{"id":34807,"date":"2022-12-05T15:30:31","date_gmt":"2022-12-05T08:30:31","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=34807"},"modified":"2022-12-05T15:31:04","modified_gmt":"2022-12-05T08:31:04","slug":"huong-dan-chan-doan-va-dieu-tri-viem-phoi","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/huong-dan-chan-doan-va-dieu-tri-viem-phoi\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i"},"content":{"rendered":"

T\u00e1c gi\u1ea3: Ti\u1ebfn s\u0129 – B\u00e1c s\u0129 Nguy\u1ec5n V\u0103n Th\u00e0nh<\/em><\/p>\n

PCT H\u1ed8I PH\u1ed4I VI\u1ec6T NAM\u00a0<\/em><\/p>\n

vnras.com\/drug – \u0110\u1ec3 t\u1ea3i file PDF c\u1ee7a b\u00e0i vi\u1ebft H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i<\/strong><\/a>, xin vui l\u00f2ng click v\u00e0o link \u1edf \u0111\u00e2y<\/a>.<\/p>\n

Thu\u1eadt ng\u1eef ph\u00e2n lo\u1ea1i<\/h2>\n
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\u0110\u1ec3 t\u0103ng t\u00ednh \u0111\u1ecbnh h\u01b0\u1edbng t\u00e1c nh\u00e2n vi sinh g\u00e2y b\u1ec7nh, g\u1ea7n \u0111\u00e2y c\u00f2n c\u00f3 th\u00eam nh\u1eefng thu\u1eadt ng\u1eef \u201cc\u1ed9ng \u0111\u1ed3ng\u201d, \u201cb\u1ec7nh vi\u1ec7n\u201d hay li\u00ean quan t\u1edbi \u201cch\u0103m s\u00f3c y t\u1ebf\u201d \u0111\u1ec3 ch\u1ec9 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p vi\u00eam ph\u1ed5i do vi khu\u1ea9n nhi\u1ec5m t\u1eeb c\u1ed9ng \u0111\u1ed3ng (kh\u00f4ng ph\u1ea3i trong b\u1ec7nh vi\u1ec7n), nhi\u1ec5m khu\u1ea9n t\u1eeb b\u1ec7nh vi\u1ec7n hay nhi\u1ec5m khu\u1ea9n gi\u1ed1ng vi khu\u1ea9n ngu\u1ed3n g\u1ed1c b\u1ec7nh vi\u1ec7n do c\u00f3 s\u1eed d\u1ee5ng k\u00e9o d\u00e0i c\u00e1c ch\u0103m s\u00f3c y t\u1ebf.<\/li>\n
Hi\u1ec7n nay c\u00e1c thu\u1eadt ng\u1eef vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng (VPC\u0110), vi\u00eam ph\u1ed5i b\u1ec7nh vi\u1ec7n (VPBV) vi\u00eam ph\u1ed5i th\u1edf m\u00e1y (VPTM) \u0111ang \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nhi\u1ec1u trong y v\u0103n v\u00e0 l\u00e0 t\u1eeb kh\u00f3a c\u1ee7a nhi\u1ec1u t\u00e0i li\u1ec7u khoa h\u1ecdc khi c\u00f4ng b\u1ed1.<\/li>\n
Thu\u1eadt ng\u1eef vi\u00eam ph\u1ed5i c\u00f3 li\u00ean quan t\u1edbi ch\u0103m s\u00f3c y t\u1ebf (health-care associated pneumonia, HCAP) \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t trong c\u00e1c y v\u0103n h\u01b0\u1edbng d\u1eabn (guideline) t\u1eeb n\u0103m 2005. Tuy nhi\u00ean sau \u0111\u00f3 nhi\u1ec1u nghi\u00ean c\u1ee9u \u0111\u00e3 kh\u00f4ng t\u00ecm th\u1ea5y m\u1ed1i li\u00ean quan c\u00f3 \u00fd ngh\u0129a gi\u1eefa c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 v\u1edbi \u0111\u1eb7c t\u00ednh nhi\u1ec5m khu\u1ea9n b\u1ec7nh vi\u1ec7n c\u0169ng nh\u01b0 v\u1edbi k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng. Do c\u00f3 kh\u1ea3 n\u0103ng \u0111\u01b0a \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh qu\u00e1 m\u1ee9c n\u00ean hi\u1ec7n nay thu\u1eadt ng\u1eef HCAP kh\u00f4ng \u0111\u01b0\u1ee3c xem l\u00e0 ch\u00ednh th\u1ee9c \u0111\u1ec3 khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb nh\u01b0 vi\u00eam ph\u1ed5i b\u1ec7nh vi\u1ec7n n\u1eefa.<\/li>\n<\/ul>\n
Nh\u1eefng \u0111i\u1ec3m c\u1ea7n l\u01b0u \u00fd<\/h2>\n
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Vi\u00eam ph\u1ed5i l\u00e0 thu\u1eadt ng\u1eef r\u1ea5t d\u1ec5 b\u1ecb l\u1ea1m d\u1ee5ng khi ch\u1ea9n \u0111o\u00e1n. S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a ti\u1ebfng ran \u1ea9m, ran n\u1ed5 khi nghe ph\u1ed5i kh\u00f4ng ph\u1ea3i lu\u00f4n \u0111\u1ed3ng ngh\u0129a v\u1edbi vi\u00eam ph\u1ed5i.<\/li>\n
Ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng vi\u00eam ph\u1ed5i kh\u00f4ng c\u00f3 ti\u00eau chu\u1ea9n v\u00e0ng n\u00ean c\u1ea7n ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t, nh\u1ea5t l\u00e0 khi b\u1ec7nh t\u1ecf ra kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh kinh nghi\u1ec7m ban \u0111\u1ea7u.<\/li>\n
\u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh kinh nghi\u1ec7m c\u1ea7n thi\u1ebft d\u1ef1a tr\u00ean s\u1ef1 ph\u00e2n t\u00edch v\u1ec1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng, nguy c\u01a1 nhi\u1ec5m khu\u1ea9n kh\u00f4ng ph\u1ed5 bi\u1ebfn, nguy c\u01a1 kh\u00e1ng thu\u1ed1c (dysbiosis, mutation).<\/li>\n
\u0110a s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa. Kh\u00f4ng c\u1ea7n v\u00e0 kh\u00f4ng n\u00ean gi\u1eef b\u1ec7nh nh\u00e2n vi\u00eam ph\u1ed5i trong b\u1ec7nh vi\u1ec7n \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb cho t\u1edbi l\u00fac kh\u1ecfi b\u1ec7nh. C\u00f3 th\u1ec3 chuy\u1ec3n thu\u1ed1c u\u1ed1ng khi \u0111i\u1ec1u ki\u1ec7n cho ph\u00e9p m\u00e0 k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb kh\u00f4ng thay \u0111\u1ed5i.<\/li>\n<\/ul>\n
Vi\u00eam ph\u1ed5i – \u0110\u1ecbnh ngh\u0129a<\/h2>\n
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Vi\u00eam ph\u1ed5i l\u00e0 t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng c\u1ea5p t\u00ednh khu v\u1ef1c trao \u0111\u1ed5i kh\u00ed (ti\u1ec3u ph\u1ebf qu\u1ea3n t\u1eadn, ph\u1ebf nang, m\u00f4 k\u1ebd) c\u1ee7a ph\u1ed5i.<\/li>\n
B\u1ec7nh h\u1ecdc c\u01a1 b\u1ea3n l\u00e0 l\u1ea5p \u0111\u1ea7y ph\u1ebf nang (alveolar filling)<\/li>\n
Trong b\u1ec7nh c\u1ea3nh nhi\u1ec5m tr\u00f9ng c\u1ea5p t\u00ednh, v\u1edbi tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3 t\u1ed5n th\u01b0\u01a1ng t\u1ea7m ph\u1ebf nang d\u1ec5 d\u00e0ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c b\u1eb1ng kh\u00e1m l\u00e2m s\u00e0ng, th\u00f4ng th\u01b0\u1eddng vi\u00eam ph\u1ed5i c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh m\u00e0 kh\u00f4ng c\u1ea7n ch\u1ee5p Xquang ng\u1ef1c. Xquang ng\u1ef1c l\u00e0 c\u1ea7n thi\u1ebft trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p ch\u1ea9n \u0111o\u00e1n c\u00f2n nghi ng\u1edd, c\u1ea7n ph\u00e2n bi\u1ec7t v\u1edbi c\u00e1c b\u1ec7nh kh\u00e1c, trong b\u1ec7nh c\u1ea3nh n\u1eb7ng v\u00e0 c\u00f3 bi\u1ebfn ch\u1ee9ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 v\u00e0 ti\u00ean l\u01b0\u1ee3ng.<\/li>\n<\/ul>\n
L\u1ea5p \u0111\u1ea7y ph\u1ebf nang<\/h2>\n
$\"L\u1ea5p$ <\/p>\n
Vi\u00eam ph\u1ed5i – T\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u1eabu b\u1ec7nh<\/h2>\n
$\"T\u1ed5n$
T\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u1eabu b\u1ec7nh vi\u00eam ph\u1ed5i c\u00f3 4 d\u1ea1ng: Vi\u00eam ph\u1ed5i th\u00f9y, vi\u00eam ph\u1ed5i d\u1ea1ng ph\u1ebf qu\u1ea3n-ph\u1ebf vi\u00eam, vi\u00eam ph\u1ed5i k\u1ebd v\u00e0 vi\u00eam ph\u1ed5i d\u1ea1ng k\u00ea.<\/figcaption><\/figure>\n
XQuang vi\u00eam ph\u1ed5i th\u00f9y, vi\u00eam ph\u1ed5i d\u1ea1ng PQPV XQuang<\/h2>\n
$\"T\u1ed5n$
T\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u1eabu b\u1ec7nh vi\u00eam ph\u1ed5i c\u00f3 4 d\u1ea1ng: Vi\u00eam ph\u1ed5i th\u00f9y, vi\u00eam ph\u1ed5i d\u1ea1ng ph\u1ebf qu\u1ea3n-ph\u1ebf vi\u00eam, vi\u00eam ph\u1ed5i k\u1ebd v\u00e0 vi\u00eam ph\u1ed5i d\u1ea1ng k\u00ea.<\/figcaption><\/figure>\n
XQuang vi\u00eam ph\u1ed5i k\u1ebd, vi\u00eam ph\u1ed5i d\u1ea1ng k\u00ea<\/h2>\n
$\"XQuang$ <\/p>\n
Ph\u1ed5i kh\u00f4ng c\u00f3 h\u00ecnh \u1ea3nh th\u00e2m nhi\u1ec5m vi\u00eam ph\u1ed5i<\/h2>\n
$\"XQuang$ <\/p>\n
$\"Ph\u1ed5i$ <\/p>\n
\u0110\u00f4ng \u0111\u1eb7c ph\u1ed5i \u0111\u1ed3ng nh\u1ea5t v\u00e0 \u0111\u00f4ng \u0111\u1eb7c ph\u1ed5i ho\u1ea1i t\u1eed<\/h2>\n
$\"\u0110\u00f4ng$ <\/p>\n
$\"\u0110\u00f4ng$ <\/p>\n
H\u00ecnh m\u1edd ph\u1ed5i kh\u00f4ng c\u1ea5p t\u00ednh<\/h2>\n
$\"H\u00ecnh$ <\/p>\n
$\"H\u00ecnh$ <\/p>\n
Xquang ng\u1ef1c v\u00e0 h\u00ecnh \u1ea3nh m\u1edd kh\u00f4ng \u0111\u1eb7c hi\u1ec7u<\/h2>\n
$\"Xquang$ <\/p>\n
Ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i b\u1eb1ng h\u00ecnh m\u1edd do l\u1ea5p \u0111\u1ea7y ph\u1ebf nang – T\u00ecnh hu\u1ed1ng<\/h2>\n\n\n\n\n\n
M\u1edd khu tr\u00fa<\/td>\n M\u1edd t\u1ea3n m\u1ea1n (1 h\u1eb7c 2 b\u00ean)<\/td>\n<\/tr>\n
C\u1ea5p t\u00ednh:<\/p>\n
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Vi\u00eam ph\u1ed5i th\u00f9y, ph\u00e2n th\u00f9y \u0111i\u1ec3n h\u00ecnh<\/li>\n
Nh\u1ed3i m\u00e1u ph\u1ed5i sau thuy\u00ean t\u1eafc<\/li>\n<\/ul>\n<\/td>\n
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Ph\u00f9 ph\u1ed5i<\/li>\n
Vi\u00eam ph\u1ed5i (vi khu\u1ea9n, virus, n\u1ea5m)<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
B\u00e1n c\u1ea5p, M\u1ea1n t\u00ednh:<\/p>\n
\n
Lao ph\u1ed5i<\/li>\n
Ung th\u01b0 ph\u1ebf nang khu tr\u00fa – Th\u00e2m nhi\u1ec5m Hodgkin<\/li>\n
Th\u00e2m nhi\u1ec5m mau bay (Loeffler)<\/li>\n<\/ul>\n<\/td>\n
\n
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Protein ph\u1ebf nang (T\u00edch t\u1ee5 b\u1ea5t th\u01b0\u1eddng lipoprotein ph\u1ebf nang) –<\/li>\n
Ung th\u01b0 ph\u1ebf nang t\u1ea3n m\u1ea1n<\/li>\n
N\u1ea5m ph\u1ed5i<\/li>\n
Vi s\u1ecfi ph\u1ebf nang (R\u1ed1i lo\u1ea1n th\u0103ng b\u1eb1ng chuy\u1ec3n h\u00f3a phosphat \u1edf ph\u1ed5i)<\/li>\n
Vi\u00eam ph\u1ed5i m\u1ea1n t\u00ednh t\u0103ng BCAT<\/li>\n
Vi\u00eam ph\u1ed5i tr\u00f3c v\u1ea3y (B\u1ec7nh m\u00f4 k\u1ebd t\u1ef1 ph\u00e1t, desquamative pneumonia)<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
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H\u1ed9i ch\u1ee9ng nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p c\u1ea5p t\u00ednh, Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3<\/li>\n
Tri\u1ec7u ch\u1ee9ng h\u00ecnh \u1ea3nh kh\u00e1c, Tri\u1ec7u ch\u1ee9ng x\u00e9t nghi\u1ec7m<\/li>\n<\/ul>\n
Gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n c\u1ee7a CXR<\/h2>\n
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\u0110\u1ed9 nh\u1ea1y c\u1ee7a ch\u1ee5p X quang ng\u1ef1c \u0111\u01a1n thu\u1ea7n trong vi\u1ec7c ph\u00e1t hi\u1ec7n vi\u00eam ph\u1ed5i l\u00e0 38% \u0111\u1ebfn 76%.<\/li>\n
M\u1eb7c d\u00f9 ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh l\u1ed3ng ng\u1ef1c (CT) \u0111\u01b0\u1ee3c coi l\u00e0 ti\u00eau chu\u1ea9n trong vi\u1ec7c ph\u00e1t hi\u1ec7n vi\u00eam ph\u1ed5i nh\u01b0ng c\u00f3 nh\u1eefng nh\u01b0\u1ee3c \u0111i\u1ec3m kh\u00f4ng c\u00f3 s\u1eb5n v\u00e0 nguy c\u01a1 nhi\u1ec5m x\u1ea1.<\/li>\n
CXR kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng \u0111\u01b0\u1ee3c nh\u00ecn th\u1ea5y tr\u00ean phim ch\u1ee5p X-quang khi vi\u00eam ph\u1ed5i giai \u0111o\u1ea1n s\u1edbm ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng \u1edf v\u1ecb tr\u00ed ph\u1ed5i \u1edf v\u1ecb tr\u00ed k\u00edn \u0111\u00e1o.<\/li>\n<\/ul>\n
Gi\u00e1 tr\u1ecb c\u1ed9ng th\u00eam ch\u1ec9 \u0111\u1ecbnh CT<\/h2>\n
$\"T\u1ed5n$
T\u1ed5n th\u01b0\u01a1ng ph\u00e2n th\u00f9y \u0111\u1ec9nh th\u00f9y d\u01b0\u1edbi tr\u00e1i tr\u00ean phim th\u1eb3ng (A) v\u00e0 nghi\u00eang tr\u00e1i (B)
CT ph\u00e1t hi\u1ec7n th\u00eam t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng ph\u1ebf qu\u1ea3n-ph\u1ebf vi\u00eam \u1edf ph\u1ed5i ph\u1ea3i v\u00e0 th\u00f9y d\u01b0\u1edbi tr\u00e1i ( C, D).<\/figcaption><\/figure>\n\n\n\n\n\n\n\n\n
D\u1ea1ng t\u1ed5n th\u01b0\u01a1ng vi\u00eam ph\u1ed5i<\/td>\n % Ph\u00e1t hi\u1ec7n b\u1eb1ng CXR<\/td>\n % Ph\u00e1t hi\u1ec7n b\u1eb1ng HRCT<\/td>\n<\/tr>\n
T\u1ed5n th\u01b0\u01a1ng khu v\u1ef1c ph\u1ebf nang<\/td>\n 22.2<\/td>\n 3.8<\/td>\n<\/tr>\n
T\u1ed5n th\u01b0\u01a1ng ph\u1ebf qu\u1ea3n-ph\u1ebf nang<\/td>\n 61.1<\/td>\n 84.6<\/td>\n<\/tr>\n
T\u1ed5n th\u01b0\u01a1ng m\u00f4 k\u1ebd<\/td>\n 0<\/td>\n 3.8<\/td>\n<\/tr>\n
D\u1ea1ng k\u1ebft h\u1ee3p \u1edf nhi\u1ec1u th\u00f9y<\/td>\n 16.7<\/td>\n 7.7<\/td>\n<\/tr>\n
T\u1ed5ng<\/td>\n 100.0<\/td>\n 100.0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i th\u1edf m\u00e1y (CPIS – Clinical Pulmonary Infection Score)<\/h2>\n\n\n\n\n\n\n\n\n\n\n
Ti\u00eau chu\u1ea9n<\/td>\n \u0110i\u1ec3m<\/td>\n<\/tr>\n
0<\/td>\n 1<\/td>\n 2<\/td>\n<\/tr>\n
Nhi\u1ec7t \u0111\u1ed9 (\u00baC)<\/td>\n >36\u00ba1 – \u226438\u00ba4<\/td>\n \u226538\u00ba5 – \u226438\u00ba9<\/td>\n \u226436\u00ba1 ho\u1eb7c \u226539\u00ba<\/td>\n<\/tr>\n
B\u1ea1ch c\u1ea7u m\u00e1u \/mm\u00b3<\/td>\n \u22654.000 – \u226411.000<\/td>\n <4.000 ho\u1eb7c >11.000<\/td>\n <4.000 ho\u1eb7c >11.000 v\u1edbi \u226550% \u0111a nh\u00e2n trung t\u00ednh<\/td>\n<\/tr>\n
D\u1ecbch ti\u1ebft kh\u00ed qu\u1ea3n<\/td>\n Kh\u00f4ng<\/td>\n C\u00f3 nh\u01b0ng kh\u00f4ng ph\u1ea3i m\u1ee7<\/td>\n \u0110\u1eddm m\u1ee7<\/td>\n<\/tr>\n
PaO2\/FiO2<\/td>\n >240 ho\u1eb7c ARDS<\/td>\n <\/td>\n \u2264240 v\u00e0 kh\u00f4ng ARDS<\/td>\n<\/tr>\n
X-quang ng\u1ef1c<\/td>\n Kh\u00f4ng th\u00e2m nhi\u1ec5m<\/td>\n C\u00f3 th\u00e2m nhi\u1ec5m ho\u1eb7c m\u1edd lan t\u1ecfa<\/td>\n Th\u00e2m nhi\u1ec5m khu tr\u00fa<\/td>\n<\/tr>\n
C\u1ea5y (\u0111\u1ecbnh l\u01b0\u1ee3ng n\u1ebfu l\u00e0 b\u1ec7nh ph\u1ea9m d\u1ecbch ti\u1ebft \u0111\u01b0\u1eddng th\u1edf)<\/td>\n \u00c2m ho\u1eb7c d\u01b0\u01a1ng t\u00ednh th\u1ea5p<\/td>\n D\u01b0\u01a1ng t\u00ednh: C\u1ed9ng th\u00eam 1 \u0111i\u1ec3m n\u1ebfu k\u1ebft qu\u1ea3 c\u1ea5y c\u00f9ng lo\u1ea1i v\u1edbi nhu\u1ed9m Gram<\/td>\n <\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
*Thang \u0111i\u1ec3m CPIS s\u1eed d\u1ee5ng cho ch\u1ea9n \u0111o\u00e1n ban \u0111\u1ea7u v\u1edbi 5 y\u1ebfu t\u1ed1 (th\u00e2n nhi\u1ec7t, b\u1ea1ch c\u1ea7u m\u00e1u, d\u1ecbch ti\u1ebft kh\u00ed qu\u1ea3n, PaO2\/FiO2, X-quang ng\u1ef1c). Sau 72 gi\u1edd, CPIS c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng 7 y\u1ebfu t\u1ed1: B\u1ed5 sung k\u1ebft qu\u1ea3 c\u1ea5y v\u00e0 ti\u1ebfn tri\u1ec3n tr\u00ean X-quang ng\u1ef1c (h\u00ecnh m\u1edd kh\u00f4ng ti\u1ebfn tri\u1ec3n tr\u00ean X-quang ng\u1ef1c – 0 \u0111i\u1ec3m, c\u00f3 ti\u1ebfn tri\u1ec3n tr\u00ean X-quang ng\u1ef1c kh\u00f4ng ph\u1ea3i do suy tim xung huy\u1ebft hay ARDS – 2 \u0111i\u1ec3m).<\/p>\n
Si\u00eau \u1ea9m ph\u1ed5i<\/h2>\n
$\"Tr\u00ean$
Tr\u00ean si\u00eau \u00e2m b\u00ecnh th\u01b0\u1eddng c\u00f3 th\u1ec3 th\u1ea5y c\u00e1c \u0111\u01b0\u1eddng:
\u0110\u01b0\u1eddng A: L\u00e0 c\u00e1c v\u1ec7t t\u0103ng ph\u1ea3n \u00e2m ch\u1ea1y song song v\u1edbi \u0111\u01b0\u1eddng m\u00e0ng ph\u1ed5i m\u00e0 b\u1ea3n ch\u1ea5t l\u00e0 v\u1ec7t ph\u1ea3n \u00e2m c\u1ee7a m\u00e0ng ph\u1ed5i. \u0110\u01b0\u1eddng B: 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.<\/figcaption><\/figure>\n
Si\u00eau \u00e2m vi\u00eam ph\u1ed5i<\/h2>\n
$\"Vi\u00eam$
Vi\u00eam ph\u1ed5i v\u1edbi t\u1ee5 d\u1ecbch n\u1ebfu s\u00e1t m\u00e0ng ph\u1ed5i c\u00f3 th\u1ec3 th\u1ea5y \u0111\u01b0\u1ee3c tr\u00ean si\u00eau \u00e2m v\u1edbi c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m: i) M\u1ea5t ph\u1ea3n \u00e2m \u0111\u01b0\u1eddng m\u00e0ng ph\u1ed5i v\u00e0 s\u1ebd kh\u00f4ng th\u1ea5y \u0111\u01b0\u1eddng A trong v\u00f9ng vi\u00eam, ii) T\u0103ng \u0111\u01b0\u1eddng B trong khu v\u1ef1c vi\u00eam, iii) \u0110\u01b0\u1eddng B xu\u1ea5t ph\u00e1t t\u1eeb d\u01b0\u1edbi v\u00f9ng vi\u00eam ch\u1ee9 kh\u00f4ng t\u1eeb m\u00e0ng ph\u1ed5i, iv) H\u00ecnh ph\u1ebf qu\u1ea3n h\u01a1i s\u1ebd th\u1ec3 hi\u1ec7n d\u1ea1ng v\u1ec7t ph\u1ea3n \u00e2m d\u1ea1ng kh\u00ed chia nh\u00e1nh ki\u1ec3u c\u00e0nh c\u00e2y ho\u1eb7c d\u1ea1ng c\u00e1c ch\u1ea5m t\u0103ng ph\u1ea3n \u00e2m t\u00f9y thu\u1ed9c v\u00e0o m\u1eb7t c\u1eaft si\u00eau \u00e2m \u0111i qua v\u00f9ng t\u1ed5n th\u01b0\u01a1ng. V\u00f9ng \u0111\u00f4ng \u0111\u1eb7c vi\u00eam r\u1ed9ng d\u01b0\u1edbi si\u00eau \u00e2m c\u00f3 bi\u1ec3u hi\u1ec7n gi\u1ed1ng gan (c\u00f3 th\u1ec3 g\u1ecdi l\u00e0 gan h\u00f3a) nh\u01b0ng kh\u00f3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c n\u1ebfu v\u00f9ng \u0111\u00f4ng \u0111\u1eb7c vi\u00eam c\u00f3 k\u00edch th\u01b0\u1edbc nh\u1ecf. N\u1ebfu c\u00f3 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i th\u00ec si\u00eau \u00e2m d\u1ec5 d\u00e0ng ph\u00e1t hi\u1ec7n v\u00e0 nh\u1ea5t l\u00e0 c\u00f3 th\u1ec3 m\u00f4 t\u1ea3 \u0111\u01b0\u1ee3c t\u00ednh thu\u1ea7n nh\u1ea5t hay kh\u00f4ng c\u1ee7a d\u1ecbch v\u00e0 c\u00f3 hay kh\u00f4ng c\u1ea5u tr\u00fac chu\u1ed7i fibrin.<\/figcaption><\/figure>\n
X\u00e9t nghi\u1ec7m th\u01b0\u1eddng quy<\/h2>\n
Khi \u0111i\u1ec1u tr\u1ecb \u1edf c\u1ed9ng \u0111\u1ed3ng<\/p>\n
\u0110\u1ed1i v\u1edbi \u0111a x\u00e9t nghi\u1ec7m s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p VPC\u0110 \u0111i\u1ec1u tr\u1ecb ngo\u00e0i b\u1ec7nh vi\u1ec7n l\u00e0m c\u00e1c l\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft.<\/p>\n
Khi \u0111i\u1ec1u tr\u1ecb \u1edf trong b\u1ec7nh vi\u1ec7n<\/p>\n
T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n c\u1ea7n l\u00e0m ngay c\u00e1c x\u00e9t nghi\u1ec7m: Oxy m\u00e1u (t\u1ed1i thi\u1ec3u c\u0169ng l\u00e0 SpO2), sinh h\u00f3a m\u00e1u (ure, creatinin, protid, \u0111i\u1ec7n gi\u1ea3i), c\u00f4ng th\u1ee9c m\u00e1u, CRP v\u00e0 ch\u1ee9c n\u0103ng gan.<\/p>\n
Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/h2>\n
\n
Ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng vi\u00eam ph\u1ed5i \u0111\u01b0\u1ee3c \u0111\u1eb7t ra khi c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p xu\u1ea5t hi\u1ec7n m\u1ed9t c\u00e1ch c\u1ea5p t\u00ednh (ho, kh\u1ea1c \u0111\u1eddm, kh\u00f3 th\u1edf, nh\u1ea5t l\u00e0 k\u00e8m theo s\u1ed1t), nghe ph\u1ed5i c\u00f3 ti\u1ebfng th\u1edf b\u1ea5t th\u01b0\u1eddng v\u00e0 ran n\u1ed5. Th\u00f4ng th\u01b0\u1eddng l\u00e0 7 ng\u00e0y.<\/li>\n
Ch\u1ea9n \u0111o\u00e1n VPC\u0110 tr\u00ean b\u1ec7nh nh\u00e2n khi nh\u1eadp vi\u1ec7n c\u1ea7n c\u00f3 Xquang ng\u1ef1c v\u1edbi h\u00ecnh m\u1edd th\u00e2m nhi\u1ec5m m\u1edbi kh\u00f4ng l\u00fd gi\u1ea3i do m\u1ed9t b\u1ec7nh l\u00fd n\u00e0o kh\u00e1c v\u00e0 ch\u1ea9n \u0111o\u00e1n VPC\u0110 l\u00e0 l\u00fd do \u0111\u1ea7u ti\u00ean khi\u1ebfn b\u1ec7nh nh\u1eadn nh\u1eadp vi\u1ec7n.<\/li>\n
Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t VPC\u0110 lu\u00f4n c\u1ea7n \u0111\u1eb7t ra v\u1edbi 2 t\u00ecnh hu\u1ed1ng: Vi\u00eam ph\u1ed5i kh\u00f4ng do t\u00e1c nh\u00e2n vi sinh th\u00f4ng th\u01b0\u1eddng (th\u00ed d\u1ee5 lao, n\u1ea5m, k\u00fd sinh tr\u00f9ng) v\u00e0 tri\u1ec7u ch\u1ee9ng gi\u1ea3 vi\u00eam ph\u1ed5i c\u1ee7a m\u1ed9t b\u1ec7nh l\u00fd kh\u00e1c, \u0111\u1eb7c bi\u1ec7t l\u00e0 b\u1ec7nh tim-m\u1ea1ch (thuy\u00ean t\u1eafc ph\u1ed5i, nh\u1ed3i m\u00e1u ph\u1ed5i, suy tim xung huy\u1ebft, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i).<\/li>\n<\/ul>\n
\u0110\u00e1nh gi\u00e1<\/h2>\n
\n
T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n khi \u0111\u00e1nh gi\u00e1 \u1edf c\u1ed9ng \u0111\u1ed3ng c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng thang \u0111i\u1ec3m CRB-65 ho\u1eb7c CURB-65.<\/li>\n
\u1ede c\u00e1c \u0111\u01a1n v\u1ecb ti\u1ebfp nh\u1eadn c\u1ea5p c\u1ee9u n\u00ean s\u1eed d\u1ee5ng c\u00e1c ti\u00eau chu\u1ea9n \u0111\u00e1nh gi\u00e1 n\u1eb7ng c\u1ee7a H\u1ed9i l\u1ed3ng ng\u1ef1c M\u1ef9 (ATS) hay SCAP.<\/li>\n
\u1ede c\u00e1c khoa \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa n\u00ean s\u1eed d\u1ee5ng thang \u0111i\u1ec3m n\u1eb7ng PSI (pneumonia severity index).<\/li>\n<\/ul>\n
Chi\u1ebfn l\u01b0\u1ee3c Kh\u00e1ng sinh trong vi\u00eam ph\u1ed5i<\/h2>\n
Vi sinh g\u00e2y b\u1ec7nh trong vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng<\/h3>\n
$\"Vi$ <\/p>\n
C\u0103n nguy\u00ean vi sinh v\u00e0 tu\u1ed5i (28)<\/h3>\n
$\"C\u0103n$
C\u0103n nguy\u00ean vi sinh v\u00e0 tu\u1ed5i (28)<\/figcaption><\/figure>\n
Vi khu\u1ea9n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh (Atypical Pathogens) trong VPC\u0110<\/h3>\n
\n
Kho\u1ea3ng 20 – 30% c\u00e1c tr\u01b0\u1eddng h\u1ee3p (t\u1ef7 l\u1ec7 th\u1ef1c kh\u00f3 x\u00e1c \u0111\u1ecbnh) (3)<\/li>\n
Chi\u1ebfm t\u1ef7 l\u1ec7 cao h\u01a1n c\u00f3 \u00fd ngh\u0129a tr\u00ean b\u1ec7nh nh\u00e2n kh\u00f4ng nh\u1eadp vi\u1ec7n, \u1edf ng\u01b0\u1eddi tr\u1ebb (3). Tr\u00ean tr\u1ebb nh\u1eadp vi\u1ec7n c\u00f3 t\u1ef7 l\u1ec7 nhi\u1ec5m cao c\u00f3 \u00fd ngh\u0129a (4).<\/li>\n
R\u1ea5t th\u01b0\u1eddng g\u1eb7p \u0111\u1ed3ng nhi\u1ec5m (co-infection) (3,4)<\/li>\n
M. pneumoniae hay g\u1eb7p nh\u1ea5t (4,5).<\/li>\n
L. pneumophila kho\u1ea3ng 1 – 4% (hay g\u1eb7p tr\u00ean b\u1ec7nh nh\u00e2n n\u1eb7ng, nh\u1eadp vi\u1ec7n) (3).<\/li>\n<\/ul>\n
Kh\u00e1ng thu\u1ed1c trong vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng<\/h2>\n
T\u00e1c \u0111\u1ed9ng kh\u00e1ng sinh v\u00e0 c\u01a1 ch\u1ebf \u0111\u1ec1 kh\u00e1ng<\/h3>\n
$\"T\u00e1c$
T\u00e1c \u0111\u1ed9ng kh\u00e1ng sinh v\u00e0 c\u01a1 ch\u1ebf \u0111\u1ec1 kh\u00e1ng<\/figcaption><\/figure>\n
S.pneumoniae kh\u00e1ng thu\u1ed1c<\/h4>\n
\n
Kho\u1ea3ng 10% c\u00e1c tr\u01b0\u1eddng h\u1ee3p nh\u1eadp vi\u1ec7n c\u00f3 MIC PNC >4 mcg\/mL (6).<\/li>\n
Hi\u1ec7n nay b\u1eb1ng ch\u1ee9ng kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 cho th\u1ea5y r\u1eb1ng m\u1eb7c d\u00f9 kh\u00e1ng thu\u1ed1c PNC l\u00e0 ph\u1ed5 bi\u1ebfn nh\u01b0ng kh\u00f4ng t\u1ea1o ra s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a tr\u00ean k\u1ebft c\u1ee5c (6).<\/li>\n
Kh\u00f4ng c\u00f3 kh\u00e1ng v\u1edbi b\u1eb1ng ch\u1ee9ng \u0111\u00e1ng tin c\u1eady x\u00e1c \u0111\u1ecbnh c\u00f3 m\u1ed1i li\u00ean quan gi\u1eefa MCL v\u00e0 th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb (6).<\/li>\n
\u0110\u00e3 c\u00f3 gia t\u0103ng nhanh kh\u00e1ng FQ trong kho\u1ea3ng 1 th\u1eadp ni\u00ean v\u1eeba qua (6). M\u1ee9c \u0111\u1ed9 li\u00ean quan l\u00e2m s\u00e0ng c\u1ee7a t\u00ecnh tr\u1ea1ng kh\u00e1ng c\u00f2n ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft ch\u00ednh x\u00e1c (7).<\/li>\n<\/ul>\n
S.pneumoniae kh\u00e1ng PNC \u1edf Vi\u1ec7t Nam<\/h4>\n
\n
2008 – 2009 (Nghi\u00ean c\u1ee9u ANSORP, b\u1ec7nh vi\u1ec7n): S.pneumoniae (kh\u00f4ng vi\u00eam m\u00e0ng n\u00e3o) kh\u00e1ng PNC 0% (v\u1edbi MIC90 l\u00e0 2 mcg\/mL) (8)<\/li>\n
2009 – 2011 (Nghi\u00ean c\u1ee9u SOAR, c\u1ed9ng \u0111\u1ed3ng v\u00e0 b\u1ec7nh vi\u1ec7n): S.pneumoniae (kh\u00f4ng vi\u00eam m\u00e0ng n\u00e3o) kh\u00e1ng PNC 30,4% (v\u1edbi MIC90 l\u00e0 3 mcg\/mL) (9).<\/li>\n
2018 (Nghi\u00ean c\u1ee9u AECRI, c\u1ed9ng \u0111\u1ed3ng): S.pneumoniae (nhi\u1ec5m khu\u1ea9n h\u00f4 h\u1ea5p d\u01b0\u1edbi, kh\u00f4ng vi\u00eam m\u00e0ng n\u00e3o) kh\u00e1ng PNC 18,5% (v\u1edbi MIC90 l\u00e0 4 mcg\/mL) (10).<\/li>\n<\/ul>\n
T\u00ecnh nh\u1eady c\u1ea3m kh\u00e1ng sinh c\u1ee7a S.Pneumoniae \u1edf Vi\u1ec7t Nam (2009-2011) t\u1eeb NC SOAR (32)<\/h2>\n
$\"T\u00ecnh$ <\/p>\n
S.pneumoniae kh\u00e1ng Fluoroquinolone \u1edf Canada (7)<\/h3>\n
$\"S.pneumoniae$ <\/p>\n
S.pneumoniae kh\u00e1ng Fluoroquinolone \u1edf Vi\u1ec7t Nam<\/h3>\n\n\n\n\n\n\n
<\/td>\n Levofloxacin (T\u1ef7 l\u1ec7 kh\u00e1ng)<\/td>\n Moxifloxacin (T\u1ef7 l\u1ec7 kh\u00e1ng)<\/td>\n<\/tr>\n
2008 – 2009
\n(Nghi\u00ean c\u1ee9u ANSORP, b\u1ec7nh vi\u1ec7n) (8)<\/td>\n 1,7%<\/td>\n 0,4%<\/td>\n<\/tr>\n
2009 – 2011
\n(Nghi\u00ean c\u1ee9u SOAR, c\u1ed9ng \u0111\u1ed3ng v\u00e0 b\u1ec7nh vi\u1ec7n) (9)<\/td>\n 9,9%<\/td>\n 6,8%<\/td>\n<\/tr>\n
2018
\n(Nghi\u00ean c\u1ee9u AECRI, c\u1ed9ng \u0111\u1ed3ng) (10)<\/td>\n 29,2%<\/td>\n 4,8%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
C\u01a1 ch\u1ebf g\u00e2y b\u1ec7nh vi khu\u1ea9n: Kh\u00f4ng ph\u1ed5 bi\u1ebfn hay kh\u00e1ng thu\u1ed1c<\/h2>\n
$\"C\u01a1$ <\/p>\n
PES (P. aeruginosa, ESBL Enterobacteriaceae Methicillin-resistant S. aureus)<\/h3>\n
\n
T\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh kh\u00f4ng ph\u1ed5 bi\u1ebfn.<\/li>\n
Kh\u00f4ng \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp t\u1edbi trong c\u00e1c thang \u0111i\u1ec3m n\u1eb7ng.<\/li>\n
T\u1ef7 l\u1ec7 m\u1eafc th\u1ea5p v\u00e0 thay \u0111\u1ed5i gi\u1eefa c\u00e1c khu v\u1ef1c.<\/li>\n
Th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 c\u01a1 \u0111\u1ecba x\u1ea5u: gi\u00e0, c\u00f3 b\u1ec7nh m\u1ea1n t\u00ednh, gi\u1ea3m ch\u1ee9c n\u0103ng, suy gi\u1ea3m mi\u1ec5n d\u1ecbch, th\u01b0\u1eddng xuy\u00ean nh\u1eadp vi\u1ec7n, s\u1eed d\u1ee5ng kh\u00e1ng sinh tr\u01b0\u1edbc \u0111\u00f3.<\/li>\n<\/ul>\n
HCAP v\u00e0 c\u00e1c thang \u0111i\u1ec3m d\u1ef1 \u0111o\u00e1n kh\u00e1ng thu\u1ed1c<\/h2>\n
$\"HCAP$ <\/p>\n
$\"HCAP$ <\/p>\n
$\"K\u1ebft$
K\u1ebft qu\u1ea3 ph\u00e2n t\u00edch h\u1ed3i quy Kh\u00e1ng Penicillin v\u00e0 Cefotaxime v\u00e0 T\u1eed vong CAP do S.pneumoniae nh\u1eadp vi\u1ec7n, 1995 – 1997 (M\u1ef9) (18)<\/figcaption><\/figure>\n
T\u00e1c \u0111\u1ed9ng t\u1eeb vi sinh\/m\u1ee9c \u0111\u1ed9 n\u1eb7ng (11)<\/h2>\n
$\"T\u00e1c$ <\/p>\n
Nguy c\u01a1 nhi\u1ec5m tr\u1ef1c khu\u1ea9n gram (-)<\/h2>\n
$\"Nguy$ <\/p>\n
Ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb l\u00fd trong vi\u00eam kh\u00e1ng sinh h\u1ee3p ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng<\/h2>\n
Key note: L\u00e2m s\u00e0ng v\u00e0 vi sinh g\u00e2y b\u1ec7nh<\/h3>\n
\n
Tu\u1ed5i t\u0103ng v\u00e0 m\u1ee9c \u0111\u1ed9 n\u1eb7ng t\u0103ng l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c vi sinh g\u00e2y b\u1ec7nh, g\u1ed3m c\u1ea3 virus, vi khu\u1ea9n v\u00e0 k\u1ebft h\u1ee3p virus-vi khu\u1ea9n (1).<\/li>\n
Vai tr\u00f2 vi khu\u1ea9n g\u00e2y b\u1ec7nh kh\u00f4ng \u0111i\u1ec3n h\u00ecnh quan tr\u1ecdng h\u01a1n \u0111i\u1ec1u ch\u00fang \u0111\u00e3 ngh\u0129 v\u00e0 tr\u1ecb li\u1ec7u kinh nghi\u1ec7m h\u01b0\u1edbng thi\u1ebft (2,3), nh\u1ea5t l\u00e0 trong b\u1ec7nh c\u1ea3nh n\u1eb7ng t\u1edbi nh\u00f3m vi khu\u1ea9n n\u00e0y l\u00e0 c\u1ea7n nh\u1eadp vi\u1ec7n (Legionallae) (4).<\/li>\n
Ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh kinh nghi\u1ec7m c\u1ea7n d\u1ef1a tr\u00ean \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng. \u0110\u00e2y l\u00e0 quan \u0111i\u1ec3m r\u1ea5t h\u1ee3p l\u00fd v\u1ec1 m\u1eb7t vi sinh g\u00e2y b\u1ec7nh. C\u1ea7n xu\u1ed1ng thang khi l\u00e0m s\u00e0ng c\u1ea3i thi\u1ec7n v\u00e0 c\u00f3 b\u1eb1ng ch\u1ee9ng vi tr\u00f9ng h\u1ecdc (4).<\/li>\n<\/ul>\n
Ti\u1ebfp c\u1eadn kh\u00e1ng sinh kinh nghi\u1ec7m v\u1edbi vai tr\u00f2 BIOMARKER<\/h3>\n
\n
R\u00f5 r\u00e0ng, vi\u1ec7c theo d\u00f5i \u0111\u1ed9ng h\u1ecdc biomarker l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 ph\u1ee5 tr\u1ee3 h\u1eefu \u00edch cho vi\u1ec7c l\u1ef1a ch\u1ecdn nhanh ch\u00f3ng c\u00e1c li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb tr\u00ean t\u1eebng tr\u01b0\u1eddng h\u1ee3p CAP<\/li>\n
Nguy c\u01a1 nhi\u1ec5m P.aeruginosa: C-reactive protein <12.35 mg\/dL(14)<\/li>\n<\/ul>\n
BC m\u00e1u, CRP v\u00e0 PCT d\u1ef1 \u0111o\u00e1n vi sinh g\u00e2y b\u1ec7nh (16)<\/h3>\n
$\"BC$ <\/p>\n
Hi\u1ec7u qu\u1ea3 T\/MIC v\u1edbi BETALACTAM (tr\u00ean s\u00fac v\u1eadt th\u00ed nghi\u1ec7m) (29)<\/h3>\n
$\"Hi\u1ec7u$ <\/p>\n
Ch\u1ecdn li\u1ec1u Amoxicilline theo PK\/PD (T\/MIC)<\/h3>\n
$\"Ch\u1ecdn$ <\/p>\n
$\"H.$
H. Influenzae kh\u00e1ng thu\u1ed1c to\u00e0n c\u1ea7u (n=8.523 m\u1eabu) (30)<\/figcaption><\/figure>\n
$\"Ph\u00e2n$
Ph\u00e2n b\u1ed1 t\u1ef7 l\u1ec7 H.influenzae theo MIC (M\u0169i t\u00ean ch\u1ec9 PK\/PD breakpoints)<\/figcaption><\/figure>\n
$\"K\u1ebeT$
K\u1ebeT H\u1ee2P KH\u00c1NG SINH Amoxicillin + Clarithromycin<\/figcaption><\/figure>\n
T\u00e1c \u0111\u1ed9ng c\u1ee7a MCL tr\u00ean t\u1eed vong CAP SEPSIS n\u1eb7ng (24)<\/h2>\n
$\"T\u00e1c$ <\/p>\n
$\"T\u00e1c$ <\/p>\n
Th\u00f4ng s\u1ed1 PK\/PD v\u00e0 Nguy c\u01a1 xu\u1ea5t hi\u1ec7n kh\u00e1ng thu\u1ed1c v\u1edbi Fluoroquinolones (31)<\/h3>\n
T\u1ef7 l\u1ec7 xu\u1ea5t hi\u1ec7n kh\u00e1ng thu\u1ed1c<\/p>\n\n\n\n\n\n\n
AUC\/MIC 24-hr<\/td>\n P. aeruginosa<\/td>\n Other GNB<\/td>\n<\/tr>\n
<100 – \u0110\u01a1n tr\u1ecb li\u1ec7u<\/td>\n 80%<\/td>\n 100%<\/td>\n<\/tr>\n
>100 – \u0110\u01a1n tr\u1ecb li\u1ec7u<\/td>\n 33%<\/td>\n 10%<\/td>\n<\/tr>\n
Tr\u1ecb li\u1ec7u k\u1ebft h\u1ee3p<\/td>\n 11%<\/td>\n 0%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Nh\u00ecn t\u1eeb b\u1eb1ng ch\u1ee9ng v\u00e0 c\u00e1c Guideline \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh trong VPC\u0110<\/h2>\n
Vai tr\u00f2 FQ kinh nghi\u1ec7m v\u1edbi ATYPICAL PATHOGENS<\/h3>\n
Kh\u00f4ng c\u00f3 l\u1ee3i \u00edch v\u1ec1 t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t ho\u1eb7c hi\u1ec7u qu\u1ea3 l\u00e2m s\u00e0ng \u1edf b\u1ec7nh nh\u00e2n CAP nh\u1eadp vi\u1ec7n khi \u0111i\u1ec1u tr\u1ecb bao v\u00e2y AP. K\u1ebft lu\u1eadn n\u00e0y ch\u1ee7 y\u1ebfu d\u1ef1a tr\u00ean so s\u00e1nh \u0111\u01a1n tr\u1ecb li\u1ec7u quinolon v\u1edbi beta-lactam. C\u00e1c th\u1eed nghi\u1ec7m ti\u1ebfp theo, so s\u00e1nh \u0111\u01a1n tr\u1ecb li\u1ec7u beta-lactam v\u1edbi c\u00f9ng m\u1ed9t \u0111\u01a1n tr\u1ecb li\u1ec7u k\u1ebft h\u1ee3p v\u1edbi macrolide, n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n (19).<\/p>\n
$\"Vai$ <\/p>\n
Kh\u00e1ng sinh kinh nghi\u1ec7m t\u1eeb c\u00e1c Guidline qu\u1ed1c t\u1ebf<\/h3>\n
$\"Kh\u00e1ng$ <\/p>\n
$\"Ti\u1ebfp$
Ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb CAP n\u1eb7ng<\/figcaption><\/figure>\n
Chi\u1ebfn l\u01b0\u1ee3c ti\u1ebfp c\u1eadn kh\u00e1ng sinh<\/h3>\n
\n
Tr\u1ecb li\u1ec7u kh\u00e1ng sinh kinh nghi\u1ec7m h\u01b0\u1edbng t\u1edbi vi khu\u1ea9n S.pneumonia, H.influenza. L\u01b0u \u00fd \u0111\u1eb7c t\u00ednh kh\u00e1ng thu\u1ed1c g\u00e2y b\u1ec7nh ph\u1ed5 bi\u1ebfn: \u1edf Vi\u1ec7t Nam.<\/li>\n
C\u1ea7n \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng v\u00e0 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh k\u1ebft h\u1ee3p trong t\u00ecnh tr\u1ea1ng n\u1eb7ng h\u01b0\u1edbng t\u1edbi bao v\u00e2y L. pneumophila.<\/li>\n
C\u1ea7n x\u00e1c \u0111\u1ecbnh y\u1ebfu t\u1ed1 nguy c\u01a1 nhi\u1ec5m TKGr \u00e2m v\u00e0 S.aureus v\u00e0 \u0111i\u1ec1u tr\u1ecb bao v\u00e2y c\u00e1c t\u00e1c nh\u00e2n n\u00e0y, nh\u1ea5t l\u00e0 tr\u00ean nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng. X\u00e9t nghi\u1ec7m vi sinh tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng kh\u00e1ng sinh l\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft.<\/li>\n
S\u1eed d\u1ee5ng c\u00e1c biomarker trong th\u1ef1c \u0111o\u00e1n, theo d\u00f5i k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb v\u00e0 ti\u1ebfn h\u00e0nh l\u00e2m s\u00e0ng \u0111\u1ec3 \u0111\u1ecbnh h\u01b0\u1edbng ch\u1ea9n l\u01b0\u1ee3ng l\u00e0 h\u1eefu \u00edch.<\/li>\n
C\u1ea7n c\u00f3 s\u1ed1 li\u1ec7u t\u00ecnh h\u00ecnh nh\u1eady c\u1ea3m kh\u00e1ng sinh t\u1ea1i ph\u01b0\u01a1ng.<\/li>\n<\/ul>\n
$\"\u0110i\u1ec1u$ <\/p>\n
$\"\u0110i\u1ec1u$ $\"\u0110i\u1ec1u$ <\/p>\n
\u0110i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i<\/h2>\n
$\"\u0110i\u1ec1u$
\u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh kinh nghi\u1ec7m<\/figcaption><\/figure>\n
T\u00e0i li\u1ec7u tham kh\u1ea3o trong b\u00e1o c\u00e1o<\/h2>\n
\n
Richard R. Watkins et al. Diagnosis and Management of Community-Acquired Pneumonia in Adults. American Family Physician. Volume 83, Number 11, June 1, 2011<\/li>\n
M. Woodhead et al. Guidelines for the management of adult lower respiratory tract infections \u2013 Summary. Clin Microbiol Infect 2011; 17 (Suppl. 6): 1\u201324<\/li>\n
Yun Yu, Aihua Fei. Atypical pathogen infection in community-acquired pneumonia. BioScience Trends. 2016; 10(1):7-13.<\/li>\n
Huong et al. First report on prevalence and risk factors of severe atypical pneumonia in Vietnamese children aged 1\u201315 years. BMC Public Health 2014, 14:1304<\/li>\n
Yun-Fong Nge et al. An Asian study on the prevalence of atypical respiratory pathogens in community-acquired pneumonia. International Journal of Infectious Diseases (2005) 9, 144\u2014153<\/li>\n
M. Woodhead. Community-acquired pneumonia in Europe: causative pathogens and resistance patterns. Eur Respir J 2002; 20: Suppl. 36, 20s\u201327s<\/li>\n
Chen DK, McGeer A, de Azavedo JC, Low DE. Decreased susceptibility of pneumoniae to fluoroquinolones in Canada. Canadian Bacterial Surveillance Network. Streptococcus N Engl J Med1999; 341: 233\u2013 239<\/li>\n
So Hyun Kim et al. Changing Trends in Antimicrobial Resistance and Serotypes of Streptococcus pneumoniae Isolates in Asian Countries: an Asian Network for Surveillance of Resistant Pathogens (ANSORP) Study. Antimicrobial Agents and Chemotherapy \u2022 March 2012<\/li>\n
Didem Torumkuney et al. Country data on AMR in Vietnam in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicines and clinical outcome. J Antimicrob Chemother 2022; 77 Suppl 1: i26\u2013i34<\/li>\n
\u0110N S\u1ef9 v\u00e0 cs. X\u00e1c \u0111\u1ecbnh t\u00e1c nh\u00e2n vi sinh g\u00e2y b\u1ec7nh v\u00e0 nh\u1eadn x\u00e9t hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb amoxicillin\/sulbactam tr\u00ean b\u1ec7nh nh\u00e2n NKHHD c\u1ea5p t\u00ednh c\u1ed9ng \u0111\u1ed3ng. Y h\u1ecdc Vi\u1ec7t Nam 1\/2019, t\u1eadp 474, 176.<\/li>\n
Ruiz M, Ewig S, Marcos MA, Martinez JA, Arancibia F, Mensa J, Torres A. Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity. AM J RESPIR CRIT CARE MED 1999;160:397\u20134<\/li>\n
Adrian Ceccato et al. Validation of a Prediction Score for Drug-Resistant Microorganisms in Community-acquired Pneumonia. Ann Am Thorac Soc Vol 18, No 2, pp 257\u2013265, Feb 2021<\/li>\n
Miquel Falguera et al. Risk factors and outcome of community-acquired pneumonia due to Gram-negative bacilli. Respirology (2009) 14, 105\u2013111.<\/li>\n
Cill\u00f3niz C, Gabarr\u00fas A, Ferrer M, et al. Community-acquired pneumonia due to multidrug and non-multidrug resistant Pseudomonas aeruginosa. Chest. 2016;150:415\u201325<\/li>\n
Elena N. Savvateeva et al. Biomarkers of Community-Acquired Pneumonia: A Key to Disease Diagnosis and Management. Hindawi BioMed Research International Volume 2019, Article ID 1701276<\/li>\n
S. Kruger, S. Ewig, J. Papassotiriou et al., \u201cInfammatory \u00a8 parameters predict etiologic patterns but do not allow for individual prediction of etiology in patients with CAP – Results from the German competence network CAPNETZ,\u201d Respiratory Research, vol. 10, no. 1, p. 65, 2009.<\/li>\n
Daniel R. Feikin et al. Mortality From Invasive Pneumococcal Pneumonia in the Era of Antibiotic Resistance, 1995\u20131997. Am J Public Health. 2000;90:223\u2013229.<\/li>\n
Elias C, Moja L, Mertz D, et al. Guideline recommendations and antimicrobial resistance: the need for a change. BMJ Open 2017;7:e016264. doi:10.1136\/ bmjopen-2017-016264.<\/li>\n
Eliakim-Raz N et al. Empiric antibiotic coverage of atypical pathogens for community acquired pneumonia in hospitalized adults (Review). Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD004418.<\/li>\n
Oliver van Hecke et al. Implications of Antibiotic Resistance for Patients\u2019 Recovery From Common Infections in the Community: A Systematic Review and Meta-analysis Clinical Infectious Diseases\u00ae 2017;65(3):371\u201382<\/li>\n
Mi Suk Lee et al. Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia. Infect Chemother 2018;50(2):160-198.<\/li>\n
Nayar S, Hasan A, Waghray P, Ramananthan S, Ahdal J, Jain R. Management of communityacquired bacterial pneumonia in adults: Limitations of current antibiotics and future therapies. Lung India 2019;36:525-33.<\/li>\n
Mathias W. Pletz et al. International Perspective on the New 2019 American Thoracic Society\/Infectious Diseases Society of America CommunityAcquired Pneumonia Guideline A Critical Appraisal by a Global Expert Panel. CHEST 2020; 158(5):1912-191<\/li>\n
M.I. Restrepo et al. Impact of macrolide therapy on mortality for patients with severe sepsis due to pneumonia. Eur Respir J 2009; 33: 153\u2013159<\/li>\n
Girish B. Nair et al. Updates on community acquired pneumonia management in the ICU. Pharmacology & Therapeutics 217 (2021) 107663<\/li>\n
Paola Faverio et al. The management of community-acquired pneumonia in the elderly. Eur J Intern Med. 2014 April ; 25(4): 312\u2013319<\/li>\n
Michael S. Niederman. Macrolide-Resistant Pneumococcus in Community-acquired Pneumonia Is There Still a Role for Macrolide Therapy?. American Journal of Respiratory and Critical Care Medicine Volume 191 Number 11 | June 1 2015<\/li>\n
Luyan Shen et al. Community-acquired pneumonia: Trends in and research on drug resistance and advances in new antibiotics. BioScience Trends. 2021; 15(5):266-275.<\/li>\n
Michael R. Jacobs. How can we predict bacterial eradication? . Int J Infect Dis 2003; 7: S13-S20<\/li>\n
Stephen Tristram et al. Antimicrobial Resistance in Haemophilus influenzae. CLINICAL MICROBIOLOGY REVIEWS, Apr. 2007, p. 368\u2013389<\/li>\n
J.K. Thomas et al. Pharmacodynamic Evaluation of Factors Associated with the Bacterial Resistance in Acutely Ill Patients during Therapy. Development of AGENTS AND ANTIMICROBIAL CHEMOTHERAPY, 0066-4804\/98\/$04.0010 Mar. 1998, p. 521\u201352<\/li>\n
D. Torumkuney et al. Results from the Survey of Antibiotic Resistance (SOAR) 2016\u201318 in Vietnam, Cambodia, Singapore and the Philippines: data based on CLSI, EUCAST (dose-specific) and pharmacokinetic\/pharmacodynamic (PK\/PD) breakpoints. J Antimicrob Chemother 2020; 75 Suppl 1: i19\u2013 i42<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"
T\u00e1c gi\u1ea3: Ti\u1ebfn s\u0129 – B\u00e1c s\u0129 Nguy\u1ec5n V\u0103n Th\u00e0nh PCT H\u1ed8I PH\u1ed4I VI\u1ec6T NAM\u00a0 vnras.com\/drug – \u0110\u1ec3 t\u1ea3i file PDF c\u1ee7a b\u00e0i vi\u1ebft H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam ph\u1ed5i, xin vui l\u00f2ng click v\u00e0o link \u1edf \u0111\u00e2y. Thu\u1eadt ng\u1eef ph\u00e2n lo\u1ea1i \u0110\u1ec3 t\u0103ng t\u00ednh \u0111\u1ecbnh h\u01b0\u1edbng t\u00e1c nh\u00e2n vi sinh g\u00e2y […]\n","protected":false},"author":1,"featured_media":34917,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-34807","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/34807","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=34807"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/34807\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/34917"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=34807"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=34807"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=34807"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}

L\u1ea5p \u0111\u1ea7y ph\u1ebf nang<\/h2>\n<\/p>\n

XQuang vi\u00eam ph\u1ed5i k\u1ebd, vi\u00eam ph\u1ed5i d\u1ea1ng k\u00ea<\/h2>\n<\/p>\n

Ph\u1ed5i kh\u00f4ng c\u00f3 h\u00ecnh \u1ea3nh th\u00e2m nhi\u1ec5m vi\u00eam ph\u1ed5i<\/h2>\n<\/p>\n<\/p>\n

\u0110\u00f4ng \u0111\u1eb7c ph\u1ed5i \u0111\u1ed3ng nh\u1ea5t v\u00e0 \u0111\u00f4ng \u0111\u1eb7c ph\u1ed5i ho\u1ea1i t\u1eed<\/h2>\n<\/p>\n<\/p>\n

H\u00ecnh m\u1edd ph\u1ed5i kh\u00f4ng c\u1ea5p t\u00ednh<\/h2>\n<\/p>\n<\/p>\n

Xquang ng\u1ef1c v\u00e0 h\u00ecnh \u1ea3nh m\u1edd kh\u00f4ng \u0111\u1eb7c hi\u1ec7u<\/h2>\n<\/p>\n

Chi\u1ebfn l\u01b0\u1ee3c Kh\u00e1ng sinh trong vi\u00eam ph\u1ed5i<\/h2>\n

Vi sinh g\u00e2y b\u1ec7nh trong vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng<\/h3>\n<\/p>\n

Kh\u00e1ng thu\u1ed1c trong vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng<\/h2>\n

T\u00ecnh nh\u1eady c\u1ea3m kh\u00e1ng sinh c\u1ee7a S.Pneumoniae \u1edf Vi\u1ec7t Nam (2009-2011) t\u1eeb NC SOAR (32)<\/h2>\n<\/p>\n

S.pneumoniae kh\u00e1ng Fluoroquinolone \u1edf Canada (7)<\/h3>\n<\/p>\n

C\u01a1 ch\u1ebf g\u00e2y b\u1ec7nh vi khu\u1ea9n: Kh\u00f4ng ph\u1ed5 bi\u1ebfn hay kh\u00e1ng thu\u1ed1c<\/h2>\n<\/p>\n

T\u00e1c \u0111\u1ed9ng t\u1eeb vi sinh\/m\u1ee9c \u0111\u1ed9 n\u1eb7ng (11)<\/h2>\n<\/p>\n

Nguy c\u01a1 nhi\u1ec5m tr\u1ef1c khu\u1ea9n gram (-)<\/h2>\n<\/p>\n

Ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb l\u00fd trong vi\u00eam kh\u00e1ng sinh h\u1ee3p ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng<\/h2>\n

BC m\u00e1u, CRP v\u00e0 PCT d\u1ef1 \u0111o\u00e1n vi sinh g\u00e2y b\u1ec7nh (16)<\/h3>\n<\/p>\n

Hi\u1ec7u qu\u1ea3 T\/MIC v\u1edbi BETALACTAM (tr\u00ean s\u00fac v\u1eadt th\u00ed nghi\u1ec7m) (29)<\/h3>\n<\/p>\n

T\u00e1c \u0111\u1ed9ng c\u1ee7a MCL tr\u00ean t\u1eed vong CAP SEPSIS n\u1eb7ng (24)<\/h2>\n<\/p>\n<\/p>\n

Nh\u00ecn t\u1eeb b\u1eb1ng ch\u1ee9ng v\u00e0 c\u00e1c Guideline \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh trong VPC\u0110<\/h2>\n

L\u1ea5p \u0111\u1ea7y ph\u1ebf nang<\/h2>\n
$\"L\u1ea5p$ <\/p>\n

XQuang vi\u00eam ph\u1ed5i k\u1ebd, vi\u00eam ph\u1ed5i d\u1ea1ng k\u00ea<\/h2>\n
$\"XQuang$ <\/p>\n

Ph\u1ed5i kh\u00f4ng c\u00f3 h\u00ecnh \u1ea3nh th\u00e2m nhi\u1ec5m vi\u00eam ph\u1ed5i<\/h2>\n
$\"XQuang$ <\/p>\n
$\"Ph\u1ed5i$ <\/p>\n

\u0110\u00f4ng \u0111\u1eb7c ph\u1ed5i \u0111\u1ed3ng nh\u1ea5t v\u00e0 \u0111\u00f4ng \u0111\u1eb7c ph\u1ed5i ho\u1ea1i t\u1eed<\/h2>\n
$\"\u0110\u00f4ng$ <\/p>\n
$\"\u0110\u00f4ng$ <\/p>\n

H\u00ecnh m\u1edd ph\u1ed5i kh\u00f4ng c\u1ea5p t\u00ednh<\/h2>\n
$\"H\u00ecnh$ <\/p>\n
$\"H\u00ecnh$ <\/p>\n

Xquang ng\u1ef1c v\u00e0 h\u00ecnh \u1ea3nh m\u1edd kh\u00f4ng \u0111\u1eb7c hi\u1ec7u<\/h2>\n
$\"Xquang$ <\/p>\n

Vi sinh g\u00e2y b\u1ec7nh trong vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng<\/h3>\n
$\"Vi$ <\/p>\n

T\u00ecnh nh\u1eady c\u1ea3m kh\u00e1ng sinh c\u1ee7a S.Pneumoniae \u1edf Vi\u1ec7t Nam (2009-2011) t\u1eeb NC SOAR (32)<\/h2>\n
$\"T\u00ecnh$ <\/p>\n

S.pneumoniae kh\u00e1ng Fluoroquinolone \u1edf Canada (7)<\/h3>\n
$\"S.pneumoniae$ <\/p>\n

C\u01a1 ch\u1ebf g\u00e2y b\u1ec7nh vi khu\u1ea9n: Kh\u00f4ng ph\u1ed5 bi\u1ebfn hay kh\u00e1ng thu\u1ed1c<\/h2>\n
$\"C\u01a1$ <\/p>\n

T\u00e1c \u0111\u1ed9ng t\u1eeb vi sinh\/m\u1ee9c \u0111\u1ed9 n\u1eb7ng (11)<\/h2>\n
$\"T\u00e1c$ <\/p>\n

Nguy c\u01a1 nhi\u1ec5m tr\u1ef1c khu\u1ea9n gram (-)<\/h2>\n
$\"Nguy$ <\/p>\n

BC m\u00e1u, CRP v\u00e0 PCT d\u1ef1 \u0111o\u00e1n vi sinh g\u00e2y b\u1ec7nh (16)<\/h3>\n
$\"BC$ <\/p>\n

Hi\u1ec7u qu\u1ea3 T\/MIC v\u1edbi BETALACTAM (tr\u00ean s\u00fac v\u1eadt th\u00ed nghi\u1ec7m) (29)<\/h3>\n
$\"Hi\u1ec7u$ <\/p>\n

T\u00e1c \u0111\u1ed9ng c\u1ee7a MCL tr\u00ean t\u1eed vong CAP SEPSIS n\u1eb7ng (24)<\/h2>\n
$\"T\u00e1c$ <\/p>\n
$\"T\u00e1c$ <\/p>\n