Title HƯỚNG DẪN SỬ DỤNG KHÁNG SINH 2024.pdf ✅

oo TMP-SMX: trimethoprim-sulfamethoxazol. oo VK: vi khu�n. oo VPCD: viem ph6i c(mg d6ng. oo VPBV: viem ph6i b�nh vi�n. oo VPTM: viem ph6i tho may. 1. NHIEM KHUAN HO HAP Bang 3.1. Phlm tang nguy oo nhiem vi khu�n da khang, gQ'i y tac nhlm gay b�nh va cJjnh hl16'ng khang sinh kinh nghi�m trong nhiem khuan hO hflp dll&i NHl�M KHUAN E>llONG HO HAP DllOI "'- ..,., 1-Nguy ca thAp 2-Nguy CO' trung binh 3-Nguy ca cao Yiu ti> nguy ca lien quan cham soc y tit/SU' d�ng khang sinh ooKhOng di�u trj t�i cac oo C6 dieu t� tc;3i cac oo si:J y te ooNAm vi�n � 5 ngay va/hoac nhi�u thu ca s6 y t6 trong vong trong vong 90 ngay tru{yc thu�t xam Ian (catheter tinh m�ch trung 90 ngay trooc ooKhong c6 thu thu.)t xam Ian tam, thong d.;:t day/ta trang, d�t n◊i khf ooKhOng dung KS trong ho�c chi xlim Ian toi thieu quan, tho may, dan lllU mang phOi. .. ) vong 90 ngay tnroc (tiem truyen tinh mc;3ch, suy ooOieu tr! nhieu KS ph6 rong, ph6i hQ'p KS th�n mc;3n, l<;>c mau chu ky, g�n day cPAP ... ) ooC6 dung KS trong vong 90 ngay Btnh di kem/£>� ntng lam sang (thang di6m, gla trj) oo< 65 tu6i oo � 65 tu6i ooC6 b�nh kem di;'lc bi�t nhll xa nang, ooKhOng c6 b�nh kem oo C6 b�nh kem ( dai thao doong b�nh ly cau true phoi, giam b�ch cau ooOiem CURB-65 khong kem soat, COPD, suy trung tf nh, suy giam mien djch nang, gian (VPCO) = 0-1 th�n. ung thll, dQt quy ... ) phe quan, khl phe thOng ex>Oiem SOFA= 0 oo Diem CURB-65 (VPCO) = 2-3 ooOiem CURB-65 (VPCO) = 4-5 oo Oiem SOFA= 1 ooOiem SOFA� 2 hoi;ic Sepsis . E>jnh hoong tac nhan gay btnh 00 Th� gap cac VK ooNguy oo nhiem VK da khang ooNguy ro cao nhiem VK da khang nhU' a)ng cJ ng, it nguy oo thllCYnQ gap nhll Enterobacteriaceae sinh ESBL, nhiem VK cJa khang nhU' Enterobacteriaceae sinh ESBL Pseudomonas/Acinetobacter, MRSA va Enterobacteriaceae sinh (khang cephalosporin the h� 3) nhO,ng VK si�u khang nhll ESBL, MRSA va MRSA Enterobacteriaceae khang carbapenem, oo Rftt ft nguy oo nhiem cac oo It nguy oo nhiem cac VK Pseudomonas khang carbapenem hoac VK khoog �n men nhU' khOng l�n men nhll Acinetobacter khang carbapenem va Pseudomonas Pseudomonas aeruginosal Enterococcus khang vancomycin aeruginosa/ Acinetobacter baumannii ooC6 nguy oo nhiem nam xlim Ian 6 BN Acinetobacter baumannii oo It nguy oo nhiem nam xam lftn ghep tuy XllNHl�M KHUAN £>l10'NG HO HAP DllOI 1-Nguy ca thAp 2-Nguy ca trung binh 3-Nguy ca cao Khang sinh kinh nghltm gc;,I y oo KS can hU'6'ng den cac ooCan chi djnh nhOng KS c6 oo Can chi djnh cac KS pho r¢ng c6 hoc;1t VK tll' cong dong nhll ho,;1t tinh tren VK sinh ESBL tinh tren Pseudomonas nhU' beta- beta-lactam/U'c che nhllng khong c6/it ho,;tt tinh lactam/(rc che beta-lactamase c6 ho,;tt betalactamase (nhll tren Pseudomonas nhU' tinh tren Pseudomonas ampicillin/sulbactam, carbapnem nh6m 1 (nhlf piperacillin/tazobactam, amoxicillin/ (ertapenem) cefoperazon/sulbactam) ho�c clavulanat) doong ooBeta-lactam/U'c che beta- carbapenem nh6m II (imipenem, u6ng, cephalosporin lactamase meropenem) the M 1,2, macrolid, (nhll ampicillin/sulbactam, Dem tr/ hO,c phol hVP v6'1 moxifloxacin piperacillin/tazobactam) c6 th� aminoglycosid (gentamicin, amikacin) oo H,;1n ch6 SU' d1,mg KS dU'c;>'C h1a chc;>n thay the trong ho�c fluoroquinolon (ciprofloxacin, phO r¢ng c6 ho,;1t tinh m¢t so tinh huong levofloxacin) tren VK sinh ESBL va ooGlycopeptid (vancomycin, oo Khi nghi ngo VK khang m6 n)ng Pseudomonas aeruginosa teicoplanin) chi dung trong (Enterobacteriaceae khang carbapenem, tru'ong hqp nghi nga ho.Jc Acinetobacter khang carbapenem), can oo Khong Gan SU' d1,mg vung djch te MRSA cao nhac phoi hqp colistin (ke ca d,;tng khi thuoc khang nam coChU'a can SU' d1,mg thuoc dung) khang nam oo Khi nghi n¢ VK Enterobacteriaceae khang carbapenem, can nhflc beta- lactam/U'c che beta-lactamase th6 h� m6'i (nhU' ceftazidim/avibactam, imipenem/cilastatin/relebactam) Khi nghi nga Pseudo�onas khang carbapenem, can nhac beta-lactam/U'c che beta-lactamase the h� m6'i (nhlY ceftolozan/tazobactam, ceftazidirn/avibactam, imipenern/cilastatin/relebactam) Khi nghi nga MRSA dung glycopeptid (vancomycin, teicoplanin). Khi nghi nga Enterococcus khang vancomycin, Staphylococcus aureus khang vancomycin, dung linezolid oo Xem xet chi djnh thu6c khang nllm Chu thfch bang: Tham khao each tinh di�m SOFA: https://www.mdcalc.com/seguential-organ-failure- assessment-sofa-score