Đặc điểm và tính kháng kháng sinh của vi khuẩn ở bệnh nhân nhiễm khuẩn huyết do các vi khuẩn gram âm tại Bệnh viện Trung ương Thái Nguyên=Characteristics and antibiotic resistance of bacteria in patients with sepsis caused by gram-negative at Thai Nguyen National Hospital

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Tác giả: Văn Thanh Dương, Thị Quỳnh Nga Lương, Thị Tuyết Nguyễn

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.395-403

Bộ sưu tập: Metadata

ID: 478065

Thêm vào giỏ

Describe some epidemiological, clinical, subclinical characteristics in patients with sepsis caused by gram negative bacteria (GN) and survey the antibiotic resistances of GN bacteria isolated in these patients. Subject and methods: Descriptive and retrospective study on 121 patients diagnosed with sepsis treated at Thai Nguyen National Hospital (2020-2023). Results: The most common pathogens causing sepsis due to GN were E.coli 63 (52.1%) and K.pneumoniae 28 (23.1%). Epidermiological, clinical and subclinical characteristics: diabetes was the comorbidity in patients with the highest rate of 39/121 (32.2%)
fever with chill accounted for the majority 68/121 (56.2 %)
the site of primary infection from the urinary tract accounted for the highest rate of 43/74 (35.5%)
followed by gastrointestinal 15/74 (12.4%)
the most patients with GN bacterial sepsis had WBC >
12 G/l (47.1%), CRP 10 - 150 mg/l (59.3%)
PCT >
1.5 ng/l (80.2%), albumin <
35 g/l 68/85 (80%). E. coli was the most susceptible to carbapenems, nitrofurantoin, piper/taz, fosfomycin, amikacin, tended to be resistant to cephalosporins and quinolones, and was highly resistant to ampicillin and piperacillin. K. pneumoniae was quite susceptible to carbapenems, quinolones, aminoglycosides, amp/sul, fosfomycin, cephalosporins, and was highly resistant to amipicillin, piperacillin, and nitrofurantoin. Recommendation: Patients with clinical signs of shivering with fever and initial infection sites in the urinary or gastrointestinal tracts may be valuable for diagnosis sepsis caused by GN. Initial antibiotic selection should be based on the drug-resistant properties of bacteria according to each country and region.Mô tả một số đặc điểm dịch tễ, lâm sàng, cận lâm sàng ở bệnh nhân (BN) nhiễm khuẩn huyết (NKH) do các vi khuẩn (VK) gram âm (GN) và khảo sát tính kháng kháng sinh của các VK GN phân lập được ở BN NKH. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang, hồi cứu trên 121 BN được chẩn đoán NKH điều trị tại Bệnh viện Trung ương Thái Nguyên (2020- 2023). Kết quả và kết luận: Nghiên cứu 121 BN đủ tiêu chuẩn chẩn đoán NKH, tác nhân gây NKH do VK GN thường gặp nhất là E. coli 63 (52,1%) và K. pneumoniae 28 (23,1%). Các đặc điểm dịch tễ, lâm sàng, cận lâm sàng: đái tháo đường là bệnh nền chiếm tỉ lệ cao nhất 39/121 (32,2%), sốt rét run chiếm đa số 68/121 (56,2 %)
ổ nhiễm trùng khởi điểm (NTKĐ) từ đường tiết niệu chiếm tỉ lệ cao nhất là 43/74 (35,5%)
tiếp theo là tiêu hóa 15/74 (12,4%)
phần lớn bệnh nhân có WBC >
12 G/l (47,1%), CRP 10-150 mg/l (59,3%)
procalcitonin >
1,5 ng/l (80,2%), albumin <
35 g/l 68/85 (80%). E. coli nhạy cảm cao nhất với kháng sinh nhóm carbapenem, nitrofurantoin, piperacillin/tazobactam (piper/taz), fosfomycin, amikacin, xu hướng kháng với cephalosporin và quinolon, kháng cao với ampicillin và piperacillin. K. pneumoniae nhạy cảm khá cao với carbapenem, quinolon, aminoglycosid, ampicillin/sulbactam (amp/sul), fosfomycin, cephalosporin, kháng cao với amipicillin, piperacilin và nitrofurantoin. Khuyến nghị: BN có lâm sàng biểu hiện sốt rét run, ổ NTKĐ từ đường tiết niệu, đường tiêu hóa có thể là dữ liệu có giá trị gợi ý căn nguyên NKH do VK GN. Lựa chọn kháng sinh ban đầu nên dựa vào đặc tính kháng thuốc của VK theo từng quốc gia, vùng, miền.

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