Thực trạng vi khuẩn đề kháng kháng sinh ở bệnh nhân ung thư tại bệnh viện Ung Bướu Tp. Hồ Chí Minh=The current situation of antibiotic resistance in cancer patients in Ho Chi Minh City Oncology Hospital

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Tác giả: Thị Ngọc Diễm Đỗ, Hoa Hạnh Huỳnh, Trung Lê, Xuân Bính Lê, Thị Hồng Nhung Nguyễn, Thị Khánh Ngọc Nguyễn, Thị Vĩnh Linh Nguyễn, Đình Cường Phạm, Thị Hải Hương Phạm, Văn Tính Phan, Huy Hoàng Trần, Anh Dũng Trương, Thị Thùy Linh Chi Vũ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.141-150

Bộ sưu tập: Metadata

ID: 243461

Thêm vào giỏ

To identify common types of infections in cancer patients, related pathogens, and trends in antibiotic resistance. Method: A retrospective surveillance study was conducted at Ho Chi Minh City Oncology Hospital. Positive microbiological culture results of cancer patients during examination and treatment at the hospital from January 1, 2017 to December 31, 2021 were collected and analyzed using descriptive statistical methods, with Epidata and Stata software for data management and analysis. Results: Over a 5-year period (2017-2021), Ho Chi Minh City Oncology Hospital recorded a total of 7,119 microbiological culture samples, with a positive culture rate of 48.1% (3,422 samples). Among the positive cultures, gram-positive bacteria accounted for 44%, gram-negative bacteria for 54%, and fungi for 2%. Skin/soft tissue infections and surgical site infections had the highest prevalence among infection types (67.5%), while the rates of respiratory tract infections, bloodstream infections, urinary tract infections, and gastrointestinal tract infections were 18.3%, 5.9%, 6.4%, and 1.8%, respectively. Common bacteria found in the hospital: Staphylococcus aureus (22.7%), Escherichia coli (18.5%), Klebsiella sp. (15.1%), Coagulase-negative Staphylococcus (14.6%), and Pseudomonas aeruginosa (12.9%). Regarding multidrug-resistant bacteria, the rate of MRSA increased from 5.9% (in 2017) to 67.1% (in 2021), ESBL-producing E. coli increased from 16.8% (in 2018) to 60.6% (in 2021), and ESBL-producing Klebsiella sp. increased from 6.3% (in 2018) to 47.5% (in 2021). The resistance rates to some antibiotics used in the hospital showed an increasing trend as follows: Amoxicillin + clavulanic acid resistance increased from 49% (in 2017) to 71% (in 2021)
Ceftazidime: from 43.6% (2017) to 53.4% (2021)
Cefepime: from 40.7% (2017) to 50% (2021)
Ciprofloxacin: from 29.3% (2017) to 34.6% (2021)
Colistin: from 0.9% (2017) to 13.7% (2021)
Levofloxacin: from 31% (2017) to 35.1% (2021). The resistance rate to Vancomycin in 2017 was 1.51%, with no cases of Vancomycin resistance recorded in the following years. Conclusion: The isolation rate of multidrug-resistant bacteria and the state of antibiotic resistance in hospitals tend to increase each year. Good coordination is needed between clinical doctors, clinical pharmacists, microbiologists, and infection control specialists to promote intervention activities that help prevent and control antibiotic resistance in cancer patients.Xác định các loại nhiễm khuẩn thường gặp ở bệnh nhân ung thư, các tác nhân gây bệnh liên quan và xu hướng đề kháng kháng sinh. Phương pháp nghiên cứu: Nghiên cứu hồi cứu được thực hiện tại BVUB. Các kết quả cấy vi sinh dương tính của bệnh nhân ung thư trong quá trình thăm khám, điều trị tại bệnh viện từ ngày 01/01/2017 đến ngày 31/12/2021 được thu thập và đưa vào phân tích bằng phương pháp thống kê mô tả, sử dụng phần mềm Epidata và Stata để quản lý và phân tích dữ liệu. Kết quả: Trong vòng 5 năm (2017-2021), BVUB ghi nhận tổng số 7.119 mẫu cấy vi sinh và tỷ lệ cấy dương tính chiếm 48,1% (3422 mẫu). Trong các mẫu cấy dương tính, vi khuẩn gram dương chiếm 44%, vi khuẩn gram âm chiếm 54%, và nấm chiếm 2%. Nhiễm khuẩn da/mô mềm và nhiễm khuẩn vết mổ chiếm tỷ lệ cao nhất trong các loại nhiễm khuẩn (67,5%), tỷ lệ nhiễm khuẩn đường hô hấp, nhiễm khuẩn huyết, nhiễm khuẩn đường tiết niệu và nhiễm khuẩn đường tiêu hóa lần lượt là 18,3%, 5,9%, 6,4% và 1,8%. Các loại vi khuẩn thường gặp tại bệnh viện: Staphylococcus aureus (22,7%), Escherichia coli (18,5%), Klebsiella sp. (15,1%), Staphylococcus coagulase âm (14,6%) và Pseudomonas aeruginosa (12,9%). Đối với các vi khuẩn đa kháng, tỷ lệ MRSA tăng từ 5,9% (năm 2017) lên 67,1% (năm 2021), vi khuẩn E. coli sinh men ESBL tăng từ 16,8% (năm 2018) lên 60,6% (năm 2021) và Klebsiella sp. sinh men ESBL tăng từ 6,3% (năm 2018) lên 47,5% (năm 2021). Tỷ lệ đề kháng một số loại kháng sinh đang được sử dụng tại bệnh viện có xu hướng tăng lên như sau: Amoxicillin + Acid Clavulanic có tỷ lệ đề kháng tăng từ 49% (năm 2017) lên 71% (năm 2021)
Ceftazidime: 43,6% (2017) lên 53,4% (2021)
Cefepime: 40,7% (2017) lên 50% (2021)
Ciprofloxacin: 29,3% (2017) lên 34,6% (2021)
Colistin: 0,9% (2017) lên 13,7% (2021)
Levofloxacin: 31% (2017) lên 35,1% (2021). Tỷ lệ kháng Vancomycin trong năm 2017 là 1,51%, các năm tiếp theo chưa ghi nhận các trường hợp kháng với Vancomycin. Kết luận: Tỷ lệ phân lập các vi khuẩn đa kháng thuốc và thực trạng đề kháng kháng sinh tại bệnh viện có xu hướng tăng dần mỗi năm. Cần có sự phối hợp tốt giữa bác sĩ lâm sàng, dược lâm sàng, vi sinh, kiểm soát nhiễm khuẩn để thúc đẩy các hoạt động can thiệp giúp phòng ngừa và kiểm soát tình trạng kháng kháng sinh ở bệnh nhân ung thư.

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