Giá trị của phương pháp cấy đàm ở bệnh nhân cao tuổi vào đợt cấp bệnh phổi tắc nghẽn mạn tính điều trị nội trú tại Bệnh viện Thống Nhất

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Tác giả: Phạm Trọng Khang Hà, Sĩ Dũng Hồ, Đình Thanh Lê, Thế Hoàng Ngô, Đức Công Nguyễn

Ngôn ngữ: vie

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Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2023

Mô tả vật lý: tr.90

Bộ sưu tập: Metadata

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- Đặt vấn đề: Bệnh phổi tắc nghẽn mạn tính (BPTNMT) là một trong những gánh nặng bệnh tật toàn cầu, với diễn tiến thường gặp nhất là đợt cấp của bệnh thường đi kèm tình trạng nhiễm trùng. Cấy đàm giúp xác định vi khuẩn nhằm điều trị kháng sinh tối ưu cho bệnh nhân.- Mục tiêu: Nghiên cứu giá trị của phương pháp cấy đàm và các yếu tố liên quan ở bệnh nhân cao tuổi vào đợt cấp BPTNMT điều trị nội trú tại khoa Nội Hô hấp của Bệnh viện Thống Nhất từ tháng 10/2019 đến hết tháng 06/2020.- Phương pháp và đối tượng: Nghiên cứu tiến cứu cắt ngang mô tả trên 167 bệnh nhân ≥ 60 tuổi nhập viện vì đợt cấp BPTNMT, được khai thác tiền căn, bệnh sử, triệu chứng lâm sàng và được cấy đàm định lượng, sau đó tiến hành phân tích kết quả cấy đàm.- Kết quả: Tỷ lệ cấy đàm phân lập được tác nhân vi sinh là 25,1%. Bệnh nhân đàm đổi màu có khả năng cấy đàm dương tính cao hơn nhóm còn lại (OR 2,24, KTC 95% 1,08 - 4,65, p = 0,033). Bệnh nhân có mức độ tắc nghẽn nặng và rất nặng (GOLD3 - 4) có tỷ lệ cấy dương tính cao hơn (OR 3,88, KTC 95% 1,42 - 10,59, p = 0,005). Không ghi nhận mối liên quan giữa phân nhóm nguy cơ thấp hoặc cao và tiền căn sử dụng kháng sinh với tỷ lệ cấy đàm dương tính.- Kết luận: Chỉ 1/4 bệnh nhân nhập viện vì đợt cấp BPTNMT có kết quả cấy đàm dương tính. Tỷ lệ nuôi cấy đàm dương tính cao hơn ở bệnh nhân có đàm đổi màu, bệnh nhân tắc nghẽn nặng và rất nặng, trong khi phân nhóm nguy cơ và tiền căn sử dụng kháng không có mối liên quan.Abstract- Background: Chronic obstructive pulmonary disease (COPD) is one of the major global burden ones. The most common course is exacerbation which is often accompanied by infection. Sputum culture helps to identify bacteria for optimal antibiotic treatment.- Objectives: To define the value of sputum culture and associated factors in older patients with exacerbation of COPDwho required inpatient treatment at the Department of Respiratory Medicine of Thong Nhat Hospital from October 2019 to June 2020.- Methods: It was a cross - sectional study in 167 patients ≥ 60 years old who were admitted with exacerbation of COPD. The in vestigation of the medical histories, the symptoms, and the signs in those patients were conducted and their sputum was cultured and analyzed thereafter. - Results: The ratio of positive sputum culture was 25.1%. Patients with changes in sputum color had higher chance of positive culture than others (OR 2,24, CI 95% 1,08 - 4,65, p = 0,033). Patients classified of severe or very severe airflow limitation (GOLD 3 - 4) were at higher chance of positive culture test (OR 3,88, CI 95% 1,42 - 10,59, p = 0,005). There was no relationship betweenprior use of antibiotics or classification of future risk of exacerbations and results of sputum culture.- Conclusions: Only a quarter of the patients who were admitted with exacerbation of COPD had positive sputum culture results. The positive sputum culture washigher in patients with sputum purulence and inthose with severe or very severe airflow limitation and was not related to prior use of antibiotics or classification of future risk of exacerbations. DOI: 10.59715/pntjmp.1.2.10

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