{"id":59430,"date":"2021-08-30T13:25:50","date_gmt":"2021-08-30T06:25:50","guid":{"rendered":"http:\/\/tcvn.gov.vn\/?p=59430"},"modified":"2021-08-30T13:28:38","modified_gmt":"2021-08-30T06:28:38","slug":"canh-bao-dung-khang-sinh-theo-kinh-nghiem-de-dan-toi-lam-dung-thuoc-trong-dieu-tri-covid-19","status":"publish","type":"post","link":"https:\/\/tcvn.gov.vn\/canh-bao-dung-khang-sinh-theo-kinh-nghiem-de-dan-toi-lam-dung-thuoc-trong-dieu-tri-covid-19\/30\/08\/2021\/","title":{"rendered":"C\u1ea3nh b\u00e1o: D\u00f9ng kh\u00e1ng sinh theo kinh nghi\u1ec7m d\u1ec5 d\u1eabn t\u1edbi l\u1ea1m d\u1ee5ng thu\u1ed1c trong \u0111i\u1ec1u tr\u1ecb COVID-19"},"content":{"rendered":"

Theo kinh nghi\u1ec7m c\u00e1c b\u00e1c s\u0129 s\u1ebd s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng sinh tr\u01b0\u1edbc khi c\u00f3 k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3, ch\u00ednh \u0111i\u1ec1u n\u00e0y \u0111\u00e3 d\u1eabn \u0111\u1ebfn vi\u1ec7c l\u1ea1m d\u1ee5ng kh\u00e1ng sinh.<\/strong><\/span><\/p>\n

Theo kinh nghi\u1ec7m c\u00e1c b\u00e1c s\u0129 s\u1ebd s\u1eed d\u1ee5ng kh\u00e1ng sinh tr\u01b0\u1edbc khi c\u00f3 k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3, v\u00ec cho r\u1eb1ng, nhi\u1ec5m khu\u1ea9n n\u1ebfu ch\u1edd \u0111\u1ebfn khi c\u00f3 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m th\u00ec t\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n s\u1ebd chuy\u1ec3n n\u1eb7ng. Ch\u00ednh \u0111i\u1ec1u n\u00e0y \u0111\u00e3 d\u1eabn \u0111\u1ebfn vi\u1ec7c l\u1ea1m d\u1ee5ng kh\u00e1ng sinh.\u00a0Tuy nhi\u00ean, c\u00e1c k\u1ebft qu\u1ea3 t\u1eeb th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng \u0111\u00e3 cho th\u1ea5y t\u1ef7 l\u1ec7 b\u1ed9i nhi\u1ec5m vi\u00eam ph\u1ed5i vi khu\u1ea9n \u1edf b\u1ec7nh nh\u00e2n vi\u00eam ph\u1ed5i do COVID-19 r\u1ea5t th\u1ea5p.<\/span><\/p>\n

\u0110\u00e2y l\u00e0 nghi\u00ean c\u1ee9u quan s\u00e1t t\u1ea1i \u0110\u1ea1i h\u1ecdc Northwestern (M\u1ef9) nh\u1eb1m x\u00e1c \u0111\u1ecbnh t\u1ef7 l\u1ec7 v\u00e0 nguy\u00ean nh\u00e2n b\u1ed9i nhi\u1ec5m t\u1ea1i th\u1eddi \u0111i\u1ec3m \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n, c\u0169ng nh\u01b0 t\u1ef7 l\u1ec7 v\u00e0 nguy\u00ean nh\u00e2n vi\u00eam ph\u1ed5i do th\u1edf m\u00e1y (VAP) tr\u00ean 179 b\u1ec7nh nh\u00e2n m\u1eafc vi\u00eam ph\u1ed5i do COVID-19 n\u1eb7ng c\u1ea7n th\u1edf m\u00e1y.<\/span><\/p>\n

C\u00e1c t\u00e1c gi\u1ea3 \u0111\u00e3 c\u1ea5y vi khu\u1ea9n v\u00e0 ch\u1ea1y x\u00e9t nghi\u1ec7m RT-PCR t\u1eeb 386 m\u1eabu d\u1ecbch r\u1eeda ph\u1ebf qu\u1ea3n c\u1ee7a c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u1ec3 bi\u1ebft \u0111\u01b0\u1ee3c ch\u00ednh x\u00e1c c\u00f3 bao nhi\u00eau vi khu\u1ea9n.\u00a0Ngo\u00e0i ra, h\u1ecd c\u0169ng so s\u00e1nh l\u01b0\u1ee3ng kh\u00e1ng sinh s\u1eed d\u1ee5ng trong th\u1ef1c t\u1ebf v\u00e0 theo khuy\u1ebfn c\u00e1o.<\/span><\/p>\n

K\u1ebft qu\u1ea3, ch\u1ec9 c\u00f3 21% ng\u01b0\u1eddi b\u1ec7nh c\u00f3 b\u1ed9i nhi\u1ec5m vi khu\u1ea9n trong 48 gi\u1edd sau khi \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n; 44% b\u1ec7nh nh\u00e2n m\u1eafc vi\u00eam ph\u1ed5i do th\u1edf m\u00e1y, trong \u0111\u00f3 c\u00f3 20,8% b\u1ec7nh nh\u00e2n m\u1eafc vi\u00eam ph\u1ed5i th\u1edf m\u00e1y do vi khu\u1ea9n kh\u00f3 \u0111i\u1ec1u tr\u1ecb g\u00e2y ra.\u00a0C\u00e1c nh\u00e0 khoa h\u1ecdc khuy\u1ebfn c\u00e1o, \u0111\u1ec3 ch\u1ec9 \u0111\u1ecbnh kh\u00e1ng sinh m\u1ed9t c\u00e1ch h\u1ee3p l\u00fd, c\u00e1c b\u00e1c s\u0129 n\u00ean ti\u1ebfn h\u00e0nh th\u00eam c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111\u00e1nh gi\u00e1 ch\u00ednh x\u00e1c h\u01a1n, thay v\u00ec ch\u1ec9 d\u1ef1a v\u00e0o t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng, ho\u1eb7c v\u00e0o m\u1ed9t s\u1ed1 nguy c\u01a1 c\u1ea9n tr\u1ecdng qu\u00e1 m\u1ee9c (nhi\u1ec5m t\u1ee5 c\u1ea7u v\u00e0ng kh\u00e1ng methicillin, tr\u1ef1c khu\u1ea9n m\u1ee7 xanh ho\u1eb7c vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng). C\u00e1c x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n nhanh r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh vi\u00eam ph\u1ed5i nghi ng\u1edd \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n… \u0111\u1ec3 d\u00f9ng kh\u00e1ng sinh h\u1ee3p l\u00fd.<\/span><\/p>\n

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S\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng sinh tr\u01b0\u1edbc khi c\u00f3 k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3, ch\u00ednh \u0111i\u1ec1u n\u00e0y \u0111\u00e3 d\u1eabn \u0111\u1ebfn vi\u1ec7c l\u1ea1m d\u1ee5ng kh\u00e1ng sinh. \u1ea2nh minh h\u1ecda<\/span><\/strong><\/p>\n<\/div>\n

Trong m\u1ed9t th\u00f4ng c\u00e1o b\u00e1o ch\u00ed, WHO cho bi\u1ebft, t\u1ef7 l\u1ec7 kh\u00e1ng kh\u00e1ng sinh (AMR) cao trong s\u1ed1 c\u00e1c kh\u00e1ng sinh th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nhi\u1ec5m tr\u00f9ng th\u00f4ng th\u01b0\u1eddng, ch\u1eb3ng h\u1ea1n nh\u01b0 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u ho\u1eb7c b\u1ec7nh ti\u00eau ch\u1ea3y. T\u00ecnh tr\u1ea1ng n\u00e0y b\u00e1o \u0111\u1ed9ng nguy c\u01a1 th\u1ebf gi\u1edbi \u0111ang d\u1ea7n h\u1ebft c\u00e1ch hi\u1ec7u qu\u1ea3 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u00e1c lo\u1ea1i b\u1ec7nh n\u00e0y.<\/span><\/p>\n

T\u1ea1i 33 qu\u1ed1c gia ghi nh\u1eadn b\u00e1o c\u00e1o, t\u1ef7 l\u1ec7 kh\u00e1ng v\u1edbi ciprofloxacin, m\u1ed9t lo\u1ea1i kh\u00e1ng sinh th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u, dao \u0111\u1ed9ng t\u1eeb 8.4% \u0111\u1ebfn 92.9%.<\/span><\/p>\n

Xu h\u01b0\u1edbng n\u00e0y s\u1ebd ti\u1ebfp t\u1ee5c gia t\u0103ng do vi\u1ec7c s\u1eed d\u1ee5ng kh\u00f4ng h\u1ee3p l\u00fd thu\u1ed1c kh\u00e1ng sinh trong \u0111\u1ea1i d\u1ecbch COVID-19. Trong khi ch\u1ec9 c\u00f3 m\u1ed9t ph\u1ea7n nh\u1ecf b\u1ec7nh nh\u00e2n COVID-19 c\u1ea7n t\u1edbi kh\u00e1ng sinh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u1ec7c nhi\u1ec5m khu\u1ea9n.<\/span><\/p>\n

Ch\u00fang ta \u0111\u1ec1u bi\u1ebft, COVID-19 l\u00e0 do SARS-CoV-2 g\u00e2y ra, v\u00ec v\u1eady kh\u00e1ng sinh kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng ch\u1ed1ng l\u1ea1i virus. M\u1eb7c d\u00f9 m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n m\u1eafc COVID-19 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh, nh\u01b0ng \u0111\u00f3 l\u00e0 bi\u1ec7n ph\u00e1p d\u00f9ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u00e1c nhi\u1ec5m tr\u00f9ng c\u01a1 h\u1ed9i hay c\u00f2n g\u1ecdi l\u00e0 bi\u1ebfn ch\u1ee9ng do nhi\u1ec5m khu\u1ea9n b\u1ed9i nhi\u1ec5m. Nh\u01b0ng c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u00e0y, vi\u1ec7c d\u00f9ng kh\u00e1ng sinh ph\u1ea3i \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb b\u1edfi c\u00e1c th\u1ea7y thu\u1ed1c, d\u1ef1a tr\u00ean t\u00ecnh tr\u1ea1ng b\u1ec7nh t\u1eadt c\u1ee7a b\u1ec7nh nh\u00e2n t\u1ea1i b\u1ec7nh vi\u1ec7n.<\/span><\/p>\n

Li\u00ean quan t\u1edbi t\u00ecnh tr\u1ea1ng l\u1ea1m d\u1ee5ng kh\u00e1ng sinh, m\u1edbi \u0111\u00e2y WHO \u0111\u00e3 gi\u00fap \u0111\u1ea9y nhanh n\u1ed7 l\u1ef1c nghi\u00ean c\u1ee9u v\u00e0 ph\u00e1t tri\u1ec3n c\u00e1c lo\u1ea1i thu\u1ed1c, vaccine ph\u00f2ng ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb COVID-19. WHO c\u0169ng ban h\u00e0nh h\u01b0\u1edbng d\u1eabn kh\u00f4ng s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p kh\u00e1ng sinh ho\u1eb7c \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph\u00f2ng cho b\u1ec7nh nh\u00e2n m\u1eafc COVID -19 nh\u1eb9 ho\u1eb7c b\u1ec7nh nh\u00e2n nghi ng\u1edd m\u1eafc b\u1ec7nh COVID -19 tr\u1eeb khi c\u00f3 m\u1ed9t ch\u1ec9 \u0111\u1ecbnh l\u00e2m s\u00e0ng ph\u1ea3i s\u1eed d\u1ee5ng kh\u00e1ng sinh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb.<\/span><\/p>\n

T\u1ed5ng gi\u00e1m \u0111\u1ed1c WHO Tedros Adhanom Ghebreyesus c\u1ea3nh b\u00e1o: “Th\u1ebf gi\u1edbi \u0111ang m\u1ea5t kh\u1ea3 n\u0103ng s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1ng sinh c\u1ef1c k\u1ef3 quan tr\u1ecdng. \u0110\u1ea1i d\u1ecbch COVID-19 \u0111\u00e3 l\u00e0m gia t\u0103ng vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh. \u0110i\u1ec1u n\u00e0y s\u1ebd g\u00e2y ra t\u1ef7 l\u1ec7 kh\u00e1ng kh\u00e1ng sinh (AMR) cao h\u01a1n”.<\/span><\/p>\n

G\u1ecdi m\u1ed1i \u0111e d\u1ecda c\u1ee7a t\u00ecnh tr\u1ea1ng kh\u00e1ng kh\u00e1ng sinh l\u00e0 “m\u1ed9t trong nh\u1eefng th\u00e1ch th\u1ee9c c\u1ea5p b\u00e1ch nh\u1ea5t c\u1ee7a th\u1eddi \u0111\u1ea1i”, \u00f4ng Tedros k\u00eau g\u1ecdi th\u1ebf gi\u1edbi t\u00ecm ra m\u00f4 h\u00ecnh m\u1edbi \u0111\u1ec3 khuy\u1ebfn kh\u00edch \u0111\u1ed5i m\u1edbi b\u1ec1n v\u1eefng trong v\u1ea5n \u0111\u1ec1 n\u00e0y nh\u1eb1m b\u1ea3o v\u1ec7 nh\u1eefng th\u00e0nh qu\u1ea3 y t\u1ebf \u0111\u00e3 \u0111\u1ea1t \u0111\u01b0\u1ee3c trong th\u1ebf k\u1ef7 tr\u01b0\u1edbc v\u00e0 b\u1ea3o \u0111\u1ea3m t\u01b0\u01a1ng lai an to\u00e0n.<\/span><\/p>\n

WHO \u0111\u00e3 th\u1ef1c hi\u1ec7n ch\u01b0\u01a1ng tr\u00ecnh b\u00e1o c\u00e1o H\u1ec7 th\u1ed1ng gi\u00e1m s\u00e1t s\u1eed d\u1ee5ng v\u00e0 kh\u00e1ng kh\u00e1ng sinh to\u00e0n c\u1ea7u (GLASS) v\u00e0o n\u0103m 2018. Khi \u0111\u00f3, m\u1edbi ch\u1ec9 c\u00f3 729 khu v\u1ef1c \u1edf 22 qu\u1ed1c gia tham gia v\u00e0o h\u1ec7 th\u1ed1ng gi\u00e1m s\u00e1t n\u00e0y. H\u00e0ng n\u0103m, s\u1ed1 l\u01b0\u1ee3ng qu\u1ed1c gia tham gia h\u1ec7 th\u1ed1ng kh\u1ea3o s\u00e1t \u0111\u00e3 t\u0103ng l\u00ean theo c\u1ea5p s\u1ed1 nh\u00e2n. Ch\u1ec9 trong 3 n\u0103m, GLASS hi\u1ec7n \u0111\u00e3 t\u1ed5ng h\u1ee3p d\u1eef li\u1ec7u t\u1eeb h\u01a1n 64.000 \u0111\u1ecba \u0111i\u1ec3m gi\u00e1m s\u00e1t v\u1edbi h\u01a1n 2 tri\u1ec7u b\u1ec7nh nh\u00e2n \u1edf 66 qu\u1ed1c gia tr\u00ean to\u00e0n th\u1ebf gi\u1edbi.<\/span><\/p>\n

TS. Balkhy – tr\u1ee3 l\u00fd T\u1ed5ng gi\u00e1m \u0111\u1ed1c WHO v\u1ec1 v\u1ea5n \u0111\u1ec1 kh\u00e1ng kh\u00e1ng sinh, cho hay: \u201cH\u01b0\u1edbng d\u1eabn r\u00f5 r\u00e0ng v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh trong \u0111\u1ea1i d\u1ecbch COVID-19 s\u1ebd gi\u00fap c\u00e1c qu\u1ed1c gia v\u01b0\u1ee3t qua COVID-19 hi\u1ec7u qu\u1ea3 v\u00e0 ng\u0103n ch\u1eb7n s\u1ef1 xu\u1ea5t hi\u1ec7n AMR\u201d.<\/span><\/p>\n

TS.Balkhy cho r\u1eb1ng ph\u1ea3i t\u0103ng c\u01b0\u1eddng h\u1ee3p t\u00e1c v\u00e0 \u0111\u1ed1i t\u00e1c to\u00e0n c\u1ea7u, bao g\u1ed3m gi\u1eefa khu v\u1ef1c c\u00f4ng v\u00e0 t\u01b0 nh\u00e2n \u0111\u1ec3 cung c\u1ea5p khuy\u1ebfn kh\u00edch t\u00e0i ch\u00ednh v\u00e0 phi t\u00e0i ch\u00ednh nh\u1eb1m ph\u00e1t tri\u1ec3n c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1ng sinh m\u1edbi.\u00a0Cho \u0111\u1ebfn nay, v\u1eabn ch\u01b0a c\u00f3 thu\u1ed1c n\u00e0o \u0111\u01b0\u1ee3c khuy\u1ebfn ngh\u1ecb \u0111\u1ec3 ng\u0103n ng\u1eeba ho\u1eb7c \u0111i\u1ec1u tr\u1ecb COVID-19 m\u1ed9t c\u00e1ch \u0111\u1eb7c hi\u1ec7u. Nh\u1eefng ng\u01b0\u1eddi b\u1ecb nhi\u1ec5m virus c\u1ea7n \u0111\u01b0\u1ee3c c\u00e1ch ly ch\u0103m s\u00f3c th\u00edch h\u1ee3p \u0111\u1ec3 l\u00e0m gi\u1ea3m v\u00e0 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng. Ng\u01b0\u1eddi b\u1ecb b\u1ec7nh n\u1eb7ng c\u1ea7n \u0111\u01b0\u1ee3c ch\u0103m s\u00f3c h\u1ed7 tr\u1ee3 t\u1ed1i \u01b0u v\u1eabn l\u00e0 bi\u1ec7n ph\u00e1p \u0111ang \u0111\u01b0\u1ee3c th\u1ebf gi\u1edbi \u00e1p d\u1ee5ng \u0111\u1ec3 \u201c\u0111\u1ed1i ph\u00f3\u201d v\u1edbi c\u0103n b\u1ec7nh n\u00e0y.<\/span><\/p>\n

An D\u01b0\u01a1ng<\/strong>\u00a0(T\/h)<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Theo kinh nghi\u1ec7m c\u00e1c b\u00e1c s\u0129 s\u1ebd s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng sinh tr\u01b0\u1edbc khi c\u00f3 k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3, ch\u00ednh \u0111i\u1ec1u n\u00e0y \u0111\u00e3 d\u1eabn \u0111\u1ebfn vi\u1ec7c l\u1ea1m d\u1ee5ng kh\u00e1ng sinh. Theo kinh nghi\u1ec7m c\u00e1c b\u00e1c s\u0129 s\u1ebd s\u1eed d\u1ee5ng kh\u00e1ng sinh tr\u01b0\u1edbc khi c\u00f3 k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3, v\u00ec cho r\u1eb1ng, nhi\u1ec5m khu\u1ea9n […]<\/p>\n","protected":false},"author":5,"featured_media":59431,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[66],"tags":[],"acf":{"linh-vuc":"C\u00e1c l\u0129nh v\u1ef1c kh\u00e1c"},"_links":{"self":[{"href":"https:\/\/tcvn.gov.vn\/wp-json\/wp\/v2\/posts\/59430"}],"collection":[{"href":"https:\/\/tcvn.gov.vn\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tcvn.gov.vn\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tcvn.gov.vn\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/tcvn.gov.vn\/wp-json\/wp\/v2\/comments?post=59430"}],"version-history":[{"count":0,"href":"https:\/\/tcvn.gov.vn\/wp-json\/wp\/v2\/posts\/59430\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tcvn.gov.vn\/wp-json\/wp\/v2\/media\/59431"}],"wp:attachment":[{"href":"https:\/\/tcvn.gov.vn\/wp-json\/wp\/v2\/media?parent=59430"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tcvn.gov.vn\/wp-json\/wp\/v2\/categories?post=59430"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tcvn.gov.vn\/wp-json\/wp\/v2\/tags?post=59430"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}