, x\u00e9t nghi\u1ec7m kh\u00e1ng nguy\u00ean nh\u1ea1y v\u00e0 \u0111\u1eb7c hi\u1ec7u h\u01a1n, c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng cho nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng th\u1ec3 ho kh\u1ea1c \u0111\u1eddm \u0111\u01b0\u1ee3c, cho k\u1ebft qu\u1ea3 nhanh v\u00e0 kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng khi \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh. X\u00e9t nghi\u1ec7m n\u00e0y ch\u1ee7 y\u1ebfu ph\u00e1t hi\u1ec7n nhi\u1ec5m L. pneumophila nh\u00f3m huy\u1ebft thanh 1 (chi\u1ebfm kho\u1ea3ng 90% c\u00e1c tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m), trong khi ng\u01b0\u1eddi b\u1ec7nh nhi\u1ec5m L. pneumophila c\u00e1c nh\u00f3m huy\u1ebft thanh kh\u00e1c ho\u1eb7c c\u00e1c lo\u00e0i Legionella kh\u00e1c kh\u00f4ng ph\u1ea3i L. pneumophila th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n. X\u00e9t nghi\u1ec7m kh\u00e1ng nguy\u00ean trong n\u01b0\u1edbc ti\u1ec3u c\u00f3 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u g\u1ea7n 99%, \u0111\u1ed9 nh\u1ea1y kho\u1ea3ng 80\u201390% \u0111\u1ed1i v\u1edbi L. pneumophila nh\u00f3m huy\u1ebft thanh 1. Tuy nhi\u00ean, \u0111\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh do c\u00e1c nh\u00f3m huy\u1ebft thanh kh\u00e1c c\u1ee7a L. pneumophila g\u00e2y ra, \u0111\u1ed9 nh\u1ea1y dao \u0111\u1ed9ng t\u1eeb 14% \u0111\u1ebfn 69%, do \u0111\u00f3 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m \u00e2m t\u00ednh kh\u00f4ng lo\u1ea1i tr\u1eeb kh\u1ea3 n\u0103ng nhi\u1ec5m b\u1ec7nh [95]. X\u00e9t nghi\u1ec7m kh\u00e1ng nguy\u00ean ph\u00e1t hi\u1ec7n L. pneumophila trong n\u01b0\u1edbc ti\u1ec3u \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho c\u00e1c ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 n\u1eb7ng hay c\u00e1c ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 kh\u00f4ng n\u1eb7ng nh\u01b0ng c\u00f3 y\u1ebfu t\u1ed1 d\u1ecbch t\u1ec5 nhi\u1ec5m Legionella pneumophila r\u00f5 r\u00e0ng [61]. Hi\u1ec7n nay, H\u1ed9i truy\u1ec1n nhi\u1ec5m Ph\u00e1p, H\u1ed9i Truy\u1ec1n nhi\u1ec5m v\u00e0 H\u1ed9i L\u1ed3ng ng\u1ef1c Hoa K\u1ef3 c\u0169ng khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng x\u00e9t nghi\u1ec7m ph\u00e1t hi\u1ec7n kh\u00e1ng nguy\u00ean trong n\u01b0\u1edbc ti\u1ec3u ch\u1ea9n \u0111o\u00e1n S. pneumoniae v\u00e0 Legionella pneumophila \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 m\u1ee9c \u0111\u1ed9 n\u1eb7ng [62] [96].<\/p>\n<p style=\"text-align: justify;\"><strong>d. X\u00e9t nghi\u1ec7m sinh h\u1ecdc ph\u00e2n t\u1eed<\/strong><\/p>\n<p style=\"text-align: justify;\">X\u00e9t nghi\u1ec7m sinh h\u1ecdc ph\u00e2n t\u1eed nhanh, nh\u1ea1y h\u01a1n nu\u00f4i c\u1ea5y, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh nh\u01b0ng l\u1ea1i h\u1ea1n ch\u1ebf r\u1ea5t nhi\u1ec1u khi \u00e1p d\u1ee5ng b\u1ec7nh ph\u1ea9m kh\u00f4ng v\u00f4 tr\u00f9ng nh\u01b0 b\u1ec7nh ph\u1ea9m \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p v\u00ec lo\u1ea1i b\u1ec7nh ph\u1ea9m n\u00e0y th\u01b0\u1eddng b\u1ecb t\u1ea1p nhi\u1ec5m c\u00e1c vi khu\u1ea9n vi h\u1ec7 \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean. M\u1eb7c d\u00f9 c\u00f3 th\u1ec3 cung c\u1ea5p c\u1ea3 c\u00e1c th\u00f4ng tin v\u1ec1 gen kh\u00e1ng thu\u1ed1c nh\u01b0ng c\u00e1c th\u00f4ng tin n\u00e0y c\u0169ng kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 h\u1ebft, nh\u1ea5t l\u00e0 \u1edf c\u00e1c vi khu\u1ea9n Gram \u00e2m [58]. PCR ph\u00e1t hi\u1ec7n \u0111\u01a1n t\u00e1c nh\u00e2n ho\u1eb7c PCR ph\u00e1t hi\u1ec7n \u0111\u1ed3ng th\u1eddi nhi\u1ec1u c\u0103n nguy\u00ean g\u00e2y VPMPC\u0110 bao g\u1ed3m c\u1ea3 virus v\u00e0 vi khu\u1ea9n \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i. C\u00e1c x\u00e9t nghi\u1ec7m \u0111a t\u00e1c nh\u00e2n gi\u00fap t\u0103ng kh\u1ea3 n\u0103ng ph\u00e1t hi\u1ec7n c\u00e1c vi sinh v\u1eadt c\u00f3 \u1edf trong m\u1eabu b\u1ec7nh ph\u1ea9m d\u1ecbch ti\u1ebft h\u00f4 h\u1ea5p nh\u01b0ng gi\u00e1 tr\u1ecb d\u1ef1 b\u00e1o c\u1ee7a x\u00e9t nghi\u1ec7m n\u00e0y c\u0169ng c\u00f2n nhi\u1ec1u tranh c\u00e3i. V\u00ed d\u1ee5 nh\u01b0 khi ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c s\u1ef1 c\u00f3 m\u1eb7t c\u1ee7a virus c\u0169ng ch\u01b0a th\u1ec3 lo\u1ea1i tr\u1eeb t\u00e1c nh\u00e2n vi khu\u1ea9n v\u00ec kh\u1ea3 n\u0103ng \u0111\u1ed3ng nhi\u1ec5m vi khu\u1ea9n v\u00e0 virus chi\u1ebfm 5 \u2013 10% c\u00e1c t\u00e1c nh\u00e2n g\u00e2y VPMPC\u0110. M\u1ed9t s\u1ed1 c\u00e1c x\u00e9t nghi\u1ec7m PCR hi\u1ec7n nay c\u0169ng c\u00f3 th\u1ec3 cung c\u1ea5p gi\u00e1 tr\u1ecb \u0111\u1ecbnh l\u01b0\u1ee3ng c\u00e1c vi khu\u1ea9n hay virus t\u1eeb b\u1ec7nh ph\u1ea9m \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p \u0111\u1ec3 h\u1ed7 tr\u1ee3 cho vi\u1ec7c phi\u00ean gi\u1ea3i k\u1ebft qu\u1ea3 c\u00e1c vi sinh v\u1eadt ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c b\u1eb1ng x\u00e9t nghi\u1ec7m PCR c\u00f3 ph\u1ea3i l\u00e0 c\u0103n nguy\u00ean g\u00e2y b\u1ec7nh th\u1ef1c s\u1ef1 hay kh\u00f4ng. Cho \u0111\u1ebfn hi\u1ec7n nay, m\u1ed9t v\u1ea5n \u0111\u1ec1 r\u1ea5t l\u1edbn v\u1eabn ch\u01b0a gi\u1ea3i quy\u1ebft \u0111\u01b0\u1ee3c \u0111\u00f3 l\u00e0 s\u1ef1 kh\u00f4ng t\u01b0\u01a1ng \u0111\u1ed3ng khi k\u1ebft qu\u1ea3 PCR ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c vi khu\u1ea9n nh\u01b0ng l\u1ea1i kh\u00f4ng th\u1ea5y vi khu\u1ea9n m\u1ecdc khi nu\u00f4i c\u1ea5y v\u00ec PCR d\u01b0\u01a1ng t\u00ednh c\u00f3 th\u1ec3 l\u00e0 d\u01b0\u01a1ng t\u00ednh th\u1eadt, c\u00f3 th\u1ec3 l\u00e0 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c vi khu\u1ea9n \u0111\u00e3 ch\u1ebft, vi khu\u1ea9n kh\u00f3 nu\u00f4i c\u1ea5y, vi khu\u1ea9n c\u01b0 tr\u00fa ho\u1eb7c nh\u1eefng con vi khu\u1ea9n khi\u1ebfm khuy\u1ebft chuy\u1ec3n h\u00f3a [63]. Do v\u1eady, nh\u1eadn \u0111\u1ecbnh k\u1ebft qu\u1ea3 c\u1ee7a x\u00e9t nghi\u1ec7m sinh h\u1ecdc ph\u00e2n t\u1eed c\u1ea7n k\u1ebft h\u1ee3p v\u1edbi \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng. Tuy nhi\u00ean, v\u1edbi vi\u1ec7c tri\u1ec3n khai x\u00e9t nghi\u1ec7m PCR \u0111a t\u00e1c nh\u00e2n, c\u00f3 k\u1ebft qu\u1ea3 s\u1edbm gi\u00fap cho vi\u1ec7c l\u00ean thang v\u00e0 xu\u1ed1ng thang kh\u00e1ng sinh s\u1edbm v\u00e0 hi\u1ec7u qu\u1ea3 h\u01a1n.<\/p>\n<p style=\"text-align: justify;\"><strong>e. Huy\u1ebft thanh h\u1ecdc<\/strong><\/p>\n<p style=\"text-align: justify;\">C\u00e1c x\u00e9t nghi\u1ec7m huy\u1ebft thanh h\u1ecdc \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho ch\u1ea9n \u0111o\u00e1n M. pneumoniae d\u1ef1a tr\u00ean s\u1ef1 gia t\u0103ng (th\u01b0\u1eddng l\u00e0 g\u1ea5p b\u1ed1n l\u1ea7n) hi\u1ec7u gi\u00e1 kh\u00e1ng th\u1ec3 IgG gi\u1eefa c\u00e1c m\u1eabu huy\u1ebft thanh \u1edf giai \u0111o\u1ea1n c\u1ea5p t\u00ednh v\u00e0 giai \u0111o\u1ea1n h\u1ed3i ph\u1ee5c. N\u00f3i chung x\u00e9t nghi\u1ec7m n\u00e0y \u00edt \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, \u0111\u1eb7c bi\u1ec7t \u0111\u1ed1i v\u1edbi M. pneumoniae v\u00ec c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 \u0111\u1ed9 ch\u00ednh x\u00e1c v\u00e0 th\u1eddi gian c\u1ea7n thi\u1ebft cho l\u1eb7p l\u1ea1i m\u1eabu huy\u1ebft thanh th\u1ee9 2. V\u1edbi kh\u00e1ng th\u1ec3 IgM th\u00ec n\u1ebfu ch\u1ec9 x\u00e9t nghi\u1ec7m 1 m\u1eabu huy\u1ebft thanh, t\u1ef7 l\u1ec7 d\u01b0\u01a1ng t\u00ednh gi\u1ea3 c\u00f3 th\u1ec3 l\u00e0 10,1%, t\u1ef7 l\u1ec7 \u00e2m t\u00ednh gi\u1ea3 l\u00e0 32,5% khi ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m t\u1ea1i th\u1eddi \u0111i\u1ec3m nh\u1eadp vi\u1ec7n [64]. \u0110\u1ec3 c\u00f3 \u0111\u01b0\u1ee3c gi\u00e1 tr\u1ecb ch\u00ednh x\u00e1c h\u01a1n, x\u00e9t nghi\u1ec7m 2 m\u1eabu huy\u1ebft thanh ph\u00e1t hi\u1ec7n IgM c\u0169ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o th\u1ef1c hi\u1ec7n. \u0110\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb \u1edf ng\u01b0\u1eddi b\u1ec7nh c\u00f3 IgM d\u01b0\u01a1ng t\u00ednh ngay khi nh\u1eadp vi\u1ec7n k\u00e9m h\u01a1n \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh c\u00f3 IgM \u00e2m t\u00ednh [65]\nM\u1ed7i ph\u01b0\u01a1ng ph\u00e1p x\u00e9t nghi\u1ec7m \u0111\u1ec1u c\u00f3 \u01b0u, nh\u01b0\u1ee3c \u0111i\u1ec3m ri\u00eang. K\u1ebft h\u1ee3p nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n s\u1ebd gi\u00fap \u0111\u1ecbnh danh \u0111\u01b0\u1ee3c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh nhanh h\u01a1n, ch\u00ednh x\u00e1c h\u01a1n v\u00e0 h\u1ed7 tr\u1ee3 hi\u1ec7u qu\u1ea3 h\u01a1n cho \u0111i\u1ec1u tr\u1ecb VPMPC\u0110. S\u1ef1 ph\u00e1t tri\u1ec3n v\u00e0 \u1ee9ng d\u1ee5ng ng\u00e0y c\u00e0ng nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p sinh h\u1ecdc ph\u00e2n t\u1eed trong ch\u1ea9n \u0111o\u00e1n VPMPC\u0110 tr\u1edf th\u00e0nh xu th\u1ebf m\u1edbi v\u00e0 \u0111\u00e3 gi\u00fap c\u1ea3i thi\u1ec7n ch\u1ea9n \u0111o\u00e1n t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh r\u1ea5t nhi\u1ec1u. Tuy nhi\u00ean, kh\u00e1i ni\u1ec7m ph\u1ed5i ho\u00e0n to\u00e0n v\u00f4 tr\u00f9ng \u0111\u00e3 thay \u0111\u1ed5i k\u1ec3 t\u1eeb khi c\u00f3 nh\u1eefng hi\u1ec3u bi\u1ebft m\u1edbi v\u1ec1 vi h\u1ec7 trong ph\u1ed5i. Vi h\u1ec7 ph\u1ed5i c\u00f3 ch\u1ee9a c\u1ea3 nhi\u1ec1u vi khu\u1ea9n \u0111\u01b0\u1ee3c coi l\u00e0 g\u00e2y VPMPC\u0110 ph\u1ed5 bi\u1ebfn nh\u01b0 S. pneumoniae v\u00e0 Mycoplasma spp. [13] v\u00e0 VPMPC\u0110 c\u00f3 th\u1ec3 x\u1ea3y ra khi m\u1ea5t c\u00e2n b\u1eb1ng vi h\u1ec7 c\u1ee7a ph\u1ed5i l\u00e0 nh\u1eefng th\u00e1ch th\u1ee9c r\u1ea5t l\u1edbn cho th\u1ef1c h\u00e0nh ch\u1ea9n \u0111o\u00e1n vi sinh v\u00e0 \u0111i\u1ec1u tr\u1ecb VPMPC\u0110.<\/p>\n<p style=\"text-align: justify;\"><strong>g. X\u00e9t nghi\u1ec7m kh\u00e1ng sinh \u0111\u1ed3<\/strong><\/p>\n<p style=\"text-align: justify;\">Khi \u0111\u00e3 nu\u00f4i c\u1ea5y v\u00e0 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c t\u00e1c nh\u00e2n vi khu\u1ea9n g\u00e2y VPMPC\u0110, kh\u00e1ng sinh \u0111\u1ed3 l\u00e0 x\u00e9t nghi\u1ec7m c\u1ea7n thi\u1ebft \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9 nh\u1ea1y c\u1ea3m v\u1edbi kh\u00e1ng sinh c\u1ee7a vi khu\u1ea9n g\u00e2y b\u1ec7nh, \u0111\u1eb7c bi\u1ec7t cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p VPMPC\u0110 n\u1eb7ng ph\u1ea3i nh\u1eadp vi\u1ec7n ho\u1eb7c \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh ph\u1ea3i n\u1eb1m t\u1ea1i khoa h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c. T\u1ea1i c\u00e1c ph\u00f2ng x\u00e9t nghi\u1ec7m vi sinh l\u00e2m s\u00e0ng, hi\u1ec7n nay, c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n ph\u01b0\u01a1ng ph\u00e1p kh\u00e1ng sinh \u0111\u1ed3 khoanh gi\u1ea5y khu\u1ebfch t\u00e1n v\u00e0 kh\u00e1ng sinh \u0111\u1ed3 pha lo\u00e3ng (x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c MIC). K\u1ebft qu\u1ea3 th\u1eed nghi\u1ec7m kh\u00e1ng sinh \u0111\u1ed3 \u0111\u01b0\u1ee3c phi\u00ean gi\u1ea3i ra c\u00e1c ph\u00e2n lo\u1ea1i nh\u1ea1y c\u1ea3m (S), \u0111\u1ec1 kh\u00e1ng (R) hay \u0111\u1ec1 kh\u00e1ng trung gian (I). X\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c MIC \u0111\u1eb7c bi\u1ec7t c\u00f3 gi\u00e1 tr\u1ecb trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u1ea7n hi\u1ec7u ch\u1ec9nh li\u1ec1u cho ng\u01b0\u1eddi b\u1ec7nh hay l\u00e0 c\u00e1 th\u1ec3 ho\u00e1 \u0111i\u1ec1u tr\u1ecb v\u00e0 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00e1ng sinh c\u00f3 li\u1ec1u \u0111\u1ed9c v\u00e0 li\u1ec1u \u0111i\u1ec1u tr\u1ecb g\u1ea7n nhau. C\u00f3 nh\u1eefng v\u1ea5n \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn kh\u00e1ng sinh \u0111\u1ed3 m\u00e0 c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng c\u0169ng c\u1ea7n bi\u1ebft \u0111\u00f3 l\u00e0 k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3 b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi r\u1ea5t nhi\u1ec1u y\u1ebfu t\u1ed1 nh\u01b0 s\u1ef1 ch\u00ednh x\u00e1c c\u1ee7a k\u1ebft qu\u1ea3 \u0111\u1ecbnh danh vi khu\u1ea9n, ch\u1ea5t l\u01b0\u1ee3ng c\u1ee7a x\u00e9t nghi\u1ec7m kh\u00e1ng sinh \u0111\u1ed3 v\u00e0 ti\u00eau chu\u1ea9n l\u1ef1a ch\u1ecdn \u0111\u1ec3 phi\u00ean gi\u1ea3i k\u1ebft qu\u1ea3. Hi\u1ec7n nay, c\u00f3 hai t\u00e0i li\u1ec7u h\u01b0\u1edbng d\u1eabn phi\u00ean gi\u1ea3i kh\u00e1ng sinh \u0111\u1ed3 ph\u1ed5 bi\u1ebfn tr\u00ean th\u1ebf gi\u1edbi l\u00e0 t\u00e0i li\u1ec7u phi\u00ean gi\u1ea3i c\u1ee7a Hoa K\u1ef3 (CLSI- Clinical Laboratory Standard Institute) v\u00e0 c\u1ee7a ch\u00e2u \u00c2u (EUCAST-European Committee on Antimicrobial Susceptibility Testing) \u0111\u01b0\u1ee3c c\u1eadp nh\u1eadt h\u00e0ng n\u0103m. Hai h\u1ec7 th\u1ed1ng h\u01b0\u1edbng d\u1eabn phi\u00ean gi\u1ea3i k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3 kh\u00f4ng ho\u00e0n to\u00e0n tr\u00f9ng kh\u00edt nhau, v\u1eabn c\u00f3 nh\u1eefng kh\u00e1c bi\u1ec7t do ti\u00eau chu\u1ea9n phi\u00ean gi\u1ea3i c\u1ee7a m\u1ed7i h\u1ec7 th\u1ed1ng \u0111\u01b0\u1ee3c x\u00e2y d\u1ef1ng d\u1ef1a tr\u00ean c\u00e1c nghi\u00ean c\u1ee9u th\u1ef1c nghi\u1ec7m. M\u1ed7i h\u1ec7 th\u1ed1ng phi\u00ean gi\u1ea3i \u0111\u1ec1u c\u00f3 \u01b0u, nh\u01b0\u1ee3c \u0111i\u1ec3m ri\u00eang. C\u00e1c ph\u00f2ng x\u00e9t nghi\u1ec7m vi sinh l\u00e2m s\u00e0ng \u1edf Vi\u1ec7t Nam hi\u1ec7n nay h\u1ea7u h\u1ebft \u0111\u1ec1u l\u1ef1a ch\u1ecdn h\u01b0\u1edbng d\u1eabn CLSI \u0111\u1ec3 phi\u00ean gi\u1ea3i k\u1ebft qu\u1ea3. Do v\u1eady, khi tham kh\u1ea3o c\u00e1c nghi\u00ean c\u1ee9u kh\u00e1c nhau v\u1ec1 m\u1ee9c \u0111\u1ed9 nh\u1ea1y c\u1ea3m v\u1edbi kh\u00e1ng sinh, c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng c\u0169ng n\u00ean bi\u1ebft k\u1ef9 thu\u1eadt kh\u00e1ng sinh \u0111\u1ed3 n\u00e0o \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u00e0 ti\u00eau chu\u1ea9n phi\u00ean gi\u1ea3i n\u00e0o \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 c\u00f3 \u0111\u01b0\u1ee3c nh\u1eadn \u0111\u1ecbnh ch\u00ednh x\u00e1c v\u1ec1 c\u00e1c k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u.<\/p>\n<p style=\"text-align: center;\"><strong>B\u1ea3ng 2.1. T\u00f3m t\u1eaft c\u00e1c x\u00e9t nghi\u1ec7m vi sinh tr\u00ean ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110<\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\">\n<tbody>\n<tr>\n<td style=\"width: 26.8115%; text-align: center;\"><strong>X\u00e9t nghi\u1ec7m<\/strong><\/td>\n<td style=\"width: 22.9364%; text-align: center;\"><strong>B\u1ec7nh ph\u1ea9m<\/strong><\/td>\n<td style=\"width: 50.252%; text-align: center;\"><strong>Ch\u1ec9 \u0111\u1ecbnh<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 26.8115%; text-align: justify;\">Nhu\u1ed9m Gram, nu\u00f4i c\u1ea5y t\u00ecm vi khu\u1ea9n<\/td>\n<td style=\"width: 22.9364%; text-align: center;\">\u0110\u1eddm\/d\u1ecbch ph\u1ebf qu\u1ea3n<\/td>\n<td style=\"width: 50.252%; text-align: justify;\">Ng\u01b0\u1eddi b\u1ec7nh vi\u00eam ph\u1ed5i \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa<\/p>\n<p>Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 nguy c\u01a1 cao nhi\u1ec5m vi khu\u1ea9n \u0111a kh\u00e1ng ho\u1eb7c c\u00e1c t\u00e1c nh\u00e2n kh\u00f4ng th\u01b0\u1eddng g\u1eb7p.<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 26.8115%; text-align: justify;\">AFB, PCR (Gene Xpert, Hain test\u2026), nu\u00f4i c\u1ea5y t\u00ecm vi khu\u1ea9n lao<\/td>\n<td style=\"width: 22.9364%; text-align: center;\">\u0110\u1eddm\/d\u1ecbch ph\u1ebf qu\u1ea3n<\/td>\n<td style=\"width: 50.252%; text-align: justify;\">\u0110\u1ec3 lo\u1ea1i tr\u1eeb lao ph\u1ed5i<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 26.8115%; text-align: justify;\">Soi t\u00ecm n\u1ea5m, nu\u00f4i c\u1ea5y n\u1ea5m<\/td>\n<td style=\"width: 22.9364%; text-align: center;\">\u0110\u1eddm\/d\u1ecbch ph\u1ebf qu\u1ea3n<\/td>\n<td style=\"width: 50.252%; text-align: justify;\">Ng\u01b0\u1eddi b\u1ec7nh suy gi\u1ea3m mi\u1ec5n d\u1ecbch, nghi ng\u1edd nhi\u1ec5m n\u1ea5m<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 26.8115%; text-align: justify;\">C\u1ea5y m\u00e1u<\/td>\n<td style=\"width: 22.9364%; text-align: center;\">M\u00e1u<\/td>\n<td style=\"width: 50.252%; text-align: justify;\">Ng\u01b0\u1eddi b\u1ec7nh vi\u00eam ph\u1ed5i n\u1eb7ng, nghi ng\u1edd nhi\u1ec5m khu\u1ea9n huy\u1ebft<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 26.8115%; text-align: justify;\">Test nhanh ph\u00e1t hi\u1ec7n kh\u00e1ng nguy\u00ean virus c\u00fam, SAR-COV2, RSV<\/td>\n<td style=\"width: 22.9364%; text-align: center;\">D\u1ecbch t\u1ef5 h\u1ea7u<\/td>\n<td style=\"width: 50.252%; text-align: justify;\">Ng\u01b0\u1eddi b\u1ec7nh nghi ng\u1edd vi\u00eam ph\u1ed5i do virus ho\u1eb7c c\u00f3 y\u1ebfu t\u1ed1 d\u1ecbch t\u1ec5<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 26.8115%; text-align: justify;\">Sinh h\u1ecdc ph\u00e2n t\u1eed (PCR)<\/td>\n<td style=\"width: 22.9364%; text-align: center;\">\u0110\u1eddm\/d\u1ecbch ph\u1ebf qu\u1ea3n\/d\u1ecbch t\u1ef5 h\u1ea7u<\/td>\n<td style=\"width: 50.252%; text-align: justify;\">Ng\u01b0\u1eddi b\u1ec7nh vi\u00eam ph\u1ed5i n\u1eb7ng kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u<\/p>\n<p>Ng\u01b0\u1eddi b\u1ec7nh nghi ng\u1edd nhi\u1ec5m c\u00e1c t\u00e1c nh\u00e2n nh\u01b0 n\u1ea5m, <em>M. pneumoniae, C. pneumoniae, Legionella <\/em>spp., virus \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 26.8115%; text-align: justify;\">Huy\u1ebft thanh ch\u1ea9n \u0111o\u00e1n<\/td>\n<td style=\"width: 22.9364%; text-align: center;\">M\u00e1u<\/td>\n<td style=\"width: 50.252%; text-align: justify;\">Ng\u01b0\u1eddi b\u1ec7nh nghi ng\u1edd nhi\u1ec5m c\u00e1c t\u00e1c nh\u00e2n nh\u01b0 n\u1ea5m, <em>M. pneumoniae, C. pneumoniae, Legionella<\/em> spp.,<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 26.8115%; text-align: justify;\">C\u1ea5y d\u1ecbch m\u00e0ng ph\u1ed5i<\/td>\n<td style=\"width: 22.9364%; text-align: center;\">D\u1ecbch m\u00e0ng ph\u1ed5i<\/td>\n<td style=\"width: 50.252%; text-align: justify;\">Ng\u01b0\u1eddi b\u1ec7nh vi\u00eam ph\u1ed5i c\u00f3 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 26.8115%; text-align: justify;\">Kh\u00e1ng nguy\u00ean ch\u1ea9n \u0111o\u00e1n <em>Legionella pneumophila, <\/em><em>S. pneumoniae<\/em><\/td>\n<td style=\"width: 22.9364%; text-align: center;\">N\u01b0\u1edbc ti\u1ec3u<\/td>\n<td style=\"width: 50.252%; text-align: justify;\">Ng\u01b0\u1eddi b\u1ec7nh vi\u00eam ph\u1ed5i n\u1eb7ng ho\u1eb7c nghi ng\u1edd nhi\u1ec5m Legionella pneumophila ho\u1eb7c c\u00f3 y\u1ebfu t\u1ed1 d\u1ecbch t\u1ec5<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: center;\"><strong>B\u1ea3ng 2.2. T\u00f3m t\u1eaft v\u1ec1 t\u00e1c nh\u00e2n VPMPC\u0110 v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n vi sinh [66]<\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%; height: 503px;\">\n<tbody>\n<tr style=\"height: 21px;\">\n<td style=\"width: 16.966%; height: 21px; text-align: center;\"><strong>T\u00e1c nh\u00e2n<\/strong><\/td>\n<td style=\"width: 25.7561%; height: 21px; text-align: center;\"><strong>Ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n<\/strong><\/td>\n<td style=\"width: 23.2987%; height: 21px; text-align: center;\"><strong>B\u1ec7nh ph\u1ea9m t\u1ed1i \u01b0u<\/strong><\/td>\n<td style=\"width: 33.9792%; height: 21px; text-align: center;\"><strong>\u0110i\u1ec1u ki\u1ec7n v\u1eadn chuy\u1ec3n v\u00e0 b\u1ea3o qu\u1ea3n t\u1ed1i \u01b0u<\/strong><\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 16.966%; height: 42px; text-align: center;\" rowspan=\"2\"><em>S. pneumoniae<\/em><\/td>\n<td style=\"width: 25.7561%; height: 21px; text-align: center;\">Nhu\u1ed9m Gram, nu\u00f4i c\u1ea5y<\/td>\n<td style=\"width: 23.2987%; height: 21px; text-align: center;\">\u0110\u1eddm, d\u1ecbch h\u00fat ph\u1ebf qu\u1ea3n<\/td>\n<td style=\"width: 33.9792%; height: 21px; text-align: justify;\">Nhi\u1ec7t \u0111\u1ed9 ph\u00f2ng, t\u1ed1i \u0111a \u0111\u01b0\u1ee3c 2 gi\u1edd ho\u1eb7c 4\u00b0C t\u1ed1i \u0111a \u0111\u01b0\u1ee3c 24 gi\u1edd.<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 25.7561%; height: 21px; text-align: center;\">Ph\u00e1t hi\u1ec7n kh\u00e1ng nguy\u00ean trong n\u01b0\u1edbc ti\u1ec3u<\/td>\n<td style=\"width: 23.2987%; height: 21px; text-align: center;\">N\u01b0\u1edbc ti\u1ec3u<\/td>\n<td style=\"width: 33.9792%; height: 21px; text-align: justify;\">Nhi\u1ec7t \u0111\u1ed9 ph\u00f2ng, t\u1ed1i \u0111a \u0111\u01b0\u1ee3c 24 gi\u1edd ho\u1eb7c 2 \u2013 8\u00b0C t\u1ed1i \u0111a \u0111\u01b0\u1ee3c 14 ng\u00e0y<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 16.966%; height: 21px; text-align: center;\"><em>S. aureus<\/em><\/p>\n<p><em>H. influenzae <\/em><\/p>\n<p><em>Enterobacterales<\/em><\/p>\n<p><em>P. aeruginosae<\/em><\/td>\n<td style=\"width: 25.7561%; height: 21px; text-align: center;\">Nhu\u1ed9m Gram, nu\u00f4i c\u1ea5y<\/td>\n<td style=\"width: 23.2987%; height: 21px; text-align: center;\">\u0110\u1eddm, d\u1ecbch h\u00fat ph\u1ebf qu\u1ea3n<\/td>\n<td style=\"width: 33.9792%; height: 21px; text-align: justify;\">Nhi\u1ec7t \u0111\u1ed9 ph\u00f2ng, t\u1ed1i \u0111a \u0111\u01b0\u1ee3c 2 gi\u1edd ho\u1eb7c 4\u00b0C t\u1ed1i \u0111a \u0111\u01b0\u1ee3c 24 gi\u1edd<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 16.966%; height: 63px; text-align: center;\" rowspan=\"3\"><em>Legionella<\/em> spp.<\/td>\n<td style=\"width: 25.7561%; height: 21px; text-align: center;\">Ph\u00e1t hi\u1ec7n kh\u00e1ng nguy\u00ean trong n\u01b0\u1edbc ti\u1ec3u<\/td>\n<td style=\"width: 23.2987%; height: 21px; text-align: center;\">N\u01b0\u1edbc ti\u1ec3u<\/td>\n<td style=\"width: 33.9792%; height: 21px; text-align: justify;\">Nhi\u1ec7t \u0111\u1ed9 ph\u00f2ng, t\u1ed1i \u0111a \u0111\u01b0\u1ee3c 24 gi\u1edd ho\u1eb7c 2 \u2013 8\u00b0C t\u1ed1i \u0111a \u0111\u01b0\u1ee3c 14 ng\u00e0y<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 25.7561%; height: 21px; text-align: center;\">Nu\u00f4i c\u1ea5y tr\u00ean m\u00f4i tr\u01b0\u1eddng ch\u1ecdn l\u1ecdc<\/td>\n<td style=\"width: 23.2987%; height: 21px; text-align: center;\">\u0110\u1eddm, d\u1ecbch h\u00fat ph\u1ebf qu\u1ea3n<\/td>\n<td style=\"width: 33.9792%; height: 21px; text-align: justify;\">Nhi\u1ec7t \u0111\u1ed9 ph\u00f2ng, t\u1ed1i \u0111a \u0111\u01b0\u1ee3c 2 gi\u1edd ho\u1eb7c 4\u00b0C t\u1ed1i \u0111a \u0111\u01b0\u1ee3c 24 gi\u1edd<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 25.7561%; height: 21px; text-align: center;\">Sinh h\u1ecdc ph\u00e2n t\u1eed (PCR)<\/td>\n<td style=\"width: 23.2987%; height: 21px; text-align: center;\">\u0110\u1eddm, d\u1ecbch h\u00fat ph\u1ebf qu\u1ea3n<\/td>\n<td style=\"width: 33.9792%; height: 21px; text-align: justify;\">Nhi\u1ec7t \u0111\u1ed9 ph\u00f2ng, t\u1ed1i \u0111a \u0111\u01b0\u1ee3c 2 gi\u1edd ho\u1eb7c 4\u00b0C t\u1ed1i \u0111a \u0111\u01b0\u1ee3c 24 gi\u1edd<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 16.966%; height: 42px; text-align: center;\" rowspan=\"2\"><em>M. pneumoniae<\/em><\/td>\n<td style=\"width: 25.7561%; height: 21px; text-align: center;\">Sinh h\u1ecdc ph\u00e2n t\u1eed (PCR)<\/td>\n<td style=\"width: 23.2987%; height: 21px; text-align: justify;\">T\u0103m b\u00f4ng ngo\u00e1y h\u1ecdng, t\u0103m b\u00f4ng th\u1ea5m d\u1ecbch t\u1ef5 h\u1ea7u, d\u1ecbch h\u00fat ph\u1ebf qu\u1ea3n, d\u1ecbch r\u1eeda ph\u1ebf qu\u1ea3n ph\u1ebf nang<\/td>\n<td style=\"width: 33.9792%; height: 21px; text-align: justify;\">M\u00f4i tr\u01b0\u1eddng v\u1eadn chuy\u1ec3n \u1edf 4\u00b0C t\u1ed1i \u0111a \u0111\u01b0\u1ee3c 48 gi\u1edd, ho\u1eb7c -70\u00b0C \u0111\u01b0\u1ee3c tr\u00ean 48 gi\u1edd<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 25.7561%; height: 21px; text-align: center;\">Ph\u00e1t hi\u1ec7n IgM, IgG<\/td>\n<td style=\"width: 23.2987%; height: 21px; text-align: center;\">Huy\u1ebft thanh<\/td>\n<td style=\"width: 33.9792%; height: 21px; text-align: justify;\">Nhi\u1ec7t \u0111\u1ed9 ph\u00f2ng, t\u1ed1i \u0111a \u0111\u01b0\u1ee3c 24 gi\u1edd ho\u1eb7c 4\u00b0C t\u1ed1i \u0111a \u0111\u01b0\u1ee3c tr\u00ean 24 gi\u1edd<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 16.966%; height: 42px; text-align: center;\" rowspan=\"2\"><em>C. pneumoniae<\/em><\/td>\n<td style=\"width: 25.7561%; height: 21px; text-align: center;\">Sinh h\u1ecdc ph\u00e2n t\u1eed (PCR)<\/td>\n<td style=\"width: 23.2987%; height: 21px; text-align: justify;\">T\u0103m b\u00f4ng th\u1ea5m d\u1ecbch t\u1ef5 h\u1ea7u, d\u1ecbch s\u00fac h\u1ecdng, \u0111\u1eddm, d\u1ecbch h\u00fat ph\u1ebf qu\u1ea3n<\/td>\n<td style=\"width: 33.9792%; height: 21px; text-align: justify;\">M\u00f4i tr\u01b0\u1eddng v\u1eadn chuy\u1ec3n \u1edf 4oC t\u1ed1i \u0111a \u0111\u01b0\u1ee3c 48 gi\u1edd, ho\u1eb7c -70\u00b0C \u0111\u01b0\u1ee3c tr\u00ean 48 gi\u1edd<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 25.7561%; height: 21px; text-align: justify;\">Ph\u00e1t hi\u1ec7n hi\u1ec7u gi\u00e1 IgM, \u0111\u1ed9ng l\u1ef1c kh\u00e1ng th\u1ec3 IgG (hai m\u1eabu huy\u1ebft thanh l\u1ea5y c\u00e1ch nhau 2-3 tu\u1ea7n)<\/td>\n<td style=\"width: 23.2987%; height: 21px; text-align: center;\">Huy\u1ebft thanh<\/td>\n<td style=\"width: 33.9792%; height: 21px; text-align: justify;\">Nhi\u1ec7t \u0111\u1ed9 ph\u00f2ng, t\u1ed1i \u0111a \u0111\u01b0\u1ee3c 24 gi\u1edd ho\u1eb7c 4\u00b0C t\u1ed1i \u0111a \u0111\u01b0\u1ee3c tr\u00ean 24 gi\u1edd<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 16.966%; height: 21px; text-align: center;\">Influenza virus A, B<\/p>\n<p>RSV<\/p>\n<p>SARS-CoV-2<\/td>\n<td style=\"width: 25.7561%; height: 21px; text-align: center;\">Test nhanh ph\u00e1t hi\u1ec7n kh\u00e1ng nguy\u00ean<\/p>\n<p>Sinh h\u1ecdc ph\u00e2n t\u1eed (PCR)<\/td>\n<td style=\"height: 272px; text-align: justify; width: 57.2779%;\" colspan=\"2\" rowspan=\"2\">D\u1ecbch ngo\u00e1y m\u0169i, t\u0103m b\u00f4ng ngo\u00e1y h\u1ecdng, t\u0103m b\u00f4ng th\u1ea5m d\u1ecbch t\u1ef5 h\u1ea7u, d\u1ecbch h\u00fat t\u1ef5 h\u1ea7u d\u1ecbch h\u00fat ph\u1ebf qu\u1ea3n, d\u1ecbch r\u1eeda ph\u1ebf qu\u1ea3n-ph\u1ebf nang.<\/p>\n<p>B\u1ea3o qu\u1ea3n, v\u1eadn chuy\u1ec3n trong m\u00f4i tr\u01b0\u1eddng v\u1eadn chuy\u1ec3n virus \u1edf nhi\u1ec7t \u0111\u1ed9 ph\u00f2ng, t\u1ed1i \u0111a \u0111\u01b0\u1ee3c d\u01b0\u1edbi 2 gi\u1edd, 2-8\u00b0C t\u1ed1i \u0111a \u0111\u01b0\u1ee3c 5 ng\u00e0y, ho\u1eb7c \u1edf -70\u00b0C \u0111\u01b0\u1ee3c tr\u00ean 5 ng\u00e0y.<\/td>\n<\/tr>\n<tr style=\"height: 251px;\">\n<td style=\"width: 16.966%; height: 251px; text-align: center;\">Parainfluenza virus<\/p>\n<p>Adenovirus<\/p>\n<p>Human<br \/>\nmetapneumovirus<\/p>\n<p>Coronavirus kh\u00e1c<\/p>\n<p>Rhinovirus<\/p>\n<p>Entero virus<\/td>\n<td style=\"width: 25.7561%; height: 251px; text-align: center;\">Sinh h\u1ecdc ph\u00e2n t\u1eed (PCR)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify;\"><strong>Nh\u1eefng \u0111i\u1ec3m c\u1ea7n nh\u1edb<\/strong><\/p>\n<p style=\"text-align: justify;\">&#8211; Vi khu\u1ea9n g\u00e2y vi\u00eam ph\u1ed5i th\u01b0\u1eddng g\u1eb7p l\u00e0: Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Enterobacterales, Pseudomonas aeruginosa, Mycoplasma pneumoniae, Legionella spp., Chlamydophila v\u00e0 Moraxella catarrhalis.<\/p>\n<p style=\"text-align: justify;\">&#8211; Virus g\u00e2y vi\u00eam ph\u1ed5i th\u01b0\u1eddng g\u1eb7p l\u00e0 Influenza A virus, Influenza B virus, RSV, Adenovirus v\u00e0 c\u00e1c Coronavirus.<\/p>\n<p style=\"text-align: justify;\">&#8211; Kh\u00f4ng khuy\u1ebfn c\u00e1o x\u00e9t nghi\u1ec7m vi sinh cho ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 ngo\u1ea1i tr\u00fa.<\/p>\n<p style=\"text-align: justify;\">&#8211; Ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 n\u1ed9i tr\u00fa, nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh ngo\u1ea1i tr\u00fa m\u00e0 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m vi sinh c\u00f3 th\u1ec3 thay \u0111\u1ed5i ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb c\u1ea7n l\u1ea5y \u0111\u1eddm t\u1ed1t nh\u1ea5t v\u00e0o bu\u1ed5i s\u00e1ng s\u1edbm \u0111\u1ec3 nhu\u1ed9m Gram v\u00e0 c\u1ea5y. B\u1ec7nh ph\u1ea9m \u0111\u1eddm: l\u1ea5y t\u1ed1i thi\u1ec3u 1-2ml c\u00f3 nh\u1ea7y &#8211; m\u1ee7 ho\u1eb7c nh\u1ea7y m\u00e1u, sau khi l\u1ea5y c\u1ea7n v\u1eadn chuy\u1ec3n \u0111\u1ebfn ph\u00f2ng x\u00e9t nghi\u1ec7m trong v\u00f2ng 2 ti\u1ebfng. K\u1ebft qu\u1ea3 nu\u00f4i c\u1ea5y \u0111\u1eddm \u0111\u01b0\u1ee3c phi\u00ean gi\u1ea3i d\u1ef1a tr\u00ean m\u1ee9c \u0111\u1ed9 vi khu\u1ea9n m\u1ecdc (1+, 2+, 3+, 4+), s\u1ef1 ph\u00f9 h\u1ee3p l\u00e2m s\u00e0ng v\u00e0 m\u1ed1i li\u00ean quan v\u1edbi nhu\u1ed9m Gram.<\/p>\n<p style=\"text-align: justify;\">&#8211; C\u1ea5y m\u00e1u c\u00f3 th\u1ec3 h\u1eefu \u00edch \u0111\u1eb7c bi\u1ec7t \u1edf ng\u01b0\u1eddi b\u1ec7nh vi\u00eam ph\u1ed5i n\u1eb7ng, ng\u01b0\u1eddi b\u1ec7nh nguy c\u01a1 cao vi\u00eam ph\u1ed5i do MRSA ho\u1eb7c P. aeruginosa. C\u1ea5y m\u00e1u t\u1ed1t nh\u1ea5t tr\u01b0\u1edbc khi d\u00f9ng kh\u00e1ng sinh, khi c\u00f3 ng\u01b0\u1eddi b\u1ec7nh c\u00f3 c\u01a1n gai r\u00e9t ho\u1eb7c s\u1ed1t \u226538,5oC. M\u1ed7i l\u1ea7n c\u1ea5y m\u00e1u, c\u1ea7n c\u1ea5y t\u1ed1i thi\u1ec3u 2 v\u1ecb tr\u00ed v\u00e0 c\u1ea5y v\u00e0o 2 chai (m\u1ed9t chai hi\u1ebfu kh\u00ed, m\u1ed9t chai k\u1ecb kh\u00ed), m\u1ed7i chai c\u1ea5y 8-10 ml.<\/p>\n<p style=\"text-align: justify;\">&#8211; C\u00e1c t\u00e1c nh\u00e2n virus v\u00e0 vi khu\u1ea9n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n b\u1eb1ng nu\u00f4i c\u1ea5y, test nhanh ph\u00e1t hi\u1ec7n kh\u00e1ng nguy\u00ean, ph\u00e1t hi\u1ec7n kh\u00e1ng th\u1ec3 \u0111\u1eb7c hi\u1ec7u ho\u1eb7c b\u1eb1ng k\u1ef9 thu\u1eadt sinh h\u1ecdc ph\u00e2n t\u1eed (PCR).<\/p>\n<p style=\"text-align: justify;\">&#8211; Kh\u00e1ng sinh \u0111\u1ed3 cho bi\u1ebft ch\u1ee7ng vi khu\u1ea9n nh\u1ea1y c\u1ea3m (S), \u0111\u1ec1 kh\u00e1ng (R) hay \u0111\u1ec1 kh\u00e1ng trung gian (I) v\u1edbi m\u1ed9t kh\u00e1ng sinh n\u00e0o \u0111\u00f3. X\u00e1c \u0111\u1ecbnh n\u1ed3ng \u0111\u1ed9 \u1ee9c ch\u1ebf t\u1ed1i thi\u1ec3u c\u1ee7a kh\u00e1ng sinh (MIC), c\u00f3 th\u1ec3 gi\u00fap hi\u1ec7u ch\u1ec9nh li\u1ec1u kh\u00e1ng sinh.<\/p>\n<h2 style=\"text-align: center;\">CH\u01af\u01a0NG 3. CH\u1ea8N \u0110O\u00c1N VI\u00caM PH\u1ed4I M\u1eaeC PH\u1ea2I C\u1ed8NG \u0110\u1ed2NG<\/h2>\n<h3 style=\"text-align: justify;\">3.1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh vi\u00eam ph\u1ed5i<\/h3>\n<h4 style=\"text-align: justify;\">3.1.1. L\u00e2m s\u00e0ng<\/h4>\n<p style=\"text-align: justify;\">&#8211; Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng:<\/p>\n<p style=\"text-align: justify;\">+\u00a0 Kh\u1edfi ph\u00e1t c\u1ea5p t\u00ednh trong v\u00e0i ng\u00e0y.<\/p>\n<p style=\"text-align: justify;\">+ Tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh: s\u1ed1t cao, r\u00e9t run, ho kh\u1ea1c \u0111\u1eddm m\u1ee7, \u0111au ng\u1ef1c ki\u1ec3u m\u00e0ng ph\u1ed5i (n\u1ebfu c\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u1ea1nh m\u00e0ng ph\u1ed5i-parapleural pneumonia). Tr\u00ean ng\u01b0\u1eddi b\u1ec7nh cao tu\u1ed5i, ng\u01b0\u1eddi b\u1ec7nh suy gi\u1ea3m mi\u1ec5n d\u1ecbch, c\u00e1c bi\u1ec3u hi\u1ec7n ban \u0111\u1ea7u c\u1ee7a vi\u00eam ph\u1ed5i c\u00f3 th\u1ec3 kh\u00f4ng r\u1ea7m r\u1ed9.<\/p>\n<p style=\"text-align: justify;\">&#8211; Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3:<\/p>\n<p style=\"text-align: justify;\">+ H\u1ed9i ch\u1ee9ng nhi\u1ec5m tr\u00f9ng: s\u1ed1t, m\u00f4i kh\u00f4, l\u01b0\u1ee1i b\u1ea9n&#8230; Tr\u00ean ng\u01b0\u1eddi b\u1ec7nh cao tu\u1ed5i, ng\u01b0\u1eddi b\u1ec7nh suy gi\u1ea3m mi\u1ec5n d\u1ecbch c\u00e1c bi\u1ec3u hi\u1ec7n ban \u0111\u1ea7u c\u1ee7a vi\u00eam ph\u1ed5i c\u00f3 th\u1ec3 kh\u00f4ng r\u1ea7m r\u1ed9.<\/p>\n<p style=\"text-align: justify;\">+ H\u1ed9i ch\u1ee9ng \u0111\u00f4ng \u0111\u1eb7c (rung thanh t\u0103ng, g\u00f5 \u0111\u1ee5c, r\u00ec r\u00e0o ph\u1ebf nang gi\u1ea3m), c\u00f3 th\u1ec3 c\u00f3 nghe th\u1ea5y ran n\u1ed5 n\u1ebfu \u1edf m\u1ed9t v\u00f9ng ho\u1eb7c nhi\u1ec1u v\u1ecb tr\u00ed n\u1ebfu t\u1ed5n th\u01b0\u01a1ng nhi\u1ec1u \u1edf ph\u1ed5i.<\/p>\n<p style=\"text-align: justify;\">+ Vi\u00eam ph\u1ed5i do t\u00e1c nh\u00e2n vi khu\u1ea9n \u0111i\u1ec3n h\u00ecnh: ph\u1ea7n l\u1edbn ng\u01b0\u1eddi b\u1ec7nh s\u1ed1t cao &gt;39\u00b0C, r\u00e9t run k\u00e8m theo ng\u01b0\u1eddi b\u1ec7nh xu\u1ea5t hi\u1ec7n ho khan l\u00fac \u0111\u1ea7u sau ho kh\u1ea1c \u0111\u1eddm m\u1ee7, c\u00f3 th\u1ec3 kh\u1ea1c \u0111\u1eddm m\u00e0u r\u1ec9 s\u1eaft v\u00e0 \u0111au ng\u1ef1c v\u00f9ng t\u1ed5n th\u01b0\u01a1ng. Tuy nhi\u00ean ng\u01b0\u1eddi l\u1edbn tu\u1ed5i c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 s\u1ed1t; ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 c\u00f3 bi\u1ec3u hi\u1ec7n t\u00edm t\u00e1i, kh\u00f3 th\u1edf, nh\u1ecbp th\u1edf nhanh &gt;30 l\u1ea7n\/ph\u00fat&#8230;<\/p>\n<p style=\"text-align: justify;\">+ Vi\u00eam ph\u1ed5i do t\u00e1c nh\u00e2n vi khu\u1ea9n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh: ph\u1ea7n l\u1edbn x\u1ea3y ra tr\u00ean ng\u01b0\u1eddi l\u1edbn tu\u1ed5i v\u00e0 tr\u1ebb em v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng \u00e2m th\u1ea7m h\u01a1n bao g\u1ed3m: s\u1ed1t nh\u1eb9, \u0111au \u0111\u1ea7u, ho khan, c\u1ea3m gi\u00e1c m\u1ec7t m\u1ecfi nh\u01b0 tri\u1ec7u ch\u1ee9ng nhi\u1ec5m virus. Kh\u00e1m kh\u00f4ng r\u00f5 h\u1ed9i ch\u1ee9ng \u0111\u00f4ng \u0111\u1eb7c, th\u1ea5y r\u1ea3i r\u00e1c ran n\u1ed5. Tuy nhi\u00ean c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u cho th\u1ec3 b\u1ec7nh.<\/p>\n<h4 style=\"text-align: justify;\">3.1.2. X\u00e9t nghi\u1ec7m m\u00e1u<\/h4>\n<p style=\"text-align: justify;\">&#8211; C\u00f4ng th\u1ee9c m\u00e1u c\u00f3 t\u0103ng s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u (&gt; 10 Giga\/l\u00edt), t\u0103ng \u01b0u th\u1ebf t\u1ebf b\u00e0o \u0111a nh\u00e2n trung t\u00ednh. Ho\u1eb7c s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u gi\u1ea3m (&lt; 4,4 Giga\/l\u00edt).<\/p>\n<p style=\"text-align: justify;\">&#8211; T\u1ed1c \u0111\u1ed9 m\u00e1u l\u1eafng t\u0103ng<\/p>\n<p style=\"text-align: justify;\">&#8211; CRP t\u0103ng<\/p>\n<p style=\"text-align: justify;\">&#8211; Procalcitonin:<\/p>\n<p style=\"text-align: justify;\">+ \u0110\u1ecbnh l\u01b0\u1ee3ng procalcitonin m\u00e1u n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u1edf ng\u01b0\u1eddi b\u1ec7nh nghi ng\u1edd nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p d\u01b0\u1edbi nh\u1eadp vi\u1ec7n<\/p>\n<p style=\"text-align: justify;\">+ \u0110\u1ecbnh l\u01b0\u1ee3ng procalcitonin n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong 24h \u0111\u1ea7u nh\u1eadp vi\u1ec7n, v\u00e0o ng\u00e0y th\u1ee9 3 v\u00e0 v\u00e0o ng\u00e0y th\u1ee9 5 \u2013 7 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh. T\u1ea7n su\u1ea5t \u0111\u1ecbnh l\u01b0\u1ee3ng procalcitonin thay \u0111\u1ed5i ph\u1ee5 thu\u1ed9c v\u00e0o \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng tr\u00ean ng\u01b0\u1eddi b\u1ec7nh c\u1ee5 th\u1ec3.<\/p>\n<p style=\"text-align: justify;\">+\u00a0 Xem x\u00e9t ng\u1eebng ho\u1eb7c xu\u1ed1ng thang kh\u00e1ng sinh khi ng\u01b0\u1ee1ng procalcitonin m\u00e1u d\u01b0\u1edbi<br \/>\n0.25 mg\/dl ho\u1eb7c gi\u00e1 tr\u1ecb n\u1ed3ng \u0111\u1ed9 procalcitonin m\u00e1u gi\u1ea3m 80% so v\u1edbi ban \u0111\u1ea7u v\u00e0 c\u1ea7n \u0111\u00e1nh gi\u00e1 ph\u1ed1i h\u1ee3p v\u1edbi \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng.<\/p>\n<h4 style=\"text-align: justify;\">3.1.3. X-quang ng\u1ef1c<\/h4>\n<p style=\"text-align: justify;\">&#8211; X-quang ng\u1ef1c l\u00e0 c\u1eadn l\u00e2m s\u00e0ng quan tr\u1ecdng trong b\u1ec7nh vi\u00eam ph\u1ed5i. H\u00ecnh \u1ea3nh t\u1ed5n th\u01b0\u01a1ng tr\u00ean X-quang ng\u1ef1c c\u1ee7a VPMPC\u0110:<\/p>\n<p style=\"text-align: justify;\">+ T\u1ed5n th\u01b0\u01a1ng ph\u1ebf nang: h\u00ecnh m\u1edd t\u01b0\u01a1ng \u0111\u1ed1i \u0111\u1ed3ng nh\u1ea5t chi\u1ebfm m\u1ed9t th\u00f9y ho\u1eb7c ph\u00e2n th\u00f9y ph\u1ed5i v\u00e0 c\u00f3 h\u00ecnh \u1ea3nh ph\u1ebf qu\u1ea3n h\u01a1i. C\u00e1c tr\u01b0\u1eddng h\u1ee3p \u00edt \u0111i\u1ec3n h\u00ecnh h\u01a1n cho th\u1ea5y c\u00e1c h\u00ecnh m\u1edd n\u00e0y kh\u00f4ng chi\u1ebfm m\u1ed9t th\u00f9y ho\u1eb7c ph\u00e2n th\u00f9y ho\u1eb7c c\u00f3 th\u1ec3 k\u00e8m theo x\u1eb9p ph\u1ed5i do d\u1ecbch ti\u1ebft g\u00e2y t\u1eafc ngh\u1ebdn c\u00e1c ph\u1ebf qu\u1ea3n.<\/p>\n<p style=\"text-align: justify;\">+ T\u1ed5n th\u01b0\u01a1ng ph\u1ebf qu\u1ea3n ph\u1ed5i: m\u1edd r\u1ea3i r\u00e1c, kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t, nh\u1eefng t\u1ed5n th\u01b0\u01a1ng m\u1edd n\u00e0y c\u00f3 th\u1ec3 ch\u1ed3ng l\u00ean nhau t\u1ea1o th\u00e0nh nh\u1eefng h\u00ecnh m\u1edd \u0111\u1eadm h\u01a1n.<\/p>\n<p style=\"text-align: justify;\">+ T\u1ed5n th\u01b0\u01a1ng d\u1ea1ng m\u00f4 k\u1ebd: h\u00ecnh \u1ea3nh m\u1edd d\u1ea1ng l\u01b0\u1edbi ho\u1eb7c l\u01b0\u1edbi n\u1ed1t kh\u1eafp c\u1ea3 hai b\u00ean ph\u1ed5i, \u0111\u00f4i khi ti\u1ebfn tri\u1ec3n th\u00e0nh nh\u1eefng h\u00ecnh m\u1edd r\u1ea3i r\u00e1c th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n \u1edf th\u00f9y d\u01b0\u1edbi.<\/p>\n<p style=\"text-align: justify;\">+ Th\u00e2m nhi\u1ec5m d\u1ea1ng n\u1ed1t: h\u00ecnh m\u1edd tr\u00f2n gi\u1edbi h\u1ea1n r\u00f5 v\u1edbi \u0111\u01b0\u1eddng k\u00ednh l\u1edbn h\u01a1n 1 cm tr\u00ean phim X-quang ng\u1ef1c.<\/p>\n<p style=\"text-align: justify;\">+ Trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng c\u00f3 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p vi\u00eam ph\u1ed5i kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c t\u1ed5n th\u01b0\u01a1ng tr\u00ean X-quang ng\u1ef1c, ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i \u0111\u01b0\u1ee3c \u0111\u1eb7t ra n\u1ebfu ng\u01b0\u1eddi b\u1ec7nh c\u00f3 nh\u1eefng tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng ph\u00f9 h\u1ee3p v\u00e0 c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh ch\u1ee5p X-quang l\u1ea1i sau 24 &#8211; 48 gi\u1edd.<\/p>\n<p style=\"text-align: justify;\">&#8211; H\u00ecnh \u1ea3nh tr\u00ean X-quang ng\u1ef1c c\u0169ng c\u00f3 h\u1ea1n ch\u1ebf trong ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i:<\/p>\n<p style=\"text-align: justify;\">+ Ch\u1ea9n \u0111o\u00e1n d\u01b0\u1edbi m\u1ee9c vi\u00eam ph\u1ed5i hay th\u1eadm ch\u00ed \u00e2m t\u00ednh gi\u1ea3 trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p: (1) B\u00e9o ph\u00ec, kh\u00ed ph\u1ebf th\u0169ng, b\u1ea5t th\u01b0\u1eddng c\u1ea5u tr\u00fac ph\u1ed5i l\u00e0m che m\u1edd t\u1ed5n th\u01b0\u01a1ng vi\u00eam ph\u1ed5i; (2) Vi\u00eam ph\u1ed5i giai \u0111o\u1ea1n qu\u00e1 s\u1edbm; (3) M\u1ea5t n\u01b0\u1edbc n\u1eb7ng, gi\u1ea3m b\u1ea1ch c\u1ea7u h\u1ea1t n\u1eb7ng l\u00e0m t\u1ed5n th\u01b0\u01a1ng vi\u00eam kh\u00f4ng th\u1ec3 hi\u1ec7n r\u00f5; (4) Nhi\u1ec5m P. jirovecii tr\u00ean ng\u01b0\u1eddi b\u1ec7nh suy gi\u1ea3m mi\u1ec5n d\u1ecbch v\u00ec t\u1ed5n th\u01b0\u01a1ng ch\u1ee7 y\u1ebfu m\u00f4 k\u1ebd ph\u1ed5i n\u00ean c\u00f3 th\u1ec3 kh\u00f4ng th\u1ec3 hi\u1ec7n r\u00f5 tr\u00ean X-quang ng\u1ef1c.<\/p>\n<p style=\"text-align: justify;\">+ Ch\u1ea9n \u0111o\u00e1n qu\u00e1 m\u1ee9c vi\u00eam ph\u1ed5i hay th\u1eadm ch\u00ed l\u00e0 d\u01b0\u01a1ng t\u00ednh gi\u1ea3 trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p: (1) Ph\u00f9 ph\u1ed5i trong suy tim \u1ee9 huy\u1ebft, h\u1eb9p hai l\u00e1; (2) Nh\u1ed3i m\u00e1u ph\u1ed5i; (3) H\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p t\u00ednh ARDS; (4) Ch\u1ea3y m\u00e1u ph\u1ebf nang; (5) Ung th\u01b0 ph\u1ebf qu\u1ea3n ho\u1eb7c ung th\u01b0 di c\u0103n ph\u1ed5i; (6) X\u1eb9p ph\u1ed5i; (7) Vi\u00eam ph\u1ed5i sau x\u1ea1 tr\u1ecb; (8) Vi\u00eam nhu m\u00f4 ph\u1ed5i kh\u00f4ng do nhi\u1ec5m tr\u00f9ng (vi\u00eam m\u1ea1ch m\u00e1u ph\u1ed5i, vi\u00eam ph\u1ebf nang do d\u1ecb \u1ee9ng, vi\u00eam m\u00f4 k\u1ebd ph\u1ed5i do mi\u1ec5n d\u1ecbch bao g\u1ed3m ph\u1ea3n \u1ee9ng thu\u1ed1c); (9) T\u0103ng t\u1ebf b\u00e0o \u00e1i toan \u1edf ph\u1ed5i; (10) Vi\u00eam ti\u1ec3u ph\u1ebf qu\u1ea3n t\u1eafc ngh\u1ebdn.<\/p>\n<h4 style=\"text-align: justify;\">3.1.4. Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh ng\u1ef1c<\/h4>\n<p style=\"text-align: justify;\">&#8211; Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh ng\u1ef1c \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u1edf ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p sau:<\/p>\n<p style=\"text-align: justify;\">+\u00a0 Vi\u00eam ph\u1ed5i n\u1eb7ng v\u00e0 di\u1ec5n bi\u1ebfn ph\u1ee9c t\u1ea1p.<\/p>\n<p style=\"text-align: justify;\">+\u00a0 Vi\u00eam ph\u1ed5i \u1edf ng\u01b0\u1eddi b\u1ec7nh suy gi\u1ea3m mi\u1ec5n d\u1ecbch.<\/p>\n<p style=\"text-align: justify;\">+\u00a0 Vi\u00eam ph\u1ed5i t\u00e1i ph\u00e1t ho\u1eb7c kh\u00f4ng \u0111i\u1ec1u tr\u1ecb d\u1ee9t \u0111i\u1ec3m \u0111\u01b0\u1ee3c.<\/p>\n<p style=\"text-align: justify;\">+ Ng\u01b0\u1eddi b\u1ec7nh nghi ng\u1edd m\u1eafc vi\u00eam ph\u1ed5i tr\u00ean l\u00e2m s\u00e0ng nh\u01b0ng h\u00ecnh \u1ea3nh X quang ng\u1ef1c kh\u00f4ng r\u00f5 t\u1ed5n th\u01b0\u01a1ng.<\/p>\n<p style=\"text-align: justify;\">+\u00a0 Nghi ng\u1edd c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c: u ph\u1ed5i, lao ph\u1ed5i, d\u1ecb v\u1eadt \u0111\u01b0\u1eddng th\u1edf, \u2026<\/p>\n<p style=\"text-align: justify;\">&#8211; C\u00e1c d\u1ea1ng t\u1ed5n th\u01b0\u01a1ng c\u1ee7a VPMPC\u0110 tr\u00ean phim ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh<\/p>\n<p style=\"text-align: justify;\">+ T\u1ed5n th\u01b0\u01a1ng ph\u1ebf nang: c\u00e1c \u0111\u00e1m m\u1edd \u0111\u1ed3ng nh\u1ea5t \u1edf nhi\u1ec1u ph\u00e2n th\u00f9y ho\u1eb7c to\u00e0n b\u1ed9 th\u00f9y ph\u1ed5i, c\u00f3 d\u1ea5u hi\u1ec7u ph\u1ebf qu\u1ea3n h\u01a1i (d\u1ea1ng vi\u00eam ph\u1ed5i th\u00f9y). C\u00f3 th\u1ec3 g\u1eb7p h\u00ecnh \u1ea3nh x\u1eb9p c\u00e1c ph\u00e2n th\u00f9y v\u00e0 h\u1ea1 ph\u00e2n th\u00f9y do t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng d\u1eabn kh\u00ed c\u00f3 k\u00edch th\u01b0\u1edbc nh\u1ecf.<\/p>\n<p style=\"text-align: justify;\">+ T\u1ed5n th\u01b0\u01a1ng ph\u1ebf qu\u1ea3n ph\u1ed5i: nhi\u1ec1u \u0111\u00e1m m\u1edd th\u00e2m nhi\u1ec5m v\u00e0 r\u1ea3i r\u00e1c \u1edf c\u00e1c ph\u00e2n th\u00f9y ph\u1ed5i, ph\u00e2n b\u1ed1 kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t xen l\u1eabn nhau gi\u1eefa ph\u1ea7n ph\u1ed5i l\u00e0nh v\u00e0 v\u00f9ng ph\u1ed5i t\u1ed5n th\u01b0\u01a1ng (d\u1ea1ng ph\u1ebf qu\u1ea3n ph\u1ebf vi\u00eam).<\/p>\n<p style=\"text-align: justify;\">+ T\u1ed5n th\u01b0\u01a1ng m\u00f4 k\u1ebd: T\u1ed5n th\u01b0\u01a1ng d\u00e0y th\u00e0nh ph\u1ebf qu\u1ea3n, t\u1ed5n th\u01b0\u01a1ng m\u00f4 k\u1ebd d\u1ea1ng n\u1ed1t kh\u00f4ng \u0111\u1ec1u ho\u1eb7c d\u1ea1ng l\u01b0\u1edbi.<\/p>\n<p style=\"text-align: justify;\">&#8211; M\u1ed9t s\u1ed1 h\u00ecnh \u1ea3nh \u0111\u1eb7c bi\u1ec7t t\u1ed5n th\u01b0\u01a1ng tr\u00ean phim ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh ng\u1ef1c g\u1ee3i \u00fd theo c\u0103n nguy\u00ean vi sinh<\/p>\n<p style=\"text-align: justify;\">+ Vi\u00eam ph\u1ed5i do S. pneumoniae: t\u1ed5n th\u01b0\u01a1ng l\u00e0 c\u00e1c v\u00f9ng \u0111\u00f4ng \u0111\u1eb7c \u0111\u1ed3ng nh\u1ea5t, c\u00f3 h\u00ecnh ph\u1ebf qu\u1ea3n h\u01a1i, gi\u1edbi h\u1ea1n \u1edf m\u1ed9t th\u00f9y ph\u1ed5i, c\u00f3 th\u1ec3 k\u00e8m theo tr\u00e0n d\u1ecbch v\u00e0 tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i.<\/p>\n<p style=\"text-align: justify;\">+ Vi\u00eam ph\u1ed5i do S. aureus g\u00e2y c\u00e1c t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng vi\u00eam ph\u1ebf qu\u1ea3n ph\u1ed5i v\u1edbi h\u00ecnh \u1ea3nh nhi\u1ec1u \u0111\u00e1m m\u1edd \u0111\u00f4ng \u0111\u1eb7c ph\u1ed5i. T\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng g\u1eb7p d\u1ea1ng hang, c\u00f3 th\u1ec3 k\u00e8m theo tr\u00e0n d\u1ecbch v\u00e0 tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i.<\/p>\n<p style=\"text-align: justify;\">+ Vi\u00eam ph\u1ed5i do Klebsiella: th\u01b0\u1eddng g\u1eb7p \u1edf th\u00f9y tr\u00ean, c\u00f3 h\u00ecnh \u1ea3nh \u0111\u00f4ng \u0111\u1eb7c ph\u1ed5i, c\u00f3 h\u00ecnh \u1ea3nh ph\u1ebf qu\u1ea3n h\u01a1i, t\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng g\u00e2y xu\u1ea5t ti\u1ebft nhi\u1ec1u \u0111\u1ea9y l\u1ed3i r\u00e3nh li\u00ean th\u00f9y v\u1ec1 ph\u00eda ph\u1ed5i l\u00e0nh, th\u01b0\u1eddng t\u1ea1o hang, c\u00f3 k\u00e8m theo tr\u00e0n d\u1ecbch v\u00e0 tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i nhi\u1ec1u h\u01a1n so v\u1edbi S. pneumoniae.<\/p>\n<p style=\"text-align: justify;\">+ Vi\u00eam ph\u1ed5i do Legionella: c\u00e1c t\u1ed5n th\u01b0\u01a1ng \u0111\u00f4ng \u0111\u1eb7c lan t\u1ecfa, \u1edf m\u1ed9t th\u00f9y ho\u1eb7c nhi\u1ec1u th\u00f9y ph\u1ed5i th\u01b0\u1eddng k\u00e8m tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i \u00edt, hi\u1ebfm khi g\u1eb7p t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng \u00e1p xe.<\/p>\n<p style=\"text-align: justify;\">+ Vi\u00eam ph\u1ed5i do Haemophilus influenzae: t\u1ed5n th\u01b0\u01a1ng d\u01b0\u1edbi d\u1ea1ng vi\u00eam ph\u1ebf qu\u1ea3n ph\u1ed5i r\u1ea3i r\u00e1c nhi\u1ec1u ph\u00e2n th\u00f9y ph\u1ed5i hai b\u00ean.<\/p>\n<p style=\"text-align: justify;\">+ Vi\u00eam ph\u1ed5i do virus: \u1ede ng\u01b0\u1eddi l\u1edbn, t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng \u0111\u00e1m m\u1edd ph\u1ebf nang \u1edf th\u00f9y d\u01b0\u1edbi hai b\u00ean hay d\u1ea1ng k\u00ednh m\u1edd. \u1ede tr\u1ebb em g\u1eb7p d\u1ea1ng n\u1ed1t l\u01b0\u1edbi lan t\u1ecfa. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i ti\u1ebfn tri\u1ec3n r\u1ea5t nhanh g\u00e2y suy h\u00f4 h\u1ea5p c\u1ea5p.<\/p>\n<p style=\"text-align: justify;\">+ Vi\u00eam ph\u1ed5i do virus SARS CoV 2: t\u1ed5n th\u01b0\u01a1ng xu\u1ea5t hi\u1ec7n hai b\u00ean ph\u1ed5i, th\u01b0\u1eddng g\u1eb7p nhi\u1ec1u \u1ed5, ph\u00e2n b\u1ed1 nhi\u1ec1u \u1edf ngo\u1ea1i vi, d\u01b0\u1edbi m\u00e0ng ph\u1ed5i v\u00e0 \u0111\u00e1y ph\u1ed5i (t\u1eadp trung nhi\u1ec1u \u1edf c\u00e1c ph\u00e2n th\u00f9y sau). T\u1ed5n th\u01b0\u01a1ng d\u1ea1ng k\u00ednh m\u1edd t\u0103ng d\u1ea7n, ti\u1ebfn tri\u1ec3n th\u00e0nh \u0111\u00e1m m\u1edd k\u00e8m theo d\u00e0y v\u00e1ch li\u00ean ti\u1ec3u th\u00f9y, v\u00e1ch trong ti\u1ec3u th\u00f9y v\u00e0 d\u00e0y d\u1ea1ng l\u01b0\u1edbi. Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh ng\u1ef1c c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng v\u00e0 theo d\u00f5i ti\u1ebfn tri\u1ec3n c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh m\u1eafc VPMPC\u0110 do virus SARS-CoV-2.<\/p>\n<h4 style=\"text-align: justify;\">3.1.5. Si\u00eau \u00e2m l\u1ed3ng ng\u1ef1c<\/h4>\n<p style=\"text-align: justify;\">Ng\u00e0y nay, si\u00eau \u00e2m l\u1ed3ng ng\u1ef1c l\u00e0 x\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i v\u00ec t\u00ednh ch\u00ednh x\u00e1c trong ch\u1ea9n \u0111o\u00e1n, thu\u1eadn ti\u1ec7n v\u00e0 chi ph\u00ed th\u1ea5p.<br \/>\nTr\u00ean si\u00eau \u00e2m, \u0111\u01b0\u1eddng B (B line) l\u00e0 v\u1ec7t s\u00e1ng d\u1ea1ng \u0111u\u00f4i sao ch\u1ed5i m\u00e0 b\u1ea3n ch\u1ea5t \u0111\u01b0\u1ee3c cho l\u00e0 c\u00e1c thay \u0111\u1ed5i c\u1ea5u tr\u00fac ph\u1ed5i gi\u1eefa kh\u00ed v\u00e0 d\u1ecbch c\u1ee7a kho\u1ea3ng k\u1ebd t\u1ea1o n\u00ean. B\u00ecnh th\u01b0\u1eddng \u0111\u01b0\u1eddng B c\u00f3 th\u1ec3 th\u1ea5y \u1edf ph\u1ed5i kh\u1ecfe m\u1ea1nh nh\u01b0ng \u0111\u01b0\u1eddng B t\u0103ng l\u00ean v\u1ec1 s\u1ed1 l\u01b0\u1ee3ng v\u00e0 m\u1eadt \u0111\u1ed9 ho\u1eb7c khi c\u00e1c \u0111\u01b0\u1eddng B k\u1ebft n\u1ed1i l\u1ea1i s\u1ebd \u0111\u01b0\u1ee3c xem l\u00e0 b\u1ec7nh l\u00fd. H\u00ecnh \u1ea3nh n\u00e0y t\u01b0\u01a1ng quan v\u1edbi t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng ph\u00f9, d\u00e0y l\u00ean c\u1ee7a v\u00e1ch li\u00ean ti\u1ec3u th\u00f9y ph\u1ed5i.<\/p>\n<p style=\"text-align: justify;\">Bi\u1ec3u hi\u1ec7n c\u1ee7a vi\u00eam ph\u1ed5i tr\u00ean si\u00eau \u00e2m l\u1ed3ng ng\u1ef1c l\u00e0 c\u00e1c h\u00ecnh \u1ea3nh t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng \u0111\u00f4ng \u0111\u1eb7c c\u00f3 di \u0111\u1ed9ng theo nh\u1ecbp th\u1edf, c\u00f3 th\u1ec3 th\u1ea5y h\u00ecnh \u1ea3nh kh\u00ed trong ph\u1ebf qu\u1ea3n v\u00e0 h\u00ecnh \u1ea3nh tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i. Si\u00eau \u00e2m l\u1ed3ng ng\u1ef1c c\u00f2n c\u00f3 vai tr\u00f2 trong theo d\u00f5i \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb, nh\u01b0 b\u1ec7nh thuy\u00ean gi\u1ea3m n\u1ebfu nh\u1eefng h\u00ecnh \u1ea3nh \u0111\u00f4ng \u0111\u1eb7c nh\u1ecf h\u01a1n v\u00e0 gi\u1ea3m d\u1ea7n s\u1ef1 hi\u1ec7n di\u1ec7n v\u00e0 s\u1ed1 l\u01b0\u1ee3ng c\u1ee7a d\u1ecbch m\u00e0ng ph\u1ed5i trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/p>\n<h4 style=\"text-align: justify;\">3.1.6. N\u1ed9i soi ph\u1ebf qu\u1ea3n<\/h4>\n<p style=\"text-align: justify;\">N\u1ed9i soi ph\u1ebf qu\u1ea3n \u1ed1ng m\u1ec1m l\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt quan tr\u1ecdng trong ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p d\u01b0\u1edbi cho ph\u00e9p l\u1ea5y b\u1ec7nh ph\u1ea9m tr\u1ef1c ti\u1ebfp t\u1eeb ph\u1ebf qu\u1ea3n\/ph\u1ebf nang gi\u00fap t\u0103ng \u0111\u1ed9 ch\u00ednh x\u00e1c trong ch\u1ea9n \u0111o\u00e1n c\u0103n nguy\u00ean g\u00e2y b\u1ec7nh. Nh\u01b0ng n\u1ed9i soi ph\u1ebf qu\u1ea3n kh\u00f4ng ph\u1ea3i l\u00e0 th\u0103m d\u00f2 th\u01b0\u1eddng quy trong ch\u1ea9n \u0111o\u00e1n VPMPC\u0110. NSPQ \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong VPMPC\u0110 khi:<\/p>\n<p style=\"text-align: justify;\">&#8211; Vi\u00eam ph\u1ed5i n\u1eb7ng c\u1ea7n x\u00e1c \u0111\u1ecbnh c\u0103n nguy\u00ean vi sinh m\u00e0 x\u00e9t nghi\u1ec7m \u0111\u1eddm kh\u00f4ng x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c.<\/p>\n<p style=\"text-align: justify;\">&#8211; Nghi ng\u1edd nhi\u1ec5m n\u1ea5m ho\u1eb7c vi khu\u1ea9n kh\u00e1ng thu\u1ed1c<\/p>\n<p style=\"text-align: justify;\">&#8211; Ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 suy gi\u1ea3m mi\u1ec5n d\u1ecbch c\u00f3 nguy c\u01a1 cao m\u1eafc c\u00e1c nhi\u1ec5m tr\u00f9ng c\u01a1 h\u1ed9i<\/p>\n<p style=\"text-align: justify;\">&#8211; Vi\u00eam ph\u1ed5i c\u00f3 bi\u1ebfn ch\u1ee9ng n\u1eb7ng nh\u01b0 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, \u00e1p xe ph\u1ed5i<\/p>\n<p style=\"text-align: justify;\">&#8211; C\u1ea7n ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi nh\u1eefng b\u1ec7nh l\u00fd kh\u00e1c: lao ph\u1ed5i, u ph\u1ed5i, d\u1ecb v\u1eadt \u0111\u01b0\u1eddng th\u1edf,\u2026<\/p>\n<h3 style=\"text-align: justify;\">3.2. Ch\u1ea9n \u0111o\u00e1n m\u1ee9c \u0111\u1ed9 n\u1eb7ng VPMPC\u0110<\/h3>\n<p style=\"text-align: justify;\">&#8211; M\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a vi\u00eam ph\u1ed5i c\u00f3 \u00fd ngh\u0129a quy\u1ebft \u0111\u1ecbnh:<\/p>\n<p style=\"text-align: justify;\">+ N\u01a1i \u0111i\u1ec1u tr\u1ecb: Ngo\u1ea1i tr\u00fa; khoa N\u1ed9i ho\u1eb7c khoa H\u00f4 h\u1ea5p; Khoa \u0110i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c<\/p>\n<p style=\"text-align: justify;\">+ Ch\u1ecdn ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh theo kinh nghi\u1ec7m.<\/p>\n<h4 style=\"text-align: justify;\">3.2.1. Thang \u0111i\u1ec3m CURB-65 c\u1ee7a BTS<\/h4>\n<p style=\"text-align: justify;\">&#8211; C\u00e1c ch\u1ec9 s\u1ed1 trong thang \u0111i\u1ec3m (m\u1ed7i ch\u1ec9 s\u1ed1 t\u00ednh 1 \u0111i\u1ec3m n\u1ebfu c\u00f3):<\/p>\n<p style=\"text-align: justify;\">+ Confusion \u2013 Thay \u0111\u1ed5i tri gi\u00e1c m\u1edbi xu\u1ea5t hi\u1ec7n<\/p>\n<p style=\"text-align: justify;\">+ Uremia \u2013 Ure m\u00e1u &gt; 7 mmol\/L<\/p>\n<p style=\"text-align: justify;\">+ Respiratory rate \u2013 T\u1ea7n s\u1ed1 th\u1edf \u2265 30 l\u1ea7n\/ph\u00fat<\/p>\n<p style=\"text-align: justify;\">+ Blood pressure \u2013 Huy\u1ebft \u00e1p t\u00e2m thu &lt; 90 v\u00e0\/ho\u1eb7c huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng \u2264 60 mmHg<\/p>\n<p style=\"text-align: justify;\">+ Age \u2013 Tu\u1ed5i \u2265 65<\/p>\n<p style=\"text-align: justify;\">&#8211; \u00dd ngh\u0129a l\u00e2m s\u00e0ng thang \u0111i\u1ec3m CURB \u2013 65:<\/p>\n<p style=\"text-align: justify;\">+ Ti\u00ean l\u01b0\u1ee3ng t\u1eed vong trong 30 ng\u00e0y cho ng\u01b0\u1eddi b\u1ec7nh c\u00f3 \u0111i\u1ec3m s\u1ed1 CURB-65 l\u1ea7n l\u01b0\u1ee3t l\u00e0: nh\u00f3m 1 (0 \u2013 1 \u0111i\u1ec3m): 1,5%; nh\u00f3m 2 (2 \u0111i\u1ec3m): 9,2%; nh\u00f3m 3 (3 \u2013 5 \u0111i\u1ec3m): 22%.<\/p>\n<p style=\"text-align: justify;\">+ \u0110i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho nh\u00f3m 1; \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa ng\u1eafn h\u1ea1n ho\u1eb7c \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa c\u00f3 ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho nh\u00f3m 2; \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho nh\u00f3m 3 trong \u0111\u00f3 \u0111i\u1ec1u tr\u1ecb t\u1ea1i khoa ICU \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho nh\u00f3m 3 nh\u01b0ng c\u00f3 \u0111i\u1ec3m CURB-65 t\u1eeb 4 &#8211; 5.<\/p>\n<p style=\"text-align: justify;\">+ Thang \u0111i\u1ec3m CURB\u201365 \u0111\u01a1n gi\u1ea3n, d\u1ec5 nh\u1edb, ch\u1ec9 c\u00f3 m\u1ed9t th\u00f4ng s\u1ed1 c\u1eadn l\u00e2m s\u00e0ng l\u00e0 Ure v\u00ec th\u1ebf r\u1ea5t ti\u1ec7n d\u1ee5ng \u0111\u1ec3 s\u1eed d\u1ee5ng trong ch\u1ea9n \u0111o\u00e1n m\u1ee9c \u0111\u1ed9 n\u1eb7ng VPMPC\u0110 t\u1ea1i l\u1ea7n kh\u00e1m \u0111\u1ea7u ti\u00ean t\u1ea1i ph\u00f2ng kh\u00e1m ngo\u1ea1i tr\u00fa. Tuy nhi\u00ean, vi\u1ec7c quy\u1ebft \u0111\u1ecbnh cho ng\u01b0\u1eddi b\u1ec7nh nh\u1eadp vi\u1ec7n hay \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa c\u1ea7n s\u1ef1 \u0111\u00e1nh gi\u00e1 linh ho\u1ea1t, k\u1ebft h\u1ee3p c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a t\u1eebng ng\u01b0\u1eddi b\u1ec7nh v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng.<\/p>\n<p style=\"text-align: justify;\">+ M\u1ed9t phi\u00ean b\u1ea3n \u0111\u01a1n gi\u1ea3n h\u01a1n c\u1ee7a thang \u0111i\u1ec3m CURB-65 l\u00e0 CRB-65 kh\u00f4ng c\u1ea7n x\u00e9t nghi\u1ec7m ure m\u00e1u \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t, t\u1ea1o \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i h\u01a1n cho th\u1ef1c h\u00e0nh ngo\u00e0i b\u1ec7nh vi\u1ec7n. V\u1edbi thang \u0111i\u1ec3m n\u00e0y n\u1ebfu c\u00f3 1-2 y\u1ebfu t\u1ed1 th\u00ec c\u1ea7n c\u00e2n nh\u1eafc nh\u1eadp vi\u1ec7n.<\/p>\n<h4 style=\"text-align: justify;\">3.2.2. Ch\u1ec9 s\u1ed1 ti\u00ean l\u01b0\u1ee3ng n\u1eb7ng vi\u00eam ph\u1ed5i PSI (Pneumonia Severity Index)<\/h4>\n<p style=\"text-align: justify;\">&#8211; C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng (B\u1ea3ng 3.1) g\u1ed3m:<\/p>\n<p style=\"text-align: justify;\">+ (1) Tu\u1ed5i;<\/p>\n<p style=\"text-align: justify;\">+ (2) \u0110\u1eb7c \u0111i\u1ec3m d\u00e2n s\u1ed1 h\u1ecdc (gi\u1edbi t\u00ednh, n\u01a1i \u1edf);<\/p>\n<p style=\"text-align: justify;\">+ (3) B\u1ec7nh \u0111\u1ed3ng m\u1eafc (ung th\u01b0, b\u1ec7nh gan, suy tim \u1ee9 huy\u1ebft, b\u1ec7nh m\u1ea1ch m\u00e1u n\u00e3o, b\u1ec7nh th\u1eadn);<\/p>\n<p style=\"text-align: justify;\">+ (4) \u0110\u1eb7c \u0111i\u1ec3m kh\u00e1m l\u00e2m s\u00e0ng (tri gi\u00e1c, t\u1ea7n s\u1ed1 th\u1edf, huy\u1ebft \u00e1p, th\u00e2n nhi\u1ec7t, m\u1ea1ch);<\/p>\n<p style=\"text-align: justify;\">+ (5) K\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m (pH m\u00e1u, BUN, natri m\u00e1u, \u0111\u01b0\u1eddng m\u00e1u, Hct, PaO2, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i tr\u00ean X-quang hay si\u00eau \u00e2m).<\/p>\n<p style=\"text-align: center;\"><strong>B\u1ea3ng 3.1. Ch\u1ec9 s\u1ed1 ti\u00ean l\u01b0\u1ee3ng n\u1eb7ng vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng (PSI)<\/strong><\/p>\n<table class=\" aligncenter\" style=\"width: 50%; border-collapse: collapse;\">\n<tbody>\n<tr>\n<td style=\"width: 53.2136%; text-align: center;\"><strong>Ti\u00eau ch\u00ed<\/strong><\/td>\n<td style=\"width: 45.7288%; text-align: center;\"><strong>\u0110i\u1ec3m<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 98.9424%; text-align: center;\" colspan=\"2\"><strong>\u0110\u1eb7c \u0111i\u1ec3m d\u00e2n s\u1ed1 h\u1ecdc<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 53.2136%; text-align: center;\">Nam<\/p>\n<p>N\u1eef<\/p>\n<p>S\u1ed1ng \u1edf nh\u00e0 d\u01b0\u1ee1ng l\u00e3o\/\u0111i\u1ec1u d\u01b0\u1ee1ng<\/td>\n<td style=\"width: 45.7288%; text-align: center;\">Tu\u1ed5i (t\u00ednh b\u1eb1ng n\u0103m)<\/p>\n<p>Tu\u1ed5i (t\u00ednh b\u1eb1ng n\u0103m) \u2013 10<\/p>\n<p>+ 10<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 98.9424%; text-align: center;\" colspan=\"2\"><strong>B\u1ec7nh \u0111\u1ed3ng m\u1eafc<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 53.2136%; text-align: center;\">B\u1ec7nh ung th\u01b0<\/p>\n<p>B\u1ec7nh gan<\/p>\n<p>Suy tim \u1ee9 huy\u1ebft<\/p>\n<p>B\u1ec7nh m\u1ea1ch m\u00e1u n\u00e3o<\/p>\n<p>B\u1ec7nh th\u1eadn<\/td>\n<td style=\"width: 45.7288%; text-align: center;\">+ 30<\/p>\n<p>+ 20<\/p>\n<p>+ 10<\/p>\n<p>+ 10<\/p>\n<p>+ 10<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 98.9424%; text-align: center;\" colspan=\"2\"><strong>Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 53.2136%; text-align: center;\">Thay \u0111\u1ed5i tri gi\u00e1c<\/p>\n<p>T\u1ea7n s\u1ed1 th\u1edf \u2265 30 l\u1ea7n\/ph\u00fat<\/p>\n<p>Huy\u1ebft \u00e1p t\u00e2m thu &lt; 90 mmHg<\/p>\n<p>Th\u00e2n nhi\u1ec7t &lt; 35oC ho\u1eb7c \u2265 40\u00b0C<\/p>\n<p>M\u1ea1ch \u2265 125 l\u1ea7n\/ph\u00fat<\/td>\n<td style=\"width: 45.7288%; text-align: center;\">+ 20<\/p>\n<p>+ 20<\/p>\n<p>+ 20<\/p>\n<p>+ 15<\/p>\n<p>+ 10<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 98.9424%; text-align: center;\" colspan=\"2\"><strong>K\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 53.2136%; text-align: center;\">pH &lt; 7,35<\/p>\n<p>BUN \u226530 mg\/dl (11 mmol\/L)<\/p>\n<p>Hematocrit &lt; 30%<\/p>\n<p>Na+ m\u00e1u &lt; 130 mmol\/L<\/p>\n<p>\u0110\u01b0\u1eddng m\u00e1u \u2265 250 mg\/dl (14 mmol\/L)<\/p>\n<p>PaO2&lt; 60 mmHg ho\u1eb7c SpO<sub>2<\/sub>&lt; 90%<\/p>\n<p>Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i<\/td>\n<td style=\"width: 45.7288%; text-align: center;\">+ 30<\/p>\n<p>+ 20<\/p>\n<p>+ 10<\/p>\n<p>+ 20<\/p>\n<p>+ 10<\/p>\n<p>+ 10<\/p>\n<p>+ 10<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify;\">\u00dd ngh\u0129a l\u00e2m s\u00e0ng thang \u0111i\u1ec3m PSI:<\/p>\n<table style=\"border-collapse: collapse; width: 100%;\">\n<tbody>\n<tr>\n<td style=\"width: 25%; text-align: center;\"><strong>PSI<\/strong><\/td>\n<td style=\"width: 25%; text-align: center;\"><strong>FINE<\/strong><\/td>\n<td style=\"width: 25%; text-align: center;\"><strong>Ti\u00ean l\u01b0\u1ee3ng t\u1eed vong 30 ng\u00e0y<\/strong><\/td>\n<td style=\"width: 25%; text-align: center;\"><strong>\u0110i\u1ec1u tr\u1ecb<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 25%; text-align: center;\">\u226470<\/p>\n<p>71-90<\/p>\n<p>91-130<\/p>\n<p>&gt;130<\/td>\n<td style=\"width: 25%; text-align: center;\">I-II<\/p>\n<p>III<\/p>\n<p>IV<\/p>\n<p>V<\/td>\n<td style=\"width: 25%; text-align: center;\">&lt;1%<\/p>\n<p>2,8%<\/p>\n<p>8,2-9,3%<\/p>\n<p>27-31,3%<\/td>\n<td style=\"width: 25%; text-align: center;\">Ngo\u1ea1i tr\u00fa<\/p>\n<p>N\u1ed9i tr\u00fa ng\u1eafn h\u1ea1n<\/p>\n<p>N\u1ed9i tr\u00fa<\/p>\n<p>ICU<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify;\">Ti\u00eau chu\u1ea9n PSI nh\u00ecn chung ph\u1ee9c t\u1ea1p, c\u1ea7n nhi\u1ec1u th\u00f4ng s\u1ed1 c\u1eadn l\u00e2m s\u00e0ng, \u0111i\u1ec3m t\u1ed5ng c\u1ed9ng \u0111\u00f2i h\u1ecfi ph\u1ea3i t\u00ednh to\u00e1n v\u00ec th\u1ebf tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng kh\u00f4ng \u0111\u01b0\u1ee3c \u1ee9ng d\u1ee5ng nhi\u1ec1u b\u1eb1ng thang \u0111i\u1ec3m CURB-65.<\/p>\n<h4 style=\"text-align: justify;\">3.2.3. Ti\u00eau chu\u1ea9n nh\u1eadp khoa \u0110i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c c\u1ee7a ATS<\/h4>\n<p style=\"text-align: justify;\">C\u00e1c ti\u00eau ch\u00ed d\u00f9ng trong \u0111\u00e1nh gi\u00e1 nh\u1eadp khoa \u0110i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c c\u1ee7a VPMPC\u0110 g\u1ed3m 2 ti\u00eau chu\u1ea9n ch\u00ednh v\u00e0 9 ti\u00eau chu\u1ea9n ph\u1ee5:<\/p>\n<table style=\"border-collapse: collapse; width: 100%;\">\n<tbody>\n<tr>\n<td style=\"width: 20.8885%;\"><\/td>\n<td style=\"width: 79.1115%; text-align: center;\"><strong>N\u1ed9i dung<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 20.8885%; text-align: center;\"><strong>Ti\u00eau chu\u1ea9n ch\u00ednh<\/strong><\/td>\n<td style=\"width: 79.1115%;\">1. Suy h\u00f4 h\u1ea5p c\u1ea7n ph\u1ea3i th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc<\/p>\n<p>2. S\u1ed1c nhi\u1ec5m khu\u1ea9n c\u1ea7n ph\u1ea3i d\u00f9ng thu\u1ed1c v\u1eadn m\u1ea1ch<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 20.8885%; text-align: center;\"><strong>Ti\u00eau chu\u1ea9n ph\u1ee5<\/strong><\/td>\n<td style=\"width: 79.1115%;\">1. T\u1ea7n s\u1ed1 th\u1edf \u226530 l\u1ea7n\/ph\u00fat<\/p>\n<p>2. PaO2\/ FiO2 \u2264250<\/p>\n<p>3. t\u1ed5n th\u01b0\u01a1ng nhi\u1ec1u th\u00f9y ph\u1ed5i tr\u00ean phim X-quang<\/p>\n<p>4. L\u00fa l\u1eabn, m\u1ea5t \u0111\u1ecbnh h\u01b0\u1edbng<\/p>\n<p>5. Ure m\u00e1u (BUN \u226520 mg\/dL)<\/p>\n<p>6. B\u1ea1ch c\u1ea7u m\u00e1u &lt; 4000\/ mm3<\/p>\n<p>7. Gi\u1ea3m ti\u1ec3u c\u1ea7u (&lt;100.000\/ mm3)<\/p>\n<p>8. H\u1ea1 th\u00e2n nhi\u1ec7t (&lt;36oC)<\/p>\n<p>9. H\u1ea1 huy\u1ebft \u00e1p c\u1ea7n ph\u1ea3i b\u00f9 d\u1ecbch t\u00edch c\u1ef1c.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify;\">\u00dd ngh\u0129a l\u00e2m s\u00e0ng thang \u0111i\u1ec3m ATS: Ch\u1ec9 \u0111\u1ecbnh nh\u1eadp khoa \u0110i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c cho ng\u01b0\u1eddi b\u1ec7nh c\u00f3 \u2265 3 ti\u00eau chu\u1ea9n ph\u1ee5 hay \u2265 1 ti\u00eau chu\u1ea9n ch\u00ednh.<br \/>\n*Ngo\u00e0i c\u00e1c thang \u0111i\u1ec3m n\u00eau tr\u00ean vi\u1ec7c ph\u00e2n t\u1ea7ng ng\u01b0\u1eddi b\u1ec7nh \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa hay n\u1ed9i tr\u00fa c\u1ea7n ph\u1ea3i linh ho\u1ea1t d\u1ef1a v\u00e0o th\u1ef1c t\u1ebf c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh. V\u00ed d\u1ee5 nh\u01b0: t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i nhi\u1ec1u thu\u1ef3, c\u00f3 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i k\u00e8m theo, ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng s\u1eed d\u1ee5ng \u0111\u01b0\u1ee3c thu\u1ed1c \u0111u\u1eddng u\u1ed1ng ho\u1eb7c kh\u00f4ng t\u1ef1 ch\u0103m s\u00f3c ho\u1eb7c kh\u00f4ng c\u00f3 ng\u01b0\u1eddi ch\u0103m s\u00f3c \u1edf nh\u00e0\u2026<\/p>\n<h3 style=\"text-align: justify;\">3.3. Ch\u1ea9n \u0111o\u00e1n c\u0103n nguy\u00ean g\u00e2y vi\u00eam ph\u1ed5i<\/h3>\n<h4 style=\"text-align: justify;\">3.3.1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh t\u00e1c nh\u00e2n g\u00e2y vi\u00eam ph\u1ed5i d\u1ef1a tr\u00ean k\u1ebft qu\u1ea3 vi sinh<\/h4>\n<p style=\"text-align: justify;\">&#8211; T\u00ednh tin c\u1eady c\u1ee7a k\u1ebft qu\u1ea3 vi sinh thay \u0111\u1ed5i t\u00f9y theo lo\u1ea1i b\u1ec7nh ph\u1ea9m v\u00e0 ph\u01b0\u01a1ng ph\u00e1p c\u1ea5y.<\/p>\n<p style=\"text-align: justify;\">&#8211; Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh t\u00e1c nh\u00e2n \u201cch\u1eafc ch\u1eafn\u201d khi:<\/p>\n<p style=\"text-align: justify;\">+\u00a0 C\u1ea5y m\u00e1u d\u01b0\u01a1ng t\u00ednh;<\/p>\n<p style=\"text-align: justify;\">+ C\u1ea5y d\u1ecbch, m\u1ee7 c\u1ee7a ph\u1ebf qu\u1ea3n\/m\u00e0ng ph\u1ed5i, b\u1ec7nh ph\u1ea9m ch\u1ecdc h\u00fat xuy\u00ean th\u00e0nh ng\u1ef1c d\u01b0\u01a1ng t\u00ednh;<\/p>\n<p style=\"text-align: justify;\">+ Hi\u1ec7n di\u1ec7n P. jirovecii trong \u0111\u1eddm, hay d\u1ecbch r\u1eeda ph\u1ebf qu\u1ea3n ph\u1ebf nang l\u1ea5y qua n\u1ed9i soi ph\u1ebf qu\u1ea3n;<\/p>\n<p style=\"text-align: justify;\">+\u00a0 Ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c Legionella pneumophila trong b\u1ec7nh ph\u1ea9m \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p;<\/p>\n<p style=\"text-align: justify;\">+ Hi\u1ec7u gi\u00e1 kh\u00e1ng th\u1ec3 kh\u00e1ng M. pneumoniae, C. pneumoniae, L. pneumophila trong m\u00e1u t\u0103ng g\u1ea5p \u2265 4 l\u1ea7n qua hai l\u1ea7n x\u00e9t nghi\u1ec7m;<\/p>\n<p style=\"text-align: justify;\">+ Kh\u00e1ng nguy\u00ean c\u1ee7a S. pneumoniae (n\u01b0\u1edbc ti\u1ec3u, m\u00e1u), L. pneumophila (n\u01b0\u1edbc ti\u1ec3u) d\u01b0\u01a1ng t\u00ednh.<\/p>\n<p style=\"text-align: justify;\">&#8211; Ch\u1ea9n \u0111o\u00e1n t\u00e1c nh\u00e2n c\u00f3 \u201ckh\u1ea3 n\u0103ng\u201d khi:<\/p>\n<p style=\"text-align: justify;\">+ Vi khu\u1ea9n ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c khi c\u1ea5y \u0111\u1eddm l\u00e0 vi khu\u1ea9n g\u00e2y b\u1ec7nh th\u01b0\u1eddng g\u1eb7p + ph\u00e1t tri\u1ec3n m\u1ea1nh + k\u1ebft qu\u1ea3 nhu\u1ed9m soi \u0111\u1eddm ph\u00f9 h\u1ee3p;<\/p>\n<p style=\"text-align: justify;\">+ Vi khu\u1ea9n ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c khi c\u1ea5y \u0111\u1eddm kh\u00f4ng ph\u1ea3i l\u00e0 lo\u1ea1i vi khu\u1ea9n g\u00e2y b\u1ec7nh th\u01b0\u1eddng g\u1eb7p + ph\u00e1t tri\u1ec3n y\u1ebfu + k\u1ebft qu\u1ea3 nhu\u1ed9m soi \u0111\u1eddm ph\u00f9 h\u1ee3p.<\/p>\n<h4 style=\"text-align: justify;\">3.3.2. Ch\u1ea9n \u0111o\u00e1n t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh d\u1ef1a tr\u00ean kinh nghi\u1ec7m<\/h4>\n<p style=\"text-align: justify;\">Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n c\u0103n nguy\u00ean c\u00f3 \u00fd ngh\u0129a quan tr\u1ecdng trong vi\u1ec7c l\u1ef1a ch\u1ecdn ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb cho ng\u01b0\u1eddi b\u1ec7nh. Tuy nhi\u00ean, khi x\u00e9t nghi\u1ec7m vi sinh kh\u00f4ng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u00ec kh\u00f4ng c\u1ea7n thi\u1ebft\/kh\u00f4ng kh\u1ea3 thi ho\u1eb7c khi x\u00e9t nghi\u1ec7m vi sinh \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n nh\u01b0ng k\u1ebft qu\u1ea3 ch\u01b0a c\u00f3 ho\u1eb7c \u00e2m t\u00ednh l\u00fac \u0111\u00f3 ch\u1ea9n \u0111o\u00e1n t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh ph\u1ea3i d\u1ef1a v\u00e0o kinh nghi\u1ec7m c\u1ee7a b\u00e1c s\u0129 l\u00e2m s\u00e0ng.<\/p>\n<p style=\"text-align: justify;\">Ch\u1ea9n \u0111o\u00e1n t\u00e1c nh\u00e2n vi khu\u1ea9n g\u00e2y vi\u00eam ph\u1ed5i theo kinh nghi\u1ec7m c\u0103n c\u1ee9 v\u00e0o: (1) m\u1ee9c \u0111\u1ed9 n\u1eb7ng vi\u00eam ph\u1ed5i: \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa, \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa t\u1ea1i khoa n\u1ed9i\/h\u00f4 h\u1ea5p\/truy\u1ec1n nhi\u1ec5m, \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa t\u1ea1i khoa \u0110i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c; (2) c\u01a1 \u0111\u1ecba ng\u01b0\u1eddi b\u1ec7nh bao g\u1ed3m tu\u1ed5i, th\u00f3i quen sinh ho\u1ea1t, b\u1ec7nh \u0111\u1ed3ng m\u1eafc (t\u1ea1i ph\u1ed5i v\u00e0 to\u00e0n th\u00e2n).<\/p>\n<p style=\"text-align: justify;\"><strong>VPMPC\u0110 m\u1ee9c \u0111\u1ed9 nh\u1eb9, \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa<\/strong><\/p>\n<p style=\"text-align: justify;\"><em>Streptococcus pneumoniae <\/em><\/p>\n<p style=\"text-align: justify;\"><em>Haemophilus influenzae <\/em><\/p>\n<p style=\"text-align: justify;\"><em>Moraxella catarrhalis<\/em><\/p>\n<p style=\"text-align: justify;\"><em>Mycoplasma pneumoniae<\/em><\/p>\n<p style=\"text-align: justify;\"><em>Chlamydia pneumoniae<\/em> (m\u1ed9t m\u00ecnh hay nhi\u1ec5m tr\u00f9ng k\u1ebft h\u1ee3p)<\/p>\n<p style=\"text-align: justify;\">Virus h\u00f4 h\u1ea5p: Influenza virus, Parainfluenza virus, Respiratory syncytial virus (RSV), Enterovirus, Rhinovirus, Adenovirus, Coronavirus, SARS-CoV2, Bocavirus<\/p>\n<p style=\"text-align: justify;\"><strong>VPMPC\u0110 m\u1ee9c \u0111\u1ed9 trung b\u00ecnh, n\u1eb7ng \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa t\u1ea1i khoa n\u1ed9i\/h\u00f4 h\u1ea5p\/truy\u1ec1n nhi\u1ec5m<\/strong><\/p>\n<p style=\"text-align: justify;\"><em>Streptococcus pneumoniae <\/em><\/p>\n<p style=\"text-align: justify;\"><em>Mycoplasma pneumoniae <\/em><\/p>\n<p style=\"text-align: justify;\"><em>Chlamydia pneumoniae<\/em><\/p>\n<p style=\"text-align: justify;\"><em>Haemophilus influenzae<\/em><\/p>\n<p style=\"text-align: justify;\">Nhi\u1ec5m tr\u00f9ng ph\u1ed1i h\u1ee3p<\/p>\n<p style=\"text-align: justify;\">Vi khu\u1ea9n gram \u00e2m \u0111\u01b0\u1eddng ru\u1ed9t<\/p>\n<p style=\"text-align: justify;\">Vi khu\u1ea9n k\u1ef5 kh\u00ed (vi\u00eam ph\u1ed5i h\u00edt)<\/p>\n<p style=\"text-align: justify;\"><em>Legionella<\/em> spp.<\/p>\n<p style=\"text-align: justify;\"><em>Bordetella pertussis<\/em><\/p>\n<p style=\"text-align: justify;\">Virus h\u00f4 h\u1ea5p: Influenza virus, Parainfluenza virus, Respiratory syncytial virus (RSV), Enterovirus, Rhinovirus, Adenovirus, Coronavirus, SARS-CoV2, Metapneumovirus, Human metapneumovirus (HMPV), Cytomegalovirus (CMV), Epstein-Barr virus, Bocavirus<\/p>\n<p style=\"text-align: justify;\"><strong>VPMPC\u0110 m\u1ee9c \u0111\u1ed9 n\u1eb7ng, \u0111i\u1ec1u tr\u1ecb t\u1ea1i ICU<\/strong><\/p>\n<p style=\"text-align: justify;\"><em>Streptococcus pneumoniae<\/em><\/p>\n<p style=\"text-align: justify;\">Vi khu\u1ea9n Gram \u00e2m \u0111\u01b0\u1eddng ru\u1ed9t<\/p>\n<p style=\"text-align: justify;\"><em>Staphylococcus aureus <\/em><\/p>\n<p style=\"text-align: justify;\"><em>Legionella<\/em> spp.<\/p>\n<p style=\"text-align: justify;\"><em>Mycoplasma pneumoniae <\/em><\/p>\n<p style=\"text-align: justify;\"><em>Pseudomonas aeruginosa<\/em><\/p>\n<p style=\"text-align: justify;\">Virus h\u00f4 h\u1ea5p: Influenza virus, Parainfluenza virus, Respiratory syncytial virus (RSV), Adenovirus, Coronavirus, SARS-CoV2, Metapneumovirus, Human metapneumovirus (HMPV)<\/p>\n<p style=\"text-align: justify;\">Trong s\u1ed1 c\u00e1c c\u0103n nguy\u00ean virus ti\u1ec1m \u1ea9n, c\u00fam l\u00e0 quan tr\u1ecdng nh\u1ea5t, m\u1eb7c d\u00f9 virus h\u1ee3p b\u00e0o h\u00f4 h\u1ea5p, adenovirus, \u00e1 c\u00fam v\u00e0 virus corona c\u0169ng c\u00f3 vai tr\u00f2. M\u1eb7c d\u00f9 virus c\u00fam ch\u1eafc ch\u1eafn c\u00f3 kh\u1ea3 n\u0103ng t\u1ef1 g\u00e2y ra b\u1ec7nh vi\u00eam ph\u1ed5i v\u00e0 g\u00e2y b\u1ec7nh n\u1eb7ng, nh\u01b0ng n\u00f3 th\u01b0\u1eddng \u0111\u01b0\u1ee3c coi l\u00e0 b\u1ec7nh nhi\u1ec5m tr\u00f9ng ti\u00ean ph\u00e1t, sau \u0111\u00f3 b\u1ecb nhi\u1ec5m tr\u00f9ng th\u1ee9 c\u1ea5p b\u1edfi m\u1ed9t lo\u1ea1i vi khu\u1ea9n nh\u01b0 S. aureus ho\u1eb7c Streptococcus pneumoniae.<\/p>\n<p style=\"text-align: justify;\">Khi \u0111\u00e1nh gi\u00e1 tr\u00ean t\u1eebng tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3, c\u00e2n nh\u1eafc to\u00e0n b\u1ed9 c\u00e1c y\u1ebfu t\u1ed1 v\u1eeba k\u1ec3 tr\u00ean c\u00f3 th\u1ec3 gi\u00fap ch\u1ea9n \u0111o\u00e1n t\u00e1c nh\u00e2n vi khu\u1ea9n. T\u1eadp h\u1ee3p c\u00e1c y\u1ebfu t\u1ed1 gi\u00fap ti\u00ean \u0111o\u00e1n m\u1ed9t t\u00e1c nh\u00e2n vi khu\u1ea9n n\u00e0o \u0111\u00f3 \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u1ec3 nhi\u1ec5m vi khu\u1ea9n \u0111\u00f3. (B\u1ea3ng 2.2)<\/p>\n<p style=\"text-align: center;\"><strong>B\u1ea3ng 3.2. Y\u1ebfu t\u1ed1 nguy c\u01a1 nhi\u1ec5m c\u00e1c t\u00e1c nh\u00e2n vi\u00eam ph\u1ed5i<\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%; height: 869px;\">\n<tbody>\n<tr style=\"height: 21px;\">\n<td style=\"width: 34.4991%; height: 21px; text-align: center;\"><strong>T\u00e1c nh\u00e2n<\/strong><\/td>\n<td style=\"width: 65.5009%; height: 21px; text-align: center;\"><strong>Y\u1ebfu t\u1ed1 nguy c\u01a1<\/strong><\/td>\n<\/tr>\n<tr style=\"height: 10px;\">\n<td style=\"width: 34.4991%; height: 10px;\"><em>Streptococcus pneumoniae<\/em><\/td>\n<td style=\"width: 65.5009%; height: 10px;\">Tu\u1ed5i \u2013 Gi\u1edbi: gi\u1edbi nam; tu\u1ed5i &lt; 2 ho\u1eb7c &gt; 65<\/p>\n<p>Th\u00f3i quen sinh ho\u1ea1t: nghi\u1ec7n r\u01b0\u1ee3u, h\u00fat thu\u1ed1c l\u00e1<\/p>\n<p>B\u1ec7nh \u0111\u1ed3ng m\u1eafc: b\u1ec7nh gan m\u1ea1n, b\u1ec7nh th\u1eadn m\u1ea1n, suy tim \u1ee9 huy\u1ebft, suy dinh d\u01b0\u1ee1ng, b\u1ec7nh t\u00e2m th\u1ea7n, b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh, suy gi\u1ea3m mi\u1ec5n d\u1ecbch, nhi\u1ec5m HIV, gh\u00e9p t\u1ea1ng<\/td>\n<\/tr>\n<tr style=\"height: 194px;\">\n<td style=\"width: 34.4991%; height: 194px;\"><em>Haemophilus influenzae<\/em><\/td>\n<td style=\"width: 65.5009%; height: 194px;\">B\u1ec7nh ph\u1ed5i m\u1ea1n t\u00ednh<\/p>\n<p>B\u1ec7nh \u00e1c t\u00ednh<\/p>\n<p>Nhi\u1ec5m HIV<\/p>\n<p>Nghi\u1ec7n r\u01b0\u1ee3u<\/p>\n<p>H\u00fat thu\u1ed1c l\u00e1<\/td>\n<\/tr>\n<tr style=\"height: 179px;\">\n<td style=\"width: 34.4991%; height: 179px;\"><em>Staphylococcus aureus<\/em><\/td>\n<td style=\"width: 65.5009%; height: 179px;\">B\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh, ung th\u01b0 ph\u1ed5i, b\u1ec7nh x\u01a1 nang<\/p>\n<p>B\u1ec7nh n\u1ed9i khoa m\u1ea1n t\u00ednh: \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, suy th\u1eadn<\/p>\n<p>Nhi\u1ec5m virus: Influenza, s\u1edfi<\/p>\n<p>Ti\u00eam ch\u00edch, thuy\u00ean t\u1eafc huy\u1ebft kh\u1ed1i nhi\u1ec5m tr\u00f9ng trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<\/td>\n<\/tr>\n<tr style=\"height: 86px;\">\n<td style=\"width: 34.4991%; height: 86px;\">Methicillin-Resistant <em>Staphylococcus aureus <\/em>(MRSA)<\/td>\n<td style=\"width: 65.5009%; height: 86px;\">Ti\u1ec1n s\u1eed nhi\u1ec5m MRSA<\/p>\n<p>N\u1eb1m vi\u1ec7n v\u00e0 d\u00f9ng kh\u00e1ng sinh t\u0129nh m\u1ea1ch trong v\u00f2ng 90 ng\u00e0y<\/td>\n<\/tr>\n<tr style=\"height: 194px;\">\n<td style=\"width: 34.4991%; height: 194px;\"><em>Klebsiella pneumoniae<\/em><\/td>\n<td style=\"width: 65.5009%; height: 194px;\">\u0110i\u1ec1u tr\u1ecb t\u1ea1i khoa \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c, \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n<\/p>\n<p>Nguy c\u01a1 h\u00edt s\u1eb7c d\u1ecbch t\u1eeb \u0111\u01b0\u1eddng ti\u00eau h\u00f3a: tai bi\u1ebfn m\u1ea1ch n\u00e3o, \u0111\u1ed9ng kinh, g\u00e2y m\u00ea<\/p>\n<p>Nghi\u1ec7n r\u01b0\u1ee3u<\/p>\n<p>B\u1ec7nh ph\u1ed5i m\u1ea1n t\u00ednh, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/p>\n<p>S\u1eed d\u1ee5ng kh\u00e1ng sinh tr\u01b0\u1edbc \u0111\u00f3<\/td>\n<\/tr>\n<tr style=\"height: 143px;\">\n<td style=\"width: 34.4991%; height: 143px;\"><em>Pseudomonas aeruginosa<\/em><\/td>\n<td style=\"width: 65.5009%; height: 143px;\">B\u1ec7nh ph\u1ed5i c\u1ea5u tr\u00fac nh\u01b0 b\u1ec7nh x\u01a1 nang, gi\u00e3n ph\u1ebf qu\u1ea3n, b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh n\u1eb7ng (FEV1&lt; 30%)<\/p>\n<p>Ti\u1ec1n s\u1eed nhi\u1ec5m <em>Pseudomonas aeruginosa<\/em><\/p>\n<p>N\u1eb1m vi\u1ec7n v\u00e0 s\u1eed d\u1ee5ng kh\u00e1ng sinh t\u0129nh m\u1ea1ch trong v\u00f2ng 90 ng\u00e0y<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 34.4991%; height: 21px;\"><em>Acinetobacter baumannii<\/em><\/td>\n<td style=\"width: 65.5009%; height: 21px;\">Nghi\u1ec7n r\u01b0\u1ee3u, tu\u1ed5i gi\u00e0, b\u1ec7nh n\u1ed9i khoa n\u1eb7ng<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 34.4991%; height: 21px;\">Vi khu\u1ea9n k\u1ef5 kh\u00ed<\/td>\n<td style=\"width: 65.5009%; height: 21px;\">B\u1ec7nh ph\u1ed5i: ung th\u01b0 ph\u1ed5i, gi\u00e3n ph\u1ebf qu\u1ea3n, nh\u1ed3i m\u00e1u ph\u1ed5i, vi\u00eam ph\u1ed5i h\u00edt.<\/p>\n<p>Nhi\u1ec5m khu\u1ea9n k\u1ef5 kh\u00ed v\u00f9ng h\u1ea7u h\u1ecdng<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3 style=\"text-align: justify;\">3.4. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/h3>\n<h4 style=\"text-align: justify;\">3.4.1. Lao ph\u1ed5i<\/h4>\n<p style=\"text-align: justify;\">&#8211; Ti\u1ec1n s\u1eed ti\u1ebfp x\u00fac v\u1edbi ng\u01b0\u1eddi m\u1eafc lao.<\/p>\n<p style=\"text-align: justify;\">&#8211; Ho kh\u1ea1c \u0111\u1eddm k\u00e9o d\u00e0i, c\u00f3 th\u1ec3 ho m\u00e1u, s\u1ed1t nh\u1eb9 v\u1ec1 chi\u1ec1u, g\u1ea7y s\u00fat c\u00e2n.<\/p>\n<p style=\"text-align: justify;\">&#8211; X-quang ng\u1ef1c c\u00f3 t\u1ed5n th\u01b0\u01a1ng nghi lao (n\u1ed1t, th\u00e2m nhi\u1ec5m, hang x\u01a1). C\u00f3 khi t\u1ed5n th\u01b0\u01a1ng tr\u00ean X quang ng\u1ef1c kh\u00f4ng \u0111i\u1ec3n h\u00ecnh, nh\u1ea5t l\u00e0 \u1edf ng\u01b0\u1eddi suy gi\u1ea3m mi\u1ec5n d\u1ecbch (HIV\/AIDS, d\u00f9ng corticoid k\u00e9o d\u00e0i. ).<\/p>\n<p style=\"text-align: justify;\">&#8211; Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh: T\u00ecm th\u1ea5y tr\u1ef1c khu\u1ea9n kh\u00e1ng c\u1ed3n &#8211; toan (AFB) trong \u0111\u1eddm ho\u1eb7c d\u1ecbch ph\u1ebf qu\u1ea3n qua nhu\u1ed9m soi tr\u1ef1c ti\u1ebfp, genExpert MTB d\u01b0\u01a1ng t\u00ednh, nu\u00f4i c\u1ea5y MGIT d\u01b0\u01a1ng t\u00ednh MTB.<\/p>\n<h4 style=\"text-align: justify;\">3.4.2. T\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/h4>\n<p style=\"text-align: justify;\">&#8211; C\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1: ng\u01b0\u1eddi b\u1ec7nh sau \u0111\u1ebb, sau ph\u1eabu thu\u1eadt \u1edf v\u00f9ng ti\u1ec3u khung, sau ch\u1ea5n th\u01b0\u01a1ng, g\u00e3y x\u01b0\u01a1ng, b\u1ea5t \u0111\u1ed9ng l\u00e2u ng\u00e0y, vi\u00eam t\u1eafc t\u0129nh m\u1ea1ch chi d\u01b0\u1edbi, d\u00f9ng thu\u1ed1c tr\u00e1nh thai.<\/p>\n<p style=\"text-align: justify;\">&#8211; \u0110au ng\u1ef1c d\u1eef d\u1ed9i, ho ra m\u00e1u, kh\u00f3 th\u1edf, c\u00f3 th\u1ec3 c\u00f3 d\u1ea5u hi\u1ec7u s\u1ed1c.<\/p>\n<p style=\"text-align: justify;\">&#8211; \u0110i\u1ec7n t\u00e2m \u0111\u1ed3 c\u00f3 th\u1ec3 th\u1ea5y d\u1ea5u hi\u1ec7u t\u00e2m ph\u1ebf c\u1ea5p: S s\u00e2u \u1edf D1, Q s\u00e2u \u1edf D3, tr\u1ee5c ph\u1ea3i, block nh\u00e1nh ph\u1ea3i.<\/p>\n<p style=\"text-align: justify;\">&#8211; Kh\u00ed m\u00e1u c\u00f3 th\u1ec3 th\u1ea5y t\u0103ng th\u00f4ng kh\u00ed: PaO2 gi\u1ea3m v\u00e0 PaCO2 gi\u1ea3m.<\/p>\n<p style=\"text-align: justify;\">&#8211; D-dimer m\u00e1u t\u0103ng cao.<\/p>\n<p style=\"text-align: justify;\">&#8211; Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh c\u00f3 ti\u00eam thu\u1ed1c c\u1ea3n quang t\u0129nh m\u1ea1ch c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n v\u1ecb tr\u00ed \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i b\u1ecb t\u1eafc.<\/p>\n<h4 style=\"text-align: justify;\">3.4.3. Ung th\u01b0 ph\u1ed5i<\/h4>\n<p style=\"text-align: justify;\">&#8211; Th\u01b0\u1eddng g\u1eb7p \u1edf ng\u01b0\u1eddi &gt; 50 tu\u1ed5i, c\u00f3 ti\u1ec1n s\u1eed nghi\u1ec7n thu\u1ed1c l\u00e1, gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi m\u1eafc ung th\u01b0.<\/p>\n<p style=\"text-align: justify;\">&#8211; Ho kh\u1ea1c \u0111\u1eddm l\u1eabn m\u00e1u, s\u00fat c\u00e2n.<\/p>\n<p style=\"text-align: justify;\">&#8211; X-quang ph\u1ed5i c\u00f3 h\u00ecnh m\u1edd.<\/p>\n<p style=\"text-align: justify;\">&#8211; Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh ng\u1ef1c, soi ph\u1ebf qu\u1ea3n v\u00e0 sinh thi\u1ebft gi\u00fap ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh.<\/p>\n<p style=\"text-align: justify;\">&#8211; N\u00ean ch\u00fa \u00fd nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd ho\u1eb7c sau khi \u0111i\u1ec1u tr\u1ecb h\u1ebft t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng m\u00e0 t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i kh\u00f4ng c\u1ea3i thi\u1ec7n sau 1 th\u00e1ng ho\u1eb7c vi\u00eam ph\u1ed5i t\u00e1i ph\u00e1t \u1edf c\u00f9ng m\u1ed9t v\u1ecb tr\u00ed.<\/p>\n<h4 style=\"text-align: justify;\">3.4.4. Gi\u00e3n ph\u1ebf qu\u1ea3n b\u1ed9i nhi\u1ec5m<\/h4>\n<p style=\"text-align: justify;\">&#8211; Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 ti\u1ec1n s\u1eed ho kh\u1ea1c \u0111\u1eddm m\u1ee7 k\u00e9o d\u00e0i, s\u1ed1t.<\/p>\n<p style=\"text-align: justify;\">&#8211; Kh\u00e1m ph\u1ed5i: C\u00f3 ran \u1ea9m, ran n\u1ed5 c\u1ed1 \u0111\u1ecbnh.<\/p>\n<p style=\"text-align: justify;\">&#8211; C\u1ea7n ch\u1ee5p phim c\u1eaft l\u1edbp vi t\u00ednh l\u1ed3ng ng\u1ef1c l\u1edbp m\u1ecfng 1mm \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n.<\/p>\n<h4 style=\"text-align: justify;\">3.4.5. Vi\u00eam ph\u1ed5i v\u1edbi c\u01a1 ch\u1ebf t\u1ef1 mi\u1ec5n do d\u00f9ng thu\u1ed1c<\/h4>\n<p style=\"text-align: justify;\">&#8211; H\u1ecfi k\u1ef9 ti\u1ec1n s\u1eed d\u00f9ng thu\u1ed1c, \u0111\u1eb7c bi\u1ec7t ch\u00fa \u00fd t\u1edbi c\u00e1c thu\u1ed1c hay g\u00e2y vi\u00eam ph\u1ed5i nh\u01b0 amiodaron&#8230;<\/p>\n<p style=\"text-align: justify;\">&#8211; C\u00e1c tri\u1ec7u ch\u1ee9ng s\u1ebd gi\u1ea3m ho\u1eb7c m\u1ea5t \u0111i khi ng\u1eebng thu\u1ed1c s\u1edbm.<\/p>\n<h4 style=\"text-align: justify;\">3.4.6. Ph\u00f9 ph\u1ed5i b\u00e1n c\u1ea5p kh\u00f4ng \u0111i\u1ec3n h\u00ecnh<\/h4>\n<p style=\"text-align: justify;\">&#8211; \u0110i\u1ec1u tr\u1ecb thu\u1ed1c l\u1ee3i ti\u1ec3u<\/p>\n<p style=\"text-align: justify;\">&#8211; Ch\u1ee5p l\u1ea1i phim X quang ph\u1ed5i \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng.<\/p>\n<h4 style=\"text-align: justify;\">3.4.7. Vi\u00eam ph\u1ed5i do h\u00edt<\/h4>\n<p style=\"text-align: justify;\">Hay g\u1eb7p: vi\u00eam ph\u1ed5i do s\u1eb7c d\u1ea7u<\/p>\n<p style=\"text-align: justify;\">&#8211; G\u1eb7p \u1edf nh\u1eefng ng\u01b0\u1eddi d\u00f9ng thu\u1ed1c nh\u1ecf m\u0169i c\u00f3 tinh d\u1ea7u, gi\u1ecdt d\u1ea7u l\u1ecdt v\u00e0o ph\u1ed5i. Ng\u01b0\u1eddi h\u00edt ph\u1ea3i x\u0103ng, d\u1ea7u h\u1ecfa, d\u1ea7u mazut.<\/p>\n<p style=\"text-align: justify;\">&#8211; Sau khi b\u1ecb s\u1eb7c, ng\u01b0\u1eddi b\u1ec7nh s\u1ed1t r\u1ea5t cao 39 \u2013 40\u2070C k\u00e9o d\u00e0i 1 \u2013 2 tu\u1ea7n l\u1ec5, \u0111au ng\u1ef1c d\u1eef d\u1ed9i, ho s\u1eb7c s\u1ee5a. Sau v\u00e0i ng\u00e0y ho kh\u1ea1c \u0111\u1eddm c\u00f3 m\u00e1u v\u00e0 m\u1ee7.<\/p>\n<p style=\"text-align: justify;\">&#8211; Kh\u00e1m: h\u1ed9i ch\u1ee9ng \u0111\u00f4ng \u0111\u1eb7c ph\u1ed5i.<\/p>\n<p style=\"text-align: justify;\">&#8211; X-quang ph\u1ed5i: c\u00f3 h\u00ecnh m\u1edd \u0111\u1ec1u thu\u1ef3 d\u01b0\u1edbi ho\u1eb7c m\u1ed9t b\u00ean ph\u1ed5i, c\u00f3 khi c\u1ea3 hai b\u00ean.<\/p>\n<h4 style=\"text-align: justify;\">3.4.8. H\u1ed9i ch\u1ee9ng Loeffler ph\u1ed5i<\/h4>\n<p style=\"text-align: justify;\">&#8211; L\u00e0 t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng th\u00e2m nhi\u1ec5m ph\u1ed5i thay \u0111\u1ed5i nhanh.<\/p>\n<p style=\"text-align: justify;\">&#8211; Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng c\u00f3 th\u1ec3 th\u1ea5y: kh\u00f3 th\u1edf, ho, kh\u00f2 kh\u00e8, s\u1ed1t.<\/p>\n<p style=\"text-align: justify;\">&#8211; Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3 c\u00f3 th\u1ec3 th\u1ea5y: h\u1ed9i ch\u1ee9ng \u0111\u00f4ng \u0111\u1eb7c, ti\u1ebfng c\u1ecd m\u00e0ng ph\u1ed5i.<\/p>\n<p style=\"text-align: justify;\">&#8211; T\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan trong m\u00e1u v\u00e0 trong \u0111\u1eddm.<\/p>\n<p style=\"text-align: justify;\">&#8211; Nguy\u00ean nh\u00e2n: do k\u00fd sinh tr\u00f9ng trong chu k\u1ef3 ph\u00e1t tri\u1ec3n \u0111i qua ph\u1ed5i g\u00e2y vi\u00eam ph\u1ed5i ho\u1eb7c ti\u1ebfp x\u00fac v\u1edbi nh\u1eefng ch\u1ea5t g\u00e2y d\u1ecb \u1ee9ng.<\/p>\n<p style=\"text-align: justify;\">&#8211; Xquang ng\u1ef1c: c\u00f3 nhi\u1ec1u d\u1ea3i m\u1edd \u0111a d\u1ea1ng v\u00e0 bi\u1ebfn m\u1ea5t sau m\u1ed9t tu\u1ea7n l\u1ec5.<\/p>\n<h3 style=\"text-align: justify;\">3.5. Ch\u1ea9n \u0111o\u00e1n bi\u1ebfn ch\u1ee9ng<\/h3>\n<p style=\"text-align: justify;\">Vi\u00eam ph\u1ed5i c\u00f3 th\u1ec3 g\u00e2y c\u00e1c bi\u1ebfn ch\u1ee9ng t\u1ea1i ph\u1ed5i, trong l\u1ed3ng ng\u1ef1c v\u00e0 bi\u1ebfn ch\u1ee9ng xa: suy h\u00f4 h\u1ea5p, nhi\u1ec5m khu\u1ea9n huy\u1ebft, s\u1ed1c nhi\u1ec5m tr\u00f9ng, \u00e1p xe ph\u1ed5i, tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i, tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i, vi\u00eam m\u00e0ng ngo\u00e0i tim, vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c,\u2026<\/p>\n<h4 style=\"text-align: justify;\">3.5.1. Bi\u1ebfn ch\u1ee9ng t\u1ea1i ph\u1ed5i<\/h4>\n<p style=\"text-align: justify;\">&#8211; B\u1ec7nh c\u00f3 th\u1ec3 lan r\u1ed9ng ra hai ho\u1eb7c nhi\u1ec1u th\u00f9y ph\u1ed5i, ng\u01b0\u1eddi b\u1ec7nh kh\u00f3 th\u1edf nhi\u1ec1u h\u01a1n, t\u00edm m\u00f4i; m\u1ea1ch nhanh, ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 t\u1eed vong trong t\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p, s\u1ed1c nhi\u1ec5m tr\u00f9ng.<\/p>\n<p style=\"text-align: justify;\">&#8211; X\u1eb9p m\u1ed9t thu\u1ef3 ph\u1ed5i: t\u1eafc ph\u1ebf qu\u1ea3n do \u0111\u1eddm.<\/p>\n<p style=\"text-align: justify;\">&#8211; \u00c1p xe ph\u1ed5i: r\u1ea5t th\u01b0\u1eddng g\u1eb7p, c\u00f3 th\u1ec3 do d\u00f9ng kh\u00e1ng sinh kh\u00f4ng hi\u1ec7u qu\u1ea3, ng\u01b0\u1eddi b\u1ec7nh s\u1ed1t dai d\u1eb3ng, kh\u1ea1c nhi\u1ec1u \u0111\u1eddm c\u00f3 m\u1ee7. X quang ng\u1ef1c c\u00f3 1 ho\u1eb7c nhi\u1ec1u h\u00ecnh hang v\u1edbi m\u1ee9c n\u01b0\u1edbc, m\u1ee9c h\u01a1i.<\/p>\n<h4 style=\"text-align: justify;\">3.5.2. Bi\u1ebfn ch\u1ee9ng trong l\u1ed3ng ng\u1ef1c<\/h4>\n<p style=\"text-align: justify;\">&#8211; Tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i, trung th\u1ea5t: th\u01b0\u1eddng do nguy\u00ean nh\u00e2n S. aureus.<\/p>\n<p style=\"text-align: justify;\">&#8211; Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i: vi\u00eam ph\u1ed5i d\u01b0\u1edbi m\u00e0ng ph\u1ed5i g\u00e2y tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i. D\u1ecbch th\u01b0\u1eddng m\u00e0u v\u00e0ng chanh nh\u1ea1t, h\u1ebft nhanh d\u01b0\u1edbi \u0111i\u1ec1u tr\u1ecb, th\u01b0\u1eddng do S. pneumoniae.<\/p>\n<p style=\"text-align: justify;\">&#8211; Tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i: ng\u01b0\u1eddi b\u1ec7nh s\u1ed1t dai d\u1eb3ng, d\u1ecbch m\u00e0ng ph\u1ed5i l\u00e0 m\u1ee7, th\u01b0\u1eddng x\u1ea3y ra trong tr\u01b0\u1eddng h\u1ee3p vi\u00eam ph\u1ed5i m\u00e0ng ph\u1ed5i, ho\u1eb7c do ch\u1ecdc d\u00f2 m\u00e0ng ph\u1ed5i g\u00e2y b\u1ed9i nhi\u1ec5m.<\/p>\n<p style=\"text-align: justify;\">&#8211; Vi\u00eam m\u00e0ng ngo\u00e0i tim: tri\u1ec7u ch\u1ee9ng \u0111au v\u00f9ng tr\u01b0\u1edbc tim, nghe c\u00f3 ti\u1ebfng c\u1ecd m\u00e0ng tim, th\u01b0\u1eddng l\u00e0 vi\u00eam m\u00e0ng tim c\u00f3 m\u1ee7.<\/p>\n<h4 style=\"text-align: justify;\">3.5.3. Bi\u1ebfn ch\u1ee9ng xa<\/h4>\n<p style=\"text-align: justify;\">&#8211; Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c c\u1ea5p t\u00ednh do S. pneumoniae: bi\u1ebfn ch\u1ee9ng n\u00e0y hi\u1ebfm g\u1eb7p, ng\u01b0\u1eddi b\u1ec7nh c\u00f3 c\u01a1n s\u1ed1t r\u00e9t run, l\u00e1ch to.<\/p>\n<p style=\"text-align: justify;\">&#8211; Vi\u00eam kh\u1edbp do S. pneumoniae: g\u1eb7p \u1edf ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i, th\u01b0\u1eddng ch\u1ec9 b\u1ecb m\u1ed9t kh\u1edbp s\u01b0ng, \u0111\u1ecf, n\u00f3ng, \u0111au.<\/p>\n<p style=\"text-align: justify;\">&#8211; Vi\u00eam m\u00e0ng n\u00e3o do S. pneumoniae: l\u00e0 bi\u1ebfn ch\u1ee9ng hi\u1ebfm g\u1eb7p, d\u1ecbch n\u00e3o tu\u1ef7 ch\u1ee9a nhi\u1ec1u S. pneumoniae, glucose gi\u1ea3m, c\u00f3 \u00edt b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n.<\/p>\n<p style=\"text-align: justify;\">&#8211; Vi\u00eam ph\u00fac m\u1ea1c: th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb em. S\u1ed1c nhi\u1ec5m tr\u00f9ng, m\u00ea s\u1ea3ng \u1edf ng\u01b0\u1eddi nghi\u1ec7n r\u01b0\u1ee3u&#8230;.<\/p>\n<p style=\"text-align: justify;\">&#8211; Nhi\u1ec5m khu\u1ea9n huy\u1ebft: vi khu\u1ea9n v\u00e0o m\u00e1u, c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c \u1ed5 \u00e1p xe nh\u1ecf \u1edf c\u00e1c c\u01a1 quan kh\u00e1c.<\/p>\n<p style=\"text-align: justify;\">&#8211; S\u1ed1c nhi\u1ec5m tr\u00f9ng: tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng, th\u01b0\u1eddng x\u1ea3y ra \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh c\u00f3 c\u01a1 \u0111\u1ecba \u0111\u1eb7c bi\u1ec7t nh\u01b0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, suy th\u1eadn, suy tim\u2026 t\u00ecnh tr\u1ea1ng s\u1ed1c k\u00e9o d\u00e0i c\u00f3 th\u1ec3 g\u00e2y h\u1ed9i ch\u1ee9ng suy \u0111a ph\u1ee7 t\u1ea1ng.<\/p>\n<h3 style=\"text-align: justify;\">3.6. \u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng c\u1ee7a m\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p g\u00e2y VPMPC\u0110<\/h3>\n<h4 style=\"text-align: justify;\">3.6.1. Vi\u00eam ph\u1ed5i do <em>S. aureus<\/em><\/h4>\n<p style=\"text-align: justify;\">&#8211; Ti\u1ec1n s\u1eed: nhi\u1ec5m tr\u00f9ng ngo\u00e0i da, \u0111\u1eb7t catheter t\u0129nh m\u1ea1ch trung t\u00e2m, nhi\u1ec5m virus c\u00fam\u2026<\/p>\n<p style=\"text-align: justify;\">&#8211; L\u00e2m s\u00e0ng: Kh\u1edfi \u0111\u1ea7u \u0111\u1ed9t ng\u1ed9t, s\u1ed1t cao, r\u00e9t run, m\u1ea1ch nhanh, kh\u00f3 th\u1edf, \u0111au ng\u1ef1c, to\u00e0n th\u00e2n suy s\u1ee5p nhanh. Ho kh\u1ea1c \u0111\u1eddm nh\u1ea7y m\u1ee7 v\u00e0ng. Kh\u00e1m ph\u1ed5i c\u00f3 ran \u1ea9m, ran n\u1ed5 r\u1ea3i r\u00e1c, g\u00f5 \u0111\u1ee5c.<\/p>\n<p style=\"text-align: justify;\">&#8211; X-quang ng\u1ef1c: t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i lan t\u1ecfa v\u00e0 bi\u1ebfn \u0111\u1ed5i nhanh, v\u00f9ng t\u1ed5n th\u01b0\u01a1ng c\u00f3 nhi\u1ec1u \u1ed5 \u00e1p xe nh\u1ecf.<\/p>\n<p style=\"text-align: justify;\">&#8211; Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh nh\u1edd c\u1ea5y \u0111\u1eddm, c\u1ea5y m\u00e1u t\u00ecm th\u1ea5y S. aureus.<\/p>\n<h4 style=\"text-align: justify;\">3.6.2. Vi\u00eam ph\u1ed5i do <em>Klebsiella pneumoniae<\/em><\/h4>\n<p style=\"text-align: justify;\">&#8211; B\u1ec7nh x\u1ea3y ra \u1edf ng\u01b0\u1eddi gi\u00e0 y\u1ebfu, nghi\u1ec7n r\u01b0\u1ee3u.<\/p>\n<p style=\"text-align: justify;\">&#8211; L\u00e2m s\u00e0ng: To\u00e0n th\u00e2n m\u1ec7t l\u1ea3, c\u00f3 th\u1ec3 k\u00e8m theo nhi\u1ec5m khu\u1ea9n huy\u1ebft, s\u1ed1c nhi\u1ec5m khu\u1ea9n. S\u1ed1t nh\u1eb9, ho kh\u1ea1c \u0111\u1eddm v\u00e0ng ho\u1eb7c xanh ho\u1eb7c \u0111\u1eddm m\u1ee7.<\/p>\n<p style=\"text-align: justify;\">&#8211; X-quang ph\u1ed5i: t\u1ed5n th\u01b0\u01a1ng lan r\u1ed9ng nhi\u1ec1u thu\u1ef3, c\u00f3 nhi\u1ec1u \u1ed5 \u00e1p xe nh\u1ecf, r\u1ed3i t\u1ea1o n\u00ean \u1ed5 \u00e1p xe l\u1edbn, vi\u1ec1n m\u1ecfng, c\u00f3 m\u1ee9c n\u01b0\u1edbc. Th\u01b0\u1eddng c\u00f3 tr\u00e0n m\u1ee7 m\u00e0ng ph\u1ed5i k\u00e8m theo.<\/p>\n<h4 style=\"text-align: justify;\">3.6.3. Vi\u00eam ph\u1ed5i do <em>Pseudomonas aeruginosa<\/em><\/h4>\n<p style=\"text-align: justify;\">&#8211; Vi\u00eam ph\u1ed5i do vi khu\u1ea9n n\u00e0y g\u1eb7p 6 \u2013 11% \u1edf c\u1ed9ng \u0111\u1ed3ng. T\u1ef7 l\u1ec7 t\u1eed vong cao: 31 \u2013 90%.<\/p>\n<p style=\"text-align: justify;\">&#8211; Pseudomonas c\u00f3 ngo\u1ea1i \u0111\u1ed9c t\u1ed1 A l\u00e0 lo\u1ea1i \u0111\u1ed9c t\u1ed1 m\u1ea1nh.<\/p>\n<p style=\"text-align: justify;\">&#8211; Ch\u1ea9n \u0111o\u00e1n d\u1ef1a v\u00e0o t\u00ecnh tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh nhi\u1ec5m \u0111\u1ed9c: v\u1ebb m\u1eb7t lo \u00e2u, l\u00fa l\u1eabn, s\u1ed1t cao, r\u00e9t run, m\u1ea1ch ch\u1eadm. Ho kh\u1ea1c \u0111\u1eddm xanh ho\u1eb7c v\u00e0ng. B\u1ea1ch c\u1ea7u t\u0103ng cao. R\u1ea5t hay g\u1eb7p vi\u00eam ph\u1ed5i c\u00f3 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i.<\/p>\n<p style=\"text-align: justify;\">&#8211; X-quang ng\u1ef1c: T\u1ed5n th\u01b0\u01a1ng th\u00e2m nhi\u1ec5m lan t\u1ecfa hai b\u00ean ph\u1ed5i, th\u01b0\u1eddng k\u00e8m theo tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i v\u00e0 c\u00f3 nhi\u1ec1u \u1ed5 \u00e1p xe nh\u1ecf \u1edf ph\u1ed5i.<\/p>\n<p style=\"text-align: justify;\">&#8211; C\u1ea5y \u0111\u1eddm, d\u1ecbch ph\u1ebf qu\u1ea3n, c\u1ea5y m\u00e1u ra Pseudomonas aeruginosa<\/p>\n<p style=\"text-align: justify;\">3.6.4. Vi\u00eam ph\u1ed5i do <em>Burkholderia pseudomallei<\/em><\/p>\n<p style=\"text-align: justify;\">&#8211; <em>B. pseudomallei<\/em> s\u1ed1ng trong \u0111\u1ea5t v\u00e0 n\u01b0\u1edbc b\u1ec1 m\u1eb7t \u1edf c\u00e1c qu\u1ed1c gia khu v\u1ef1c \u0110\u00f4ng Nam \u00c1 v\u00e0 B\u1eafc Australia. B\u1ec7nh th\u01b0\u1eddng g\u1eb7p v\u00e0o m\u00f9a m\u01b0a. T\u1ea1i Vi\u1ec7t Nam, b\u1ec7nh g\u1eb7p t\u1ef7 l\u1ec7 cao t\u1eeb th\u00e1ng 9 \u0111\u1ebfn th\u00e1ng 11.<\/p>\n<p style=\"text-align: justify;\">&#8211; Ph\u01b0\u01a1ng th\u1ee9c l\u00e2y truy\u1ec1n ch\u1ee7 y\u1ebfu qua da khi ti\u1ebfp x\u00fac v\u1edbi \u0111\u1ea5t ho\u1eb7c n\u01b0\u1edbc b\u1ecb nhi\u1ec5m <em>B. pseudomallei<\/em> \u1edf c\u00e1c n\u01b0\u1edbc v\u00f9ng nhi\u1ec7t \u0111\u1edbi.<\/p>\n<p style=\"text-align: justify;\">&#8211; C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 quan tr\u1ecdng nh\u1ea5t c\u1ee7a melioidosis (b\u1ec7nh do <em>B. pseudomallei<\/em>) l\u00e0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, nghi\u1ec7n r\u01b0\u1ee3u, b\u1ec7nh th\u1eadn m\u1ea1n t\u00ednh v\u00e0 b\u1ec7nh ph\u1ed5i m\u1ea1n t\u00ednh.<\/p>\n<p style=\"text-align: justify;\">&#8211; Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng bao g\u1ed3m c\u00e1c th\u1ec3 c\u1ea5p t\u00ednh, b\u00e1n c\u1ea5p v\u00e0 m\u1ea1n t\u00ednh. Bi\u1ec3u hi\u1ec7n c\u1ea5p t\u00ednh bao g\u1ed3m s\u1ed1t cao, ho, kh\u1ea1c \u0111\u1eddm m\u1ee7, \u0111au ng\u1ef1c ki\u1ec3u m\u00e0ng ph\u1ed5i, \u1edbn l\u1ea1nh, s\u1ed1t r\u00e9t, suy h\u00f4 h\u1ea5p ti\u1ebfn tri\u1ec3n nhanh, c\u00f3 th\u1ec3 k\u00e8m theo nhi\u1ec5m khu\u1ea9n huy\u1ebft, \u1edf c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n s\u1ed1c nhi\u1ec5m khu\u1ea9n, suy \u0111a t\u1ea1ng v\u00e0 t\u1eed vong. Th\u1ec3 di\u1ec5n bi\u1ebfn b\u00e1n c\u1ea5p ho\u1eb7c m\u1ea1n t\u00ednh th\u01b0\u1eddng g\u1eb7p \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng n\u1eb1m trong v\u00f9ng d\u1ecbch t\u1ec5, melioidosis xu\u1ea5t hi\u1ec7n sau khi ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e3 r\u1eddi kh\u1ecfi khu v\u1ef1c b\u1ec7nh l\u01b0u h\u00e0nh, c\u00e1c tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 g\u1eb7p nh\u01b0 ho, kh\u1ea1c \u0111\u1eddm m\u1ee7, ho m\u00e1u, s\u00fat c\u00e2n v\u00e0 ra m\u1ed3 h\u00f4i ban \u0111\u00eam, nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m n\u00e0y d\u1ec5 nh\u1ea7m v\u1edbi lao ph\u1ed5i. Melioidosis m\u1ea1n t\u00ednh ti\u1ebfn tri\u1ec3n th\u01b0\u1eddng ch\u1eadm, c\u00e1c tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 k\u00e9o d\u00e0i t\u1eeb 1 \u0111\u1ebfn nhi\u1ec1u th\u00e1ng.<\/p>\n<p style=\"text-align: justify;\">&#8211; Xquang ng\u1ef1c: t\u1ed5n th\u01b0\u01a1ng r\u1ea5t \u0111a d\u1ea1ng, t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i c\u1ea5p t\u00ednh c\u00f3 th\u1ec3 g\u1eb7p: \u0111\u00f4ng \u0111\u1eb7c m\u1ed9t ho\u1eb7c nhi\u1ec1u th\u00f9y, th\u00e2m nhi\u1ec5m r\u1ea3i r\u00e1c, k\u00ednh m\u1edd, \u00e1p xe ph\u1ed5i, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, h\u1ea1ch trung th\u1ea5t, t\u1ed5n th\u01b0\u01a1ng ho\u1ea1i t\u1eed d\u1ea1ng hang, c\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n r\u1ea5t nhanh. Tr\u01b0\u1eddng h\u1ee3p melioidosis m\u1ea1n t\u00ednh c\u00f3 th\u1ec3 g\u1eb7p c\u00e1c t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng hang, \u0111\u00f4ng \u0111\u1eb7c ho\u1eb7c th\u00e2m nhi\u1ec5m th\u00f9y tr\u00ean, c\u00e1c d\u1ea3i x\u01a1, c\u00e1c n\u1ed1t th\u00e2m nhi\u1ec5m nh\u1ecf gi\u1ed1ng t\u1ed5n th\u01b0\u01a1ng do lao, c\u00f3 h\u1ea1ch trung th\u1ea5t nh\u01b0ng hi\u1ebfm khi canxi h\u00f3a v\u00e0 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i \u0111\u01a1n thu\u1ea7n.<\/p>\n<p style=\"text-align: justify;\">&#8211; C\u1ea5y \u0111\u1eddm, d\u1ecbch ph\u1ebf qu\u1ea3n, c\u1ea5y m\u00e1u ra B. pseudomallei<\/p>\n<h4 style=\"text-align: justify;\">3.6.5. Vi\u00eam ph\u1ed5i \u1edf ng\u01b0\u1eddi suy gi\u1ea3m mi\u1ec5n d\u1ecbch<\/h4>\n<p style=\"text-align: justify;\">&#8211; Ng\u01b0\u1eddi thi\u1ebfu gamma globulin m\u00e1u d\u1ec5 b\u1ecb vi\u00eam ph\u1ed5i do <em>S. pneumoniae, Haemophilus influenzae<\/em>.<\/p>\n<p style=\"text-align: justify;\">&#8211; Khi gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh m\u00e1u, th\u01b0\u1eddng b\u1ecb vi\u00eam ph\u1ed5i do <em>P. aeruginosa v\u00e0 S. aureus<\/em>.<\/p>\n<p style=\"text-align: justify;\">&#8211; Khi suy gi\u1ea3m mi\u1ec5n d\u1ecbch qua trung gian t\u1ebf b\u00e0o m\u00e0 s\u1ed1 l\u01b0\u1ee3ng CD4 &lt; 200\/mL hay b\u1ecb vi\u00eam ph\u1ed5i do <em>P. jirovecii<\/em>.<\/p>\n<p style=\"text-align: justify;\">&#8211; Ng\u01b0\u1eddi nhi\u1ec5m HIV hay b\u1ecb vi\u00eam ph\u1ed5i do <em>P. jirovecii<\/em>, do <em>S. pneumoniae v\u00e0 H. influenzae<\/em>.<\/p>\n<p style=\"text-align: justify;\">&#8211; Vi\u00eam ph\u1ed5i do CMV \u1edf ng\u01b0\u1eddi s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch.<\/p>\n<p style=\"text-align: justify;\"><strong>Nh\u1eefng \u0111i\u1ec3m c\u1ea7n nh\u1edb:<\/strong><\/p>\n<p style=\"text-align: justify;\">1. Vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i \u1edf c\u1ed9ng \u0111\u1ed3ng v\u1edbi c\u00e1c bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng \u0111a d\u1ea1ng, c\u00e1c tri\u1ec7u ch\u1ee9ng bi\u1ec3u hi\u1ec7n t\u1eeb m\u1ee9c \u0111\u1ed9 nh\u1eb9 \u0111\u1ebfn n\u1eb7ng, t\u00f9y thu\u1ed9c v\u00e0o c\u0103n nguy\u00ean vi sinh, c\u01a1 \u0111\u1ecba c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh&#8230;<\/p>\n<p style=\"text-align: justify;\">2. Th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng c\u1ea7n \u00e1p d\u1ee5ng linh ho\u1ea1t c\u00e1c thang \u0111i\u1ec3m \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng, c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ec3 ph\u00e2n lo\u1ea1i m\u1ee9c \u0111\u1ed9 n\u1eb7ng v\u00e0 \u0111\u00e1nh gi\u00e1 ti\u00ean l\u01b0\u1ee3ng ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110.<\/p>\n<p style=\"text-align: justify;\">3. \u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh c\u00f3 vai tr\u00f2 quan tr\u1ecdng \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh n\u01a1i \u0111i\u1ec1u tr\u1ecb c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh (ngo\u1ea1i tr\u00fa, nh\u1eadp vi\u1ec7n khoa n\u1ed9i, khoa \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c) v\u00e0 ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh ban \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb theo kinh nghi\u1ec7m.<\/p>\n<p style=\"text-align: justify;\">4. C\u00e1c k\u1ef9 thu\u1eadt ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh nh\u01b0 ch\u1ee5p X quang ng\u1ef1c, Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh ng\u1ef1c v\u00e0 si\u00eau \u00e2m l\u1ed3ng ng\u1ef1c l\u00e0 c\u00e1c x\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh, \u0111\u00e1nh m\u1ee9c \u0111\u1ed9 n\u1eb7ng, x\u00e1c \u0111\u1ecbnh bi\u1ebfn ch\u1ee9ng, \u0111\u1ecbnh h\u01b0\u1edbng c\u0103n nguy\u00ean vi sinh v\u00e0 theo d\u00f5i \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb c\u1ee7a VPMPC\u0110.<\/p>\n<p style=\"text-align: justify;\">5. Ch\u1ea9n \u0111o\u00e1n \u0111\u1ecbnh h\u01b0\u1edbng c\u00e1c t\u00e1c nh\u00e2n vi sinh g\u00e2y VPMPC\u0110 theo kinh nghi\u1ec7m d\u1ef1a v\u00e0o k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u d\u1ecbch t\u1ec5 v\u1ec1 ch\u1ee7ng lo\u1ea1i vi khu\u1ea9n th\u01b0\u1eddng g\u00e2y VPMPC\u0110 t\u1ea1i \u0111\u1ecba ph\u01b0\u01a1ng, b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng, m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh v\u00e0 c\u01a1 \u0111\u1ecba c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n<p style=\"text-align: justify;\">6. X\u00e9t nghi\u1ec7m t\u00ecm c\u0103n nguy\u00ean vi sinh \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 c\u1ea7n nh\u1eadp vi\u1ec7n \u0111i\u1ec1u tr\u1ecb t\u1ea1i khoa n\u1ed9i ho\u1eb7c khoa \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c ho\u1eb7c trong m\u1ed9t s\u1ed1 t\u00ecnh hu\u1ed1ng \u0111\u1eb7c bi\u1ec7t (b\u1ea3ng \u1edf tr\u00ean).<\/p>\n<h2 style=\"text-align: center;\">CH\u01af\u01a0NG 4. D\u01af\u1ee2C L\u00dd L\u00c2M S\u00c0NG S\u1eec D\u1ee4NG KH\u00c1NG SINH H\u1ee2P L\u00dd TRONG \u0110I\u1ec0U TR\u1eca VI\u00caM PH\u1ed4I C\u1ed8NG \u0110\u1ed2NG<\/h2>\n<h3 style=\"text-align: justify;\">4.1. L\u1ef1a ch\u1ecdn kh\u00e1ng sinh d\u1ef1a tr\u00ean ph\u1ed5 kh\u00e1ng khu\u1ea9n<\/h3>\n<p style=\"text-align: justify;\">L\u1ef1a ch\u1ecdn kh\u00e1ng sinh theo kinh nghi\u1ec7m d\u1ef1a tr\u00ean t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh k\u1ebft h\u1ee3p v\u1edbi ph\u1ed5 kh\u00e1ng khu\u1ea9n c\u1ee7a kh\u00e1ng sinh v\u00e0 kh\u1ea3 n\u0103ng x\u00e2m nh\u1eadp c\u01a1 quan \u0111\u00edch (d\u1ecbch l\u00f3t bi\u1ec3u m\u00f4 ph\u1ebf nang v\u00e0 \u0111\u1ea1i th\u1ef1c b\u00e0o ph\u1ebf nang). Do c\u00e1c t\u00e1c nh\u00e2n vi khu\u1ea9n g\u00e2y ra VPMPC\u0110 th\u01b0\u1eddng \u0111\u1ed3ng m\u1eafc v\u1edbi virus v\u00e0 hi\u1ec7n kh\u00f4ng c\u00f3 c\u00e1c test ch\u1ea9n \u0111o\u00e1n nhanh v\u00e0 ch\u00ednh x\u00e1c b\u1ec7nh c\u00f3 nguy\u00ean nh\u00e2n \u0111\u01a1n \u0111\u1ed9c do virus hay kh\u00f4ng, n\u00ean b\u1eaft \u0111\u1ea7u ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh theo kinh nghi\u1ec7m s\u1edbm ngay khi nghi ng\u1edd t\u00e1c nh\u00e2n vi khu\u1ea9n ho\u1eb7c vi khu\u1ea9n \u0111\u1ed3ng m\u1eafc v\u1edbi virus.<\/p>\n<p style=\"text-align: justify;\">\u1ede nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 m\u1ee9c \u0111\u1ed9 nh\u1eb9 \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa, c\u00e1c vi khu\u1ea9n g\u00e2y b\u1ec7nh VPMPC\u0110 th\u01b0\u1eddng g\u1eb7p bao g\u1ed3m Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis v\u00e0 c\u00e1c vi khu\u1ea9n n\u1ed9i b\u00e0o, trong \u0111\u00f3, th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 Streptococcus pneumoniae. T\u01b0\u01a1ng \u1ee9ng, ba nh\u00f3m kh\u00e1ng sinh ph\u1ed5 bi\u1ebfn trong \u0111i\u1ec1u tr\u1ecb VPMPC\u0110 bao g\u1ed3m: \u03b2-lactam, macrolide v\u00e0 fluoroquinolon (FQ). T\u00ecnh tr\u1ea1ng gia t\u0103ng \u0111\u1ec1 kh\u00e1ng l\u00e0m ho\u1ea1t t\u00ednh c\u1ee7a \u03b2-lactam b\u1ecb suy gi\u1ea3m nh\u01b0ng \u0111\u00e2y v\u1eabn l\u00e0 nh\u00f3m kh\u00e1ng sinh th\u1ec3 hi\u1ec7n ho\u1ea1t t\u00ednh m\u1ea1nh v\u1edbi S. pneumoniae v\u00e0 ph\u1ea7n l\u1edbn c\u00e1c ph\u00e1c \u0111\u1ed3 VPMPC\u0110 theo kinh nghi\u1ec7m \u0111\u1ec1u bao ph\u1ee7 vi khu\u1ea9n n\u00e0y. Khi nghi ng\u1edd c\u0103n nguy\u00ean g\u00e2y b\u1ec7nh l\u00e0 c\u00e1c vi khu\u1ea9n n\u1ed9i b\u00e0o bao g\u1ed3m Mycoplasma pneumoniae, Chlamydia pneumoniae v\u00e0 Legionella spp., c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng kh\u00e1ng sinh macrolid (v\u00ed d\u1ee5: azithromycin, clarithromycin) ho\u1eb7c doxycyclin \u0111\u01a1n \u0111\u1ed9c c\u00f3 ho\u1ea1t t\u00ednh m\u1ea1nh tr\u00ean c\u00e1c vi khu\u1ea9n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh.<\/p>\n<p style=\"text-align: justify;\">Kh\u00e1ng sinh penicilin ph\u1ed5 h\u1eb9p tr\u00ean S. pneumoniae ho\u1eb7c vi khu\u1ea9n n\u1ed9i b\u00e0o kh\u00f4ng ph\u00f9 h\u1ee3p \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh c\u00f3 b\u1ec7nh l\u00fd \u0111\u1ed3ng m\u1eafc (b\u1ec7nh l\u00fd tim, ph\u1ed5i, gan, th\u1eadn m\u1ea1n t\u00ednh, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, nghi\u1ec7n r\u01b0\u1ee3u, b\u1ec7nh l\u00fd \u00e1c t\u00ednh) ho\u1eb7c c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1ng thu\u1ed1c. \u1ede nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng n\u00e0y, H. influenzae v\u00e0 M. catarrhalis (th\u01b0\u1eddng sinh enzym \u03b2-lactamase), tr\u1ef1c khu\u1ea9n Gram \u00e2m v\u00e0 S. aureus l\u00e0 c\u00e1c nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p g\u00e2y ra VPMPC\u0110, v\u00ec v\u1eady, ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb VPMPC\u0110 theo kinh nghi\u1ec7m c\u1ea7n c\u00f3 ph\u1ed5 kh\u00e1ng khu\u1ea9n r\u1ed9ng h\u01a1n. Theo \u0111\u00f3, kh\u00e1ng sinh amoxicilin\/acid clavulanic ho\u1eb7c kh\u00e1ng sinh cephalosporin th\u1ebf h\u1ec7 3 \u0111\u01b0\u1eddng u\u1ed1ng c\u00f3 ph\u1ed5 tr\u00ean ph\u1ebf c\u1ea7u (cefpodoxim, cefdinir, cefditoren) th\u01b0\u1eddng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o k\u1ebft h\u1ee3p v\u1edbi kh\u00e1ng sinh macrolid ho\u1eb7c doxycyclin \u0111\u1ec3 bao ph\u1ee7 c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh kh\u00f4ng \u0111i\u1ec3n h\u00ecnh.<\/p>\n<p style=\"text-align: justify;\">Kh\u00e1ng sinh FQ h\u00f4 h\u1ea5p (levofloxacin, moxifloxacin) c\u00f3 ph\u1ed5 kh\u00e1ng khu\u1ea9n r\u1ed9ng bao ph\u1ee7 \u0111\u01b0\u1ee3c c\u1ea3 S. pneumoniae v\u00e0 vi khu\u1ea9n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh, tuy nhi\u00ean c\u1ea7n d\u1ef1 tr\u1eef nh\u00f3m kh\u00e1ng sinh n\u00e0y, kh\u00f4ng n\u00ean l\u1ef1a ch\u1ecdn ban \u0111\u1ea7u cho c\u00e1c ng\u01b0\u1eddi b\u1ec7nh ngo\u1ea1i tr\u00fa kh\u00f4ng c\u00f3 b\u1ec7nh n\u1ec1n m\u1eafc k\u00e8m, kh\u00f4ng c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 nhi\u1ec5m S. pneumoniae kh\u00e1ng thu\u1ed1c ho\u1eb7c kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed s\u1eed d\u1ee5ng kh\u00e1ng sinh trong th\u1eddi gian g\u1ea7n \u0111\u00e2y \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 kh\u00e1ng thu\u1ed1c.<\/p>\n<p style=\"text-align: justify;\">\u1ede nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 m\u1ee9c \u0111\u1ed9 trung b\u00ecnh c\u1ea7n \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa nh\u01b0ng ch\u01b0a c\u1ea7n n\u1eb1m ICU, ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh c\u1ea7n bao ph\u1ee7 r\u1ed9ng h\u01a1n c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh, v\u1edbi nguy c\u01a1 cao kh\u00e1ng thu\u1ed1c v\u1edbi c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh th\u00f4ng th\u01b0\u1eddng, ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh th\u01b0\u1eddng khuy\u1ebfn c\u00e1o bao g\u1ed3m kh\u00e1ng sinh beta-lactam +\/- ch\u1ea5t \u1ee9c ch\u1ebf beta-lactamase (ampicillin\/ sulbactam, amoxicillin\/acid clavulanic, cefotaxim, ceftriaxon, ceftarolin) k\u1ebft h\u1ee3p v\u1edbi kh\u00e1ng sinh macrolid ho\u1eb7c fluoroquinolon.<\/p>\n<p style=\"text-align: justify;\">\u1ede nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb t\u1ea1i ICU, n\u00ean c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng c\u00e1c ph\u00e1c \u0111\u1ed3 k\u1ebft h\u1ee3p kh\u00e1ng sinh \u03b2-lactam v\u1edbi macrolid ho\u1eb7c fluoroquinolon truy\u1ec1n t\u0129nh m\u1ea1ch. Vi\u1ec7c c\u00e2n nh\u1eafc ph\u1ed1i h\u1ee3p macrolid hay fluoroquinolon n\u00ean d\u1ef1a tr\u00ean \u0111\u00e1nh gi\u00e1 c\u00e2n b\u1eb1ng nguy c\u01a1\/l\u1ee3i \u00edch, chi ph\u00ed, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c v\u00e0 nguy c\u01a1 \u0111\u1ec1 kh\u00e1ng. Khuy\u1ebfn c\u00e1o c\u1ee7a Hi\u1ec7p h\u1ed9i Vi sinh l\u00e2m s\u00e0ng v\u00e0 B\u1ec7nh truy\u1ec1n nhi\u1ec5m Ch\u00e2u \u00c2u (ESCMID) n\u0103m 2023, \u01b0u ti\u00ean ph\u00e1c \u0111\u1ed3 ph\u1ed1i h\u1ee3p kh\u00e1ng sinh \u03b2-lactam v\u1edbi macrolid (trong 3 &#8211; 5 ng\u00e0y), h\u01a1n l\u00e0 fluoroquinolon [81]. B\u1eb1ng ch\u1ee9ng t\u1eeb m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y cho th\u1ea5y, ph\u00e1c \u0111\u1ed3 ph\u1ed1i h\u1ee3p v\u1edbi macrolid gi\u00fap t\u0103ng \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng s\u1edbm v\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong so v\u1edbi ph\u1ed1i h\u1ee3p fluoroquinolon [92], [93]. Ngo\u00e0i vai tr\u00f2 bao ph\u1ee7 t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh l\u00e0 vi khu\u1ea9n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh, l\u1ee3i \u00edch n\u00e0y c\u1ee7a macrolid c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn t\u00e1c d\u1ee5ng \u0111i\u1ec1u bi\u1ebfn mi\u1ec5n d\u1ecbch c\u1ee7a thu\u1ed1c [92].<\/p>\n<p style=\"text-align: justify;\">Tr\u00ean ng\u01b0\u1eddi b\u1ec7nh vi\u00eam ph\u1ed5i n\u1eb7ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb t\u1ea1i ICU, ngo\u00e0i c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh th\u01b0\u1eddng g\u1eb7p, c\u00f3 th\u1ec3 c\u1ea7n c\u00e2n nh\u1eafc \u0111\u1ebfn vai tr\u00f2 c\u1ee7a vi khu\u1ea9n \u0111a kh\u00e1ng thu\u1ed1c nh\u01b0 S. aureus kh\u00e1ng methicilin (MRSA) v\u00e0 P. aeruginosa. Thang \u0111i\u1ec3m PES ph\u00e2n t\u1ea7ng nguy c\u01a1 m\u1eafc c\u00e1c vi khu\u1ea9n \u0111a kh\u00e1ng thu\u1ed1c th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong VPMPC\u0110 (bao g\u1ed3m P. aeruginosa, MRSA v\u00e0 Enterobacteriaceae sinh ESBL) \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng ph\u1ed5 bi\u1ebfn tr\u00ean th\u1ebf gi\u1edbi [94].<\/p>\n<p style=\"text-align: center;\"><strong>B\u1ea3ng 4.1. Ph\u00e2n t\u1ea7ng nguy c\u01a1 m\u1eafc vi khu\u1ea9n kh\u00e1ng thu\u1ed1c theo thang \u0111i\u1ec3m PES<\/strong><\/p>\n<table class=\" aligncenter\" style=\"height: 433px; width: 39.6987%; border-collapse: collapse;\">\n<tbody>\n<tr style=\"height: 21px;\">\n<td style=\"width: 60.1331%; height: 21px; text-align: center;\"><strong>Ti\u00eau ch\u00ed<\/strong><\/td>\n<td style=\"width: 11.8954%; height: 21px; text-align: center;\"><strong>\u0110i\u1ec3m<\/strong><\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 72.0285%; height: 21px;\" colspan=\"2\"><strong>Tu\u1ed5i (n\u0103m)<\/strong><\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 60.1331%; height: 21px;\">&lt;40<\/p>\n<p>40 \u2013 65<\/p>\n<p>&gt;65<\/p>\n<p>Nam gi\u1edbi<\/p>\n<p>S\u1eed d\u1ee5ng kh\u00e1ng sinh g\u1ea7n \u0111\u00e2y<\/p>\n<p>B\u1ec7nh ph\u1ed5i m\u1ea1n t\u00ednh (COPD ho\u1eb7c gi\u00e3n ph\u1ebf qu\u1ea3n)<\/p>\n<p>Suy th\u1eadn m\u1ea1n<\/td>\n<td style=\"width: 11.8954%; height: 21px; text-align: center;\">0<\/p>\n<p>1<\/p>\n<p>2<\/p>\n<p>1<\/p>\n<p>2<\/p>\n<p>2<\/p>\n<p>3<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 72.0285%; height: 21px;\" colspan=\"2\"><strong>\u1ede ph\u00f2ng c\u1ea5p c\u1ee9u<\/strong><\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 60.1331%; height: 10px;\">Gi\u1ea3m nh\u1eadn th\u1ee9c<\/p>\n<p>S\u1ed1t<\/td>\n<td style=\"width: 11.8954%; height: 10px; text-align: center;\">2<\/p>\n<p>-1<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify;\">K\u1ebft lu\u1eadn: Nguy c\u01a1 th\u1ea5p: \u22641; Nguy c\u01a1 trung b\u00ecnh: 2-4; Nguy c\u01a1 cao: \u22655.<\/p>\n<p style=\"text-align: justify;\">D\u1ef1a tr\u00ean thang \u0111i\u1ec3m n\u00e0y, ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb kinh nghi\u1ec7m c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc b\u1ed5 sung kh\u00e1ng sinh c\u00f3 ph\u1ed5 t\u00e1c d\u1ee5ng tr\u00ean MRSA (vancomycin, teicoplanin ho\u1eb7c linezolid), kh\u00e1ng sinh \u03b2-lactam c\u00f3 ho\u1ea1t t\u00ednh tr\u00ean P. aeruginosa (ceftazidim, cefepim, piperacilin\/tazobactam, imipenem, doripenem ho\u1eb7c meropenem) ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c kh\u00e1ng sinh nh\u00f3m kh\u00e1c c\u00f3 ho\u1ea1t t\u00ednh tr\u00ean vi khu\u1ea9n n\u00e0y (ciprofloxacin, levofloxacin, tobramycin ho\u1eb7c amikacin). C\u00e1c vi khu\u1ea9n \u0111a kh\u00e1ng thu\u1ed9c h\u1ecd Enterobacteriaceae nh\u01b0 K. pneumoniae c\u0169ng c\u00f3 th\u1ec3 l\u00e0 c\u0103n nguy\u00ean trong m\u1ed9t s\u1ed1 \u00edt ca VPMPC\u0110, ph\u00e1c \u0111\u1ed3 h\u01b0\u1edbng \u0111\u1ebfn vi khu\u1ea9n Gram \u00e2m \u0111\u01b0\u1eddng ru\u1ed9t (ertapenem, imipenem ho\u1eb7c meropenem) ho\u1eb7c tr\u1ef1c khu\u1ea9n m\u1ee7 xanh P. aeruginosa (carbapenem nh\u00f3m 2, aminoglycosid) th\u01b0\u1eddng c\u0169ng bao ph\u1ee7 \u0111\u01b0\u1ee3c c\u00e1c t\u00e1c nh\u00e2n n\u00e0y [67].<\/p>\n<p style=\"text-align: justify;\">Ceftarolin l\u00e0 m\u1ed9t kh\u00e1ng sinh cephalosporin m\u1edbi c\u00f3 ph\u1ed5 kh\u00e1ng khu\u1ea9n bao ph\u1ee7 c\u00e1c t\u00e1c nh\u00e2n g\u00e2y VPMPC\u0110 th\u01b0\u1eddng g\u1eb7p bao g\u1ed3m c\u00e1c c\u1ea7u khu\u1ea9n Gram d\u01b0\u01a1ng hi\u1ebfu kh\u00ed (Streptococcus pneumoniae, Staphylococcus aureus) v\u00e0 h\u1ecd tr\u1ef1c khu\u1ea9n Gram \u00e2m<\/p>\n<p style=\"text-align: justify;\">Enterobacteriaceae kh\u00f4ng sinh \u03b2-lactamase. Thu\u1ed1c c\u00f3 ho\u1ea1t l\u1ef1c m\u1ea1nh ch\u1ed1ng l\u1ea1i c\u00e1c ch\u1ee7ng Streptococcus pneumoniae kh\u00e1ng penicillin v\u00e0 MRSA. V\u00ec v\u1eady, kh\u00e1ng sinh n\u00e0y c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p VPMPC\u0110 do c\u00e1c ch\u1ee7ng S. pneumoniae \u0111\u1ec1 kh\u00e1ng \u1edf m\u1ee9c \u0111\u1ed9 cao v\u1edbi penicillin ho\u1eb7c l\u00e0 l\u1ef1a ch\u1ecdn thay th\u1ebf cho vancomycin hay linezolid \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i do MRSA tuy nhi\u00ean c\u00f2n c\u1ea7n th\u00eam c\u00e1c d\u1eef li\u1ec7u t\u1eeb th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng.<\/p>\n<h3 style=\"text-align: justify;\">4.2. L\u1ef1a ch\u1ecdn v\u00e0 t\u1ed1i \u01b0u h\u00f3a ch\u1ebf \u0111\u1ed9 li\u1ec1u d\u1ef1a tr\u00ean \u0111\u1eb7c \u0111i\u1ec3m d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc\/d\u01b0\u1ee3c l\u1ef1c h\u1ecdc v\u00e0 ch\u1ee9c n\u0103ng th\u1eadn c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh<\/h3>\n<p style=\"text-align: justify;\">T\u1ed1i \u01b0u h\u00f3a ch\u1ebf \u0111\u1ed9 li\u1ec1u kh\u00e1ng sinh d\u1ef1a tr\u00ean \u0111\u1eb7c \u0111i\u1ec3m d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc\/d\u01b0\u1ee3c l\u1ef1c h\u1ecdc (PK\/PD) g\u00f3p ph\u1ea7n t\u0103ng hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb v\u00e0 gi\u1ea3m nguy c\u01a1 kh\u00e1ng thu\u1ed1c. D\u1ef1a v\u00e0o c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m PK\/PD, c\u00e1c kh\u00e1ng sinh \u0111i\u1ec1u tr\u1ecb VPMPC\u0110 \u0111\u01b0\u1ee3c chia l\u00e0m ba nh\u00f3m: ph\u1ee5 thu\u1ed9c th\u1eddi gian, ph\u1ee5 thu\u1ed9c n\u1ed3ng \u0111\u1ed9 v\u00e0 ph\u1ee5 thu\u1ed9c v\u00e0o t\u1ed5ng l\u01b0\u1ee3ng thu\u1ed1c v\u00e0o c\u01a1 th\u1ec3 [68-70].<\/p>\n<p style=\"text-align: center;\"><strong>B\u1ea3ng 4.2. Ph\u00e2n lo\u1ea1i nh\u00f3m kh\u00e1ng sinh theo \u0111\u1eb7c \u0111i\u1ec3m PK\/PD v\u00e0 \u0111\u1ec1 xu\u1ea5t chi\u1ebfn l\u01b0\u1ee3c t\u1ed1i \u01b0u li\u1ec1u<\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%; height: 106px;\">\n<tbody>\n<tr style=\"height: 43px;\">\n<td style=\"width: 33.5066%; height: 43px; text-align: center;\"><strong>Nh\u00f3m kh\u00e1ng sinh ph\u00e2n lo\u1ea1i theo \u0111\u1eb7c \u0111i\u1ec3m PK\/PD<\/strong><\/td>\n<td style=\"width: 25.3781%; height: 43px; text-align: center;\"><strong>Th\u00f4ng s\u1ed1 PK\/PD \u0111\u1eb7c tr\u01b0ng<\/strong><\/td>\n<td style=\"width: 16.1153%; height: 43px; text-align: center;\"><strong>Nh\u00f3m kh\u00e1ng sinh ho\u1eb7c thu\u1ed1c c\u1ee5 th\u1ec3<\/strong><\/td>\n<td style=\"width: 25%; height: 43px; text-align: center;\"><strong>Chi\u1ebfn l\u01b0\u1ee3c t\u1ed1i \u01b0u h\u00f3a s\u1eed d\u1ee5ng<\/strong><\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 33.5066%; height: 21px; text-align: center;\">Ph\u1ee5 thu\u1ed9c th\u1eddi gian<\/td>\n<td style=\"width: 25.3781%; height: 21px; text-align: justify;\">T\u1ef7 l\u1ec7 % gi\u1eefa th\u1eddi gian kh\u00e1ng sinh c\u00f3 n\u1ed3ng \u0111\u1ed9 trong m\u00e1u v\u01b0\u1ee3t qu\u00e1 gi\u00e1 tr\u1ecb MIC so v\u1edbi kho\u1ea3ng th\u1eddi gian \u0111\u01b0a li\u1ec1u (%T&gt;MIC)<\/td>\n<td style=\"width: 16.1153%; height: 21px; text-align: center;\">\u03b2-lactam Linezolid<\/td>\n<td style=\"width: 25%; height: 21px; text-align: justify;\">T\u0103ng li\u1ec1u<\/p>\n<p>T\u0103ng t\u1ea7n su\u1ea5t \u0111\u01b0a thu\u1ed1c trong ng\u00e0y<\/p>\n<p>C\u00e2n nh\u1eafc truy\u1ec1n k\u00e9o d\u00e0i ho\u1eb7c truy\u1ec1n li\u00ean t\u1ee5c trong tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m khu\u1ea9n n\u1eb7ng ho\u1eb7c tr\u00ean ng\u01b0\u1eddi b\u1ec7nh n\u1eb7ng<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 33.5066%; height: 21px; text-align: center;\">Ph\u1ee5 thu\u1ed9c n\u1ed3ng \u0111\u1ed9<\/td>\n<td style=\"width: 25.3781%; height: 21px; text-align: justify;\">T\u1ef7 l\u1ec7 gi\u1eefa n\u1ed3ng \u0111\u1ed9 t\u1ed1i \u0111a c\u1ee7a thu\u1ed1c trong m\u00e1u so v\u1edbi gi\u00e1 tr\u1ecb MIC (Cmax\/MIC).<\/td>\n<td style=\"width: 16.1153%; height: 21px; text-align: center;\">Aminoglycosid<\/td>\n<td style=\"width: 25%; height: 21px; text-align: justify;\">S\u1eed d\u1ee5ng li\u1ec1u t\u1ed1i \u0111a c\u00f3 hi\u1ec7u qu\u1ea3 k\u1ebft h\u1ee3p v\u1edbi gi\u00e3n c\u00e1ch kho\u1ea3ng \u0111\u01b0a li\u1ec1u \u0111\u1ec3 gi\u1ea3m thi\u1ec3u \u0111\u1ed9c t\u00ednh<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 33.5066%; height: 21px; text-align: center;\">Ph\u1ee5 thu\u1ed9c v\u00e0o t\u1ed5ng l\u01b0\u1ee3ng thu\u1ed1c v\u00e0o c\u01a1 th\u1ec3<\/td>\n<td style=\"width: 25.3781%; height: 21px; text-align: justify;\">T\u1ef7 l\u1ec7 gi\u1eefa t\u1ed5ng l\u01b0\u1ee3ng thu\u1ed1c trong c\u01a1 th\u1ec3 (t\u00ednh b\u1eb1ng AUC) so v\u1edbi gi\u00e1 tr\u1ecb MIC (AUC\/MIC)<\/td>\n<td style=\"width: 16.1153%; height: 21px; text-align: center;\">Fluoroquinolon<\/p>\n<p>Macrolid<\/p>\n<p>Vancomycin<\/td>\n<td style=\"width: 25%; height: 21px; text-align: justify;\">T\u0103ng t\u1ed5ng li\u1ec1u trong 24 gi\u1edd<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify;\">Ch\u1ebf \u0111\u1ed9 li\u1ec1u kh\u00e1ng sinh c\u1ea7n hi\u1ec7u ch\u1ec9nh d\u1ef1a tr\u00ean ch\u1ee9c n\u0103ng th\u1eadn c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh. Vi\u1ec7c hi\u1ec7u ch\u1ec9nh li\u1ec1u \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng v\u1edbi c\u00e1c kh\u00e1ng sinh c\u00f3 kho\u1ea3ng \u0111i\u1ec1u tr\u1ecb h\u1eb9p, nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh \u0111ang s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi c\u00e1c thu\u1ed1c kh\u00e1c c\u0169ng c\u00f3 \u0111\u1ed9c t\u00ednh tr\u00ean th\u1eadn ho\u1eb7c \u0111ang c\u00f3 c\u00e1c b\u1ec7nh l\u00fd th\u1eadn ho\u1eb7c b\u1ec7nh n\u1ec1n t\u0103ng nguy c\u01a1 \u0111\u1ed9c t\u00ednh tr\u00ean th\u1eadn. Th\u00f4ng tin chi ti\u1ebft v\u1ec1 li\u1ec1u d\u00f9ng v\u00e0 hi\u1ec7u ch\u1ec9nh li\u1ec1u \u1edf ng\u01b0\u1eddi b\u1ec7nh suy th\u1eadn c\u1ee7a c\u00e1c kh\u00e1ng sinh s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb VPMPC\u0110 \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong Ph\u1ee5 l\u1ee5c 1 [71-73].<\/p>\n<h3 style=\"text-align: justify;\">4.3. L\u1ef1a ch\u1ecdn kh\u00e1ng sinh d\u1ef1a tr\u00ean kh\u1ea3 n\u0103ng x\u00e2m nh\u1eadp v\u00e0o c\u01a1 quan \u0111\u00edch<\/h3>\n<p style=\"text-align: justify;\">Kh\u1ea3 n\u0103ng x\u00e2m nh\u1eadp c\u1ee7a kh\u00e1ng sinh v\u00e0o c\u01a1 quan \u0111\u00edch c\u0169ng l\u00e0 y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn vi\u1ec7c l\u1ef1a ch\u1ecdn kh\u00e1ng sinh m\u1eb7c d\u00f9 th\u00f4ng s\u1ed1 n\u00e0y kh\u00f4ng d\u1ec5 d\u00e0ng x\u00e1c \u0111\u1ecbnh tr\u00ean ng\u01b0\u1eddi b\u1ec7nh. Kh\u1ea3 n\u0103ng n\u00e0y ph\u1ee5 thu\u1ed9c v\u00e0o \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a kh\u00e1ng sinh (v\u00ed d\u1ee5: t\u00ednh th\u00e2n lipid, k\u00edch th\u01b0\u1edbc ph\u00e2n t\u1eed thu\u1ed1c) v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a m\u00f4 \u0111\u00edch (nh\u01b0 h\u1ec7 t\u01b0\u1edbi m\u00e1u t\u1ea1i m\u00f4 \u0111\u00edch, c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 t\u00ecnh tr\u1ea1ng vi\u00eam, \u00e1p xe) [70]. Trong VPMPC\u0110, c\u01a1 quan \u0111\u00edch kh\u00e1ng sinh c\u1ea7n x\u00e2m nh\u1eadp l\u00e0 d\u1ecbch l\u00f3t bi\u1ec3u m\u00f4 ph\u1ebf nang (v\u1edbi vi khu\u1ea9n ngo\u1ea1i b\u00e0o) v\u00e0 \u0111\u1ea1i th\u1ef1c b\u00e0o ph\u1ebf nang (v\u1edbi vi khu\u1ea9n n\u1ed9i b\u00e0o). Chi ti\u1ebft t\u1ef7 l\u1ec7 n\u1ed3ng \u0111\u1ed9 kh\u00e1ng sinh trong d\u1ecbch l\u00f3t bi\u1ec3u m\u00f4 ph\u1ebf nang so v\u1edbi n\u1ed3ng \u0111\u1ed9 trong huy\u1ebft thanh \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong Ph\u1ee5 l\u1ee5c 2 [68].<\/p>\n<h3 style=\"text-align: justify;\">4.4. C\u00e2n nh\u1eafc v\u1ec1 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c khi l\u1ef1a ch\u1ecdn kh\u00e1ng sinh<\/h3>\n<p style=\"text-align: justify;\">Hai nh\u00f3m kh\u00e1ng sinh \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n ph\u1ed5 bi\u1ebfn trong \u0111i\u1ec1u tr\u1ecb VPMPC\u0110 l\u00e0 macrolid v\u00e0 FQ \u0111\u1ec1u ti\u1ec1m t\u00e0ng nguy c\u01a1 t\u01b0\u01a1ng t\u00e1c v\u1edbi nhi\u1ec1u nh\u00f3m thu\u1ed1c kh\u00e1c, th\u00f4ng qua c\u01a1 ch\u1ebf t\u01b0\u01a1ng t\u00e1c d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc (\u1ee9c ch\u1ebf h\u1ec7 enzyme CYP450 chuy\u1ec3n ho\u00e1 thu\u1ed1c) v\u00e0 d\u01b0\u1ee3c l\u1ef1c h\u1ecdc (k\u00e9o d\u00e0i kho\u1ea3ng QT tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3). Linezolid l\u00e0 m\u1ed9t ch\u1ea5t \u1ee9c ch\u1ebf y\u1ebfu monoaminoxidase (MAO) c\u0169ng c\u00f3 kh\u1ea3 n\u0103ng cao t\u01b0\u01a1ng t\u00e1c khi k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c t\u00e1c \u0111\u1ed9ng tr\u00ean h\u1ec7 serotonergic, d\u1eabn \u0111\u1ebfn nguy c\u01a1 x\u1ea3y ra h\u1ed9i ch\u1ee9ng serotonin (t\u0103ng th\u00e2n nhi\u1ec7t, t\u0103ng ph\u1ea3n x\u1ea1, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn h\u00f4n m\u00ea).<\/p>\n<p style=\"text-align: justify;\">Chi ti\u1ebft c\u00e1c t\u01b0\u01a1ng t\u00e1c thu\u1ed1c \u1edf m\u1ee9c \u0111\u1ed9 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh li\u00ean quan \u0111\u1ebfn kh\u00e1ng sinh \u0111i\u1ec1u tr\u1ecb VPMPC\u0110, k\u00e8m theo h\u1eadu qu\u1ea3 v\u00e0 c\u00e1ch x\u1eed tr\u00ed c\u1ee7a c\u00e1c c\u1eb7p t\u01b0\u01a1ng t\u00e1c n\u00e0y \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong Ph\u1ee5 l\u1ee5c 3 [73, 74].<\/p>\n<h3 style=\"text-align: justify;\">4.5. Nguy\u00ean t\u1eafc chuy\u1ec3n \u0111\u1ed5i kh\u00e1ng sinh \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch sang \u0111\u01b0\u1eddng u\u1ed1ng<\/h3>\n<p style=\"text-align: justify;\">Ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa c\u00f3 th\u1ec3 chuy\u1ec3n \u0111\u1ed5i kh\u00e1ng sinh \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch sang c\u00e1c kh\u00e1ng sinh \u0111\u01b0\u1eddng u\u1ed1ng t\u01b0\u01a1ng \u0111\u01b0\u01a1ng sau khi c\u00f3 c\u1ea3i thi\u1ec7n v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng ho\u1eb7c c\u1eaft s\u1ed1t. Chuy\u1ec3n \u0111\u1ed5i \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch (IV) sang \u0111\u01b0\u1eddng u\u1ed1ng (PO) gi\u00fap g\u1ed3m gi\u1ea3m chi ph\u00ed \u0111i\u1ec1u tr\u1ecb, gi\u1ea3m th\u1eddi gian n\u1eb1m vi\u1ec7n, gi\u1ea3m c\u00e1c tai bi\u1ebfn li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch v\u00e0 d\u1ec5 s\u1eed d\u1ee5ng h\u01a1n cho ng\u01b0\u1eddi b\u1ec7nh. C\u00e1c \u0111i\u1ec1u ki\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh cho ph\u00e9p chuy\u1ec3n \u0111\u1ed5i t\u1eeb \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch sang \u0111\u01b0\u1eddng u\u1ed1ng bao g\u1ed3m [75].<\/p>\n<ul>\n<li style=\"text-align: justify;\">Nhi\u1ec7t \u0111\u1ed9 \u2264 37,8oC<\/li>\n<li style=\"text-align: justify;\">Nh\u1ecbp tim \u2264 100 l\u1ea7n\/ph\u00fat<\/li>\n<li style=\"text-align: justify;\">Nh\u1ecbp th\u1edf \u2264 24 l\u1ea7n\/ph\u00fat<\/li>\n<li style=\"text-align: justify;\">Huy\u1ebft \u00e1p t\u00e2m thu \u2265 90 mmHg<\/li>\n<li style=\"text-align: justify;\">B\u00e3o h\u00f2a oxy m\u00e1u \u0111\u1ed9ng m\u1ea1ch (SaO2) \u2265 90% ho\u1eb7c PO2 \u2265 60 mmHg \u1edf \u0111i\u1ec1u ki\u1ec7n kh\u00ed ph\u00f2ng<\/li>\n<li style=\"text-align: justify;\">C\u00f3 kh\u1ea3 n\u0103ng \u0103n u\u1ed1ng<\/li>\n<li style=\"text-align: justify;\">S\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n b\u00ecnh th\u01b0\u1eddng<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">T\u00f9y theo \u0111\u1eb7c \u0111i\u1ec3m d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc, c\u00e1c kh\u00e1ng sinh chuy\u1ec3n \u0111\u1ed5i \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch sang \u0111\u01b0\u1eddng u\u1ed1ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chia th\u00e0nh 04 nh\u00f3m t\u01b0\u01a1ng \u1ee9ng v\u1edbi c\u00e1c nguy\u00ean t\u1eafc chuy\u1ec3n \u0111\u1ed5i ri\u00eang (B\u1ea3ng 4.3).<\/p>\n<p style=\"text-align: center;\"><strong>B\u1ea3ng 4.3. H\u01b0\u1edbng d\u1eabn chuy\u1ec3n \u0111\u1ed5i \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch\/\u0111\u01b0\u1eddng u\u1ed1ng v\u1edbi m\u1ed9t s\u1ed1 nh\u00f3m kh\u00e1ng sinh<\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\">\n<tbody>\n<tr>\n<td style=\"width: 11.5942%; text-align: center;\"><strong>Nh\u00f3m<\/strong><\/td>\n<td style=\"width: 71.8966%; text-align: center;\"><strong>\u0110\u1ecbnh ngh\u0129a<\/strong><\/td>\n<td style=\"width: 16.5091%; text-align: center;\"><strong>Kh\u00e1ng sinh<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 11.5942%; text-align: center;\">Nh\u00f3m 1<\/td>\n<td style=\"width: 71.8966%; text-align: justify;\">Kh\u00e1ng sinh c\u00f3 sinh kh\u1ea3 d\u1ee5ng \u0111\u01b0\u1eddng u\u1ed1ng cao (&gt;90%), h\u1ea5p thu t\u1ed1t v\u00e0 dung n\u1ea1p t\u1ed1t \u1edf li\u1ec1u t\u01b0\u01a1ng t\u1ef1 li\u1ec1u \u0111\u01b0\u1eddng ti\u00eam<\/td>\n<td style=\"width: 16.5091%; text-align: center;\">Co-trimoxazol<\/p>\n<p>Levofloxacin<\/p>\n<p>Linezolid<\/p>\n<p>Moxifloxacin<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 11.5942%; text-align: center;\">Nh\u00f3m 2<\/td>\n<td style=\"width: 71.8966%; text-align: justify;\">Kh\u00e1ng sinh c\u00f3 sinh kh\u1ea3 d\u1ee5ng \u0111\u01b0\u1eddng u\u1ed1ng th\u1ea5p h\u01a1n (70-80%) nh\u01b0ng c\u00f3 th\u1ec3 b\u00f9 tr\u1eeb b\u1eb1ng t\u0103ng li\u1ec1u c\u1ee7a kh\u00e1ng sinh u\u1ed1ng<\/td>\n<td style=\"width: 16.5091%; text-align: center;\">Ciprofloxacin<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 11.5942%; text-align: center;\">Nh\u00f3m 3<\/td>\n<td style=\"width: 71.8966%; text-align: justify;\">Kh\u00e1ng sinh c\u00f3 sinh kh\u1ea3 d\u1ee5ng \u0111\u01b0\u1eddng u\u1ed1ng cao (&gt;90%) nh\u01b0ng c\u00f3 li\u1ec1u t\u1ed1i \u0111a \u0111\u01b0\u1eddng u\u1ed1ng th\u1ea5p h\u01a1n so v\u1edbi li\u1ec1u \u0111\u01b0\u1eddng ti\u00eam (do dung n\u1ea1p ti\u00eau h\u00f3a k\u00e9m)<\/td>\n<td style=\"width: 16.5091%; text-align: center;\">Amoxicillin<\/p>\n<p>Cephalexin<\/p>\n<p>Clindamycin<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 11.5942%; text-align: center;\">Nh\u00f3m 4<\/td>\n<td style=\"width: 71.8966%; text-align: justify;\">Kh\u00e1ng sinh c\u00f3 sinh kh\u1ea3 d\u1ee5ng \u0111\u01b0\u1eddng u\u1ed1ng th\u1ea5p h\u01a1n v\u00e0 li\u1ec1u t\u1ed1i \u0111a th\u1ea5p h\u01a1n \u0111\u01b0\u1eddng ti\u00eam<\/td>\n<td style=\"width: 16.5091%; text-align: center;\">Cefuroxim<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify;\">\u0110\u1ed1i v\u1edbi kh\u00e1ng sinh thu\u1ed9c nh\u00f3m 1, 2: c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng u\u1ed1ng v\u1edbi c\u00e1c nhi\u1ec5m khu\u1ea9n kh\u00f4ng \u0111e d\u1ecda t\u00ednh m\u1ea1ng, ng\u01b0\u1eddi b\u1ec7nh c\u00f3 huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh v\u00e0 kh\u00f4ng c\u00f3 v\u1ea5n \u0111\u1ec1 v\u1ec1 h\u1ea5p thu, m\u1eb7t kh\u00e1c c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng trong chuy\u1ec3n ti\u1ebfp \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch\/\u0111\u01b0\u1eddng u\u1ed1ng n\u1ebfu \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u ki\u1ec7n l\u00e2m s\u00e0ng.<\/p>\n<p style=\"text-align: justify;\">\u0110\u1ed1i v\u1edbi kh\u00e1ng sinh thu\u1ed9c nh\u00f3m 3, 4, c\u00f3 th\u1ec3 chuy\u1ec3n ti\u1ebfp \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch\/\u0111\u01b0\u1eddng u\u1ed1ng theo nguy\u00ean t\u1eafc: nhi\u1ec5m khu\u1ea9n c\u01a1 b\u1ea3n \u0111\u00e3 \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft b\u1eb1ng kh\u00e1ng sinh \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch ban \u0111\u1ea7u, do \u0111\u00f3 n\u1ed3ng \u0111\u1ed9 kh\u00e1ng sinh trong huy\u1ebft thanh khi d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng d\u00f9 th\u1ea5p h\u01a1n so v\u1edbi khi d\u00f9ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 ti\u1ebfp t\u1ee5c duy tr\u00ec hi\u1ec7u qu\u1ea3 c\u1ee7a li\u1ec7u ph\u00e1p kh\u00e1ng sinh [76].<\/p>\n<p style=\"text-align: justify;\">H\u01b0\u1edbng d\u1eabn chi ti\u1ebft v\u1ec1 li\u1ec1u d\u00f9ng c\u1ee7a kh\u00e1ng sinh khi chuy\u1ec3n \u0111\u1ed5i \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch\/\u0111\u01b0\u1eddng u\u1ed1ng \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong (B\u1ea3ng 4.4).<\/p>\n<p style=\"text-align: center;\"><strong>B\u1ea3ng 4.4. H\u01b0\u1edbng d\u1eabn chuy\u1ec3n \u0111\u1ed5i \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch\/\u0111\u01b0\u1eddng u\u1ed1ng v\u1edbi m\u1ed9t s\u1ed1 kh\u00e1ng sinh<\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%; height: 751px;\">\n<tbody>\n<tr style=\"height: 21px;\">\n<td style=\"width: 50%; height: 21px;\">Kh\u00e1ng sinh t\u0129nh m\u1ea1ch<\/td>\n<td style=\"width: 50%; height: 21px;\">Kh\u00e1ng sinh \u0111\u01b0\u1eddng u\u1ed1ng<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 50%; height: 21px;\">Penicilin G 2 MIU (ho\u1eb7c 1,2 g) m\u1ed7i 6 gi\u1edd<\/td>\n<td style=\"width: 50%; height: 21px;\">Amoxicilin 1 g m\u1ed7i 8 gi\u1edd<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 50%; height: 21px;\">Amoxicilin\/acid clavulanic 1000 mg\/200 mg m\u1ed7i 8 gi\u1edd<\/td>\n<td style=\"width: 50%; height: 21px;\">Amoxicilin\/acid clavulanic 875 mg\/125 mg m\u1ed7i 8-12 gi\u1edd<\/td>\n<\/tr>\n<tr style=\"height: 86px;\">\n<td style=\"width: 50%; height: 86px;\">Ampicillin 1-2 g m\u1ed7i 6 gi\u1edd<\/p>\n<p>Ampicillin\/sulbactam (li\u1ec1u theo ampicillin)<\/td>\n<td style=\"width: 50%; height: 86px;\">Amoxicillin 1000 mg m\u1ed7i 8 gi\u1edd<\/p>\n<p>Ho\u1eb7c amoxicillin\/acid clavulanic 875 mg\/125 mg m\u1ed7i 8-12 gi\u1edd<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 50%; height: 21px;\">Cloxacillin 1 g m\u1ed7i 6 gi\u1edd<\/td>\n<td style=\"width: 50%; height: 21px;\">Cloxacillin 500 mg m\u1ed7i 6 gi\u1edd<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 50%; height: 21px;\">Cefazolin 2 g m\u1ed7i 8 gi\u1edd<\/td>\n<td style=\"width: 50%; height: 21px;\">Cefalexin 500 mg m\u1ed7i 6 gi\u1edd<\/td>\n<\/tr>\n<tr style=\"height: 143px;\">\n<td style=\"width: 50%; height: 143px;\">Cefotaxim 1-2 g m\u1ed7i 8 gi\u1edd<\/td>\n<td style=\"width: 50%; height: 143px;\">Amoxicilin 1000 mg m\u1ed7i 8 gi\u1edd<\/p>\n<p>Ho\u1eb7c amoxicillin\/acid clavulanic 875 mg\/125 mg m\u1ed7i 8-12 gi\u1edd<\/p>\n<p>Ho\u1eb7c cephalosporin th\u1ebf h\u1ec7 3 \u0111\u01b0\u1eddng u\u1ed1ng (cefpodoxim 200 mg m\u1ed7i 12 gi\u1edd ho\u1eb7c cefditoren 400 mg m\u1ed7i 12 gi\u1edd)<\/td>\n<\/tr>\n<tr style=\"height: 143px;\">\n<td style=\"width: 50%; height: 143px;\">Ceftriaxon 1-2g m\u1ed7i 24 gi\u1edd<\/td>\n<td style=\"width: 50%; height: 143px;\">Amoxicilin 1000 mg m\u1ed7i 8 gi\u1edd<\/p>\n<p>Ho\u1eb7c amoxicillin\/acid clavulanic 875 mg\/125 mg m\u1ed7i 8-12 gi\u1edd<\/p>\n<p>Ho\u1eb7c cephalosporin th\u1ebf h\u1ec7 3 \u0111\u01b0\u1eddng u\u1ed1ng (cefpodoxim 200 mg m\u1ed7i 12 gi\u1edd ho\u1eb7c cefditoren 400 mg m\u1ed7i 12 gi\u1edd)<\/td>\n<\/tr>\n<tr style=\"height: 43px;\">\n<td style=\"width: 50%; height: 43px;\">Ceftazidim ho\u1eb7c cefepim (2g m\u1ed7i 8 gi\u1edd)<\/td>\n<td style=\"width: 50%; height: 43px;\">Ciprofloxacin (750 mg m\u1ed7i 12 gi\u1edd) ho\u1eb7c levofloxacin (500 mg m\u1ed7i 12 gi\u1edd ho\u1eb7c 750mg m\u1ed7i 24 gi\u1edd)<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 50%; height: 21px;\">Azithromycin 500mg m\u1ed7i 24 gi\u1edd<\/td>\n<td style=\"width: 50%; height: 21px;\">Azithromycin 500mg m\u1ed7i 24 gi\u1edd<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 50%; height: 21px;\">Clarithromycin 500 mg m\u1ed7i 12 gi\u1edd<\/td>\n<td style=\"width: 50%; height: 21px;\">Clarithromycin 500 mg m\u1ed7i 12 gi\u1edd ho\u1eb7c 500 mg m\u1ed7i 24 gi\u1edd (d\u1ea1ng gi\u1ea3i ph\u00f3ng k\u00e9o d\u00e0i)<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 50%; height: 21px;\">Gentamicin 5 mg\/kg m\u1ed7i 24 gi\u1edd<\/td>\n<td style=\"width: 50%; height: 21px;\">Ciprofloxacin 500 mg m\u1ed7i 12 gi\u1edd (750 mg m\u1ed7i 12 gi\u1edd cho P. aeruginosa)<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 50%; height: 21px;\">Tobramycin 5 mg\/kg m\u1ed7i 24 gi\u1edd<\/td>\n<td style=\"width: 50%; height: 21px;\">Ciprofloxacin 750 mg m\u1ed7i 12 gi\u1edd (cho P. aeruginosa)<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 50%; height: 21px;\">Ciprofloxacin 400mg m\u1ed7i 12 gi\u1edd<\/td>\n<td style=\"width: 50%; height: 21px;\">Ciprofloxacin 500mg m\u1ed7i 12 gi\u1edd<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 50%; height: 21px;\">Levofloxacin 500 m\u1ed7i 12 gi\u1edd ho\u1eb7c 750mg m\u1ed7i 24 gi\u1edd<\/td>\n<td style=\"width: 50%; height: 21px;\">Levofloxacin 500 m\u1ed7i 12 gi\u1edd ho\u1eb7c 750mg m\u1ed7i 24 gi\u1edd<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 50%; height: 21px;\">Moxifloxacin 400mg m\u1ed7i 24 gi\u1edd<\/td>\n<td style=\"width: 50%; height: 21px;\">Moxifloxacin 400mg m\u1ed7i 24 gi\u1edd<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 50%; height: 21px;\">Vancomycin (li\u1ec1u theo khuy\u1ebfn c\u00e1o)<\/td>\n<td style=\"width: 50%; height: 21px;\">Linezolid 600mg m\u1ed7i 12 gi\u1edd<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 50%; height: 21px;\">Linezolid 600mg m\u1ed7i 12 gi\u1edd<\/td>\n<td style=\"width: 50%; height: 21px;\">Linezolid 600mg m\u1ed7i 12 gi\u1edd<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 50%; height: 21px;\">Clindamycin 600mg m\u1ed7i 8 gi\u1edd<\/td>\n<td style=\"width: 50%; height: 21px;\">Clindamycin 300 &#8211; 450 mg m\u1ed7i 6 gi\u1edd<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 50%; height: 21px;\">Metronidazol 500 mg m\u1ed7i 8 gi\u1edd<\/td>\n<td style=\"width: 50%; height: 21px;\">Metronidazol 500 mg m\u1ed7i 8 gi\u1edd<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 50%;\">Sulfamethoxazol\/trimethoprim 5-20 mg\/kg\/ng\u00e0y (chia li\u1ec1u m\u1ed7i 6-12 gi\u1edd) (li\u1ec1u t\u00ednh theo trimethoprim)<\/td>\n<td style=\"width: 50%;\">Sulfamethoxazol\/trimethoprim 5-20 mg\/kg\/ng\u00e0y (chia li\u1ec1u m\u1ed7i 6-12 gi\u1edd) (li\u1ec1u t\u00ednh theo trimethoprim)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify;\"><strong>Nh\u1eefng \u0111i\u1ec3m c\u1ea7n nh\u1edb:<\/strong><\/p>\n<p style=\"text-align: justify;\">&#8211; L\u1ef1a ch\u1ecdn kh\u00e1ng sinh theo kinh nghi\u1ec7m d\u1ef1a tr\u00ean t\u00e1c nh\u00e2n nghi ng\u1edd g\u00e2y b\u1ec7nh k\u1ebft h\u1ee3p v\u1edbi ph\u1ed5 kh\u00e1ng khu\u1ea9n c\u1ee7a kh\u00e1ng sinh, kh\u1ea3 n\u0103ng x\u00e2m nh\u1eadp c\u1ee7a thu\u1ed1c v\u00e0o c\u01a1 quan \u0111\u00edch (d\u1ecbch l\u00f3t bi\u1ec3u m\u00f4 ph\u1ebf nang ho\u1eb7c \u0111\u1ea1i th\u1ef1c b\u00e0o ph\u1ebf nang) v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh (nguy c\u01a1 nhi\u1ec5m vi khu\u1ea9n kh\u00e1ng thu\u1ed1c ho\u1eb7c \u0111\u1ed1i t\u01b0\u1ee3ng ng\u01b0\u1eddi b\u1ec7nh \u0111\u1eb7c bi\u1ec7t\u2026)<\/p>\n<p style=\"text-align: justify;\">&#8211; T\u1ed1i \u01b0u h\u00f3a ch\u1ebf \u0111\u1ed9 li\u1ec1u kh\u00e1ng sinh d\u1ef1a tr\u00ean \u0111\u1eb7c \u0111i\u1ec3m d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc\/d\u01b0\u1ee3c l\u1ef1c h\u1ecdc (PK\/PD). C\u00e1c kh\u00e1ng sinh \u0111\u01b0\u1ee3c chia l\u00e0m 3 nh\u00f3m: ph\u1ee5 thu\u1ed9c th\u1eddi gian (\u03b2-lactam, linezolid), ph\u1ee5 thu\u1ed9c n\u1ed3ng \u0111\u1ed3 (aminoglycosid) v\u00e0 ph\u1ee5 thu\u1ed9c t\u1ed5ng l\u01b0\u1ee3ng thu\u1ed1c v\u00e0o c\u01a1 th\u1ec3 (fluoroquinolon, macrolid, vancomycin). Ch\u1ebf \u0111\u1ed9 li\u1ec1u c\u1ea7n hi\u1ec7u ch\u1ec9nh d\u1ef1a tr\u00ean ch\u1ee9c n\u0103ng th\u1eadn c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n<p style=\"text-align: justify;\">&#8211; L\u01b0u \u00fd c\u00e1c t\u01b0\u01a1ng t\u00e1c thu\u1ed1c c\u1ee7a kh\u00e1ng sinh v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c khi d\u00f9ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 fluoroquinolon, macrolid v\u00e0 linezolid.<\/p>\n<p style=\"text-align: justify;\">&#8211; Chuy\u1ec3n \u0111\u1ed5i kh\u00e1ng sinh \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch sang \u0111\u01b0\u1eddng u\u1ed1ng khi c\u00f3 c\u1ea3i thi\u1ec7n v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng ho\u1eb7c c\u1eaft s\u1ed1t.<\/p>\n<h2 style=\"text-align: center;\">CH\u01af\u01a0NG 5. \u0110I\u1ec0U TR\u1eca VI\u00caM PH\u1ed4I M\u1eaeC PH\u1ea2I C\u1ed8NG \u0110\u1ed2NG<\/h2>\n<h3 style=\"text-align: justify;\">5.1. M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb<\/h3>\n<p style=\"text-align: justify;\">\u0110\u1ea1t hi\u1ec7u qu\u1ea3 l\u00e2m s\u00e0ng t\u1ed1i \u01b0u:<\/p>\n<p style=\"text-align: justify;\">&#8211; Kh\u1ecfi b\u1ec7nh, tr\u00e1nh bi\u1ebfn ch\u1ee9ng, gi\u1ea3m t\u1ef7 l\u1ec7 nh\u1eadp vi\u1ec7n v\u00e0 th\u1eddi gian n\u1eb1m vi\u1ec7n<\/p>\n<p style=\"text-align: justify;\">&#8211; Gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong<\/p>\n<p style=\"text-align: justify;\">&#8211; Tr\u00e1nh kh\u00e1ng thu\u1ed1c<\/p>\n<p style=\"text-align: justify;\">&#8211; C\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng<\/p>\n<p style=\"text-align: justify;\">Nhi\u1ec1u h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb VPMPC\u0110 tr\u00ean th\u1ebf gi\u1edbi ph\u00e2n t\u1ea7ng ng\u01b0\u1eddi b\u1ec7nh d\u1ef1a v\u00e0o y\u1ebfu t\u1ed1 nguy c\u01a1 m\u1eafc vi khu\u1ea9n kh\u00e1ng thu\u1ed1c, b\u1ec7nh \u0111\u1ed3ng m\u1eafc, kh\u1ea3 n\u0103ng vi khu\u1ea9n g\u00e2y b\u1ec7nh v\u00e0 m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh [65].<\/p>\n<h3 style=\"text-align: justify;\">5.2. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh<\/h3>\n<p style=\"text-align: justify;\">Tu\u00e2n th\u1ee7 c\u00e1c nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh gi\u00fap t\u1ed1i \u01b0u h\u00f3a hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb v\u00e0 gi\u1ea3m thi\u1ec3u nguy c\u01a1 bi\u1ebfn ch\u1ee9ng [65, 77]:<\/p>\n<p style=\"text-align: justify;\">&#8211; C\u1ea7n \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh s\u1edbm trong 4 gi\u1edd \u0111\u1ea7u nh\u1eadp vi\u1ec7n d\u1ef1a theo kinh nghi\u1ec7m, khi c\u00f3 k\u1ebft qu\u1ea3 nu\u00f4i c\u1ea5y v\u00e0 kh\u00e1ng sinh \u0111\u1ed3 c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh theo kh\u00e1ng sinh \u0111\u1ed3 v\u00e0 \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh. Tr\u00e1nh d\u00f9ng kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng n\u1ebfu kh\u00f4ng c\u1ea7n thi\u1ebft.<\/p>\n<p style=\"text-align: justify;\">&#8211; S\u1eed d\u1ee5ng kh\u00e1ng sinh theo d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc v\u00e0 d\u01b0\u1ee3c l\u1ef1c h\u1ecdc, hi\u1ec7u ch\u1ec9nh li\u1ec1u theo m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn.<\/p>\n<p style=\"text-align: justify;\">&#8211; L\u1ea5y b\u1ec7nh ph\u1ea9m (nhu\u1ed9m Gram v\u00e0 c\u1ea5y \u0111\u1eddm, c\u1ea5y m\u00e1u) tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh \u1edf ng\u01b0\u1eddi b\u1ec7nh nh\u1eadp vi\u1ec7n.<\/p>\n<p style=\"text-align: justify;\">&#8211; N\u00ean ch\u1ecdn thu\u1ed1c di\u1ec7t khu\u1ea9n, \u0111\u1eb7c bi\u1ec7t \u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi b\u1ec7nh c\u00f3 b\u1ec7nh l\u00fd \u0111\u1ed3ng m\u1eafc n\u1eb7ng v\u00e0\/ho\u1eb7c suy gi\u1ea3m mi\u1ec5n d\u1ecbch [78].<\/p>\n<p style=\"text-align: justify;\">&#8211; Ng\u01b0\u1eddi b\u1ec7nh nh\u1eadp vi\u1ec7n n\u00ean b\u1eaft \u0111\u1ea7u v\u1edbi kh\u00e1ng sinh \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch, \u0111\u1ee7 li\u1ec1u. Sau v\u00e0i ng\u00e0y c\u00f3 th\u1ec3 chuy\u1ec3n sang u\u1ed1ng n\u1ebfu c\u00f3 \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng.<\/p>\n<p style=\"text-align: justify;\">&#8211; Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb t\u00f9y theo b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng v\u00e0 X-quang ng\u1ef1c, th\u01b0\u1eddng 3-5 ng\u00e0y sau khi h\u1ebft s\u1ed1t \u0111\u1ed1i v\u1edbi S. pneumoniae. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh trung b\u00ecnh t\u1eeb 7 \u2013 10 ng\u00e0y \u0111\u1ed1i v\u1edbi VPMPC\u0110 kh\u00f4ng bi\u1ebfn ch\u1ee9ng. N\u1ebfu do Legionella, Chlamydia th\u1eddi gian t\u1ed1i thi\u1ec3u 2-3 tu\u1ea7n. Ng\u01b0\u1eddi b\u1ec7nh s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch v\u00e0 \u0111i\u1ec1u tr\u1ecb l\u00e2u d\u00e0i corticoid: &gt; 14 ng\u00e0y.<\/p>\n<p style=\"text-align: justify;\">&#8211; \u0110\u00e1nh gi\u00e1 \u0111i\u1ec1u tr\u1ecb sau 48-72 gi\u1edd, n\u1ebfu t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng kh\u00f4ng c\u1ea3i thi\u1ec7n ho\u1eb7c x\u1ea5u h\u01a1n c\u1ea7n thay \u0111\u1ed5i ph\u00e1c \u0111\u1ed3.<\/p>\n<p style=\"text-align: justify;\">&#8211; Chuy\u1ec3n sang \u0111\u01b0\u1eddng u\u1ed1ng khi ng\u01b0\u1eddi b\u1ec7nh c\u1ea3i thi\u1ec7n ho, kh\u00f3 th\u1edf, h\u1ebft s\u1ed1t 2 l\u1ea7n c\u00e1ch 8 gi\u1edd v\u00e0 ng\u01b0\u1eddi b\u1ec7nh u\u1ed1ng \u0111\u01b0\u1ee3c.<\/p>\n<p style=\"text-align: justify;\">&#8211; Xu\u1ea5t vi\u1ec7n: khi \u1ed5n \u0111\u1ecbnh l\u00e2m s\u00e0ng v\u00e0 chuy\u1ec3n sang kh\u00e1ng sinh u\u1ed1ng cho \u0111\u1ee7 li\u1ec7u tr\u00ecnh.<\/p>\n<h3 style=\"text-align: justify;\">5.3. \u0110i\u1ec1u tr\u1ecb ban \u0111\u1ea7u theo kinh nghi\u1ec7m<\/h3>\n<p style=\"text-align: justify;\">Khi l\u1ef1a ch\u1ecdn kh\u00e1ng sinh theo kinh nghi\u1ec7m, n\u00ean c\u00e2n nh\u1eafc ph\u1ed5 vi khu\u1ea9n v\u00e0 m\u1ee9c \u0111\u1ed9 kh\u00e1ng thu\u1ed1c theo d\u1ecbch t\u1ec5 t\u1ea1i b\u1ec7nh vi\u1ec7n v\u00e0 khu v\u1ef1c, d\u1ef1a tr\u00ean kh\u00e1ng sinh \u0111\u1ed3 hi\u1ec7n c\u00f3, \u0111\u1ec3 t\u0103ng hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u v\u00e0 h\u1ea1n ch\u1ebf kh\u00e1ng thu\u1ed1c.<\/p>\n<p style=\"text-align: justify;\">\u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh ban \u0111\u1ea7u theo kinh nghi\u1ec7m n\u00ean h\u01b0\u1edbng \u0111\u1ebfn nh\u1eefng t\u00e1c nh\u00e2n th\u01b0\u1eddng g\u1eb7p ngo\u00e0i c\u1ed9ng \u0111\u1ed3ng nh\u01b0 S. pneumoniae, H. influenzae v\u00e0 M. catarrhalis.<\/p>\n<p style=\"text-align: justify;\">Kh\u00e1ng sinh c\u00f3 hi\u1ec7u qu\u1ea3 l\u00e0 betalactam\/\u1ee9c ch\u1ebf beta-lactamase +\/- macrolid hay quinolone h\u00f4 h\u1ea5p (levofloxacin, moxifloxacin) [65, 77].<\/p>\n<p style=\"text-align: justify;\">Tr\u01b0\u1edbc khi l\u1ef1a ch\u1ecdn ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb c\u1ea7n \u0111\u00e1nh gi\u00e1 v\u00e0 ph\u00e2n lo\u1ea1i ng\u01b0\u1eddi b\u1ec7nh theo c\u00e1c m\u1ee9c \u0111\u1ed9 n\u1eb7ng v\u00e0 nh\u00f3m nguy c\u01a1. (Xem chi ti\u1ebft trong Ch\u01b0\u01a1ng 3: Ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i c\u1ed9ng \u0111\u1ed3ng).<\/p>\n<h4 style=\"text-align: justify;\">5.3.1. Ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 m\u1ee9c \u0111\u1ed9 nh\u1eb9, \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa<\/h4>\n<p style=\"text-align: justify;\">Nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p: S. pneumoniae, M. pneumoniae, C. pneumoniae (m\u1ed9t m\u00ecnh hay nhi\u1ec5m tr\u00f9ng k\u1ebft h\u1ee3p), H. influenzae, virus h\u00f4 h\u1ea5p [65, 77, 79].<\/p>\n<ul>\n<li style=\"text-align: justify;\">Ng\u01b0\u1eddi b\u1ec7nh &lt; 65 tu\u1ed5i, kh\u00f4ng c\u00f3 b\u1ec7nh \u0111i k\u00e8m, kh\u00f4ng d\u00f9ng kh\u00e1ng sinh trong 3 th\u00e1ng tr\u01b0\u1edbc hay kh\u00f4ng c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 m\u1eafc m\u1ea7m b\u1ec7nh kh\u00e1ng kh\u00e1ng sinh: ampicillin hay amoxicillin h\u01b0\u1edbng \u0111\u1ebfn S. pneumoniae ho\u1eb7c macrolid th\u1ebf h\u1ec7 m\u1edbi (clarithromycin, azithromycin) khi ch\u01b0a lo\u1ea1i tr\u1eeb M. pneumoniae. Tuy nhi\u00ean, kh\u00f4ng khuy\u1ebfn c\u00e1o macrolid \u0111\u01a1n tr\u1ecb th\u01b0\u1eddng quy t\u1ea1i khu v\u1ef1c c\u00f3 t\u1ef7 l\u1ec7 S. pneumoniae kh\u00e1ng macrolid cao ho\u1eb7c khi kh\u00f4ng c\u00f3 d\u1eef li\u1ec7u kh\u00e1ng thu\u1ed1c \u0111\u1ecba ph\u01b0\u01a1ng. C\u00f3 th\u1ec3 d\u00f9ng: Amoxicillin 1g x 3 l\u1ea7n\/ng\u00e0y ho\u1eb7c doxycyclin 100mg x 2 l\u1ea7n\/ng\u00e0y ho\u1eb7c macrolid: azithromycin (u\u1ed1ng) 500mg ng\u00e0y \u0111\u1ea7u, sau \u0111\u00f3 250mg \u1edf nh\u1eefng ng\u00e0y ti\u1ebfp theo (ho\u1eb7c 500 mg\/ng\u00e0y trong 3 ng\u00e0y) ho\u1eb7c clarithromycin (u\u1ed1ng) 500mg 2 l\u1ea7n\/ng\u00e0y ho\u1eb7c clarithromycin ph\u00f3ng th\u00edch ch\u1eadm 1g 1 l\u1ea7n\/ng\u00e0y. N\u1ebfu nhi\u1ec1u kh\u1ea3 n\u0103ng H. influenzae n\u00ean d\u00f9ng beta lactam + \u1ee9c ch\u1ebf beta-lactamase \u0111\u01b0\u1eddng u\u1ed1ng (amoxicillin\/acid clavulanic) v\u00ec g\u1ea7n 50% H. influenzae ti\u1ebft beta-lactamase t\u1ea1i Vi\u1ec7t Nam. Nh\u00f3m ng\u01b0\u1eddi b\u1ec7nh n\u00e0y h\u1ea1n ch\u1ebf d\u00f9ng quinolon h\u00f4 h\u1ea5p ngo\u1ea1i tr\u1eeb ng\u01b0\u1eddi b\u1ec7nh d\u1ecb \u1ee9ng v\u1edbi beta lactam hay macrolid.<\/li>\n<li style=\"text-align: justify;\">Ng\u01b0\u1eddi b\u1ec7nh &gt; 65 tu\u1ed5i, c\u00f3 b\u1ec7nh \u0111\u1ed3ng m\u1eafc (b\u1ec7nh tim, ph\u1ed5i, b\u1ec7nh gan, b\u1ec7nh th\u1eadn m\u1ea1n t\u00ednh, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, nghi\u1ec7n r\u01b0\u1ee3u, ung th\u01b0), suy gi\u1ea3m mi\u1ec5n d\u1ecbch, \u0111\u00e3 d\u00f9ng kh\u00e1ng sinh 3 th\u00e1ng tr\u01b0\u1edbc ho\u1eb7c nguy c\u01a1 S. pneumoniae kh\u00e1ng thu\u1ed1c ho\u1eb7c trong v\u00f9ng d\u1ecbch t\u1ec5 S. pneumoniae kh\u00e1ng macrolid cao (MIC \u2265 16\u00b5g\/mL) [78].<br \/>\nNh\u1eefng nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p trong nh\u00f3m ng\u01b0\u1eddi b\u1ec7nh n\u00e0y ngo\u00e0i nh\u1eefng vi khu\u1ea9n th\u00f4ng th\u01b0\u1eddng nh\u01b0 tr\u00ean, c\u1ea7n l\u01b0u \u00fd \u0111\u1ebfn PRSP, H. influenzae v\u00e0 M. catarrhalis (th\u01b0\u1eddng sinh men beta-lactamase), S. aureus, vi khu\u1ea9n gram \u00e2m \u0111\u01b0\u1eddng ru\u1ed9t, vi khu\u1ea9n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh, virus h\u00f4 h\u1ea5p.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Kh\u00e1ng sinh ch\u1ecdn l\u1ef1a g\u1ed3m [55, 65, 77]:<\/p>\n<p style=\"text-align: justify;\">&#8211; Ph\u1ed1i h\u1ee3p beta lactam\/\u1ee9c ch\u1ebf beta-lactamase (amoxicillin\/acid clavulanic) ho\u1eb7c cephalosporin ph\u1ed5 r\u1ed9ng (cefpodoxim, cefdinir, cefditoren) + macrolid th\u1ebf h\u1ec7 m\u1edbi\/doxycyclin; ho\u1eb7c<\/p>\n<p style=\"text-align: justify;\">&#8211; Quinolone h\u00f4 h\u1ea5p (levofloxacin, moxifloxacin) \u0111\u01a1n tr\u1ecb li\u1ec7u.<\/p>\n<p style=\"text-align: justify;\">B\u1ed5 sung thu\u1ed1c kh\u00e1ng virus, nh\u01b0 oseltamivir cho ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 c\u00f3 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m d\u01b0\u01a1ng t\u00ednh v\u1edbi c\u00fam, kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o th\u1eddi gian b\u1ec7nh tr\u01b0\u1edbc khi ch\u1ea9n \u0111o\u00e1n. Nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh n\u00e0y n\u1ebfu to\u00e0n tr\u1ea1ng suy ki\u1ec7t, X quang ng\u1ef1c c\u00f3 nh\u1eefng t\u1ed5n th\u01b0\u01a1ng n\u1eb7ng (th\u00e2m nhi\u1ec5m &gt; 1 thu\u1ef3, t\u1ed5n th\u01b0\u01a1ng ho\u1ea1i t\u1eed, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, t\u1ed5n th\u01b0\u01a1ng ti\u1ebfn tri\u1ec3n trong 48-72 gi\u1edd) th\u00ec n\u00ean cho ng\u01b0\u1eddi b\u1ec7nh nh\u1eadp vi\u1ec7n \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa v\u1edbi kh\u00e1ng sinh \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, m\u1eb7c d\u00f9 thang \u0111i\u1ec3m PSI hay CURB-65 ch\u01b0a \u0111\u1ee7 ti\u00eau chu\u1ea9n nh\u1eadp vi\u1ec7n.<\/p>\n<h4 style=\"text-align: justify;\">5.3.2. Ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 nh\u1eadp vi\u1ec7n<\/h4>\n<p style=\"text-align: justify;\">Nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh n\u1eb7ng c\u1ea7n l\u00e0m ngay x\u00e9t nghi\u1ec7m \u0111\u1eddm (nhu\u1ed9m gram, c\u1ea5y) tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh. C\u1ea7n l\u00e0m th\u00eam x\u00e9t nghi\u1ec7m nhanh nh\u01b0 multiplex PCR \u0111\u1ec3 ph\u00e1t hi\u1ec7n vi khu\u1ea9n, n\u1ea5m, virus nh\u1eb1m h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh.<br \/>\nNg\u01b0\u1eddi b\u1ec7nh n\u1eb7ng c\u1ea7n l\u00e0m PCT (khi nh\u1eadp vi\u1ec7n, sau 48-72 gi\u1edd v\u00e0 sau 5-7 ng\u00e0y) \u0111\u1ec3 gi\u00fap gi\u1ea3m th\u1eddi gian \u0111i\u1ec1u tr\u1ecb v\u00e0 xu\u1ed1ng thang kh\u00e1ng sinh. CRP thay th\u1ebf PCT \u1edf nh\u1eefng n\u01a1i kh\u00f4ng c\u00f3 x\u00e9t nghi\u1ec7m n\u00e0y.<\/p>\n<p style=\"text-align: justify;\">Ng\u01b0\u1eddi b\u1ec7nh gi\u1ea3m oxy m\u00e1u c\u1ea7n th\u1edf HFNC hay NIV n\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n thay v\u00ec oxy ti\u00eau chu\u1ea9n nh\u1eb1m tr\u00e1nh \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n v\u00e0 gi\u1ea3m t\u1eed vong.<\/p>\n<p style=\"text-align: justify;\">Kh\u00e1ng virus k\u1ebft h\u1ee3p (oseltamivir) n\u1ebfu test nhanh (+).<\/p>\n<p style=\"text-align: justify;\">Nh\u00f3m ng\u01b0\u1eddi b\u1ec7nh nh\u1eadp vi\u1ec7n \u0111\u01b0\u1ee3c chia l\u00e0m 2 nh\u00f3m, n\u1eb1m t\u1ea1i khoa n\u1ed9i\/h\u00f4 h\u1ea5p\/truy\u1ec1n nhi\u1ec5m v\u00e0 ICU.<\/p>\n<h5 style=\"text-align: justify;\">5.3.2.1. Nh\u00f3m ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 trung b\u00ecnh &#8211; n\u1eb7ng n\u1eb1m t\u1ea1i khoa n\u1ed9i\/khoa h\u00f4 h\u1ea5p\/truy\u1ec1n nhi\u1ec5m<\/h5>\n<p style=\"text-align: justify;\">Nh\u1eefng t\u00e1c nh\u00e2n th\u01b0\u1eddng g\u1eb7p: S. pneumoniae (PRSP), H. influenzae, M. pneumoniae, C. pneumoniae, nhi\u1ec5m tr\u00f9ng k\u1ebft h\u1ee3p, Gram \u00e2m \u0111\u01b0\u1eddng ru\u1ed9t, vi khu\u1ea9n y\u1ebfm kh\u00ed do h\u00edt, virus, Legionella. \u0110i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p beta lactam +\/- \u1ee9c ch\u1ebf beta-lactamase (amoxicillin\/acid clavulanic; ampicillin, amoxicillin\/sulbactam), kh\u00e1ng sinh cephalosporin (cefotaxim, ceftriaxon, ceftarolin n\u1ebfu nghi ng\u1edd PRSP ho\u1eb7c MRSA) \u00b1 macrolid (azithromycin, clarithromycin) ho\u1eb7c quinolon h\u00f4 h\u1ea5p \u0111\u01a1n tr\u1ecb (levofloxacin, moxifloxacin). C\u1ea7n x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n lao cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd.<\/p>\n<p style=\"text-align: justify;\">Tr\u01b0\u1eddng h\u1ee3p ng\u01b0\u1eddi b\u1ec7nh n\u1eb7ng, quinolone h\u00f4 h\u1ea5p kh\u00f4ng d\u00f9ng \u0111\u01a1n tr\u1ecb m\u00e0 k\u1ebft h\u1ee3p betalactam nh\u01b0 tr\u00ean.<\/p>\n<p style=\"text-align: justify;\">N\u00ean l\u01b0u \u00fd t\u00e1c nh\u00e2n vi khu\u1ea9n gram \u00e2m \u0111\u01b0\u1eddng ru\u1ed9t, P. aeruginosa n\u1ebfu c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 nhi\u1ec5m t\u00e1c nh\u00e2n n\u00e0y v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u00ean bao ph\u1ee7 lu\u00f4n t\u00e1c nh\u00e2n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh. N\u00ean d\u00f9ng kh\u00e1ng sinh \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch beta lactam\/\u1ee9c ch\u1ebf beta-lactamase piperacillin\/tazobactam, ceftazidim, cefepim k\u1ebft h\u1ee3p macrolid hay quinolon.<\/p>\n<h5 style=\"text-align: justify;\">5.3.2.2. Nh\u00f3m ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 n\u1eb7ng nh\u1eadp ICU, nguy c\u01a1 vi khu\u1ea9n \u0111a kh\u00e1ng<\/h5>\n<p style=\"text-align: justify;\">Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p r\u1ea5t n\u1eb7ng, c\u1ea7n n\u1eb1m \u1edf trung t\u00e2m h\u00f4 h\u1ea5p, c\u00e1c khoa h\u00f4 h\u1ea5p c\u00f3 ngu\u1ed3n l\u1ef1c v\u1ec1 c\u1ea5p c\u1ee9u, ICU, ng\u01b0\u1eddi b\u1ec7nh c\u00f3 nguy c\u01a1 t\u1eed vong cao nh\u01b0 c\u00f3 suy h\u00f4 h\u1ea5p c\u1ea7n th\u1edf m\u00e1y hay s\u1ed1c nhi\u1ec5m khu\u1ea9n.<\/p>\n<p style=\"text-align: justify;\">S\u1eed d\u1ee5ng th\u00eam corticoid khi c\u00f3 d\u1ea5u hi\u1ec7u vi\u00eam ph\u1ed5i n\u1eb7ng (khuy\u1ebfn c\u00e1o n\u00ean s\u1eed d\u1ee5ng s\u1edbm trong 24h \u0111\u1ea7u khi kh\u1edfi ph\u00e1t c\u00e1c d\u1ea5u hi\u1ec7u n\u1eb7ng) ho\u1eb7c khi c\u00f3 s\u1ed1c, n\u00ean x\u00e9t nghi\u1ec7m c\u00fam v\u00e0 Covid tr\u01b0\u1edbc khi quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb. Li\u1ec1u kh\u1edfi \u0111\u1ea7u: hydrocortisone hemisucccinate 200mg\/ng\u00e0y ho\u1eb7c methylprednisolone 0.5mg\/kg m\u1ed7i 12 gi\u1edd, \u0111\u00e1nh gi\u00e1 sau 4 ng\u00e0y \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh gi\u1ea3m li\u1ec1u v\u1edbi t\u1ed5ng th\u1eddi gian \u0111i\u1ec1u tr\u1ecb t\u1eeb 8-14 ng\u00e0y [96].<\/p>\n<p style=\"text-align: justify;\">Vi khu\u1ea9n g\u00e2y b\u1ec7nh c\u1ea7n h\u1ebft s\u1ee9c l\u01b0u \u00fd nguy c\u01a1 nhi\u1ec5m S. aureus v\u00e0 P. aeruginosa.<\/p>\n<p style=\"text-align: justify;\">Kh\u00e1ng sinh c\u1ea7n s\u1eed d\u1ee5ng l\u00e0 carbapenem th\u1ebf h\u1ec7 1 (kh\u00f4ng bao ph\u1ee7 Pseudomonas) hay th\u1ebf h\u1ec7 2 k\u1ebft h\u1ee3p fluoroquinolon hay macrolid +\/- thu\u1ed1c bao ph\u1ee7 S. aureus n\u1ebfu ch\u01b0a lo\u1ea1i tr\u1eeb (vancomycin, teicoplanin, linezolid). \u01afu ti\u00ean k\u1ebft h\u1ee3p beta lactam ph\u1ed5 r\u1ed9ng (cephalosporin th\u1ebf h\u1ec7 3, 4, 5 nh\u01b0 ceftriaxon, ceftazidim, cefepim, ceftarolin) v\u1edbi macrolid.<\/p>\n<p style=\"text-align: justify;\">Khi nghi ng\u1edd P. aeruginosa, n\u00ean ph\u1ed1i h\u1ee3p beta lactam +\/- \u1ee9c ch\u1ebf beta-lactamase ch\u1ed1ng Pseudomonas k\u1ebft h\u1ee3p quinolon ch\u1ed1ng Pseudomonas hay aminoglycosid (B\u1ea3ng 5.1) [1,7].<\/p>\n<p style=\"text-align: center;\"><strong>B\u1ea3ng 5.1. Nh\u1eefng \u0111i\u1ec3m c\u1ea7n nh\u1edb \u0111i\u1ec1u tr\u1ecb VPMPC\u0110<\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\">\n<tbody>\n<tr>\n<td style=\"width: 100%;\"><strong>Ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 m\u1ee9c \u0111\u1ed9 nh\u1eb9 ngo\u1ea1i tr\u00fa:<\/strong><\/p>\n<p>&#8211; Amoxicillin \u0111\u01a1n thu\u1ea7n hay k\u1ebft h\u1ee3p v\u1edbi \u1ee9c ch\u1ebf beta-lactamase (n\u1ebfu nghi ng\u1edd H. influenzae, M. catarrhalis): amoxicillin\/acid clavulanic. N\u1ebfu nhi\u1ec1u kh\u1ea3 n\u0103ng VK kh\u00f4ng \u0111i\u1ec3n h\u00ecnh th\u00ec ch\u1ecdn azithromycin hay clarithromycin.<\/p>\n<p>&#8211; Quinolone h\u00f4 h\u1ea5p (levofloxacin, moxifloxacin) n\u1ebfu d\u1ecb \u1ee9ng v\u1edbi betalactam.<\/p>\n<p>&#8211; N\u1ebfu nghi ng\u1edd S. pneumoniae kh\u00e1ng thu\u1ed1c: amoxicillin li\u1ec1u cao ho\u1eb7c quinolon h\u00f4 h\u1ea5p.<\/p>\n<p>&#8211; BN l\u1edbn tu\u1ed5i c\u00f3 b\u1ec7nh \u0111\u1ed3ng m\u1eafc, suy gi\u1ea3m mi\u1ec5n d\u1ecbch: k\u1ebft h\u1ee3p betalactam\/\u1ee9c ch\u1ebf beta-lactamase ho\u1eb7c cephalosporin ph\u1ed5 r\u1ed9ng (cefpodoxim, cefdinir, cefditoren&#8230;) v\u00e0 macrolid; ho\u1eb7c quinolon h\u00f4 h\u1ea5p \u0111\u01a1n tr\u1ecb.<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 100%;\"><strong>Ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 trung b\u00ecnh, n\u1eb7ng n\u1ed9i tr\u00fa, kh\u00f4ng n\u1eb1m ICU<\/strong><\/p>\n<p>&#8211; Beta lactam +\/- \u1ee9c ch\u1ebf beta-lactamase (amoxicillin\/acid clavulanic; ampicillin, amoxicillin\/sulbactam), kh\u00e1ng sinh cephalosporin (cefotaxim, ceftriaxon, ceftarolin), ertapenem + macrolid\/quinolon truy\u1ec1n t\u0129nh m\u1ea1ch (TTM). L\u01b0u \u00fd \u01b0u ti\u00ean truy\u1ec1n kh\u00e1ng sinh t\u0129nh m\u1ea1ch, tr\u00e1nh kh\u00f4ng ti\u00eam kh\u00e1ng sinh t\u0129nh m\u1ea1ch \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 tai bi\u1ebfn khi ti\u00eam truy\u1ec1n. Nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh c\u00f3 nguy c\u01a1 nhi\u1ec5m P. aeruginosa c\u1ea7n ch\u1ecdn nh\u1eefng beta lactam ch\u1ed1ng Pseudomonas.<\/p>\n<p>&#8211; Quinolone h\u00f4 h\u1ea5p (moxifloxacin, levofloxacin) +\/- beta lactam nh\u01b0 tr\u00ean.<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 100%;\"><strong>Ng\u01b0\u1eddi b\u1ec7nh VPMPC\u0110 m\u1ee9c \u0111\u1ed9 n\u1eb7ng, n\u1eb1m ICU<\/strong><\/p>\n<p>Beta Lactam ph\u1ed5 r\u1ed9ng +\/- \u1ee9c ch\u1ebf beta-lactamase, ertapenem, ceftazidim, ceftriaxon, cefepim, ceftarolin \u2026 k\u1ebft h\u1ee3p macrolid hay quinolone TTM.<\/p>\n<p><strong><em>N\u1ebfu c\u00f3 nguy c\u01a1 nhi\u1ec5m Pseudomonas:<\/em><\/strong><\/p>\n<p>&#8211; M\u1ed9t beta lactam ch\u1ed1ng Pseudomonas [piperacillin\/tazobactam, ceftazidim, cefepim, imipenem, meropenem, doripenem] + ciprofloxacin ho\u1eb7c levofloxacin.<\/p>\n<p>&#8211; Betalactam k\u1ec3 tr\u00ean + 1 kh\u00e1ng sinh aminoglycosid v\u00e0 azithromycin\/clarithromycin.<\/p>\n<p><em><strong>N\u1ebfu c\u00f3 nguy c\u01a1 nhi\u1ec5m S. aureus kh\u00e1ng methicillin c\u1ed9ng \u0111\u1ed3ng (CA-MRSA):<\/strong><\/em><\/p>\n<p>&#8211; Th\u00eam vancomycin, teicoplanin hay linezolid<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3 style=\"text-align: justify;\">5.4. \u0110i\u1ec1u tr\u1ecb khi c\u00f3 k\u1ebft qu\u1ea3 vi sinh<\/h3>\n<h4 style=\"text-align: justify;\">5.4.1. Vi khu\u1ea9n c\u00f3 k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3<\/h4>\n<p style=\"text-align: justify;\">D\u1ef1a v\u00e0o kh\u00e1ng sinh \u0111\u1ed3. N\u1ebfu ng\u01b0\u1eddi b\u1ec7nh c\u00f3 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb t\u1ed1t th\u00ec kh\u00f4ng c\u1ea7n thay \u0111\u1ed5i kh\u00e1ng sinh \u0111ang s\u1eed d\u1ee5ng m\u1eb7c d\u00f9 kh\u00e1ng sinh \u0111\u1ed3 cho k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111ang d\u00f9ng b\u1ecb \u0111\u1ec1 kh\u00e1ng. D\u1ef1a v\u00e0o kh\u00e1ng sinh \u0111\u1ed3 c\u00f3 th\u1ec3 xu\u1ed1ng thang kh\u00e1ng sinh n\u1ebfu c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c.<\/p>\n<h5 style=\"text-align: justify;\">5.4.1.1. Streptococcus pneumoniae<\/h5>\n<p style=\"text-align: justify;\">&#8211; \u0110i\u1ec1u tr\u1ecb cho \u0111\u1ebfn khi ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng c\u00f2n s\u1ed1t 3-5 ng\u00e0y (t\u1ed1i thi\u1ec3u 5 ng\u00e0y).<\/p>\n<p style=\"text-align: justify;\">&#8211; Do c\u00f3 s\u1ef1 gia t\u0103ng t\u1ef7 l\u1ec7 \u0111\u1ec1 kh\u00e1ng n\u00ean kh\u00e1ng sinh macrolid c\u1ea7n \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m kh\u00e1ng sinh \u0111\u1ed3 tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng \u0111i\u1ec1u tr\u1ecb.<\/p>\n<table style=\"border-collapse: collapse; width: 100%; height: 207px;\">\n<tbody>\n<tr style=\"height: 50px;\">\n<td style=\"width: 28.891%; height: 50px; text-align: center;\"><strong>\u0110\u1eb7c \u0111i\u1ec3m nh\u1ea1y c\u1ea3m kh\u00e1ng sinh<\/strong><\/td>\n<td style=\"width: 35.7908%; height: 50px; text-align: center;\"><strong>L\u1ef1a ch\u1ecdn \u0111\u1ea7u tay<\/strong><\/td>\n<td style=\"width: 35.3181%; height: 50px; text-align: center;\"><strong>L\u1ef1a ch\u1ecdn kh\u00e1c<\/strong><\/td>\n<\/tr>\n<tr style=\"height: 50px;\">\n<td style=\"width: 28.891%; height: 50px;\">Nh\u1ea1y c\u1ea3m Penicillin (MIC \u2264 2\u00b5g\/ml)<\/td>\n<td style=\"width: 35.7908%; height: 50px; text-align: justify;\">C\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn kh\u00e1ng sinh t\u0129nh m\u1ea1ch ho\u1eb7c u\u1ed1ng<\/p>\n<ul>\n<li>Kh\u00e1ng sinh t\u0129nh m\u1ea1ch<\/li>\n<\/ul>\n<p>Penicillin G 2MIU truy\u1ec1n t\u0129nh m\u1ea1ch (TTM) m\u1ed7i 4h<\/p>\n<p>Ho\u1eb7c ceftriaxon 1-2g TTM m\u1ed7i 24h Ho\u1eb7c cefotaxim 2g TTM m\u1ed7i 8h<\/p>\n<ul>\n<li>Kh\u00e1ng sinh u\u1ed1ng<\/li>\n<\/ul>\n<p>Amoxicillin 1g u\u1ed1ng 3 l\u1ea7n\/ng\u00e0y<\/p>\n<p>Ho\u1eb7c doxycyclin 100mg u\u1ed1ng 2 l\u1ea7n\/ng\u00e0y.<\/td>\n<td style=\"width: 35.3181%; height: 157px; text-align: justify;\" rowspan=\"2\">N\u1ebfu d\u1ecb \u1ee9ng Beta-lactam Moxifloxacin 400mg U\/TTM m\u1ed7i 24h Ho\u1eb7c levofloxacin 750mg U\/TTM m\u1ed7i 24h.<\/p>\n<p>Ho\u1eb7c linezolid 600mg u\u1ed1ng\/TTM m\u1ed7i 12h<\/p>\n<p>Ho\u1eb7c clindamycin 600mg TTM m\u1ed7i 8h.<\/td>\n<\/tr>\n<tr style=\"height: 107px;\">\n<td style=\"width: 28.891%; height: 107px;\">Trung gian ho\u1eb7c \u0111\u1ec1 kh\u00e1ng v\u1edbi Penicillin (MIC &gt; 4\u00b5g\/ml)<\/td>\n<td style=\"width: 35.7908%; height: 107px; text-align: justify;\">Vancomycin 15-20mg\/kg TTM 8-12h (\u0111\u1eb7c bi\u1ec7t l\u00e0 trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p MIC Penicillin \u2265 8 \u00b5g\/ml).<\/p>\n<p>Ho\u1eb7c ceftarolin 600mg TTM m\u1ed7i 12h<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h5>5.4.1.2. Haemophilus influenzae v\u00e0 Moraxella catarrhalis<\/h5>\n<p>&#8211; Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb: 5-7 ng\u00e0y<\/p>\n<p>&#8211; Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 chuy\u1ec3n sang \u0111i\u1ec1u tr\u1ecb thu\u1ed1c u\u1ed1ng khi l\u00e2m s\u00e0ng c\u1ea3i thi\u1ec7n v\u00e0 ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 u\u1ed1ng \u0111\u01b0\u1ee3c.<\/p>\n<table style=\"border-collapse: collapse; width: 100%; height: 207px;\">\n<tbody>\n<tr style=\"height: 50px;\">\n<td style=\"width: 28.891%; height: 50px; text-align: center;\"><strong>\u0110\u1eb7c \u0111i\u1ec3m nh\u1ea1y c\u1ea3m kh\u00e1ng sinh<\/strong><\/td>\n<td style=\"width: 35.7908%; height: 50px; text-align: center;\"><strong>L\u1ef1a ch\u1ecdn \u0111\u1ea7u tay<\/strong><\/td>\n<td style=\"width: 35.3181%; height: 50px; text-align: center;\"><strong>L\u1ef1a ch\u1ecdn kh\u00e1c<\/strong><\/td>\n<\/tr>\n<tr style=\"height: 50px;\">\n<td style=\"width: 28.891%; height: 50px;\">Nh\u1ea1y c\u1ea3m v\u1edbi Ampicillin, Amoxicillin (beta-lactamase \u00e2m t\u00ednh)<\/td>\n<td style=\"width: 35.7908%; height: 50px; text-align: justify;\">Ampicillin 2g truy\u1ec1n t\u0129nh m\u1ea1ch (TTM) m\u1ed7i 6h<\/p>\n<p>Ho\u1eb7c amoxicillin 1g u\u1ed1ng m\u1ed7i 8h.<\/td>\n<td style=\"width: 35.3181%; height: 157px; text-align: justify;\" rowspan=\"2\">Cotrimoxazol (TMP-SMX) 5-10mg\/kg (li\u1ec1u d\u1ef1a tr\u00ean trimethoprim, TMP) TTM\/u\u1ed1ng m\u1ed7i 12h<\/p>\n<p>Ho\u1eb7c doxycyclin 100mg u\u1ed1ng 2 l\u1ea7n\/ng\u00e0y<\/p>\n<p>Ho\u1eb7c azithromycin 500mg x 1 l\u1ea7n v\u00e0o ng\u00e0y 1, sau \u0111\u00f3 250mg l\u1ea7n\/ng\u00e0y x 4 ng\u00e0y (ho\u1eb7c 500 mg\/ng\u00e0y trong 3 ng\u00e0y)<\/p>\n<p>Ho\u1eb7c ciprofloxacin 400mg TM m\u1ed7i 12h (ho\u1eb7c 500mg u\u1ed1ng 2 l\u1ea7n\/ng\u00e0y) Ho\u1eb7c levofloxacin 750mg u\u1ed1ng\/TM m\u1ed7i 24h<\/td>\n<\/tr>\n<tr style=\"height: 107px;\">\n<td style=\"width: 28.891%; height: 107px;\">Kh\u00e1ng Ampicillin, Amoxicillin (beta-lactamase<br \/>\nd\u01b0\u01a1ng t\u00ednh)<\/td>\n<td style=\"width: 35.7908%; height: 107px; text-align: justify;\">Ceftriaxon 1g TTM m\u1ed7i 12h<\/p>\n<p>Ho\u1eb7c amoxicillin\/acid clavulanic 875\/125 mg u\u1ed1ng 2 l\u1ea7n\/ng\u00e0y.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h5>5.4.1.3. Klebsiella pneumoniae<\/h5>\n<p>Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p trung b\u00ecnh \u2013 n\u1eb7ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch.<\/p>\n<table style=\"border-collapse: collapse; width: 100%; height: 207px;\">\n<tbody>\n<tr style=\"height: 50px;\">\n<td style=\"width: 28.891%; height: 50px; text-align: center;\"><strong>\u0110\u1eb7c \u0111i\u1ec3m nh\u1ea1y c\u1ea3m kh\u00e1ng sinh<\/strong><\/td>\n<td style=\"width: 35.7908%; height: 50px; text-align: center;\"><strong>L\u1ef1a ch\u1ecdn \u0111\u1ea7u tay<\/strong><\/td>\n<td style=\"width: 35.3181%; height: 50px; text-align: center;\"><strong>L\u1ef1a ch\u1ecdn kh\u00e1c<\/strong><\/td>\n<\/tr>\n<tr style=\"height: 50px;\">\n<td style=\"width: 28.891%; height: 50px;\" rowspan=\"2\">Nh\u1ea1y c\u1ea3m v\u1edbi 1 trong c\u00e1c nh\u00f3m KS:<\/p>\n<ul>\n<li>Cephalosporin th\u1ebf h\u1ec7 3(ESBL \u00e2m t\u00ednh)<\/li>\n<li>Beta-lactam ph\u1ed1i h\u1ee3p v\u1edbi \u1ee9c ch\u1ebf beta-lactamase<\/li>\n<li>Quinolon<\/li>\n<\/ul>\n<\/td>\n<td style=\"width: 35.7908%; height: 50px; text-align: justify;\">Ceftriaxon 1g TTM m\u1ed7i 12h<\/p>\n<p>Ho\u1eb7c Piperacillin\/tazobactam 3,375g &#8211; 4,5 g li\u1ec1u t\u1ea3i TTM trong 30 ph\u00fat, l\u1eb7p l\u1ea1i m\u1ed7i 6h<\/p>\n<p>Ho\u1eb7c ciprofloxacin 400mg TTM m\u1ed7i 12h<\/p>\n<p>Ho\u1eb7c levofloxacin 750mg TTM m\u1ed7i 24h (ho\u1eb7c 500 mg TTM m\u1ed7i 12 h)<\/td>\n<td style=\"height: 157px; text-align: justify; width: 35.3181%;\">TMP-SMX TTM 10mg\/kg\/ng\u00e0y (t\u00ednh theo TMP) chia 2-3 l\u1ea7n.<\/p>\n<p>Ho\u1eb7c Amoxicillin\/acid clavulanic 1,2-2,4g TM m\u1ed7i 8h<\/p>\n<p>Ho\u1eb7c gentamicin ho\u1eb7c tobramycin 7mg\/kg m\u1ed7i 24h, amikacin li\u1ec1u 15-20 mg\/kg (\u0111i\u1ec1u ch\u1ec9nh li\u1ec1u theo ch\u1ee9c n\u0103ng th\u1eadn, n\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n ch\u1ec9nh li\u1ec1u theo \u0111\u1ecbnh l\u01b0\u1ee3ng n\u1ed3ng \u0111\u1ed9 thu\u1ed1c trong m\u00e1u).<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 71.1089%; text-align: justify;\" colspan=\"2\">Kh\u00e1ng sinh \u0111\u01b0\u1eddng u\u1ed1ng:<\/p>\n<p>Ciprofloxacin 500mg u\u1ed1ng m\u1ed7i 12h<\/p>\n<p>Ho\u1eb7c levofloxacin 750mg u\u1ed1ng m\u1ed7i 24h (ho\u1eb7c 500 mg u\u1ed1ng m\u1ed7i 12 h)<\/td>\n<\/tr>\n<tr style=\"height: 107px;\">\n<td style=\"width: 28.891%; height: 107px;\">\u0110\u1ec1 kh\u00e1ng v\u1edbi c\u00e1c nh\u00f3m KS:<\/p>\n<ul>\n<li>Cephalosporin th\u1ebf h\u1ec7 3 (ESBL \u00e2m ho\u1eb7c<br \/>\nd\u01b0\u01a1ng)<\/li>\n<li>Beta-lactam ph\u1ed1i h\u1ee3p v\u1edbi \u1ee9c ch\u1ebf beta-lactamase<\/li>\n<li>Quinolon<\/li>\n<\/ul>\n<p>V\u00c0 nh\u1ea1y c\u1ea3m v\u1edbi carbapenem<\/td>\n<td style=\"width: 35.7908%; height: 107px; text-align: justify;\"><strong>Vi khu\u1ea9n ESBL (-):<\/strong><\/p>\n<p>Cefepim 1-2g TTM m\u1ed7i 8h<\/p>\n<p><strong>Vi khu\u1ea9n ESBL (+):<\/strong><\/p>\n<p>Ertapenem 1g TTM m\u1ed7i 24h<\/p>\n<p>Ho\u1eb7c imipenem 0,5g TTM m\u1ed7i 6h<\/p>\n<p>Ho\u1eb7c Meropenem 1g TTM m\u1ed7i 8h<\/p>\n<p><strong>L\u01b0u \u00fd:<\/strong> C\u00e1c ch\u1ee7ng vi khu\u1ea9n sinh men ESBL c\u00f3 th\u1ec3 nh\u1ea1y c\u1ea3m piperacillin\/tazobactam in vitro nh\u01b0ng kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb, do \u0111\u00f3 kh\u00f4ng khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng.<\/td>\n<td style=\"text-align: justify; width: 35.3181%;\"><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 style=\"text-align: center;\">CH\u01af\u01a0NG 6. PH\u00d2NG B\u1ec6NH VI\u00caM PH\u1ed4I M\u1eaeC PH\u1ea2I C\u1ed8NG \u0110\u1ed2NG<\/h2>\n<p style=\"text-align: justify;\">6.1. C\u00e1c bi\u1ec7n ph\u00e1p d\u1ef1 ph\u00f2ng chung<\/p>\n<p style=\"text-align: justify;\">&#8211; \u0110i\u1ec1u tr\u1ecb tri\u1ec7t \u0111\u1ec3 c\u00e1c \u1ed5 nhi\u1ec5m khu\u1ea9n v\u00f9ng tai m\u0169i h\u1ecdng, r\u0103ng mi\u1ec7ng.<\/p>\n<p style=\"text-align: justify;\">&#8211; Qu\u1ea3n l\u00fd tri\u1ec7t \u0111\u1ec3 c\u00e1c b\u1ec7nh l\u00fd n\u1ec1n c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh: \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh, b\u1ec7nh gan th\u1eadn m\u1ea1n t\u00ednh.<\/p>\n<p style=\"text-align: justify;\">&#8211; Lo\u1ea1i b\u1ecf c\u00e1c k\u00edch th\u00edch c\u00f3 h\u1ea1i s\u1ee9c kh\u1ecfe: thu\u1ed1c l\u00e1, thu\u1ed1c l\u00e0o, r\u01b0\u1ee3u bia.<\/p>\n<p style=\"text-align: justify;\">&#8211; Gi\u1eef \u1ea5m c\u1ed5 ng\u1ef1c trong m\u00f9a l\u1ea1nh<\/p>\n<p style=\"text-align: justify;\">&#8211; H\u00ecnh th\u00e0nh mi\u1ec5n d\u1ecbch ch\u1ee7 \u0111\u1ed9ng b\u1eb1ng c\u00e1ch ti\u00eam ch\u1ee7ng vacxin ch\u1ed1ng virus, vi khu\u1ea9n.<\/p>\n<p style=\"text-align: justify;\">6.2. Ti\u00eam ph\u00f2ng v\u1eafc xin: th\u1ef1c hi\u1ec7n theo h\u01b0\u1edbng d\u1eabn c\u1ee7a B\u1ed9 Y t\u1ebf.<\/p>\n<p style=\"text-align: justify;\">6.3. Cai thu\u1ed1c l\u00e1: Th\u1ef1c hi\u1ec7n theo h\u01b0\u1edbng d\u1eabn hi\u1ec7n h\u00e0nh.<\/p>\n<p style=\"text-align: justify;\"><strong>Nh\u1eefng \u0111i\u1ec3m c\u1ea7n nh\u1edb:<\/strong><\/p>\n<p style=\"text-align: justify;\">D\u1ef1 ph\u00f2ng VPMPC\u0110 c\u1ea7n:<\/p>\n<p style=\"text-align: justify;\">&#8211; \u0110i\u1ec1u tr\u1ecb tri\u1ec7t \u0111\u1ec3 c\u00e1c \u1ed5 nhi\u1ec5m khu\u1ea9n v\u00f9ng tai m\u0169i h\u1ecdng, r\u0103ng mi\u1ec7ng, qu\u1ea3n l\u00fd tri\u1ec7t \u0111\u1ec3 c\u00e1c b\u1ec7nh l\u00fd n\u1ec1n c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n<p style=\"text-align: justify;\">&#8211; Gi\u1eef \u1ea5m c\u1ed5 ng\u1ef1c trong m\u00f9a l\u1ea1nh, lo\u1ea1i b\u1ecf k\u00edch th\u00edch c\u00f3 h\u1ea1i: r\u01b0\u1ee3u bia, thu\u1ed1c l\u00e1<\/p>\n<p style=\"text-align: justify;\">&#8211; Ti\u00eam ph\u00f2ng theo h\u01b0\u1edbng d\u1eabn c\u1ee7a B\u1ed9 Y t\u1ebf<\/p>\n<p style=\"text-align: justify;\">&#8211; T\u01b0 v\u1ea5n cai thu\u1ed1c l\u00e1.<\/p>\n<h2>T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/h2>\n<p style=\"text-align: justify;\">1. File TM, Ramirez JA. Community-Acquired Pneumonia. O\u2019Malley PG, editor. N Engl J Med. 2023 Aug 17;389(7):632\u201341. doi:10.1056\/NEJMcp2303286<\/p>\n<p style=\"text-align: justify;\">2. Oliveira E Silva PG, Cerqueira Batista Filho LA, P\u00e9rez Flores I, Vilins E Silva V, Toledo Maciel A, Seraphim Medeiros L. Community-acquired pneumonia: Epidemiology, diagnosis, prognostic severity scales, and new therapeutic options. Medwave. 2023 Dec 13;23(11):e2719\u2013e2719. doi:10.5867\/medwave.2023.11.2719<\/p>\n<p style=\"text-align: justify;\">3. Martin-Loeches I, Torres A, Nagavci B, Aliberti S, Antonelli M, Bassetti M, et al. ERS\/ESICM\/ESCMID\/ALAT guidelines for the management of severe community-acquired pneumonia. Eur Respir J. 2023 Apr;61(4):2200735. doi:10.1183\/13993003.00735-2022<\/p>\n<p style=\"text-align: justify;\">4. Manikam L, Lakhanpaul M. Epidemiology of community acquired pneumonia. Paediatrics and Child Health. 2012 Jul;22(7):299\u2013306. doi:10.1016\/j.paed.2012.05.002<\/p>\n<p style=\"text-align: justify;\">5. Cill\u00f3niz C, Cardozo C, Garc\u00eda-Vidal C. Epidemiology, pathophysiology, and microbiology of community-acquired pneumonia. Ann Res Hosp. 2018 Jan 9;2:1\u20131. doi:10.21037\/arh.2017.12.03<\/p>\n<p style=\"text-align: justify;\">6. Arnold FW, Wiemken TL, Peyrani P, Ramirez JA, Brock GN. Mortality differences among hospitalized patients with community-acquired pneumonia in three world regions: Results from the Community-Acquired Pneumonia Organization (CAPO) International Cohort Study. Respiratory Medicine. 2013 Jul;107(7):1101\u201311. doi:10.1016\/j.rmed.2013.04.003<\/p>\n<p style=\"text-align: justify;\">7. Tr\u1ea7n V\u0103n Chung, \u0110\u1ed7 M\u1ea1nh Hi\u1ec3u, Ho\u00e0ng Thu Th\u1ee7y. T\u00ecnh h\u00ecnh b\u1ec7nh t\u1eadt t\u1ea1i khoa H\u00f4 h\u1ea5p b\u1ec7nh vi\u1ec7n B\u1ea1ch Mai 1996-2001. B\u00e1o c\u00e1o h\u1ed9i ngh\u1ecb khoa h\u1ecdc tu\u1ed5i tr\u1ebb. Tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc Y H\u00e0 N\u1ed9i. 2001.<\/p>\n<p style=\"text-align: justify;\">8. B\u1ed9 Y t\u1ebf. Ni\u00ean gi\u00e1m th\u1ed1ng k\u00ea y t\u1ebf 2014. Nh\u00e0 xu\u1ea5t b\u1ea3n Y h\u1ecdc; 2015.<\/p>\n<p style=\"text-align: justify;\">9. Calabretta D, Mart\u00ecn-Loeches I, Torres A. New Guidelines for Severe Community-acquired Pneumonia. Semin Respir Crit Care Med. 2024 Apr;45(02):274\u201386. doi:10.1055\/s-0043-1777797<\/p>\n<p style=\"text-align: justify;\">10. Candel FJ, Salavert M, Basaras M, Borges M, Cant\u00f3n R, Cercenado E, et al. Ten Issues for Updating in Community-Acquired Pneumonia: An Expert Review. JCM. 2023 Oct 30;12(21):6864. doi:10.3390\/jcm12216864<\/p>\n<p style=\"text-align: justify;\">11. Shoar S, Musher DM. Etiology of community-acquired pneumonia in adults: a systematic review. Pneumonia. 2020 Dec;12(1):11. doi:10.1186\/s41479-020-00074-3<br \/>\n12. UpToDate Inc. Epidemiology, pathogenesis, and microbiology of community-acquired pneumonia in adults. 2019.<\/p>\n<p style=\"text-align: justify;\">13. Wunderink RG, Waterer G. Advances in the causes and management of community acquired pneumonia in adults. BMJ. 2017 Jul 10;j2471. doi:10.1136\/bmj.j2471<\/p>\n<p style=\"text-align: justify;\">14. Musher DM, Thorner AR. Community-Acquired Pneumonia. N Engl J Med. 2014 Oct 23;371(17):1619\u201328. doi:10.1056\/NEJMra1312885<\/p>\n<p style=\"text-align: justify;\">15. Steel HC, Cockeran R, Anderson R, Feldman C. Overview of Community-Acquired Pneumonia and the Role of Inflammatory Mechanisms in the Immunopathogenesis of Severe Pneumococcal Disease. Mediators of Inflammation. 2013;2013:1\u201318. doi:10.1155\/2013\/490346<\/p>\n<p style=\"text-align: justify;\">16. Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, et al. Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults. N Engl J Med. 2015 Jul 30;373(5):415\u201327. doi:10.1056\/NEJMoa1500245<\/p>\n<p style=\"text-align: justify;\">17. Restrepo MI, Mortensen EM, Velez JA, Frei C, Anzueto A. A Comparative Study of Community-Acquired Pneumonia Patients Admitted to the Ward and the ICU. Chest. 2008 Mar;133(3):610\u20137. doi:10.1378\/chest.07-1456<\/p>\n<p style=\"text-align: justify;\">18. Gadsby NJ, Russell CD, McHugh MP, Mark H, Conway Morris A, Laurenson IF, et al. Comprehensive Molecular Testing for Respiratory Pathogens in Community-Acquired Pneumonia. Clin Infect Dis. 2016 Apr 1;62(7):817\u201323. doi:10.1093\/cid\/civ1214<\/p>\n<p style=\"text-align: justify;\">19. Haas\u00a0 AR,\u00a0 Marik\u00a0 PE.\u00a0 COMMUNITY-ACQUIRED\u00a0 PNEUMONIA.\u00a0 In:<br \/>\nPharmacology and Therapeutics [Internet]. Elsevier; 2009 [cited 2026 Mar 5]. p. 1081\u2013<br \/>\n7. Available from: https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/B9781416032915500822 doi:10.1016\/B978-1-4160-3291-5.50082-2<\/p>\n<p style=\"text-align: justify;\">20. Holter JC, M\u00fcller F, Bj\u00f8rang O, Samdal HH, Marthinsen JB, Jenum PA, et al. Etiology of community-acquired pneumonia and diagnostic yields of microbiological methods: a 3-year prospective study in Norway. BMC Infect Dis. 2015 Dec;15(1):64. doi:10.1186\/s12879-015-0803-5<\/p>\n<p style=\"text-align: justify;\">21. Said MA, Johnson HL, Nonyane BAS, Deloria-Knoll M, O\u2032Brien KL, for the AGEDD Adult Pneumococcal Burden Study Team. Estimating the Burden of Pneumococcal Pneumonia among Adults: A Systematic Review and Meta-Analysis of Diagnostic Techniques. Hill PC, editor. PLoS ONE. 2013 Apr 2;8(4):e60273. doi:10.1371\/journal.pone.0060273<\/p>\n<p style=\"text-align: justify;\">22. Marrie TJ, Poulin-Costello M, Beecroft MD, Herman-Gnjidic Z. Etiology of community-acquired pneumonia treated in an ambulatory setting. Respiratory Medicine. 2005 Jan;99(1):60\u20135. doi:10.1016\/j.rmed.2004.05.010<\/p>\n<p style=\"text-align: justify;\">23. Johansson N, Kalin M, Tiveljung-Lindell A, Giske CG, Hedlund J. Etiology of Community-Acquired\u00a0 Pneumonia:\u00a0 Increased\u00a0 Microbiological\u00a0 Yield\u00a0 with\u00a0 New Diagnostic Methods. CLIN INFECT DIS. 2010 Jan 15;50(2):202\u20139. doi:10.1086\/648678<\/p>\n<p style=\"text-align: justify;\">24. Cilloniz C, Ewig S, Polverino E, Marcos MA, Esquinas C, Gabarrus A, et al. Microbial aetiology of community-acquired pneumonia and its relation to severity. Thorax. 2011 Apr 1;66(4):340\u20136. doi:10.1136\/thx.2010.143982<\/p>\n<p style=\"text-align: justify;\">25. Shibli F, Chazan B, Nitzan O, Flatau E, Edelstein H, Blondheim O, et al. Etiology of community-acquired pneumonia in hospitalized patients in northern Israel. Isr Med Assoc J. 2010 Aug;12(8):477\u201382. PubMed PMID: 21337816.<\/p>\n<p style=\"text-align: justify;\">26. on behalf of the GLIMP Study Group, Gramegna A, Sotgiu G, Di Pasquale M, Radovanovic D, Terraneo S, et al. Atypical pathogens in hospitalized patients with community-acquired pneumonia: a worldwide perspective. BMC Infect Dis. 2018 Dec;18(1):677. doi:10.1186\/s12879-018-3565-z<\/p>\n<p style=\"text-align: justify;\">27. Eshwara VK, Mukhopadhyay C, Rello J. Community-acquired bacterial pneumonia in adults: An update. Indian Journal of Medical Research. 2020 Apr;151(4):287\u2013302. doi:10.4103\/ijmr.IJMR_1678_19<\/p>\n<p style=\"text-align: justify;\">28. Paganin F, Lilienthal F, Bourdin A, Lugagne N, Tixier F, G\u00e9nin R, et al. Severe community-acquired pneumonia: assessment of microbial aetiology as mortality factor. Eur Respir J. 2004 Nov;24(5):779\u201385. doi:10.1183\/09031936.04.00119503<\/p>\n<p style=\"text-align: justify;\">29. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America\/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 1;44 Suppl 2(Suppl 2):S27-72. doi:10.1086\/511159 PubMed PMID: 17278083; PubMed Central PMCID: PMC7107997.<\/p>\n<p style=\"text-align: justify;\">30. Verduin CM, Hol C, Fleer A, Van Dijk H, Van Belkum A. Moraxella catarrhalis : from Emerging to Established Pathogen. Clin Microbiol Rev. 2002 Jan;15(1):125\u201344. doi:10.1128\/CMR.15.1.125-144.2002<\/p>\n<p style=\"text-align: justify;\">31. Aliberti S, Reyes LF, Faverio P, Sotgiu G, Dore S, Rodriguez AH, et al. Global initiative for meticillin-resistant Staphylococcus aureus pneumonia (GLIMP): an international, observational cohort study. The Lancet Infectious Diseases. 2016 Dec;16(12):1364\u201376. doi:10.1016\/S1473-3099(16)30267-5<\/p>\n<p style=\"text-align: justify;\">32. Francis JS, Doherty MC, Lopatin U, Johnston CP, Sinha G, Ross T, et al. Severe Community-Onset Pneumonia in Healthy Adults Caused by Methicillin-Resistant Staphylococcus aureus Carrying the Panton-Valentine Leukocidin Genes. Clinical Infectious Diseases. 2005 Jan 1;40(1):100\u20137. doi:10.1086\/427148<\/p>\n<p style=\"text-align: justify;\">33. Vayalumkal JV, Whittingham H, Vanderkooi O, Stewart TE, Low DE, Mulvey M, et al. Necrotizing pneumonia and septic shock: suspecting CA-MRSA in patients presenting to Canadian emergency departments. CJEM. 2007 Jul;9(4):300\u20133. doi:10.1017\/s1481803500015219 PubMed PMID: 17626697.<\/p>\n<p style=\"text-align: justify;\">34. Muller MP, Low DE, Green KA, Simor AE, Loeb M, Gregson D, et al. Clinical and epidemiologic features of group a streptococcal pneumonia in Ontario, Canada. Arch Intern Med. 2003 Feb 24;163(4):467\u201372. doi:10.1001\/archinte.163.4.467 PubMed PMID: 12588207.<\/p>\n<p style=\"text-align: justify;\">35. Bartlett JG. Anaerobic bacterial infection of the lung. Anaerobe. 2012 Apr;18(2):235\u20139. doi:10.1016\/j.anaerobe.2011.12.004<\/p>\n<p style=\"text-align: justify;\">36. Kung CT, Li CJ, Hung SC, Ko SF, Chen MC, Lee CH, et al. Acute melioid community-acquired pneumonia. International Journal of Infectious Diseases. 2011 Sep;15(9):e627\u201330. doi:10.1016\/j.ijid.2011.04.015<\/p>\n<p style=\"text-align: justify;\">37. Jartti T, Jartti L, Peltola V, Waris M, Ruuskanen O. Identification of Respiratory Viruses in Asymptomatic Subjects: Asymptomatic Respiratory Viral Infections. Pediatric Infectious Disease Journal. 2008 Dec;27(12):1103\u20137. doi:10.1097\/INF.0b013e31817e695d<\/p>\n<p style=\"text-align: justify;\">38. Templeton KE, Scheltinga SA, Van Den Eeden WCJFM, Graffelman WA, Van Den Broek PJ, Claas ECJ. Improved Diagnosis of the Etiology of Community-Acquired Pneumonia with Real-Time Polymerase Chain Reaction. Clinical Infectious Diseases. 2005 Aug 1;41(3):345\u201351. doi:10.1086\/431588<\/p>\n<p style=\"text-align: justify;\">39. Self WH, Williams DJ, Zhu Y, Ampofo K, Pavia AT, Chappell JD, et al. Respiratory Viral Detection in Children and Adults: Comparing Asymptomatic Controls and Patients With Community-Acquired Pneumonia. J Infect Dis. 2016 Feb 15;213(4):584\u201391. doi:10.1093\/infdis\/jiv323<\/p>\n<p style=\"text-align: justify;\">40. Falsey AR, Becker KL, Swinburne AJ, Nylen ES, Formica MA, Hennessey PA, et al. Bacterial Complications of Respiratory Tract Viral Illness: A Comprehensive Evaluation. Journal of Infectious Diseases. 2013 Aug 1;208(3):432\u201341. doi:10.1093\/infdis\/jit190<\/p>\n<p style=\"text-align: justify;\">41. Johansson N, Kalin M, Hedlund J. Clinical impact of combined viral and bacterial infection in patients with community-acquired pneumonia. Scandinavian Journal of Infectious Diseases. 2011 Aug;43(8):609\u201315. doi:10.3109\/00365548.2011.570785<\/p>\n<p style=\"text-align: justify;\">42. Wang L, Wang Y, Ye D, Liu Q. Review of the 2019 novel coronavirus (SARS-CoV-2) based on current evidence. Int J Antimicrob Agents. 2020 Jun;55(6):105948. doi:10.1016\/j.ijantimicag.2020.105948 PubMed PMID: 32201353; PubMed Central PMCID: PMC7156162.<\/p>\n<p style=\"text-align: justify;\">43. Hayden FG. Editorial Response: Rhinovirus Pneumonia: A Clinical Entity? CLIN INFECT DIS. 1999 Sep;29(3):533\u20135. doi:10.1086\/598628<\/p>\n<p style=\"text-align: justify;\">44. Hage CA, Knox KS, Wheat LJ. Endemic mycoses: Overlooked causes of community acquired pneumonia. Respiratory Medicine. 2012 Jun;106(6):769\u201376. doi:10.1016\/j.rmed.2012.02.004<\/p>\n<p style=\"text-align: justify;\">45. Cilloniz C, Martin-Loeches I, Garcia-Vidal C, San Jose A, Torres A. Microbial Etiology of Pneumonia: Epidemiology, Diagnosis and Resistance Patterns. IJMS. 2016 Dec 16;17(12):2120. doi:10.3390\/ijms17122120<\/p>\n<p style=\"text-align: justify;\">46. Cill\u00f3niz C, Domined\u00f2 C, Torres A. Multidrug Resistant Gram-Negative Bacteria in Community-Acquired Pneumonia. Crit Care. 2019 Mar 9;23(1):79. doi:10.1186\/s13054-019-2371-3<\/p>\n<p style=\"text-align: justify;\">47. Hu F, Zhu D, Wang F, Morrissey I, Wang J, Torumkuney D. Results from the Survey of Antibiotic Resistance (SOAR) 2009\u201311 and 2013\u201314 in China. J Antimicrob Chemother. 2016 May;71(suppl 1):i33\u201343. doi:10.1093\/jac\/dkw065<\/p>\n<p style=\"text-align: justify;\">48. Torumkuney D, Chaiwarith R, Reechaipichitkul W, Malatham K, Chareonphaibul V, Rodrigues C, et al. Results from the Survey of Antibiotic Resistance (SOAR) 2012\u201314 in Thailand, India, South Korea and Singapore. J Antimicrob Chemother. 2016 May;71(suppl 1):i3\u201319. doi:10.1093\/jac\/dkw073<\/p>\n<p style=\"text-align: justify;\">49. Kacou-Ndouba A, Revathi G, Mwathi P, Seck A, Diop A, Kabedi-Bajani MJ, et al. Results from the Survey of Antibiotic Resistance (SOAR) 2011\u201314 in the Democratic Republic of Congo, Ivory Coast, Republic of Senegal and Kenya. J Antimicrob Chemother. 2016 May;71(suppl 1):i21\u201331. doi:10.1093\/jac\/dkw070<\/p>\n<p style=\"text-align: justify;\">50. Van PH, Binh PT, Minh NHL, Morrissey I, Torumkuney D. Results from the Survey of Antibiotic Resistance (SOAR) 2009\u201311 in Vietnam. J Antimicrob Chemother. 2016 May;71(suppl 1):i93\u2013102. doi:10.1093\/jac\/dkw069<\/p>\n<p style=\"text-align: justify;\">51. Lee JK, Yun KW, Choi EH, Kim SJ, Lee SY, Lee HJ. Changes in the Serotype Distribution among Antibiotic Resistant Carriage Streptococcus pneumoniae Isolates in Children after the Introduction of the Extended-Valency Pneumococcal Conjugate Vaccine. J Korean Med Sci. 2017;32(9):1431. doi:10.3346\/jkms.2017.32.9.1431<\/p>\n<p style=\"text-align: justify;\">52. Golden AR, Rosenthal M, Fultz B, Nichol KA, Adam HJ, Gilmour MW, et al. Characterization of MDR and XDR Streptococcus pneumoniae in Canada, 2007\u201313. Journal of Antimicrobial Chemotherapy. 2015 Aug 1;70(8):2199\u2013202. doi:10.1093\/jac\/dkv107<\/p>\n<p style=\"text-align: justify;\">53. Takahashi K, Suzuki M, Minh LN, Anh NH, Huong LTM, Son TVV, et al. The incidence and aetiology of hospitalised community-acquired pneumonia among Vietnamese adults: a prospective surveillance in Central Vietnam. BMC Infect Dis. 2013 Dec;13(1):296. doi:10.1186\/1471-2334-13-296<\/p>\n<p style=\"text-align: justify;\">54. T\u1ea1 Th\u1ecb Di\u1ec7u N, Nguy\u1ec5n V\u0103n K, Nguy\u1ec5n V\u0169 T. Nghi\u00ean c\u1ee9u \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, c\u1eadn l\u00e2m s\u00e0ng v\u00e0 c\u0103n nguy\u00ean c\u1ee7a vi\u00eam ph\u1ed5i m\u1eafc ph\u1ea3i t\u1ea1i c\u1ed9ng \u0111\u1ed3ng [Lu\u1eadn \u00e1n Ti\u1ebfn s\u0129 Y h\u1ecdc]. 2016.<\/p>\n<p style=\"text-align: justify;\">55. B\u1ed9 Y t\u1ebf. B\u00e1o c\u00e1o gi\u00e1m s\u00e1t kh\u00e1ng kh\u00e1ng sinh t\u1ea1i Vi\u1ec7t Nam n\u0103m 2020. 2023.<\/p>\n<p style=\"text-align: justify;\">56. Ph\u1ea1m H\u00f9ng V. T\u00e1c nh\u00e2n g\u00e2y nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p d\u01b0\u1edbi c\u1ed9ng \u0111\u1ed3ng c\u1ea5p t\u00ednh kh\u00f4ng nh\u1eadp vi\u1ec7n &#8211; K\u1ebft qu\u1ea3 b\u01b0\u1edbc \u0111\u1ea7u t\u1eeb nghi\u00ean c\u1ee9u EACRI. H\u1ed9i H\u00f4 h\u1ea5p Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh.<\/p>\n<p style=\"text-align: justify;\">57. Huong PLT, Hien PT, Lan NTP, Binh TQ, Tuan DM, Anh DD. First report on prevalence and risk factors of severe atypical pneumonia in Vietnamese children aged 1\u201315 years. BMC Public Health. 2014 Dec;14(1):1304. doi:10.1186\/1471-2458-14-<br \/>\n1304<\/p>\n<p style=\"text-align: justify;\">58. CIBER de Enfermedades Respiratorias, CIBERES, Barcelona, Spain, Tejada S, Vall d\u2019Hebron Institut of Research (VHIR), Barcelona, Spain, Romero A, CIBER de Enfermedades Respiratorias, CIBERES, Barcelona, Spain, Vall d\u2019Hebron Institut of Research (VHIR), Barcelona, Spain, et al. Community-Acquired Pneumonia in Adults: What\u2019s New Focusing on Epidemiology, Microorganisms and Diagnosis? Erciyes Med J. 2018 Dec 17;40(4):177\u201382. doi:10.5152\/etd.2018.18128<\/p>\n<p style=\"text-align: justify;\">59. Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. American Journal of Respiratory and Critical Care Medicine. 2019 Oct 1;200(7):e45\u201367. doi:10.1164\/rccm.201908-1581ST<\/p>\n<p style=\"text-align: justify;\">60. Amy L. Leber. Clinical Microbiology Procedures Handbook, 4th Edition. American Society for Microbiology (ASM Press); 2016.<\/p>\n<p style=\"text-align: justify;\">61. Haubitz S, Hitz F, Graedel L, Batschwaroff M, Wiemken TL, Peyrani P, et al. Ruling Out Legionella in Community-acquired Pneumonia. The American Journal of Medicine. 2014 Oct;127(10):1010.e11-1010.e19. doi:10.1016\/j.amjmed.2014.03.042<\/p>\n<p style=\"text-align: justify;\">62. Miller JM, Binnicker MJ, Campbell S, Carroll KC, Chapin KC, Gonzalez MD, et al. Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clinical Infectious Diseases. 2024 Mar 5;ciae104. doi:10.1093\/cid\/ciae104<\/p>\n<p style=\"text-align: justify;\">63. Gadsby NJ, Musher DM. The Microbial Etiology of Community-Acquired Pneumonia in Adults: from Classical Bacteriology to Host Transcriptional Signatures. Clin Microbiol Rev. 2022 Dec 21;35(4):e00015-22. doi:10.1128\/cmr.00015-22<\/p>\n<p style=\"text-align: justify;\">64. Lee WJ, Huang EY, Tsai CM, Kuo KC, Huang YC, Hsieh KS, et al. Role of Serum Mycoplasma pneumoniae IgA, IgM, and IgG in the Diagnosis of Mycoplasma pneumoniae-Related Pneumonia in School-Age Children and Adolescents. Rosenberg HF, editor. Clin Vaccine Immunol. 2017 Jan;24(1). doi:10.1128\/CVI.00471-16<\/p>\n<p style=\"text-align: justify;\">65. Choo S, Kim SH, Lee E. Clinical significance of Mycoplasma pneumoniae specific IgM titer in children hospitalized with Mycoplasma pneumoniae pneumonia. BMC Infect Dis. 2022 Dec;22(1):470. doi:10.1186\/s12879-022-07456-6<\/p>\n<p style=\"text-align: justify;\">66. Miller JM, Binnicker MJ, Campbell S, Carroll KC, Chapin KC, Gilligan PH, et al. A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology. Clin Infect Dis. 2018 Aug 31;67(6):e1\u201394. doi:10.1093\/cid\/ciy381 PubMed PMID: 29955859; PubMed Central PMCID: PMC7108105.<\/p>\n<p style=\"text-align: justify;\">67. Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45\u201367. doi:10.1164\/rccm.201908-1581ST PubMed PMID: 31573350; PubMed Central PMCID: PMC6812437.<\/p>\n<p style=\"text-align: justify;\">68. Jamal JA, Abdul-Aziz MH, Lipman J, Roberts JA. Defining Antibiotic Dosing in Lung Infections. Clinical Pulmonary Medicine. 2013 May;20(3):121\u20138. doi:10.1097\/CPM.0b013e31828fc646<\/p>\n<p style=\"text-align: justify;\">69. Shah S, Barton G, Fischer A. Pharmacokinetic considerations and dosing strategies of antibiotics in the critically ill patient. Journal of the Intensive Care Society. 2015 May;16(2):147\u201353. doi:10.1177\/1751143714564816<\/p>\n<p style=\"text-align: justify;\">70. Burke A Cunha. Antibiotic essentials 2017. Jaypee Medical Publishers; 2017.<\/p>\n<p style=\"text-align: justify;\">71. Gilbert DN, Eliopoulos GM, Chambers HF, Saag MS, Pavia AT, editors. Sanford guide to antimicrobial therapy 2017. 47th edition. Sperryville, VA, USA: Antimicrobial Therapy, Inc; 2017. 256 p.<\/p>\n<p style=\"text-align: justify;\">72. Ashley C, Dunleavy A. The Renal Drug Handbook: The Ultimate Prescribing Guide for Renal Practitioners [Internet]. 5th ed. Ashley C, Dunleavy A, Cunningham J, editors. CRC Press; 2018 [cited 2026 Mar 5]. Available from: https:\/\/www.taylorfrancis.com\/books\/9780429863646 doi:10.1201\/9780429460418<\/p>\n<p style=\"text-align: justify;\">73. Datapharm [Internet]. 2024. Available from: https:\/\/www.medicines.org.uk\/emc<\/p>\n<p style=\"text-align: justify;\">74. IBM Corporation [Internet]. Available from: https:\/\/www.micromedexsolutions.com\/<\/p>\n<p style=\"text-align: justify;\">75. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America\/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clinical Infectious Diseases. 2007 Mar 1;44(Supplement_2):S27\u201372. doi:10.1086\/511159<\/p>\n<p style=\"text-align: justify;\">76. B\u00e9\u00efque L, Zvonar R. Addressing Concerns about Changing the Route of Antimicrobial Administration from Intravenous to Oral in Adult Inpatients. CJHP. 2015 Aug 25;68(4). doi:10.4212\/cjhp.v68i4.1472<\/p>\n<p style=\"text-align: justify;\">77. Nguy\u1ec5n Tri T, L\u00ea Qu\u1ed1c H. H\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng kh\u00e1ng sinh. Nh\u00e0 xu\u1ea5t b\u1ea3n Y h\u1ecdc; 2020.<\/p>\n<p style=\"text-align: justify;\">78. Ramirez JA, Musher DM, Evans SE, Dela Cruz C, Crothers KA, Hage CA, et al. Treatment of Community-Acquired Pneumonia in Immunocompromised Adults. Chest. 2020 Nov;158(5):1896\u2013911. doi:10.1016\/j.chest.2020.05.598<\/p>\n<p style=\"text-align: justify;\">79. Lee MS, Oh JY, Kang CI, Kim ES, Park S, Rhee CK, et al. Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia. Infect Chemother. 2018;50(2):160. doi:10.3947\/ic.2018.50.2.160<\/p>\n<p style=\"text-align: justify;\">80. Zakhour J, Sharara SL, Hindy JR, Haddad SF, Kanj SS. Antimicrobial Treatment of Pseudomonas aeruginosa Severe Sepsis. Antibiotics. 2022 Oct 18;11(10):1432. doi:10.3390\/antibiotics11101432<\/p>\n<p style=\"text-align: justify;\">81. Martin-Loeches I, Torres A, Nagavci B, Aliberti S, Antonelli M, Bassetti M, et al. ERS\/ESICM\/ESCMID\/ALAT guidelines for the management of severe community-acquired pneumonia. Intensive Care Med. 2023 Jun;49(6):615\u201332. doi:10.1007\/s00134-023-07033-8<\/p>\n<p style=\"text-align: justify;\">82. Grant J, Saux NL, members of the Antimicrobial Stewardship and Resistance Committee (ASRC) of the Association of Medical Microbiology and Infectious Disease (AMMI) Canada. Duration of antibiotic therapy for common infections. J Assoc Med Microbiol Infect Dis Can. 2021 Sep;6(3):181\u201397. doi:10.3138\/jammi-2021-04-29 PubMed PMID: 36337760; PubMed Central PMCID: PMC9615468.<\/p>\n<p style=\"text-align: justify;\">83. Furukawa Y, Luo Y, Funada S, Onishi A, Ostinelli E, Hamza T, et al. Optimal duration of antibiotic treatment for community-acquired pneumonia in adults: a systematic review and duration-effect meta-analysis. BMJ Open. 2023 Mar;13(3):e061023. doi:10.1136\/bmjopen-2022-061023<\/p>\n<p style=\"text-align: justify;\">84. Auwaerter, P.M.D. Staphylococcus aureus. 2022.<\/p>\n<p style=\"text-align: justify;\">85. Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK, et al. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices \u2014 United States, 2022\u201323 Influenza Season. MMWR Recomm Rep. 2022 Aug 26;71(1):1\u201328. doi:10.15585\/mmwr.rr7101a1<\/p>\n<p style=\"text-align: justify;\">86. Kobayashi M, Pilishvili T, Farrar JL, Leidner AJ, Gierke R, Prasad N, et al. Pneumococcal Vaccine for Adults Aged \u226519 Years: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023. MMWR Recomm Rep. 2023 Sep 8;72(3):1\u201339. doi:10.15585\/mmwr.rr7203a1<\/p>\n<p style=\"text-align: justify;\">87. Gatwood J, Shuvo S, Hohmeier KC, Hagemann T, Chiu CY, Tong R, et al. Pneumococcal vaccination in older adults: An initial analysis of social determinants of health and vaccine uptake. Vaccine. 2020 Jul;38(35):5607\u201317. doi:10.1016\/j.vaccine.2020.06.077<\/p>\n<p style=\"text-align: justify;\">88. National Foundation for Infectious Diseases (NFID). Respiratory Syncytial Virus (RSV). 2023.<\/p>\n<p style=\"text-align: justify;\">89. Lu L, Robertson G, Ashworth J, Pham Hong A, Shi T, Ivens A, et al. Epidemiology and Phylogenetic Analysis of Viral Respiratory Infections in Vietnam. Front Microbiol. 2020 May 15;11:833. doi:10.3389\/fmicb.2020.00833<\/p>\n<p style=\"text-align: justify;\">90. Melgar M, Britton A, Roper LE, Talbot HK, Long SS, Kotton CN, et al. Use of Respiratory Syncytial Virus Vaccines in Older Adults: Recommendations of the Advisory Committee on Immunization Practices \u2014 United States, 2023. American Journal of Transplantation. 2023 Oct;23(10):1631\u201340. doi:10.1016\/j.ajt.2023.09.003<\/p>\n<p style=\"text-align: justify;\">91. 2008 PHS Guideline Update Panel, Liaisons, and Staff. Treating tobacco use and dependence: 2008 update U.S. Public Health Service Clinical Practice Guideline executive summary. Respir Care. 2008 Sep;53(9):1217\u201322. PubMed PMID: 18807274.<\/p>\n<p style=\"text-align: justify;\">92. Giamarellos-Bourboulis EJ, Siampanos A, Bolanou A, Doulou S, Kakavoulis N, Tsiakos K, et al. Clarithromycin for early anti-inflammatory responses in community-acquired pneumonia in Greece (ACCESS): a randomised, double-blind, placebo-controlled trial. The Lancet Respiratory Medicine. 2024 Apr;12(4):294\u2013304. doi:10.1016\/S2213-2600(23)00412-5<\/p>\n<p style=\"text-align: justify;\">93. Antonakos N, Giamarellos-Bourboulis EJ, Niederman MS. The role of macrolides in severe community-acquired pneumonia and the potential impact of macrolide-resistant Mycoplamsa pneumoniae. Current Opinion in Infectious Diseases. 2025 Apr;38(2):190\u20137. doi:10.1097\/QCO.0000000000001087<\/p>\n<p style=\"text-align: justify;\">94. Prina E, Ranzani OT, Polverino E, Cill\u00f3niz C, Ferrer M, Fernandez L, et al. Risk Factors Associated with Potentially Antibiotic-Resistant Pathogens in Community-Acquired Pneumonia. Annals of the American Thoracic Society. 2015 Feb 1;12(2):153\u2013<br \/>\n60. doi:10.1513\/AnnalsATS.201407-305OC<\/p>\n<p style=\"text-align: justify;\">95. Leber AL. Clinical Microbiology Procedures Handbook, Multi-Volume. 5th ed. Newark: ASM Press; 2023. 1 p. (ASM Bks).<\/p>\n<p style=\"text-align: justify;\">96. Dinh A, Barbier F, Bedos JP, Blot M, Cattoir V, Claessens YE, et al. Update of guidelines for management of Community Acquired pneumonia in adults by the French Infectious Disease Society (SPILF) and the French-Speaking Society of Respiratory Diseases (SPLF). Respiratory Medicine and Research. 2025 May;87:101161. doi:10.1016\/j.resmer.2025.101161<\/p>\n<p style=\"text-align: justify;\">97. Britton A, Roper LE, Kotton CN, Hutton DW, Fleming-Dutra KE, Godfrey M, et al. Use of Respiratory Syncytial Virus Vaccines in Adults Aged \u226560 Years: Updated Recommendations of the Advisory Committee on Immunization Practices \u2014 United States, 2024. MMWR Morb Mortal Wkly Rep. 2024 Aug 15;73(32):696\u2013702. doi:10.15585\/mmwr.mm7332e1<\/p>\n<p style=\"text-align: justify;\">98. Redondo E, Rivero-Calle I, Mascar\u00f3s E, Oca\u00f1a D, Jimeno I, Gil \u00c1, et al. Respiratory Syncytial Virus Vaccination Recommendations for Adults Aged 60 Years and Older: The NeumoExperts Prevention Group Position Paper. Archivos de Bronconeumolog\u00eda. 2024 Mar;60(3):161\u201370. doi:10.1016\/j.arbres.2024.01.004<\/p>\n<p style=\"text-align: justify;\">99. Giannelos N, Curran D, Nguyen C, Kagia C, Vroom N, Vroling H. The Incidence of Herpes Zoster Complications: A Systematic Literature Review. Infect Dis Ther. 2024 Jul;13(7):1461\u201386. doi:10.1007\/s40121-024-01002-4<\/p>\n<p style=\"text-align: justify;\">100. Dooling KL, Guo A, Patel M, Lee GM, Moore K, Belongia EA, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR Morb Mortal Wkly Rep. 2018 Jan 26;67(3):103\u20138. doi:10.15585\/mmwr.mm6703a5<\/p>\n<p style=\"text-align: justify;\">101. Anderson TC, Masters NB, Guo A, Shepersky L, Leidner AJ, Lee GM, et al. Use of Recombinant Zoster Vaccine in Immunocompromised Adults Aged \u226519 Years: Recommendations of the Advisory Committee on Immunization Practices \u2014 United States, 2022. 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