![\"fosfomycin\"](\"https:\/\/www.hmm88i.com\/drug\/wp-content\/uploads\/2019\/05\/fosfomycin_1.jpg\" "\\"\\"")
Trong b\u1ed1i c\u1ea3nh \u0111\u00f3, B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n \u0111\u00e3 tri\u1ec3n khai ch\u01b0\u01a1ng tr\u00ecnh \u201cQu\u1ea3n l\u00fd s\u1eed d\u1ee5ng kh\u00e1ng sinh\u201d nh\u1eb1m t\u0103ng c\u01b0\u1eddng s\u1eed d\u1ee5ng h\u1ee3p l\u00fd kh\u00e1ng sinh n\u00f3i chung v\u00e0 fosfomycin IV n\u00f3i ri\u00eang trong b\u1ec7nh vi\u1ec7n v\u1edbi c\u00e1c quy tr\u00ecnh duy\u1ec7t \u0111\u01a1n ch\u1eb7t ch\u1ebd v\u00e0 h\u01b0\u1edbng d\u1eabn chi ti\u1ebft v\u1ec1 ch\u1ec9 \u0111\u1ecbnh, x\u00e9t nghi\u1ec7m vi sinh, l\u1ef1a ch\u1ecdn ph\u00e1c \u0111\u1ed3 c\u0169ng nh\u01b0 li\u1ec1u d\u00f9ng v\u00e0 c\u00e1ch d\u00f9ng c\u1ee7a fosfomycin IV. Nghi\u00ean c\u1ee9u “\u0110\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 can thi\u1ec7p c\u1ee7a ch\u01b0\u01a1ng tr\u00ecnh qu\u1ea3n l\u00fd kh\u00e1ng sinh v\u1edbi fosfomycin truy\u1ec1n t\u0129nh m\u1ea1ch t\u1ea1i B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n” \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n nh\u1eb1m \u0111\u00e1nh gi\u00e1 t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u00e1c bi\u1ec7n ph\u00e1p can thi\u1ec7p n\u00f3i tr\u00ean \u0111\u1ebfn t\u00ecnh h\u00ecnh ti\u00eau th\u1ee5 c\u0169ng nh\u01b0 vi\u1ec7c s\u1eed d\u1ee5ng fosfomycin IV t\u1ea1i b\u1ec7nh vi\u1ec7n, l\u00e0m c\u01a1 s\u1edf \u0111\u1ec3 ho\u00e0n thi\u1ec7n quy tr\u00ecnh qu\u1ea3n l\u00fd kh\u00e1ng sinh v\u00e0 nh\u00e2n r\u1ed9ng ho\u1ea1t \u0111\u1ed9ng n\u00e0y trong ch\u01b0\u01a1ng tr\u00ecnh qu\u1ea3n l\u00fd kh\u00e1ng sinh c\u1ee7a b\u1ec7nh vi\u1ec7n.<\/p>\n
K\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u cho th\u1ea5y c\u00e1c can thi\u1ec7p t\u1eeb H\u0110T&\u0110T \u0111\u00e3 c\u00f3 t\u00e1c \u0111\u1ed9ng t\u00edch c\u1ef1c l\u00ean ti\u00eau th\u1ee5 fosfomycin IV v\u1edbi xu h\u01b0\u1edbng h\u1ea1n ch\u1ebf s\u1eed d\u1ee5ng trong to\u00e0n vi\u1ec7n, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf kh\u1ed1i ngo\u1ea1i \u0111\u1ec3 t\u1eadp trung \u01b0u ti\u00ean \u0111i\u1ec1u tr\u1ecb c\u00e1c nhi\u1ec5m khu\u1ea9n n\u1eb7ng, nhi\u1ec5m khu\u1ea9n do vi khu\u1ea9n \u0111a kh\u00e1ng, th\u01b0\u1eddng g\u1eb7p t\u1ea1i c\u00e1c \u0111\u01a1n v\u1ecb h\u1ed3i s\u1ee9c. Vi\u1ec7c s\u1eed d\u1ee5ng fosfomycin IV \u0111\u00e3 c\u00f3 c\u1ea3i thi\u1ec7n \u0111\u00e1ng k\u1ec3 v\u1edbi t\u1ef7 l\u1ec7 s\u1eed d\u1ee5ng ch\u1ebf \u0111\u1ed9 li\u1ec1u cao t\u0103ng tr\u00ean 10 l\u1ea7n, t\u1ef7 l\u1ec7 c\u00f3 ch\u1ec9 \u0111\u1ecbnh ph\u00f9 h\u1ee3p v\u00e0 c\u00f3 x\u00e9t nghi\u1ec7m vi sinh tr\u01b0\u1edbc khi d\u00f9ng fosfomycin c\u0169ng t\u0103ng h\u01a1n 4 l\u1ea7n, t\u1ef7 l\u1ec7 s\u1eed d\u1ee5ng fosfomycin l\u00e0 kh\u00e1ng sinh thay th\u1ebf v\u00e0 c\u00f3 ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c kh\u00e1ng sinh kh\u00e1c c\u0169ng t\u0103ng l\u1ea7n l\u01b0\u1ee3t 2,9 v\u00e0 1,5 l\u1ea7n.<\/p>\n
Kinh nghi\u1ec7m r\u00fat ra t\u1eeb nghi\u00ean c\u1ee9u n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng cho c\u00e1c ho\u1ea1t \u0111\u1ed9ng kh\u00e1c c\u1ee7a ch\u01b0\u01a1ng tr\u00ecnh qu\u1ea3n l\u00fd kh\u00e1ng sinh, gi\u00fap b\u1ea3o t\u1ed3n hi\u1ec7u l\u1ef1c c\u1ee7a c\u00e1c kh\u00e1ng sinh d\u1ef1 tr\u1eef tr\u01b0\u1edbc t\u00ecnh tr\u1ea1ng gia t\u0103ng \u0111\u1ec1 kh\u00e1ng kh\u00e1ng sinh c\u1ee7a vi khu\u1ea9n g\u00e2y b\u1ec7nh.<\/p>\n
Nh\u00f3m t\u00e1c gi\u1ea3 T\u1ea0P CH\u00cd D\u01af\u1ee2C H\u1eccC ISSN 0866 – 7861 05\/2019 (S\u1ed1 517 N\u0102M 59).<\/h2>\n\n- NGUY\u1ec4N TH\u1eca L\u1eacP, NGUY\u1ec4N XU\u00c2N B\u1eaeC: T\u1ed5ng quan v\u1ec1 ph\u01b0\u01a1ng ph\u00e1p chuy\u1ec3n gen trong gen tr\u1ecb li\u1ec7u b\u1ec7nh ung th\u01b0.<\/li>\n
- TR\u1ea6N TH\u00c0NH \u0110\u1ea0O, L\u00ca MINH TR\u00cd, L\u1ea0I H\u1ed2NG H\u1ea0NH, HO\u00c0NG VI\u1ebeT NH\u00c2M, NGUY\u1ec4N L\u00ca ANH TU\u1ea4N, MAI TH\u00c0NH T\u1ea4N, PH\u1ea0M TO\u00c0N QUY\u1ec0N, TH\u00c1I KH\u1eaeC MINH: Nghi\u00ean c\u1ee9u x\u00e2y d\u1ef1ng m\u00f4 h\u00ecnh QSAR nh\u1ecb ph\u00e2n v\u00e0 Pharmacophore tr\u00ean c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf cytochrom P450 CYP 2D6.<\/li>\n
- NGUY\u1ec4N L\u00ca TR\u00c0 GIANG, NGUY\u1ec4N L\u00ca S\u01a0N, \u0110INH TH\u1eca OANH, TR\u01af\u01a0NG V\u0102N \u0110\u1ea0T, NGUY\u1ec4N TH\u1ee4Y VI\u1ec6T PH\u01af\u01a0NG: Nghi\u00ean c\u1ee9u kh\u1ea3 n\u0103ng g\u1eafn k\u1ebft v\u00e0 t\u01b0\u01a1ng t\u00e1c c\u1ee7a c\u00e1c h\u1ee3p ch\u1ea5t t\u1ef1 nhi\u00ean tr\u00ean m\u1ed9t s\u1ed1 th\u1ee5 th\u1ec3 kh\u00e1ng s\u1ed1t r\u00e9t.<\/li>\n
- V\u0168 \u0110\u00ccNH H\u00d2A, \u0110\u1eb6NG TH\u1eca LAN ANH, NGUY\u1ec4N HO\u00c0NG ANH B, NGUY\u1ec4N TH\u1eca MAI ANH, L\u00ca TH\u1eca THANH NGA, NGUY\u1ec4N TH\u1eca THANH TH\u1ee6Y, \u0110\u00c0O QUANG MINH, V\u00d5 TH\u1eca THU TH\u1ee6Y, NGUY\u1ec4N HO\u00c0NG ANH: \u0110\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 can thi\u1ec7p c\u1ee7a ch\u01b0\u01a1ng tr\u00ecnh qu\u1ea3n l\u00fd kh\u00e1ng sinh v\u1edbi fosfomycin truy\u1ec1n t\u0129nh m\u1ea1ch t\u1ea1i B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n.<\/li>\n
- NGUY\u1ec4N TH\u00c0NH H\u1ea2I, NGUY\u1ec4N TH\u1eca THANH TUY\u1ec0N: Khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n \u1edf b\u1ec7nh nh\u00e2n suy gi\u1ea3m ch\u1ee9c n\u0103ng gan.<\/li>\n
- NGUY\u1ec4N THANH LAN, NGUY\u1ec4N TH\u1eca THU TH\u1ee6Y: Ph\u00e2n ti\u0301ch chi ph\u00ed \u0111i\u00ea\u0300u tri\u0323 n\u1ed9i tr\u00fa b\u1ec7nh hemophilia A t\u1ea1i B\u00ea\u0323nh vi\u00ea\u0323n Nhi \u0110\u00f4\u0300ng 1.<\/li>\n
- NGUY\u1ec4N TH\u1eca THANH DUY\u00caN, TR\u1ea6N V\u0102N TH\u1eaeNG, NGUY\u1ec4N PH\u00daC NGH\u0128A, \u0110\u00c0M THANH XU\u00c2N, L\u00ca NG\u1eccC KH\u00c1NH, KI\u1ec0U TH\u1eca H\u1ed2NG: B\u01b0\u1edbc \u0111\u1ea7u nghi\u00ean c\u1ee9u b\u00e0o ch\u1ebf m\u00e0ng propranolol d\u00ednh ni\u00eam m\u1ea1c mi\u1ec7ng.<\/li>\n
- \u0110\u1eb6NG TR\u01af\u1edcNG GIANG, NGUY\u1ec4N H\u1eeeU M\u1ef8, NGUY\u1ec4N V\u0102N LONG, NGUY\u1ec4N QU\u1ef2NH HOA, TR\u1ea6N TH\u1eca HI\u1ec6N, V\u0168 B\u00ccNH D\u01af\u01a0NG: X\u00e2y d\u1ef1ng v\u00e0 th\u1ea9m \u0111\u1ecbnh ph\u01b0\u01a1ng ph\u00e1p \u0111\u1ecbnh l\u01b0\u1ee3ng phosphatidyl cholin b\u1eb1ng HPLC.<\/li>\n
- T\u1ea0 M\u1ea0NH H\u00d9NG, NGUY\u1ec4N TH\u1eca DUNG, TR\u1ea6N NGUY\u1ec4N H\u00c0, V\u0168 TH\u00d9Y DUNG: X\u00e2y d\u1ef1ng ph\u01b0\u01a1ng ph\u00e1p LC-MS\/MS ph\u00e2n t\u00edch lisinopril trong huy\u1ebft t\u01b0\u01a1ng ng\u01b0\u1eddi v\u00e0 \u1ee9ng d\u1ee5ng trong nghi\u00ean c\u1ee9u t\u01b0\u01a1ng \u0111\u01b0\u01a1ng sinh h\u1ecdc.<\/li>\n
- \u0110\u1ed6 TH\u1eca THANH TH\u1ee6Y, L\u00ca TR\u1ea6N TI\u1ebeN, NGUY\u00ca\u0303 HA\u0309I NAM, \u0110O\u00c0N CAO S\u01a0N: Tinh ch\u1ebf terazosin l\u00e0m nguy\u00ean li\u1ec7u thi\u1ebft l\u1eadp ch\u1ea5t chu\u1ea9n.<\/li>\n
- PHAN NGUY\u1ec4N TR\u01af\u1edcNG TH\u1eaeNG, H\u00c0 MINH HI\u1ec2N: Nghi\u00ean c\u1ee9u x\u00e2y d\u1ef1ng quy tr\u00ecnh \u0111\u1ecbnh l\u01b0\u1ee3ng butyl hydroxytoluen ch\u1ebf ph\u1ea9m c\u00f3 ch\u1ee9a d\u1ea7u m\u00f9 u b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p HPLC.<\/li>\n
- HU\u1ef2NH NG\u1eccC TRINH, L\u00ca TH\u1eca M\u01afU HU\u1ef2NH, PH\u1ea0M QU\u1ef2NH H\u01af\u01a0NG, HU\u1ef2NH NG\u1eccC TH\u1ee4Y: Kh\u1ea3o s\u00e1t th\u00e0nh ph\u1ea7n h\u00f3a h\u1ecdc v\u00e0 ho\u1ea1t t\u00ednh ch\u1ed1ng oxy h\u00f3a in vitro c\u1ee7a c\u00e1c cao chi\u1ebft t\u1eeb l\u00e1 t\u00eda t\u00f4 thu h\u00e1i t\u1ea1i c\u00e1c \u0111\u1ecba \u0111i\u1ec3m kh\u00e1c nhau.<\/li>\n
- T\u00c0O MAI VINH, \u0110\u1ed6 CH\u00c2U MINH V\u0128NH TH\u1ecc: Nghi\u00ean c\u1ee9u x\u00e2y d\u1ef1ng quy tr\u00ecnh \u0111\u1ecbnh l\u01b0\u1ee3ng ochratoxin A v\u00e0 aflatoxin B1 trong h\u1ea1t c\u00e0 ph\u00ea b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p LC-MS\/MS.<\/li>\n
- NGUY\u1ec4N THANH T\u00d9NG, NGUY\u1ec4N TH\u1eca LUY\u1ebeN, NGUY\u1ec4N TI\u1ebeN \u0110\u1ea0T, NGUY\u1ec4N QUANG H\u01afNG: \u0110\u1eb7c \u0111i\u1ec3m h\u00ecnh th\u00e1i th\u1ef1c v\u1eadt v\u00e0 ba h\u1ee3p ch\u1ea5t lignan ph\u00e2n l\u1eadp t\u1eeb lo\u00e0i d\u00f3 \u0111\u1ea5t (Balanophora fungosa subsp. Indica, (Arnott.) B. Hansen) thu t\u1ea1i Sapa, L\u00e0o Cai.<\/li>\n
- TR\u1ea6N TR\u1eccNG BI\u00caN, NGUY\u1ec4N V\u0102N H\u00c2N: Ph\u1ee9c h\u1ee3p resinat: Ph\u01b0\u01a1ng ph\u00e1p b\u00e0o ch\u1ebf v\u00e0 \u0111\u00e1nh gi\u00e1.<\/li>\n
- L\u00ca H\u1ea2I H\u00c0 LINH, NGUY\u1ec4N NG\u1eccC TH\u1ea2O MY, NGUY\u1ec4N KIM MINH T\u00c2M, NGUY\u1ec4N V\u0102N THANH, NGUY\u1ec4N TH\u1eca CHI, L\u00ca XU\u00c2N TI\u1ebeN:Nghi\u00ean c\u1ee9u quy
\ntr\u00ecnh chi\u1ebft xu\u1ea5t 6-O-benzoylarbutin t\u1eeb l\u00e1 c\u00e2y c\u00f9 \u0111\u1ec1
\n(Breynia vitis-idaea (Burm. f.) C. E. C. Fischer.).<\/li>\n - PH\u1ea0M TH\u1eca THANH TUY\u1ec0N, NGUY\u1ec4N TH\u1eca AN, \u0110INH TH\u1eca THANH H\u1ea2I, TR\u1ea6N TH\u00daY H\u1ea0NH, NGUY\u1ec4N TH\u1eca KI\u1ec0U ANH: Nghi\u00ean c\u1ee9u ph\u00e1t hi\u1ec7n c\u00e1c thu\u1ed1c ch\u1ed1ng d\u1ecb \u1ee9ng tr\u1ed9n tr\u00e1i ph\u00e9p trong ch\u1ebf ph\u1ea9m \u0110\u00f4ng d\u01b0\u1ee3c b\u1eb1ng LC-MS\/MS.<\/li>\n
- TR\u1ea6N KH\u00c1NH DUY, V\u00d5 TH\u1eca B\u1ea0CH HU\u1ec6: X\u00e2y d\u1ef1ng quy tr\u00ecnh \u0111\u1ecbnh l\u01b0\u1ee3ng paeoniflorin trong x\u00edch th\u01b0\u1ee3c b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p HPLC \u2013 PDA.<\/li>\n
- NGUY\u1ec4N QU\u1ed0C DUY, \u0110\u1ed6 CH\u00c2U MINH V\u0128NH TH\u1ecc: Nghi\u00ean c\u1ee9u \u1ee9ng d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p LCMS\/MS x\u00e1c \u0111\u1ecbnh d\u01b0 l\u01b0\u1ee3ng kh\u00e1ng sinh doxycyclin v\u00e0 oxytetrcyclin trong n\u01b0\u1edbc th\u1ea3i ch\u0103n nu\u00f4i v\u00e0 nu\u00f4i tr\u1ed3ng th\u1ee7y s\u1ea3n.<\/li>\n
- NGUY\u1ec4N TH\u1eca MINH H\u1ea0NH, NGUY\u1ec4N HO\u00c0NG TU\u1ea4N, NGUY\u1ec4N V\u0102N H\u00c2N, V\u01af\u01a0NG MINH VI\u1ec6T, HO\u00c0NG KIM K\u1ef2, NGUY\u1ec4N HO\u00c0NG LAN ANH:\u00a0 X\u00e2y d\u1ef1ng v\u00e0 th\u1ea9m \u0111\u1ecbnh ph\u01b0\u01a1ng ph\u00e1p \u0111\u1ecbnh l\u01b0\u1ee3ng diosgenin b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p s\u1eafc k\u00fd l\u1edbp m\u1ecfng hi\u1ec7u n\u0103ng cao (HPTLC).<\/li>\n<\/ol>\n
\u0110\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 can thi\u1ec7p c\u1ee7a ch\u01b0\u01a1ng tr\u00ecnh qu\u1ea3n l\u00fd kh\u00e1ng sinh v\u1edbi fosfomycin truy\u1ec1n t\u0129nh m\u1ea1ch t\u1ea1i B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n<\/p>\n
T\u00e1c gi\u1ea3:<\/p>\n
\n- V\u0169 \u0110\u00ecnh H\u00f2a2 ,<\/li>\n
- \u0110\u1eb7ng Th\u1ecb Lan Anh1 ,<\/li>\n
- Nguy\u1ec5n Ho\u00e0ng Anh B2<\/li>\n
- Nguy\u1ec5n Th\u1ecb Mai Anh1 ,<\/li>\n
- L\u00ea Th\u1ecb Thanh Nga1 ,<\/li>\n
- Nguy\u1ec5n Th\u1ecb Thanh Th\u1ee7y1<\/li>\n
- \u0110\u00e0o Quang Minh1 ,<\/li>\n
- V\u00f5 Th\u1ecb Thu Th\u1ee7y2 ,<\/li>\n
- Nguy\u1ec5n Ho\u00e0ng Anh2*<\/li>\n
- 1 B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n 2 Trung t\u00e2m DI v\u00e0 ADR Qu\u1ed1c gia, Tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc D\u01b0\u1ee3c H\u00e0 N\u1ed9i *E-mail: anh90tk@yahoo.com.<\/li>\n<\/ol>\n
Summary<\/h2>\n
With regard that antibiotic resistance, especially multi-drug resistance, is a growing threat to the public health, and antimicrobial stewardship program (ASP) is recommended to promote rational use of antibiotics including appropriate indication, optimization of the dose, route, and length of treatment, and on the other hand, fosfomycin is considered as the last resource for gram-negative pathogens and therefore emerges as the target of ASP, \u2026the utilization of intravenous fosfomycin in Thanh Nhan Hospital (Hanoi, SRV) from April 2017 to July 2018 was investigated in three periods. The first was non-intervention, the second was the intervention referring to the guidance by the Ministry of Health and the third was the intervention based on the hospital internal guidance. Average fosfomycin consumption was reduced period by period from 0.855 to 0.278 and to 0.457 DDD\/100 patient-day, reppestively. Fosfomycin consumption appeared to be shifted from surgery departments to intensive care units during interventions. Appropriate use of fosfomycin increased up to over 80%. Patients prescribed with high dose fosfomycin and in combination regimens were further elevated to 100 % in the second intervention. The rearrangement of fosfomycin consumption and the impact on prescribing practice suggested that ASP could justify the irrational antibiotic use and therefore improve the infectious disease control in the hospital.<\/p>\n
Keywords: Fosfomycin, antibiotic, consumption, DDD, intervention, Thanh Nhan hospital.<\/p>\n
\u0110\u1eb7t v\u1ea5n \u0111\u1ec1<\/h2>\n
Fosfomycin l\u00e0 kh\u00e1ng sinh c\u00f3 ho\u1ea1t ph\u1ed5 r\u1ed9ng tr\u00ean c\u00e1c vi khu\u1ea9n Gram d\u01b0\u01a1ng v\u00e0 Gram \u00e2m, bao g\u1ed3m c\u1ea3 S. aureus kh\u00e1ng methicillin (MRSA) v\u00e0 vi khu\u1ea9n sinh enzym beta-lactamase ph\u1ed5 r\u1ed9ng (ESBL). Fosfomycin \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch (fosfomycin IV) \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c kh\u00e1ng sinh kh\u00e1c \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u00e1c nhi\u1ec5m khu\u1ea9n n\u1eb7ng do vi khu\u1ea9n \u0111a kh\u00e1ng v\u00e0 c\u00f2n nh\u1ea1y c\u1ea3m v\u1edbi fosfomycin, \u0111\u1eb7c bi\u1ec7t l\u00e0 K. pneumoniae kh\u00e1ng carbapenem [1,2]. G\u1ea7n \u0111\u00e2y, T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi (WHO) v\u00e0 B\u1ed9 Y t\u1ebf Vi\u1ec7t Nam \u0111\u00e3 \u0111\u01b0a fosfomycin IV v\u00e0o danh s\u00e1ch nh\u00f3m c\u00e1c kh\u00e1ng sinh \u201cd\u1ef1 tr\u1eef\u201d c\u1ea7n c\u00f3 chi\u1ebfn l\u01b0\u1ee3c qu\u1ea3n l\u00fd \u0111\u1eb7c bi\u1ec7t [3,4]. Trong b\u1ed1i c\u1ea3nh \u0111\u00f3, B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n c\u00f3 ch\u01b0\u01a1ng tr\u00ecnh \u201cQu\u1ea3n
\nl\u00fd s\u1eed d\u1ee5ng kh\u00e1ng sinh\u201d nh\u1eb1m t\u0103ng c\u01b0\u1eddng s\u1eed d\u1ee5ng h\u1ee3p l\u00fd kh\u00e1ng sinh n\u00f3i chung v\u00e0 fosfomycin IV n\u00f3i ri\u00eang. Ng\u00e0y 26\/3\/2017, H\u1ed9i \u0111\u1ed3ng Thu\u1ed1c v\u00e0 \u0110i\u1ec1u tr\u1ecb c\u1ee7a B\u1ec7nh vi\u1ec7n (H\u0110T&\u0110T) ban h\u00e0nh Quy\u1ebft \u0111\u1ecbnh s\u1ed1 26\/BVTN v\u1edbi \u201cQuy \u0111\u1ecbnh v\u1ec1 qu\u1ea3n l\u00fd s\u1eed d\u1ee5ng kh\u00e1ng
\nsinh trong B\u1ec7nh vi\u1ec7n\u201d, trong \u0111\u00f3 fosfomycin IV l\u00e0 thu\u1ed1c n\u1eb1m trong \u201cDanh m\u1ee5c c\u00e1c kh\u00e1ng sinh ph\u1ea3i ph\u00ea duy\u1ec7t tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng\u201d v\u00e0 c\u1ea7n tu\u00e2n th\u1ee7 quy tr\u00ecnh duy\u1ec7t \u0111\u01a1n ch\u1eb7t ch\u1ebd. Ti\u1ebfp \u0111\u00f3, H\u0110T&\u0110T ti\u1ebfp t\u1ee5c ban h\u00e0nh \u201cH\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng fosfomycin IV t\u1ea1i B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n\u201d k\u00e8m theo Quy\u1ebft \u0111\u1ecbnh s\u1ed1 125\/BVTN ng\u00e0y 26\/6\/2018 v\u1edbi quy \u0111\u1ecbnh chi ti\u1ebft v\u1ec1 ch\u1ec9 \u0111\u1ecbnh, x\u00e9t nghi\u1ec7m vi sinh, l\u1ef1a ch\u1ecdn ph\u00e1c \u0111\u1ed3 c\u0169ng nh\u01b0 li\u1ec1u d\u00f9ng v\u00e0 c\u00e1ch d\u00f9ng c\u1ee7a fosfomycin IV v\u00e0 quy tr\u00ecnh gi\u00e1m s\u00e1t vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh n\u00e0y th\u00f4ng qua can thi\u1ec7p c\u1ee7a d\u01b0\u1ee3c s\u0129 l\u00e2m s\u00e0ng. Nghi\u00ean c\u1ee9u n\u00e0y \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n nh\u1eb1m \u0111\u00e1nh gi\u00e1 t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u00e1c bi\u1ec7n ph\u00e1p can thi\u1ec7p n\u00f3i tr\u00ean \u0111\u1ebfn t\u00ecnh h\u00ecnh ti\u00eau th\u1ee5 c\u0169ng nh\u01b0 vi\u1ec7c s\u1eed d\u1ee5ng
\nfosfomycin IV t\u1ea1i B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n, l\u00e0m c\u01a1 s\u1edf \u0111\u1ec3 ho\u00e0n thi\u1ec7n quy tr\u00ecnh qu\u1ea3n l\u00fd kh\u00e1ng sinh v\u00e0 nh\u00e2n r\u1ed9ng ho\u1ea1t \u0111\u1ed9ng n\u00e0y trong ch\u01b0\u01a1ng tr\u00ecnh qu\u1ea3n l\u00fd kh\u00e1ng
\nsinh c\u1ee7a b\u1ec7nh vi\u1ec7n.<\/p>\n
\u0110\u1ed1i t\u01b0\u1ee3ng v\u00e0 ph\u01b0\u01a1ng ph\u00e1p nghi\u00ean c\u1ee9u<\/h2>\n\u0110\u1ed1i t\u01b0\u1ee3ng nghi\u00ean c\u1ee9u<\/h3>\n
\u0110\u00e1nh gi\u00e1 t\u00ecnh h\u00ecnh ti\u00eau th\u1ee5 fosfomycin IV c\u1ee7a c\u00e1c Khoa L\u00e2m s\u00e0ng v\u00e0 to\u00e0n B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n giai \u0111o\u1ea1n 2013 \u2013 2018 d\u1ef1a tr\u00ean h\u1ed3i c\u1ee9u s\u1ed1 li\u1ec7u s\u1eed d\u1ee5ng fosfomycin IV c\u1ee7a b\u1ec7nh nh\u00e2n n\u1ed9i tr\u00fa v\u00e0 s\u1ed1 ng\u00e0y n\u1eb1m vi\u1ec7n \u0111\u01b0\u1ee3c tr\u00edch xu\u1ea5t theo th\u00e1ng t\u1eeb ph\u1ea7n m\u1ec1m
\nqu\u1ea3n l\u00fd thu\u1ed1c c\u1ee7a Khoa D\u01b0\u1ee3c v\u00e0 ph\u1ea7n m\u1ec1m qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n n\u1ed9i tr\u00fa c\u1ee7a Ph\u00f2ng K\u1ebf ho\u1ea1ch t\u1ed5ng h\u1ee3p.<\/p>\n
\u201cH\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng fosfomycin IV t\u1ea1i B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n\u201d \u00e1p d\u1ee5ng tr\u00ean \u0111\u1ed1i t\u01b0\u1ee3ng ng\u01b0\u1eddi l\u1edbn, do \u0111\u00f3 Khoa Nhi v\u00e0 \u0110\u01a1n nguy\u00ean s\u01a1 sinh \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb kh\u1ecfi nghi\u00ean c\u1ee9u. Vi\u1ec7c s\u1eed d\u1ee5ng fosfomycin IV \u0111\u01b0\u1ee3c ph\u00e2n t\u00edch d\u1ef1a tr\u00ean b\u1ec7nh \u00e1n c\u1ee7a b\u1ec7nh nh\u00e2n ng\u01b0\u1eddi l\u1edbn \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa c\u00f3 s\u1eed d\u1ee5ng fosfomycin IV t\u1eeb 1\/1\/2017 \u0111\u1ebfn 30\/12\/2018. C\u00e1c b\u00ea\u0323nh nh\u00e2n nhi ho\u1eb7c c\u00e1c tr\u01b0\u1eddng h\u1ee3p HSBA kh\u00f4ng ti\u1ebfp c\u1eadn \u0111\u01b0\u1ee3c trong qu\u00e1 tr\u00ecnh thu th\u1eadp th\u00f4ng tin s\u1ebd \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb.<\/p>\n
Thi\u1ebft k\u1ebf nghi\u00ean c\u1ee9u<\/h3>\n
Nghi\u00ean c\u1ee9u can thi\u1ec7p, theo d\u00f5i d\u1ecdc theo th\u1eddi gian \u0111\u01b0\u1ee3c chia l\u00e0m giai \u0111o\u1ea1n tr\u01b0\u1edbc can thi\u1ec7p v\u00e0 hai giai \u0111o\u1ea1n sau can thi\u1ec7p t\u01b0\u01a1ng \u1ee9ng v\u1edbi vi\u1ec7c ban h\u00e0nh \u201cDanh m\u1ee5c c\u00e1c kh\u00e1ng sinh ph\u1ea3i ph\u00ea duy\u1ec7t tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng\u201d th\u00e1ng 4\/2017 (can thi\u1ec7p 1) v\u00e0 \u201cH\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng kh\u00e1ng sinh fosfomycin IV t\u1ea1i B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n\u201d th\u00e1ng 7\/2018 (can thi\u1ec7p 2) c\u1ee7a H\u0110T&\u0110T (h\u00ecnh 1).<\/p>\n
H\u00ecnh 1. S\u01a1 \u0111\u1ed3 giai \u0111o\u1ea1n di\u1ec5n ti\u1ebfn can thi\u1ec7p t\u0103ng c\u01b0\u1eddng s\u1eed d\u1ee5ng h\u1ee3p l\u00fd fosfomycin<\/p>\n
M\u1ee9c \u0111\u1ed9 ti\u00eau th\u1ee5 fosfomycin IV t\u1ea1i c\u00e1c Khoa L\u00e2m s\u00e0ng v\u00e0 to\u00e0n B\u1ec7nh vi\u1ec7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 d\u1ef1a tr\u00ean s\u1ed1 li\u1ec1u DDD\/100 ng\u00e0y n\u1eb1m vi\u1ec7n theo c\u00f4ng th\u1ee9c sau, trong \u0111\u00f3 gi\u00e1 tr\u1ecb DDD c\u1ee7a fosfomycin IV l\u00e0 8 g [5]. DDD\/100 ng\u00e0y n\u1eb1m vi\u1ec7n = T\u1ed5ng s\u1ed1 gram s\u1eed d\u1ee5ng x 100
\nDDD x s\u1ed1 ng\u00e0y n\u1eb1m vi\u1ec7n.<\/p>\n
Vi\u1ec7c s\u1eed d\u1ee5ng fosfomycin \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 d\u1ef1a tr\u00ean h\u1ed3i c\u1ee9u b\u1ec7nh \u00e1n trong giai \u0111o\u1ea1n 1 v\u00e0 2 sau \u0111\u00f3 theo d\u00f5i ti\u1ebfn c\u1ee9u trong giai \u0111o\u1ea1n 3 c\u00f3 can thi\u1ec7p tr\u1ef1c ti\u1ebfp c\u1ee7a d\u01b0\u1ee3c s\u0129 l\u00e2m s\u00e0ng. Giai \u0111o\u1ea1n 3 ti\u1ebfp n\u1ed1i quy tr\u00ecnh duy\u1ec7t s\u1eed d\u1ee5ng fosfomycin IV \u1edf giai \u0111o\u1ea1n 2, \u0111\u1ed3ng th\u1eddi s\u1eed d\u1ee5ng \u201cH\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng fosfomycin IV t\u1ea1i B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n\u201d l\u00e0m c\u0103n c\u1ee9 ch\u00ednh th\u1ee9c \u0111\u1ec3 d\u01b0\u1ee3c s\u0129 duy\u1ec7t \u0111\u01a1n v\u00e0 c\u00f3 \u00fd ki\u1ebfn t\u01b0 v\u1ea5n tr\u1ef1c ti\u1ebfp cho b\u00e1c s\u0129 trong tr\u01b0\u1eddng h\u1ee3p s\u1eed d\u1ee5ng thu\u1ed1c ch\u01b0a ph\u00f9 h\u1ee3p v\u1edbi h\u01b0\u1edbng d\u1eabn.<\/p>\n
T\u00e0i li\u1ec7u n\u00e0y c\u0169ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e2n t\u00edch, so s\u00e1nh \u0111\u1eb7c \u0111i\u1ec3m s\u1eed d\u1ee5ng fosfomycin gi\u1eefa c\u00e1c giai \u0111o\u1ea1n. C\u00e1c ch\u1ec9 ti\u00eau \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 ph\u00f9 h\u1ee3p bao g\u1ed3m ch\u1ec9 \u0111\u1ecbnh d\u00f9ng thu\u1ed1c, ch\u1ec9 \u0111\u1ecbnh x\u00e9t nghi\u1ec7m vi sinh tr\u01b0\u1edbc khi d\u00f9ng fosfomycin IV, l\u1ef1a ch\u1ecdn fosfomycin IV l\u00e0
\nkh\u00e1ng sinh thay th\u1ebf trong ph\u00e1c \u0111\u1ed3 h\u01a1n l\u00e0 ph\u00e1c \u0111\u1ed3 kh\u1edfi \u0111\u1ea7u, t\u1ef7 l\u1ec7 c\u00f3 s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p fosfomycin IV v\u1edbi kh\u00e1ng sinh kh\u00e1c v\u00e0 s\u1eed d\u1ee5ng fosfomycin IV ch\u1ebf \u0111\u1ed9 li\u1ec1u cao (li\u1ec1u > 4 g\/ng\u00e0y \u1edf b\u1ec7nh nh\u00e2n c\u00f3 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn \u2265 20 ml\/ph\u00fat).<\/p>\n
X\u1eed l\u00fd s\u1ed1 li\u1ec7u<\/h2>\n
S\u1ed1 li\u1ec7u \u0111\u01b0\u1ee3c thu th\u1eadp v\u00e0 x\u1eed l\u00fd th\u1ed1ng k\u00ea b\u1eb1ng ph\u1ea7n m\u1ec1m SPSS 21.0. Ki\u1ec3m \u0111\u1ecbnh phi tham s\u1ed1 Wilcoxon Signed Ranks Test \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 so s\u00e1nh m\u1ee9c ti\u00eau th\u1ee5 fosfomycin trung b\u00ecnh gi\u1eefa c\u00e1c giai \u0111o\u1ea1n nghi\u00ean c\u1ee9u. So s\u00e1nh t\u1ef7 l\u1ec7 s\u1eed d\u1ee5ng fosfomycin ph\u00f9 h\u1ee3p \u1edf c\u00e1c giai \u0111o\u1ea1n b\u1eb1ng ki\u1ec3m \u0111\u1ecbnh chi b\u00ecnh ph\u01b0\u01a1ng. Kh\u00e1c bi\u1ec7t \u0111\u01b0\u1ee3c coi l\u00e0 c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea n\u1ebfu p < 0,05.<\/p>\n
K\u1ebft qu\u1ea3<\/h2>\n
T\u00e1c \u0111\u1ed9ng c\u1ee7a can thi\u1ec7p l\u00ean ti\u00eau th\u1ee5 fosfomycin IV Sau khi H\u0110T\u0110T B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n ban h\u00e0nh \u201cDanh m\u1ee5c c\u00e1c kh\u00e1ng sinh ph\u1ea3i ph\u00ea duy\u1ec7t tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng\u201d v\u00e0o th\u00e1ng 4\/2017, m\u1ee9c \u0111\u1ed9 ti\u00eau th\u1ee5 fosfomycin IV trung b\u00ecnh tr\u00ean to\u00e0n B\u1ec7nh vi\u1ec7n \u0111\u00e3 gi\u1ea3m
\nc\u00f2n 1\/3 so v\u1edbi giai \u0111o\u1ea1n tr\u01b0\u1edbc \u0111\u00f3 (t\u1eeb 0,855 xu\u1ed1ng c\u00f2n 0,278 li\u1ec1u DDD\/100 ng\u00e0y n\u1eb1m vi\u1ec7n). Sang giai \u0111o\u1ea1n 3, l\u01b0\u1ee3ng fosfomycin ti\u00eau th\u1ee5 t\u0103ng g\u1ea5p 1,6 l\u1ea7n so v\u1edbi giai \u0111o\u1ea1n 2 (0,457 li\u1ec1u DDD\/100 ng\u00e0y n\u1eb1m vi\u1ec7n) tuy nhi\u00ean v\u1eabn th\u1ea5p h\u01a1n r\u00f5 r\u1ec7t so v\u1edbi giai \u0111o\u1ea1n 1.<\/p>\n
H\u00ecnh 2 bi\u1ec3u di\u1ec5n m\u1ee9c \u0111\u1ed9 ti\u00eau th\u1ee5 fosfomycin IV h\u00e0ng th\u00e1ng tr\u00ean to\u00e0n B\u1ec7nh vi\u1ec7n v\u00e0 c\u00e1c kh\u1ed1i Khoa Ph\u00f2ng qua 3 giai \u0111o\u1ea1n.<\/p>\n
*Kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea<\/p>\n
H\u00ecnh 3. Thay \u0111\u1ed5i m\u1ee9c \u0111\u1ed9 ti\u00eau th\u1ee5 fosfomycin chung c\u1ee7a B\u1ec7nh vi\u1ec7n, c\u00e1c kh\u1ed1i \u0110i\u1ec1u tr\u1ecb v\u00e0 m\u1ed9t s\u1ed1 Khoa L\u00e2m s\u00e0ng s\u1eed d\u1ee5ng fosfomycin v\u1edbi s\u1ed1 l\u01b0\u1ee3ng l\u1edbn d\u01b0\u1edbi t\u00e1c \u0111\u1ed9ng c\u1ee7a can thi\u1ec7p.<\/p>\n
C\u01a1 c\u1ea5u khoa ph\u00f2ng ti\u00eau th\u1ee5 fosfomycin IV trong B\u1ec7nh vi\u1ec7n c\u0169ng c\u00f3 nhi\u1ec1u thay \u0111\u1ed5i sau can thi\u1ec7p.<\/p>\n
Trong giai \u0111o\u1ea1n 1, 19\/21 khoa ph\u00f2ng c\u00f3 s\u1eed d\u1ee5ng fosfomycin v\u1edbi ph\u00e2n b\u1ed1 kh\u00e1 \u0111\u1ed3ng \u0111\u1ec1u \u1edf c\u00e1c kh\u1ed1i \u0111i\u1ec1u tr\u1ecb, trong \u0111\u00f3 ti\u00eau th\u1ee5 fosfomycin c\u1ee7a kh\u1ed1i ngo\u1ea1i lu\u00f4n \u1edf m\u1ee9c cao nh\u1ea5t. Sang giai \u0111o\u1ea1n 2 v\u00e0 3, s\u1ed1 l\u01b0\u1ee3ng Khoa L\u00e2m s\u00e0ng c\u00f3 s\u1eed d\u1ee5ng fosfomycin \u0111\u00e3 gi\u1ea3m xu\u1ed1ng l\u1ea7n l\u01b0\u1ee3t c\u00f2n 15 v\u00e0 12 Khoa v\u1edbi m\u1ee9c ti\u00eau th\u1ee5 l\u1edbn nh\u1ea5t l\u00e0 \u1edf Kh\u1ed1i H\u1ed3i s\u1ee9c (g\u1ea5p kho\u1ea3ng 10 l\u1ea7n ti\u00eau th\u1ee5 trung b\u00ecnh c\u1ee7a to\u00e0n B\u1ec7nh vi\u1ec7n, t\u01b0\u01a1ng \u1ee9ng v\u1edbi 2,65 v\u00e0 5,14 li\u1ec1u
\nDDD\/100 ng\u00e0y n\u1eb1m vi\u1ec7n). Nh\u1eb1m \u0111\u00e1nh gi\u00e1 xu h\u01b0\u1edbng s\u1eed d\u1ee5ng fosfomycin IV
\nc\u1ee5 th\u1ec3 \u1edf m\u1ed9t s\u1ed1 Khoa L\u00e2m s\u00e0ng, ch\u00fang t\u00f4i ch\u1ecdn c\u00e1c khoa c\u00f3 m\u1ee9c ti\u00eau th\u1ee5 cao nh\u1ea5t \u0111\u1ec3 so s\u00e1nh tr\u01b0\u1edbc v\u00e0 sau c\u00e1c can thi\u1ec7p. H\u00ecnh 3 bi\u1ec3u di\u1ec5n m\u1ee9c \u0111\u1ed9 ti\u00eau th\u1ee5 fosfomycin IV tr\u00ean to\u00e0n B\u1ec7nh vi\u1ec7n, c\u00e1c kh\u1ed1i khoa \u0111i\u1ec1u tr\u1ecb v\u00e0 m\u1ed9t s\u1ed1 khoa l\u00e2m s\u00e0ng c\u00f3 s\u1ed1 l\u01b0\u1ee3ng s\u1eed d\u1ee5ng fosfomycin IV l\u1edbn trong 3 giai \u0111o\u1ea1n. Theo \u0111\u00f3, m\u1ee9c \u0111\u1ed9 ti\u00eau th\u1ee5 \u1edf kh\u1ed1i Ngo\u1ea1i, bao g\u1ed3m c\u00e1c Khoa Ngo\u1ea1i s\u1ecd, Ngo\u1ea1i th\u1eadn, Ngo\u1ea1i t\u1ed5ng h\u1ee3p \u1edf giai \u0111o\u1ea1n 2 \u0111\u1ec1u gi\u1ea3m m\u1ea1nh (p < 0,05). Trong khi \u0111\u00f3 kh\u1ed1i h\u1ed3i s\u1ee9c (n\u1ed9iv\u00e0 ngo\u1ea1i) c\u00f3 m\u1ee9c \u0111\u1ed9 s\u1eed d\u1ee5ng t\u0103ng d\u1ea7n trong c\u1ea3 giai \u0111o\u1ea1n 2 v\u00e0 giai \u0111o\u1ea1n 3. Ti\u00eau th\u1ee5 t\u1ea1i kh\u1ed1i n\u1ed9i v\u00e0 to\u00e0n B\u1ec7nh vi\u1ec7n c\u0169ng c\u00f3 gi\u1ea3m nh\u01b0ng s\u1ef1 kh\u00e1c bi\u1ec7t ch\u01b0a \u0111\u1ea1t m\u1ee9c c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea. T\u00e1c \u0111\u1ed9ng c\u1ee7a can thi\u1ec7p l\u00ean vi\u1ec7c s\u1eed d\u1ee5ng fosfomycin.<\/p>\n
\u0110\u1eb7c \u0111i\u1ec3m s\u1eed d\u1ee5ng fosfomycin IV \u0111\u01b0\u1ee3c ph\u00e2n t\u00edch tr\u00ean 227 b\u1ec7nh \u00e1n c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u1ea1t ti\u00eau chu\u1ea9n l\u1ef1a ch\u1ecdn v\u00e0 lo\u1ea1i tr\u1eeb trong \u0111\u00f3 71 b\u1ec7nh \u00e1n c\u1ee7a giai \u0111o\u1ea1n 1, 96 b\u1ec7nh \u00e1n c\u1ee7a giai \u0111o\u1ea1n 2 v\u00e0 60 b\u1ec7nh \u00e1n c\u1ee7a giai \u0111o\u1ea1n 3. V\u1ec1 \u0111\u1eb7c \u0111i\u1ec3m b\u1ec7nh nh\u00e2n, \u1edf giai \u0111o\u1ea1n 2 v\u00e0 3
\nb\u1ec7nh nh\u00e2n c\u00f3 xu h\u01b0\u1edbng cao tu\u1ed5i h\u01a1n, t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n c\u00f3 suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn (\u0111\u1ed9 thanh th\u1ea3i creatinin < 60 ml\/ph) cao h\u01a1n v\u00e0 th\u1eddi gian n\u1eb1m vi\u1ec7n d\u00e0i h\u01a1n so v\u1edbi giai \u0111o\u1ea1n 1, b\u1ea3ng 1.<\/p>\n
B\u1ea3ng 1. \u0110\u1eb7c \u0111i\u1ec3m b\u1ec7nh nh\u00e2n trong c\u00e1c giai \u0111o\u1ea1n c\u1ee7a nghi\u00ean c\u1ee9u<\/p>\n
Vi\u1ec7c s\u1eed d\u1ee5ng fosfomycin IV \u0111\u00e3 c\u00f3 c\u1ea3i thi\u1ec7n \u0111\u00e1ng k\u1ec3 sau khi H\u0110T&\u0110T ban h\u00e0nh \u201cDanh m\u1ee5c c\u00e1c kh\u00e1ng sinh ph\u1ea3i ph\u00ea duy\u1ec7t tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng\u201d v\u00e0o th\u00e1ng 4\/2017 v\u1edbi t\u1ef7 l\u1ec7 ph\u00f9 h\u1ee3p tr\u00ean 80 % tr\u00ean t\u1ea5t c\u1ea3 c\u00e1c ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 (h\u00ecnh 4). C\u1ee5 th\u1ec3, t\u1ef7 l\u1ec7 s\u1eed d\u1ee5ng ch\u1ebf \u0111\u1ed9
\nli\u1ec1u cao c\u00f3 m\u1ee9c t\u0103ng cao nh\u1ea5t (tr\u00ean 10 l\u1ea7n), ti\u00eau ch\u00ed v\u1ec1 ch\u1ec9 \u0111\u1ecbnh ph\u00f9 h\u1ee3p v\u00e0 c\u00f3 x\u00e9t nghi\u1ec7m vi sinh tr\u01b0\u1edbc khi d\u00f9ng fosfomycin c\u0169ng t\u0103ng h\u01a1n 4 l\u1ea7n, c\u00e1c thay \u0111\u1ed5i n\u00e0y \u0111\u1ec1u c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea. Trong giai \u0111o\u1ea1n 3, sau khi ban h\u00e0nh \u201cH\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng fosfomycin IV c\u1ee7a H\u0110T&\u0110T B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n\u201d, t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng fosfomycin IV ph\u00f9 h\u1ee3p ti\u1ebfp t\u1ee5c t\u0103ng l\u00ean (tr\u1eeb ti\u00eau ch\u00ed v\u1ec1 x\u00e9t nghi\u1ec7m vi sinh), \u0111\u1eb7c bi\u1ec7t l\u00e0 t\u1ef7 l\u1ec7 s\u1eed d\u1ee5ng fosfomycin trong ph\u00e1c \u0111\u1ed3 ph\u1ed1i h\u1ee3p kh\u00e1ng sinh v\u00e0 \u00e1p d\u1ee5ng ch\u1ebf \u0111\u1ed9 li\u1ec1u cao \u0111\u1ec1u \u0111\u1ea1t 100 %, \u0111\u1ed3ng th\u1eddi c\u1ea3i thi\u1ec7n r\u00f5 r\u1ec7t so v\u1edbi giai \u0111o\u1ea1n 2 (p < 0,05).<\/p>\n
H\u00ecnh 4. T\u00e1c \u0111\u1ed9ng c\u1ee7a can thi\u1ec7p \u0111\u1ebfn t\u1ef7 l\u1ec7 ph\u00f9 h\u1ee3p trong s\u1eed d\u1ee5ng fosfomycin v\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a H\u0110T&\u0110T B\u1ec7nh vi\u1ec7n.<\/p>\n
B\u00e0n lu\u1eadn<\/h2>\n
Nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i cho th\u1ea5y c\u00e1c can thi\u1ec7p t\u1eeb H\u0110T&\u0110T c\u00f3 \u1ea3nh h\u01b0\u1edfng l\u1edbn \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 ti\u00eau th\u1ee5 fosfomycin IV t\u1ea1i c\u00e1c Khoa L\u00e2m s\u00e0ng c\u0169ng nh\u01b0 c\u00e1c kh\u1ed1i \u0110i\u1ec1u tr\u1ecb trong B\u1ec7nh vi\u1ec7n, trong \u0111\u00f3 xu h\u01b0\u1edbng gia t\u0103ng s\u1eed d\u1ee5ng t\u1ea1i c\u00e1c \u0111\u01a1n v\u1ecb h\u1ed3i s\u1ee9c v\u00e0 h\u1ea1n ch\u1ebf s\u1eed
\nd\u1ee5ng t\u1ea1i \u0111\u01a1n v\u1ecb Ngo\u1ea1i khoa. C\u00f9ng v\u1edbi \u0111\u00f3, vi\u1ec7c s\u1eed d\u1ee5ng fosfomycin \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n trong t\u1ea5t c\u1ea3 c\u00e1c ti\u00eau ch\u00ed quan tr\u1ecdng nh\u1eb1m \u0111\u1ea3m b\u1ea3o s\u1eed d\u1ee5ng h\u1ee3p l\u00fd fosfomycin IV. Fosfomycin IV \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng t\u1ea1i B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n t\u1eeb n\u0103m 2010. G\u1ea7n \u0111\u00e2y, kh\u00e1ng sinh n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o danh s\u00e1ch c\u00e1c kh\u00e1ng sinh c\u1ea7n qu\u1ea3n l\u00fd ch\u1eb7t ch\u1ebd nh\u1eb1m b\u1ea3o t\u1ed3n hi\u1ec7u l\u1ef1c tr\u01b0\u1edbc t\u00ecnh tr\u1ea1ng gia t\u0103ng \u0111\u1ec1 kh\u00e1ng c\u1ee7a c\u00e1c vi khu\u1ea9n Gram d\u01b0\u01a1ng v\u00e0 Gram \u00e2m ch\u00ednh g\u00e2y nhi\u1ec5m khu\u1ea9n b\u1ec7nh vi\u1ec7n. B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n \u0111\u00e3 l\u1ea7n l\u01b0\u1ee3t ban h\u00e0nh \u201cDanh m\u1ee5c kh\u00e1ng sinh ph\u1ea3i ph\u00ea duy\u1ec7t tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng\u201d v\u00e0 \u201cH\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng fosfomycin IV\u201d nh\u1eb1m \u0111\u1ea3m b\u1ea3o s\u1eed d\u1ee5ng fosfomycin h\u1ee3p l\u00fd, hi\u1ec7u qu\u1ea3.<\/p>\n
T\u1eeb th\u00e1ng 3\/2017, vi\u1ec7c s\u1eed d\u1ee5ng fosfomycin IV \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t theo quy tr\u00ecnh ch\u1eb7t ch\u1ebd, l\u00e0m gi\u1ea3m r\u00f5 r\u1ec7t m\u1ee9c \u0111\u1ed9 ti\u00eau th\u1ee5 fosfomycin IV tr\u00ean to\u00e0n B\u1ec7nh vi\u1ec7n t\u1eeb 0,855 xu\u1ed1ng c\u00f2n 0,278 DDD\/100 ng\u00e0y n\u1eb1m vi\u1ec7n.<\/p>\n
M\u1ee9c gi\u1ea3m n\u00e0y ch\u1ee7 y\u1ebfu l\u00e0 do gi\u1ea3m s\u1eed d\u1ee5ng \u1edf c\u00e1c Khoa kh\u1ed1i Ngo\u1ea1i v\u00e0 kh\u1ed1i N\u1ed9i, trong khi \u0111\u00f3 c\u00e1c Khoa H\u1ed3i s\u1ee9c c\u00f3 m\u1ee9c s\u1eed d\u1ee5ng t\u0103ng d\u1ea7n. Xu h\u01b0\u1edbng n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch do c\u00e1c b\u00e1c s\u0129 \u0111\u00e3 ch\u00fa \u00fd h\u01a1n \u0111\u1ebfn vai tr\u00f2 \u01b0u ti\u00ean c\u1ee7a fosfomycin IV trong c\u00e1c nhi\u1ec5m khu\u1ea9n n\u1eb7ng, \u0111\u1eb7c bi\u1ec7t t\u1ea1i Khoa H\u1ed3i s\u1ee9c t\u00edch c\u1ef1c. Ng\u01b0\u1ee3c l\u1ea1i, c\u00e1c khoa ngo\u00e0i kh\u1ed1i H\u1ed3i s\u1ee9c \u0111\u00e3 c\u00f3 s\u1ef1 gi\u1ea3m s\u1eed d\u1ee5ng kh\u00e1ng sinh r\u00f5 r\u1ec7t do b\u1ec7nh \u00e1n c\u00f3 y l\u1ec7nh fosfomycin IV
\n\u0111\u1ec1u ph\u1ea3i duy\u1ec7t tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng v\u00e0 c\u0103n c\u1ee9 \u0111\u1ec3 duy\u1ec7t d\u1ef1a tr\u00ean vi\u1ec7c kh\u00f4ng c\u00f2n l\u1ef1a ch\u1ecdn kh\u00e1ng sinh n\u00e0o kh\u00e1c thay th\u1ebf. Trong giai \u0111o\u1ea1n 1, fosfomycin \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng tr\u00ean nhi\u1ec1u lo\u1ea1i nhi\u1ec5m khu\u1ea9n nh\u01b0: vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng, nhi\u1ec5m khu\u1ea9n da – m\u00f4 m\u1ec1m, nhi\u1ec5m khu\u1ea9n \u1ed5 b\u1ee5ng (do vi\u00eam t\u1ee5y c\u1ea5p, s\u1ecfi m\u1eadt, vi\u00eam ph\u00fac m\u1ea1c, vi\u00eam ru\u1ed9t th\u1eeba). \u0110\u1ebfn giai \u0111o\u1ea1n 2, fosfomycin IV \u0111\u00e3 \u0111\u01b0\u1ee3c \u01b0u ti\u00ean d\u1ef1 tr\u1eef d\u00e0nh cho c\u00e1c nhi\u1ec5m khu\u1ea9n n\u1eb7ng,
\nnhi\u1ec5m khu\u1ea9n do vi khu\u1ea9n \u0111a kh\u00e1ng, ch\u1ec9 th\u01b0\u1eddng g\u1eb7p \u1edf c\u00e1c \u0111\u01a1n v\u1ecb H\u1ed3i s\u1ee9c trong B\u1ec7nh vi\u1ec7n. Nh\u01b0 v\u1eady, m\u1eb7c d\u00f9 ch\u01b0a c\u00f3 h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng fosfomycin IV c\u1ee5 th\u1ec3, nh\u01b0ng chi\u1ebfn l\u01b0\u1ee3c \u201ch\u1ea1n ch\u1ebf tr\u01b0\u1edbc k\u00ea \u0111\u01a1n\u201d \u0111\u00e3 gi\u00fap thay \u0111\u1ed5i t\u01b0\u01a1ng \u0111\u1ed1i t\u00edch c\u1ef1c t\u00ecnh h\u00ecnh ti\u00eau th\u1ee5 thu\u1ed1c ngay t\u1eeb giai \u0111o\u1ea1n 2. Sang giai \u0111o\u1ea1n 3, h\u01b0\u1edbng d\u1eabn c\u1ee5 th\u1ec3 v\u1ec1 l\u1ef1a ch\u1ecdn v\u00e0 s\u1eed d\u1ee5ng fosfomycin IV \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ed1ng nh\u1ea5t v\u00e0 ph\u1ed5 bi\u1ebfn r\u1ed9ng r\u00e3i gi\u00fap b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb
\nc\u00f3 \u0111\u1ea7y \u0111\u1ee7 th\u00f4ng tin v\u00e0 c\u01a1 s\u1edf ph\u00e1p l\u00fd \u0111\u1ec3 k\u00ea \u0111\u01a1n. Do v\u1eady, ti\u00eau th\u1ee5 fosfomycin IV t\u1ea1i c\u00e1c \u0111\u01a1n v\u1ecb H\u1ed3i s\u1ee9c ti\u1ebfp t\u1ee5c t\u0103ng, d\u1eabn \u0111\u1ebfn ti\u00eau th\u1ee5 trung b\u00ecnh to\u00e0n vi\u1ec7n t\u0103ng l\u00ean m\u1ee9c 0,457 DDD\/100 ng\u00e0y n\u1eb1m vi\u1ec7n, trong khi \u0111\u00f3 m\u1ee9c ti\u00eau th\u1ee5 \u1edf kh\u1ed1i Ngo\u1ea1i v\u00e0 kh\u1ed1i N\u1ed9i v\u1eabn duy tr\u00ec \u1edf m\u1ee9c th\u1ea5p.<\/p>\n
C\u1ea3i thi\u1ec7n v\u1ec1 ch\u1ea5t l\u01b0\u1ee3ng s\u1eed d\u1ee5ng fosfomycin IV \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n c\u1ee5 th\u1ec3 d\u1ef1a tr\u00ean ph\u00e2n t\u00edch b\u1ec7nh \u00e1n. Trong giai \u0111o\u1ea1n 2 khi ch\u01b0a c\u00f3 \u201cH\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng fosfomycin IV t\u1ea1i B\u1ec7nh vi\u1ec7n\u201d, t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng fosfomycin ph\u00f9 h\u1ee3p \u0111\u00e3 t\u0103ng \u0111\u00e1ng k\u1ec3 (tr\u00ean 80 % b\u1ec7nh nh\u00e2n ph\u00f9 h\u1ee3p \u1edf c\u1ea3 5 ti\u00eau ch\u00ed ch\u00ednh). \u1ede giai \u0111o\u1ea1n 3, c\u00e1c ch\u1ec9 \u0111\u1ecbnh c\u1ee7a b\u00e1c s\u0129 v\u00e0 ho\u1ea1t \u0111\u1ed9ng duy\u1ec7t s\u1eed d\u1ee5ng thu\u1ed1c c\u1ee7a d\u01b0\u1ee3c s\u0129 ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c duy tr\u00ec v\u00e0 c\u1ee7ng
\nc\u1ed1 th\u00eam b\u1edfi s\u1ef1 th\u1ed1ng nh\u1ea5t v\u1ec1 h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng fosfomycin IV c\u1ee7a H\u0110T&\u0110T. Do \u0111\u00f3, c\u00e1c ch\u1ec9 s\u1ed1 v\u1ec1 s\u1eed d\u1ee5ng h\u1ee3p l\u00fd fosfomycin IV ph\u00f9 h\u1ee3p v\u1edbi H\u01b0\u1edbng d\u1eabn \u0111\u00e3 \u0111\u01b0\u1ee3c ban h\u00e0nh ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n so v\u1edbi giai \u0111o\u1ea1n 2, \u0111\u1eb7c bi\u1ec7t tr\u00ean ti\u00eau ch\u00ed \u201cch\u1ebf \u0111\u1ed9 li\u1ec1u\u201d v\u00e0 \u201cs\u1eed d\u1ee5ng ph\u00e1c \u0111\u1ed3 ph\u1ed1i h\u1ee3p kh\u00e1ng sinh\u201d \u0111\u00e3 \u0111\u1ea1t 100 %. \u0110\u00e2y l\u00e0 c\u00e1c c\u1ea3i thi\u1ec7n quan tr\u1ecdng nh\u1eb1m \u0111\u1ea3m b\u1ea3o hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb, gi\u1ea3m nguy c\u01a1 gia t\u0103ng c\u00e1c vi khu\u1ea9n \u0111\u1ec1 kh\u00e1ng. M\u1ed9t
\ns\u1ed1 nghi\u00ean c\u1ee9u tr\u00ean th\u1ebf gi\u1edbi c\u0169ng \u0111\u00e3 ch\u1ee9ng minh hi\u1ec7u qu\u1ea3 can thi\u1ec7p c\u1ee7a d\u01b0\u1ee3c s\u0129 l\u00e2m s\u00e0ng \u0111\u1ebfn s\u1eed d\u1ee5ng kh\u00e1ng sinh, \u0111\u1eb7c bi\u1ec7t l\u00e0 s\u1ef1 ph\u00f9 h\u1ee3p v\u1ec1 ch\u1ec9 \u0111\u1ecbnh v\u00e0 li\u1ec1u d\u00f9ng c\u0169ng nh\u01b0 t\u00ecnh h\u00ecnh ti\u00eau th\u1ee5 thu\u1ed1c [6]. Nghi\u00ean c\u1ee9u n\u00e0y m\u1ed9t l\u1ea7n n\u1eefa kh\u1eb3ng \u0111\u1ecbnh c\u00e1c t\u00e1c \u0111\u1ed9ng t\u00edch c\u1ef1c qua ch\u01b0\u01a1ng tr\u00ecnh qu\u1ea3n l\u00fd s\u1eed d\u1ee5ng fosfomycin t\u1ea1i B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n.<\/p>\n
M\u1eb7c d\u00f9 \u0111\u00e3 c\u00f3 chuy\u1ec3n bi\u1ebfn t\u00edch c\u1ef1c, ch\u00fang t\u00f4i v\u1eabn ghi nh\u1eadn m\u1ed9t t\u1ef7 l\u1ec7 \u0111\u00e1ng k\u1ec3 b\u1ec7nh nh\u00e2n ch\u01b0a \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m vi sinh tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng fosfomycin IV \u1edf giai \u0111o\u1ea1n 2 (19,8 %) v\u00e0 h\u00ecnh \u1ea3nh n\u00e0y ch\u01b0a \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n \u1edf giai \u0111o\u1ea1n 3 (21,7 %). Nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 do m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng l\u1ea5y \u0111\u01b0\u1ee3c m\u1eabu b\u1ec7nh ph\u1ea9m ho\u1eb7c y l\u1ec7nh trong gi\u1edd tr\u1ef1c \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n ngay v\u00e0 kh\u00f4ng qua b\u01b0\u1edbc duy\u1ec7t s\u1eed d\u1ee5ng, \u0111\u1eb7c bi\u1ec7t t\u1ea1i c\u00e1c khoa ngo\u00e0i
\n\u0111\u01a1n v\u1ecb H\u1ed3i s\u1ee9c. \u0110\u00e2y l\u00e0 v\u1ea5n \u0111\u1ec1 c\u1ea7n \u0111\u01b0\u1ee3c l\u01b0u \u00fd v\u00e0 ti\u1ebfp t\u1ee5c c\u00f3 c\u00e1c can thi\u1ec7p ph\u00f9 h\u1ee3p \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o tu\u00e2n th\u1ee7 H\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng thu\u1ed1c, gi\u00fap chu\u1ea9n h\u00f3a quy tr\u00ecnh s\u1eed d\u1ee5ng kh\u00e1ng sinh d\u1ef1 tr\u1eef n\u00e0y. Th\u00eam v\u00e0o \u0111\u00f3, t\u1ef7 l\u1ec7 ch\u1ec9 \u0111\u1ecbnh ch\u01b0a ph\u00f9 h\u1ee3p v\u1edbi H\u01b0\u1edbng d\u1eabn \u1edf giai \u0111o\u1ea1n 3 \u0111\u00e3 kh\u00f4ng c\u1ea3i thi\u1ec7n nhi\u1ec1u, ch\u1ee7 y\u1ebfu li\u00ean quan \u0111\u1ebfn nhi\u1ec5m tr\u00f9ng \u1ed5 b\u1ee5ng v\u00e0 nhi\u1ec5m khu\u1ea9n da – m\u00f4 m\u1ec1m. M\u1eb7c d\u00f9 kh\u00f4ng n\u1eb1m trong h\u01b0\u1edbng d\u1eabn c\u1ee7a B\u1ec7nh vi\u1ec7n, c\u00e1c ch\u1ec9 \u0111\u1ecbnh n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn trong m\u1ed9t s\u1ed1 t\u00e0i li\u1ec7u kh\u00e1c, \u0111\u1ed3ng th\u1eddi k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3 c\u0169ng cho th\u1ea5y vi khu\u1ea9n \u0111\u00e3 kh\u00e1ng c\u00e1c kh\u00e1ng sinh \u01b0u ti\u00ean kh\u00e1c v\u00e0 ch\u1ec9 c\u00f2n nh\u1ea1y c\u1ea3m v\u1edbi fosfomycin [7,8].<\/p>\n
K\u1ebft lu\u1eadn<\/h2>\n
C\u00e1c can thi\u1ec7p t\u1eeb H\u0110T&\u0110T \u0111\u00e3 c\u00f3 t\u00e1c \u0111\u1ed9ng t\u00edch c\u1ef1c l\u00ean ti\u00eau th\u1ee5 fosfomycin IV v\u1edbi xu h\u01b0\u1edbng h\u1ea1n ch\u1ebf s\u1eed d\u1ee5ng trong to\u00e0n B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n, \u0111\u1eb7c bi\u1ec7t l\u00e0 kh\u1ed1i ngo\u1ea1i \u0111\u1ec3 t\u1eadp trung \u01b0u ti\u00ean \u0111i\u1ec1u tr\u1ecb c\u00e1c nhi\u1ec5m khu\u1ea9n n\u1eb7ng, nhi\u1ec5m khu\u1ea9n do vi khu\u1ea9n \u0111a kh\u00e1ng th\u01b0\u1eddng g\u1eb7p t\u1ea1i c\u00e1c \u0111\u01a1n v\u1ecb H\u1ed3i s\u1ee9c. Kinh nghi\u1ec7m r\u00fat\u00a0 ra t\u1eeb nghi\u00ean c\u1ee9u n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng cho c\u00e1c ho\u1ea1t \u0111\u1ed9ng kh\u00e1c c\u1ee7a ch\u01b0\u01a1ng tr\u00ecnh qu\u1ea3n l\u00fd kh\u00e1ng sinh, gi\u00fap b\u1ea3o t\u1ed3n hi\u1ec7u l\u1ef1c c\u1ee7a c\u00e1c kh\u00e1ng sinh d\u1ef1 tr\u1eef tr\u01b0\u1edbc t\u00ecnh tr\u1ea1ng gia t\u0103ng \u0111\u1ec1 kh\u00e1ng kh\u00e1ng sinh c\u1ee7a vi khu\u1ea9n g\u00e2y b\u1ec7nh.<\/p>\n
T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n\n- Bielen L., Likic R., et al. (2018), \u201cActivity of fosfomycin against nosocomial multiresistant bacterial pathogens from Croatia: A multicentric study\u201d, Croat. Med. J., 59(2), pp. 56-64.<\/li>\n
- Grabein B., Graninger W., et al. (2017), \u201cIntravenous fosfomycin-back to the future, Systematic review and metaanalysis of the clinical literature\u201d, Clin. Microbiol. Infect., 23(6), pp. 363-372.<\/li>\n
- World Health Organization (2017), \u201cWHO Model Lists of Essential Medicines\u201d, Retrieved 08\/4\/2019, from http:\/\/www. who.int\/medicines\/publications\/essentialmedicines\/en\/<\/a>.<\/li>\n
- B\u1ed9 Y t\u1ebf (2016), \u201cH\u01b0\u1edbng d\u1eabn th\u1ef1c hi\u1ec7n qu\u1ea3n l\u00fd s\u1eed d\u1ee5ng kh\u00e1ng sinh trong b\u1ec7nh vi\u1ec7n\u201d ban h\u00e0nh k\u00e8m theo Quy\u1ebft \u0111\u1ecbnh s\u1ed1 772\/Q\u0110-BYT ng\u00e0y 4\/3\/2016.<\/li>\n
- WHO Collaborating Centre for drug statistics methodology, Retrieved 08\/4\/2019, from https:\/\/www.whocc.no\/.<\/li>\n
- Seah X. F., Ong Y. L., et al. (2014), \u201cImpact of an antimicrobial stewardship program on the use of carbapenems in a tertiary women\u2019s and children\u2019s hospital, Singapore\u201d, Pharmacotherapy, 34(11), pp. 1141-50.<\/li>\n
- Kusachi S., Nagao J., et al. (2011), \u201cAntibiotic time-lag combination therapy with fosfomycin for postoperative intraabdominal abscesses\u201d, J. Infect. Chemother., 17(1), pp. 91-6.<\/li>\n
- Schintler M. V., Traunmuller F., et al. (2009), \u201cHigh fosfomycin concentrations in bone and peripheral soft tissue in diabetic patients presenting with bacterial foot infection\u201d, J. Antimicrob. Chemother., 64(3), pp. 574-8. (Ng\u00e0y nh\u1eadn b\u00e0i: 09\/03\/2019 – Ng\u00e0y ph\u1ea3n bi\u1ec7n: 10\/04\/2019 – Ng\u00e0y duy\u00ea\u0323t \u0111\u0103ng: 02\/05\/2019).<\/li>\n<\/ol>\n
Trung T\u00e2m C\u1ea3nh Gi\u00e1c D\u01b0\u1ee3c Qu\u1ed1c Gia – Trung T\u00e2m DI v\u00e0 ADR Qu\u1ed1c Gia.<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
B\u00e0i b\u00e1o: \u0110\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 can thi\u1ec7p c\u1ee7a ch\u01b0\u01a1ng tr\u00ecnh qu\u1ea3n l\u00fd kh\u00e1ng sinh v\u1edbi fosfomycin truy\u1ec1n t\u0129nh m\u1ea1ch t\u1ea1i B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n. Hi\u1ec7n nay, t\u00ecnh tr\u1ea1ng vi khu\u1ea9n \u0111\u1ec1 kh\u00e1ng kh\u00e1ng sinh ng\u00e0y c\u00e0ng gia t\u0103ng c\u00f9ng v\u1edbi h\u1ea1n ch\u1ebf trong vi\u1ec7c ph\u00e1t tri\u1ec3n c\u00e1c kh\u00e1ng sinh m\u1edbi \u0111\u00e3 g\u00e2y \u1ea3nh h\u01b0\u1edfng […]\n","protected":false},"author":1,"featured_media":9492,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-9487","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts\/9487","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/comments?post=9487"}],"version-history":[{"count":0,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts\/9487\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/media\/9492"}],"wp:attachment":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/media?parent=9487"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/categories?post=9487"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/tags?post=9487"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\ntr\u00ecnh chi\u1ebft xu\u1ea5t 6-O-benzoylarbutin t\u1eeb l\u00e1 c\u00e2y c\u00f9 \u0111\u1ec1
\n(Breynia vitis-idaea (Burm. f.) C. E. C. Fischer.).<\/li>\n
\u0110\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 can thi\u1ec7p c\u1ee7a ch\u01b0\u01a1ng tr\u00ecnh qu\u1ea3n l\u00fd kh\u00e1ng sinh v\u1edbi fosfomycin truy\u1ec1n t\u0129nh m\u1ea1ch t\u1ea1i B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n<\/p>\n
T\u00e1c gi\u1ea3:<\/p>\n
- \n
- V\u0169 \u0110\u00ecnh H\u00f2a2 ,<\/li>\n
- \u0110\u1eb7ng Th\u1ecb Lan Anh1 ,<\/li>\n
- Nguy\u1ec5n Ho\u00e0ng Anh B2<\/li>\n
- Nguy\u1ec5n Th\u1ecb Mai Anh1 ,<\/li>\n
- L\u00ea Th\u1ecb Thanh Nga1 ,<\/li>\n
- Nguy\u1ec5n Th\u1ecb Thanh Th\u1ee7y1<\/li>\n
- \u0110\u00e0o Quang Minh1 ,<\/li>\n
- V\u00f5 Th\u1ecb Thu Th\u1ee7y2 ,<\/li>\n
- Nguy\u1ec5n Ho\u00e0ng Anh2*<\/li>\n
- 1 B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n 2 Trung t\u00e2m DI v\u00e0 ADR Qu\u1ed1c gia, Tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc D\u01b0\u1ee3c H\u00e0 N\u1ed9i *E-mail: anh90tk@yahoo.com.<\/li>\n<\/ol>\n
Summary<\/h2>\n
With regard that antibiotic resistance, especially multi-drug resistance, is a growing threat to the public health, and antimicrobial stewardship program (ASP) is recommended to promote rational use of antibiotics including appropriate indication, optimization of the dose, route, and length of treatment, and on the other hand, fosfomycin is considered as the last resource for gram-negative pathogens and therefore emerges as the target of ASP, \u2026the utilization of intravenous fosfomycin in Thanh Nhan Hospital (Hanoi, SRV) from April 2017 to July 2018 was investigated in three periods. The first was non-intervention, the second was the intervention referring to the guidance by the Ministry of Health and the third was the intervention based on the hospital internal guidance. Average fosfomycin consumption was reduced period by period from 0.855 to 0.278 and to 0.457 DDD\/100 patient-day, reppestively. Fosfomycin consumption appeared to be shifted from surgery departments to intensive care units during interventions. Appropriate use of fosfomycin increased up to over 80%. Patients prescribed with high dose fosfomycin and in combination regimens were further elevated to 100 % in the second intervention. The rearrangement of fosfomycin consumption and the impact on prescribing practice suggested that ASP could justify the irrational antibiotic use and therefore improve the infectious disease control in the hospital.<\/p>\n
Keywords: Fosfomycin, antibiotic, consumption, DDD, intervention, Thanh Nhan hospital.<\/p>\n
\u0110\u1eb7t v\u1ea5n \u0111\u1ec1<\/h2>\n
Fosfomycin l\u00e0 kh\u00e1ng sinh c\u00f3 ho\u1ea1t ph\u1ed5 r\u1ed9ng tr\u00ean c\u00e1c vi khu\u1ea9n Gram d\u01b0\u01a1ng v\u00e0 Gram \u00e2m, bao g\u1ed3m c\u1ea3 S. aureus kh\u00e1ng methicillin (MRSA) v\u00e0 vi khu\u1ea9n sinh enzym beta-lactamase ph\u1ed5 r\u1ed9ng (ESBL). Fosfomycin \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch (fosfomycin IV) \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c kh\u00e1ng sinh kh\u00e1c \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u00e1c nhi\u1ec5m khu\u1ea9n n\u1eb7ng do vi khu\u1ea9n \u0111a kh\u00e1ng v\u00e0 c\u00f2n nh\u1ea1y c\u1ea3m v\u1edbi fosfomycin, \u0111\u1eb7c bi\u1ec7t l\u00e0 K. pneumoniae kh\u00e1ng carbapenem [1,2]. G\u1ea7n \u0111\u00e2y, T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi (WHO) v\u00e0 B\u1ed9 Y t\u1ebf Vi\u1ec7t Nam \u0111\u00e3 \u0111\u01b0a fosfomycin IV v\u00e0o danh s\u00e1ch nh\u00f3m c\u00e1c kh\u00e1ng sinh \u201cd\u1ef1 tr\u1eef\u201d c\u1ea7n c\u00f3 chi\u1ebfn l\u01b0\u1ee3c qu\u1ea3n l\u00fd \u0111\u1eb7c bi\u1ec7t [3,4]. Trong b\u1ed1i c\u1ea3nh \u0111\u00f3, B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n c\u00f3 ch\u01b0\u01a1ng tr\u00ecnh \u201cQu\u1ea3n
\nl\u00fd s\u1eed d\u1ee5ng kh\u00e1ng sinh\u201d nh\u1eb1m t\u0103ng c\u01b0\u1eddng s\u1eed d\u1ee5ng h\u1ee3p l\u00fd kh\u00e1ng sinh n\u00f3i chung v\u00e0 fosfomycin IV n\u00f3i ri\u00eang. Ng\u00e0y 26\/3\/2017, H\u1ed9i \u0111\u1ed3ng Thu\u1ed1c v\u00e0 \u0110i\u1ec1u tr\u1ecb c\u1ee7a B\u1ec7nh vi\u1ec7n (H\u0110T&\u0110T) ban h\u00e0nh Quy\u1ebft \u0111\u1ecbnh s\u1ed1 26\/BVTN v\u1edbi \u201cQuy \u0111\u1ecbnh v\u1ec1 qu\u1ea3n l\u00fd s\u1eed d\u1ee5ng kh\u00e1ng
\nsinh trong B\u1ec7nh vi\u1ec7n\u201d, trong \u0111\u00f3 fosfomycin IV l\u00e0 thu\u1ed1c n\u1eb1m trong \u201cDanh m\u1ee5c c\u00e1c kh\u00e1ng sinh ph\u1ea3i ph\u00ea duy\u1ec7t tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng\u201d v\u00e0 c\u1ea7n tu\u00e2n th\u1ee7 quy tr\u00ecnh duy\u1ec7t \u0111\u01a1n ch\u1eb7t ch\u1ebd. Ti\u1ebfp \u0111\u00f3, H\u0110T&\u0110T ti\u1ebfp t\u1ee5c ban h\u00e0nh \u201cH\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng fosfomycin IV t\u1ea1i B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n\u201d k\u00e8m theo Quy\u1ebft \u0111\u1ecbnh s\u1ed1 125\/BVTN ng\u00e0y 26\/6\/2018 v\u1edbi quy \u0111\u1ecbnh chi ti\u1ebft v\u1ec1 ch\u1ec9 \u0111\u1ecbnh, x\u00e9t nghi\u1ec7m vi sinh, l\u1ef1a ch\u1ecdn ph\u00e1c \u0111\u1ed3 c\u0169ng nh\u01b0 li\u1ec1u d\u00f9ng v\u00e0 c\u00e1ch d\u00f9ng c\u1ee7a fosfomycin IV v\u00e0 quy tr\u00ecnh gi\u00e1m s\u00e1t vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh n\u00e0y th\u00f4ng qua can thi\u1ec7p c\u1ee7a d\u01b0\u1ee3c s\u0129 l\u00e2m s\u00e0ng. Nghi\u00ean c\u1ee9u n\u00e0y \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n nh\u1eb1m \u0111\u00e1nh gi\u00e1 t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u00e1c bi\u1ec7n ph\u00e1p can thi\u1ec7p n\u00f3i tr\u00ean \u0111\u1ebfn t\u00ecnh h\u00ecnh ti\u00eau th\u1ee5 c\u0169ng nh\u01b0 vi\u1ec7c s\u1eed d\u1ee5ng
\nfosfomycin IV t\u1ea1i B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n, l\u00e0m c\u01a1 s\u1edf \u0111\u1ec3 ho\u00e0n thi\u1ec7n quy tr\u00ecnh qu\u1ea3n l\u00fd kh\u00e1ng sinh v\u00e0 nh\u00e2n r\u1ed9ng ho\u1ea1t \u0111\u1ed9ng n\u00e0y trong ch\u01b0\u01a1ng tr\u00ecnh qu\u1ea3n l\u00fd kh\u00e1ng
\nsinh c\u1ee7a b\u1ec7nh vi\u1ec7n.<\/p>\n\u0110\u1ed1i t\u01b0\u1ee3ng v\u00e0 ph\u01b0\u01a1ng ph\u00e1p nghi\u00ean c\u1ee9u<\/h2>\n
\u0110\u1ed1i t\u01b0\u1ee3ng nghi\u00ean c\u1ee9u<\/h3>\n
\u0110\u00e1nh gi\u00e1 t\u00ecnh h\u00ecnh ti\u00eau th\u1ee5 fosfomycin IV c\u1ee7a c\u00e1c Khoa L\u00e2m s\u00e0ng v\u00e0 to\u00e0n B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n giai \u0111o\u1ea1n 2013 \u2013 2018 d\u1ef1a tr\u00ean h\u1ed3i c\u1ee9u s\u1ed1 li\u1ec7u s\u1eed d\u1ee5ng fosfomycin IV c\u1ee7a b\u1ec7nh nh\u00e2n n\u1ed9i tr\u00fa v\u00e0 s\u1ed1 ng\u00e0y n\u1eb1m vi\u1ec7n \u0111\u01b0\u1ee3c tr\u00edch xu\u1ea5t theo th\u00e1ng t\u1eeb ph\u1ea7n m\u1ec1m
\nqu\u1ea3n l\u00fd thu\u1ed1c c\u1ee7a Khoa D\u01b0\u1ee3c v\u00e0 ph\u1ea7n m\u1ec1m qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n n\u1ed9i tr\u00fa c\u1ee7a Ph\u00f2ng K\u1ebf ho\u1ea1ch t\u1ed5ng h\u1ee3p.<\/p>\n\u201cH\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng fosfomycin IV t\u1ea1i B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n\u201d \u00e1p d\u1ee5ng tr\u00ean \u0111\u1ed1i t\u01b0\u1ee3ng ng\u01b0\u1eddi l\u1edbn, do \u0111\u00f3 Khoa Nhi v\u00e0 \u0110\u01a1n nguy\u00ean s\u01a1 sinh \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb kh\u1ecfi nghi\u00ean c\u1ee9u. Vi\u1ec7c s\u1eed d\u1ee5ng fosfomycin IV \u0111\u01b0\u1ee3c ph\u00e2n t\u00edch d\u1ef1a tr\u00ean b\u1ec7nh \u00e1n c\u1ee7a b\u1ec7nh nh\u00e2n ng\u01b0\u1eddi l\u1edbn \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa c\u00f3 s\u1eed d\u1ee5ng fosfomycin IV t\u1eeb 1\/1\/2017 \u0111\u1ebfn 30\/12\/2018. C\u00e1c b\u00ea\u0323nh nh\u00e2n nhi ho\u1eb7c c\u00e1c tr\u01b0\u1eddng h\u1ee3p HSBA kh\u00f4ng ti\u1ebfp c\u1eadn \u0111\u01b0\u1ee3c trong qu\u00e1 tr\u00ecnh thu th\u1eadp th\u00f4ng tin s\u1ebd \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb.<\/p>\n
Thi\u1ebft k\u1ebf nghi\u00ean c\u1ee9u<\/h3>\n
Nghi\u00ean c\u1ee9u can thi\u1ec7p, theo d\u00f5i d\u1ecdc theo th\u1eddi gian \u0111\u01b0\u1ee3c chia l\u00e0m giai \u0111o\u1ea1n tr\u01b0\u1edbc can thi\u1ec7p v\u00e0 hai giai \u0111o\u1ea1n sau can thi\u1ec7p t\u01b0\u01a1ng \u1ee9ng v\u1edbi vi\u1ec7c ban h\u00e0nh \u201cDanh m\u1ee5c c\u00e1c kh\u00e1ng sinh ph\u1ea3i ph\u00ea duy\u1ec7t tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng\u201d th\u00e1ng 4\/2017 (can thi\u1ec7p 1) v\u00e0 \u201cH\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng kh\u00e1ng sinh fosfomycin IV t\u1ea1i B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n\u201d th\u00e1ng 7\/2018 (can thi\u1ec7p 2) c\u1ee7a H\u0110T&\u0110T (h\u00ecnh 1).<\/p>\n
H\u00ecnh 1. S\u01a1 \u0111\u1ed3 giai \u0111o\u1ea1n di\u1ec5n ti\u1ebfn can thi\u1ec7p t\u0103ng c\u01b0\u1eddng s\u1eed d\u1ee5ng h\u1ee3p l\u00fd fosfomycin<\/p>\n
M\u1ee9c \u0111\u1ed9 ti\u00eau th\u1ee5 fosfomycin IV t\u1ea1i c\u00e1c Khoa L\u00e2m s\u00e0ng v\u00e0 to\u00e0n B\u1ec7nh vi\u1ec7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 d\u1ef1a tr\u00ean s\u1ed1 li\u1ec1u DDD\/100 ng\u00e0y n\u1eb1m vi\u1ec7n theo c\u00f4ng th\u1ee9c sau, trong \u0111\u00f3 gi\u00e1 tr\u1ecb DDD c\u1ee7a fosfomycin IV l\u00e0 8 g [5]. DDD\/100 ng\u00e0y n\u1eb1m vi\u1ec7n = T\u1ed5ng s\u1ed1 gram s\u1eed d\u1ee5ng x 100
\nDDD x s\u1ed1 ng\u00e0y n\u1eb1m vi\u1ec7n.<\/p>\nVi\u1ec7c s\u1eed d\u1ee5ng fosfomycin \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 d\u1ef1a tr\u00ean h\u1ed3i c\u1ee9u b\u1ec7nh \u00e1n trong giai \u0111o\u1ea1n 1 v\u00e0 2 sau \u0111\u00f3 theo d\u00f5i ti\u1ebfn c\u1ee9u trong giai \u0111o\u1ea1n 3 c\u00f3 can thi\u1ec7p tr\u1ef1c ti\u1ebfp c\u1ee7a d\u01b0\u1ee3c s\u0129 l\u00e2m s\u00e0ng. Giai \u0111o\u1ea1n 3 ti\u1ebfp n\u1ed1i quy tr\u00ecnh duy\u1ec7t s\u1eed d\u1ee5ng fosfomycin IV \u1edf giai \u0111o\u1ea1n 2, \u0111\u1ed3ng th\u1eddi s\u1eed d\u1ee5ng \u201cH\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng fosfomycin IV t\u1ea1i B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n\u201d l\u00e0m c\u0103n c\u1ee9 ch\u00ednh th\u1ee9c \u0111\u1ec3 d\u01b0\u1ee3c s\u0129 duy\u1ec7t \u0111\u01a1n v\u00e0 c\u00f3 \u00fd ki\u1ebfn t\u01b0 v\u1ea5n tr\u1ef1c ti\u1ebfp cho b\u00e1c s\u0129 trong tr\u01b0\u1eddng h\u1ee3p s\u1eed d\u1ee5ng thu\u1ed1c ch\u01b0a ph\u00f9 h\u1ee3p v\u1edbi h\u01b0\u1edbng d\u1eabn.<\/p>\n
T\u00e0i li\u1ec7u n\u00e0y c\u0169ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ph\u00e2n t\u00edch, so s\u00e1nh \u0111\u1eb7c \u0111i\u1ec3m s\u1eed d\u1ee5ng fosfomycin gi\u1eefa c\u00e1c giai \u0111o\u1ea1n. C\u00e1c ch\u1ec9 ti\u00eau \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 ph\u00f9 h\u1ee3p bao g\u1ed3m ch\u1ec9 \u0111\u1ecbnh d\u00f9ng thu\u1ed1c, ch\u1ec9 \u0111\u1ecbnh x\u00e9t nghi\u1ec7m vi sinh tr\u01b0\u1edbc khi d\u00f9ng fosfomycin IV, l\u1ef1a ch\u1ecdn fosfomycin IV l\u00e0
\nkh\u00e1ng sinh thay th\u1ebf trong ph\u00e1c \u0111\u1ed3 h\u01a1n l\u00e0 ph\u00e1c \u0111\u1ed3 kh\u1edfi \u0111\u1ea7u, t\u1ef7 l\u1ec7 c\u00f3 s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p fosfomycin IV v\u1edbi kh\u00e1ng sinh kh\u00e1c v\u00e0 s\u1eed d\u1ee5ng fosfomycin IV ch\u1ebf \u0111\u1ed9 li\u1ec1u cao (li\u1ec1u > 4 g\/ng\u00e0y \u1edf b\u1ec7nh nh\u00e2n c\u00f3 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn \u2265 20 ml\/ph\u00fat).<\/p>\nX\u1eed l\u00fd s\u1ed1 li\u1ec7u<\/h2>\n
S\u1ed1 li\u1ec7u \u0111\u01b0\u1ee3c thu th\u1eadp v\u00e0 x\u1eed l\u00fd th\u1ed1ng k\u00ea b\u1eb1ng ph\u1ea7n m\u1ec1m SPSS 21.0. Ki\u1ec3m \u0111\u1ecbnh phi tham s\u1ed1 Wilcoxon Signed Ranks Test \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 so s\u00e1nh m\u1ee9c ti\u00eau th\u1ee5 fosfomycin trung b\u00ecnh gi\u1eefa c\u00e1c giai \u0111o\u1ea1n nghi\u00ean c\u1ee9u. So s\u00e1nh t\u1ef7 l\u1ec7 s\u1eed d\u1ee5ng fosfomycin ph\u00f9 h\u1ee3p \u1edf c\u00e1c giai \u0111o\u1ea1n b\u1eb1ng ki\u1ec3m \u0111\u1ecbnh chi b\u00ecnh ph\u01b0\u01a1ng. Kh\u00e1c bi\u1ec7t \u0111\u01b0\u1ee3c coi l\u00e0 c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea n\u1ebfu p < 0,05.<\/p>\n
K\u1ebft qu\u1ea3<\/h2>\n
T\u00e1c \u0111\u1ed9ng c\u1ee7a can thi\u1ec7p l\u00ean ti\u00eau th\u1ee5 fosfomycin IV Sau khi H\u0110T\u0110T B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n ban h\u00e0nh \u201cDanh m\u1ee5c c\u00e1c kh\u00e1ng sinh ph\u1ea3i ph\u00ea duy\u1ec7t tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng\u201d v\u00e0o th\u00e1ng 4\/2017, m\u1ee9c \u0111\u1ed9 ti\u00eau th\u1ee5 fosfomycin IV trung b\u00ecnh tr\u00ean to\u00e0n B\u1ec7nh vi\u1ec7n \u0111\u00e3 gi\u1ea3m
\nc\u00f2n 1\/3 so v\u1edbi giai \u0111o\u1ea1n tr\u01b0\u1edbc \u0111\u00f3 (t\u1eeb 0,855 xu\u1ed1ng c\u00f2n 0,278 li\u1ec1u DDD\/100 ng\u00e0y n\u1eb1m vi\u1ec7n). Sang giai \u0111o\u1ea1n 3, l\u01b0\u1ee3ng fosfomycin ti\u00eau th\u1ee5 t\u0103ng g\u1ea5p 1,6 l\u1ea7n so v\u1edbi giai \u0111o\u1ea1n 2 (0,457 li\u1ec1u DDD\/100 ng\u00e0y n\u1eb1m vi\u1ec7n) tuy nhi\u00ean v\u1eabn th\u1ea5p h\u01a1n r\u00f5 r\u1ec7t so v\u1edbi giai \u0111o\u1ea1n 1.<\/p>\nH\u00ecnh 2 bi\u1ec3u di\u1ec5n m\u1ee9c \u0111\u1ed9 ti\u00eau th\u1ee5 fosfomycin IV h\u00e0ng th\u00e1ng tr\u00ean to\u00e0n B\u1ec7nh vi\u1ec7n v\u00e0 c\u00e1c kh\u1ed1i Khoa Ph\u00f2ng qua 3 giai \u0111o\u1ea1n.<\/p>\n
*Kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea<\/p>\n
H\u00ecnh 3. Thay \u0111\u1ed5i m\u1ee9c \u0111\u1ed9 ti\u00eau th\u1ee5 fosfomycin chung c\u1ee7a B\u1ec7nh vi\u1ec7n, c\u00e1c kh\u1ed1i \u0110i\u1ec1u tr\u1ecb v\u00e0 m\u1ed9t s\u1ed1 Khoa L\u00e2m s\u00e0ng s\u1eed d\u1ee5ng fosfomycin v\u1edbi s\u1ed1 l\u01b0\u1ee3ng l\u1edbn d\u01b0\u1edbi t\u00e1c \u0111\u1ed9ng c\u1ee7a can thi\u1ec7p.<\/p>\n
C\u01a1 c\u1ea5u khoa ph\u00f2ng ti\u00eau th\u1ee5 fosfomycin IV trong B\u1ec7nh vi\u1ec7n c\u0169ng c\u00f3 nhi\u1ec1u thay \u0111\u1ed5i sau can thi\u1ec7p.<\/p>\n
Trong giai \u0111o\u1ea1n 1, 19\/21 khoa ph\u00f2ng c\u00f3 s\u1eed d\u1ee5ng fosfomycin v\u1edbi ph\u00e2n b\u1ed1 kh\u00e1 \u0111\u1ed3ng \u0111\u1ec1u \u1edf c\u00e1c kh\u1ed1i \u0111i\u1ec1u tr\u1ecb, trong \u0111\u00f3 ti\u00eau th\u1ee5 fosfomycin c\u1ee7a kh\u1ed1i ngo\u1ea1i lu\u00f4n \u1edf m\u1ee9c cao nh\u1ea5t. Sang giai \u0111o\u1ea1n 2 v\u00e0 3, s\u1ed1 l\u01b0\u1ee3ng Khoa L\u00e2m s\u00e0ng c\u00f3 s\u1eed d\u1ee5ng fosfomycin \u0111\u00e3 gi\u1ea3m xu\u1ed1ng l\u1ea7n l\u01b0\u1ee3t c\u00f2n 15 v\u00e0 12 Khoa v\u1edbi m\u1ee9c ti\u00eau th\u1ee5 l\u1edbn nh\u1ea5t l\u00e0 \u1edf Kh\u1ed1i H\u1ed3i s\u1ee9c (g\u1ea5p kho\u1ea3ng 10 l\u1ea7n ti\u00eau th\u1ee5 trung b\u00ecnh c\u1ee7a to\u00e0n B\u1ec7nh vi\u1ec7n, t\u01b0\u01a1ng \u1ee9ng v\u1edbi 2,65 v\u00e0 5,14 li\u1ec1u
\nDDD\/100 ng\u00e0y n\u1eb1m vi\u1ec7n). Nh\u1eb1m \u0111\u00e1nh gi\u00e1 xu h\u01b0\u1edbng s\u1eed d\u1ee5ng fosfomycin IV
\nc\u1ee5 th\u1ec3 \u1edf m\u1ed9t s\u1ed1 Khoa L\u00e2m s\u00e0ng, ch\u00fang t\u00f4i ch\u1ecdn c\u00e1c khoa c\u00f3 m\u1ee9c ti\u00eau th\u1ee5 cao nh\u1ea5t \u0111\u1ec3 so s\u00e1nh tr\u01b0\u1edbc v\u00e0 sau c\u00e1c can thi\u1ec7p. H\u00ecnh 3 bi\u1ec3u di\u1ec5n m\u1ee9c \u0111\u1ed9 ti\u00eau th\u1ee5 fosfomycin IV tr\u00ean to\u00e0n B\u1ec7nh vi\u1ec7n, c\u00e1c kh\u1ed1i khoa \u0111i\u1ec1u tr\u1ecb v\u00e0 m\u1ed9t s\u1ed1 khoa l\u00e2m s\u00e0ng c\u00f3 s\u1ed1 l\u01b0\u1ee3ng s\u1eed d\u1ee5ng fosfomycin IV l\u1edbn trong 3 giai \u0111o\u1ea1n. Theo \u0111\u00f3, m\u1ee9c \u0111\u1ed9 ti\u00eau th\u1ee5 \u1edf kh\u1ed1i Ngo\u1ea1i, bao g\u1ed3m c\u00e1c Khoa Ngo\u1ea1i s\u1ecd, Ngo\u1ea1i th\u1eadn, Ngo\u1ea1i t\u1ed5ng h\u1ee3p \u1edf giai \u0111o\u1ea1n 2 \u0111\u1ec1u gi\u1ea3m m\u1ea1nh (p < 0,05). Trong khi \u0111\u00f3 kh\u1ed1i h\u1ed3i s\u1ee9c (n\u1ed9iv\u00e0 ngo\u1ea1i) c\u00f3 m\u1ee9c \u0111\u1ed9 s\u1eed d\u1ee5ng t\u0103ng d\u1ea7n trong c\u1ea3 giai \u0111o\u1ea1n 2 v\u00e0 giai \u0111o\u1ea1n 3. Ti\u00eau th\u1ee5 t\u1ea1i kh\u1ed1i n\u1ed9i v\u00e0 to\u00e0n B\u1ec7nh vi\u1ec7n c\u0169ng c\u00f3 gi\u1ea3m nh\u01b0ng s\u1ef1 kh\u00e1c bi\u1ec7t ch\u01b0a \u0111\u1ea1t m\u1ee9c c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea. T\u00e1c \u0111\u1ed9ng c\u1ee7a can thi\u1ec7p l\u00ean vi\u1ec7c s\u1eed d\u1ee5ng fosfomycin.<\/p>\n\u0110\u1eb7c \u0111i\u1ec3m s\u1eed d\u1ee5ng fosfomycin IV \u0111\u01b0\u1ee3c ph\u00e2n t\u00edch tr\u00ean 227 b\u1ec7nh \u00e1n c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u1ea1t ti\u00eau chu\u1ea9n l\u1ef1a ch\u1ecdn v\u00e0 lo\u1ea1i tr\u1eeb trong \u0111\u00f3 71 b\u1ec7nh \u00e1n c\u1ee7a giai \u0111o\u1ea1n 1, 96 b\u1ec7nh \u00e1n c\u1ee7a giai \u0111o\u1ea1n 2 v\u00e0 60 b\u1ec7nh \u00e1n c\u1ee7a giai \u0111o\u1ea1n 3. V\u1ec1 \u0111\u1eb7c \u0111i\u1ec3m b\u1ec7nh nh\u00e2n, \u1edf giai \u0111o\u1ea1n 2 v\u00e0 3
\nb\u1ec7nh nh\u00e2n c\u00f3 xu h\u01b0\u1edbng cao tu\u1ed5i h\u01a1n, t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n c\u00f3 suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn (\u0111\u1ed9 thanh th\u1ea3i creatinin < 60 ml\/ph) cao h\u01a1n v\u00e0 th\u1eddi gian n\u1eb1m vi\u1ec7n d\u00e0i h\u01a1n so v\u1edbi giai \u0111o\u1ea1n 1, b\u1ea3ng 1.<\/p>\nB\u1ea3ng 1. \u0110\u1eb7c \u0111i\u1ec3m b\u1ec7nh nh\u00e2n trong c\u00e1c giai \u0111o\u1ea1n c\u1ee7a nghi\u00ean c\u1ee9u<\/p>\n
Vi\u1ec7c s\u1eed d\u1ee5ng fosfomycin IV \u0111\u00e3 c\u00f3 c\u1ea3i thi\u1ec7n \u0111\u00e1ng k\u1ec3 sau khi H\u0110T&\u0110T ban h\u00e0nh \u201cDanh m\u1ee5c c\u00e1c kh\u00e1ng sinh ph\u1ea3i ph\u00ea duy\u1ec7t tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng\u201d v\u00e0o th\u00e1ng 4\/2017 v\u1edbi t\u1ef7 l\u1ec7 ph\u00f9 h\u1ee3p tr\u00ean 80 % tr\u00ean t\u1ea5t c\u1ea3 c\u00e1c ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 (h\u00ecnh 4). C\u1ee5 th\u1ec3, t\u1ef7 l\u1ec7 s\u1eed d\u1ee5ng ch\u1ebf \u0111\u1ed9
\nli\u1ec1u cao c\u00f3 m\u1ee9c t\u0103ng cao nh\u1ea5t (tr\u00ean 10 l\u1ea7n), ti\u00eau ch\u00ed v\u1ec1 ch\u1ec9 \u0111\u1ecbnh ph\u00f9 h\u1ee3p v\u00e0 c\u00f3 x\u00e9t nghi\u1ec7m vi sinh tr\u01b0\u1edbc khi d\u00f9ng fosfomycin c\u0169ng t\u0103ng h\u01a1n 4 l\u1ea7n, c\u00e1c thay \u0111\u1ed5i n\u00e0y \u0111\u1ec1u c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea. Trong giai \u0111o\u1ea1n 3, sau khi ban h\u00e0nh \u201cH\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng fosfomycin IV c\u1ee7a H\u0110T&\u0110T B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n\u201d, t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng fosfomycin IV ph\u00f9 h\u1ee3p ti\u1ebfp t\u1ee5c t\u0103ng l\u00ean (tr\u1eeb ti\u00eau ch\u00ed v\u1ec1 x\u00e9t nghi\u1ec7m vi sinh), \u0111\u1eb7c bi\u1ec7t l\u00e0 t\u1ef7 l\u1ec7 s\u1eed d\u1ee5ng fosfomycin trong ph\u00e1c \u0111\u1ed3 ph\u1ed1i h\u1ee3p kh\u00e1ng sinh v\u00e0 \u00e1p d\u1ee5ng ch\u1ebf \u0111\u1ed9 li\u1ec1u cao \u0111\u1ec1u \u0111\u1ea1t 100 %, \u0111\u1ed3ng th\u1eddi c\u1ea3i thi\u1ec7n r\u00f5 r\u1ec7t so v\u1edbi giai \u0111o\u1ea1n 2 (p < 0,05).<\/p>\nH\u00ecnh 4. T\u00e1c \u0111\u1ed9ng c\u1ee7a can thi\u1ec7p \u0111\u1ebfn t\u1ef7 l\u1ec7 ph\u00f9 h\u1ee3p trong s\u1eed d\u1ee5ng fosfomycin v\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a H\u0110T&\u0110T B\u1ec7nh vi\u1ec7n.<\/p>\n
B\u00e0n lu\u1eadn<\/h2>\n
Nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i cho th\u1ea5y c\u00e1c can thi\u1ec7p t\u1eeb H\u0110T&\u0110T c\u00f3 \u1ea3nh h\u01b0\u1edfng l\u1edbn \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 ti\u00eau th\u1ee5 fosfomycin IV t\u1ea1i c\u00e1c Khoa L\u00e2m s\u00e0ng c\u0169ng nh\u01b0 c\u00e1c kh\u1ed1i \u0110i\u1ec1u tr\u1ecb trong B\u1ec7nh vi\u1ec7n, trong \u0111\u00f3 xu h\u01b0\u1edbng gia t\u0103ng s\u1eed d\u1ee5ng t\u1ea1i c\u00e1c \u0111\u01a1n v\u1ecb h\u1ed3i s\u1ee9c v\u00e0 h\u1ea1n ch\u1ebf s\u1eed
\nd\u1ee5ng t\u1ea1i \u0111\u01a1n v\u1ecb Ngo\u1ea1i khoa. C\u00f9ng v\u1edbi \u0111\u00f3, vi\u1ec7c s\u1eed d\u1ee5ng fosfomycin \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n trong t\u1ea5t c\u1ea3 c\u00e1c ti\u00eau ch\u00ed quan tr\u1ecdng nh\u1eb1m \u0111\u1ea3m b\u1ea3o s\u1eed d\u1ee5ng h\u1ee3p l\u00fd fosfomycin IV. Fosfomycin IV \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng t\u1ea1i B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n t\u1eeb n\u0103m 2010. G\u1ea7n \u0111\u00e2y, kh\u00e1ng sinh n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o danh s\u00e1ch c\u00e1c kh\u00e1ng sinh c\u1ea7n qu\u1ea3n l\u00fd ch\u1eb7t ch\u1ebd nh\u1eb1m b\u1ea3o t\u1ed3n hi\u1ec7u l\u1ef1c tr\u01b0\u1edbc t\u00ecnh tr\u1ea1ng gia t\u0103ng \u0111\u1ec1 kh\u00e1ng c\u1ee7a c\u00e1c vi khu\u1ea9n Gram d\u01b0\u01a1ng v\u00e0 Gram \u00e2m ch\u00ednh g\u00e2y nhi\u1ec5m khu\u1ea9n b\u1ec7nh vi\u1ec7n. B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n \u0111\u00e3 l\u1ea7n l\u01b0\u1ee3t ban h\u00e0nh \u201cDanh m\u1ee5c kh\u00e1ng sinh ph\u1ea3i ph\u00ea duy\u1ec7t tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng\u201d v\u00e0 \u201cH\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng fosfomycin IV\u201d nh\u1eb1m \u0111\u1ea3m b\u1ea3o s\u1eed d\u1ee5ng fosfomycin h\u1ee3p l\u00fd, hi\u1ec7u qu\u1ea3.<\/p>\nT\u1eeb th\u00e1ng 3\/2017, vi\u1ec7c s\u1eed d\u1ee5ng fosfomycin IV \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t theo quy tr\u00ecnh ch\u1eb7t ch\u1ebd, l\u00e0m gi\u1ea3m r\u00f5 r\u1ec7t m\u1ee9c \u0111\u1ed9 ti\u00eau th\u1ee5 fosfomycin IV tr\u00ean to\u00e0n B\u1ec7nh vi\u1ec7n t\u1eeb 0,855 xu\u1ed1ng c\u00f2n 0,278 DDD\/100 ng\u00e0y n\u1eb1m vi\u1ec7n.<\/p>\n
M\u1ee9c gi\u1ea3m n\u00e0y ch\u1ee7 y\u1ebfu l\u00e0 do gi\u1ea3m s\u1eed d\u1ee5ng \u1edf c\u00e1c Khoa kh\u1ed1i Ngo\u1ea1i v\u00e0 kh\u1ed1i N\u1ed9i, trong khi \u0111\u00f3 c\u00e1c Khoa H\u1ed3i s\u1ee9c c\u00f3 m\u1ee9c s\u1eed d\u1ee5ng t\u0103ng d\u1ea7n. Xu h\u01b0\u1edbng n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch do c\u00e1c b\u00e1c s\u0129 \u0111\u00e3 ch\u00fa \u00fd h\u01a1n \u0111\u1ebfn vai tr\u00f2 \u01b0u ti\u00ean c\u1ee7a fosfomycin IV trong c\u00e1c nhi\u1ec5m khu\u1ea9n n\u1eb7ng, \u0111\u1eb7c bi\u1ec7t t\u1ea1i Khoa H\u1ed3i s\u1ee9c t\u00edch c\u1ef1c. Ng\u01b0\u1ee3c l\u1ea1i, c\u00e1c khoa ngo\u00e0i kh\u1ed1i H\u1ed3i s\u1ee9c \u0111\u00e3 c\u00f3 s\u1ef1 gi\u1ea3m s\u1eed d\u1ee5ng kh\u00e1ng sinh r\u00f5 r\u1ec7t do b\u1ec7nh \u00e1n c\u00f3 y l\u1ec7nh fosfomycin IV
\n\u0111\u1ec1u ph\u1ea3i duy\u1ec7t tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng v\u00e0 c\u0103n c\u1ee9 \u0111\u1ec3 duy\u1ec7t d\u1ef1a tr\u00ean vi\u1ec7c kh\u00f4ng c\u00f2n l\u1ef1a ch\u1ecdn kh\u00e1ng sinh n\u00e0o kh\u00e1c thay th\u1ebf. Trong giai \u0111o\u1ea1n 1, fosfomycin \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng tr\u00ean nhi\u1ec1u lo\u1ea1i nhi\u1ec5m khu\u1ea9n nh\u01b0: vi\u00eam ph\u1ed5i c\u1ed9ng \u0111\u1ed3ng, nhi\u1ec5m khu\u1ea9n da – m\u00f4 m\u1ec1m, nhi\u1ec5m khu\u1ea9n \u1ed5 b\u1ee5ng (do vi\u00eam t\u1ee5y c\u1ea5p, s\u1ecfi m\u1eadt, vi\u00eam ph\u00fac m\u1ea1c, vi\u00eam ru\u1ed9t th\u1eeba). \u0110\u1ebfn giai \u0111o\u1ea1n 2, fosfomycin IV \u0111\u00e3 \u0111\u01b0\u1ee3c \u01b0u ti\u00ean d\u1ef1 tr\u1eef d\u00e0nh cho c\u00e1c nhi\u1ec5m khu\u1ea9n n\u1eb7ng,
\nnhi\u1ec5m khu\u1ea9n do vi khu\u1ea9n \u0111a kh\u00e1ng, ch\u1ec9 th\u01b0\u1eddng g\u1eb7p \u1edf c\u00e1c \u0111\u01a1n v\u1ecb H\u1ed3i s\u1ee9c trong B\u1ec7nh vi\u1ec7n. Nh\u01b0 v\u1eady, m\u1eb7c d\u00f9 ch\u01b0a c\u00f3 h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng fosfomycin IV c\u1ee5 th\u1ec3, nh\u01b0ng chi\u1ebfn l\u01b0\u1ee3c \u201ch\u1ea1n ch\u1ebf tr\u01b0\u1edbc k\u00ea \u0111\u01a1n\u201d \u0111\u00e3 gi\u00fap thay \u0111\u1ed5i t\u01b0\u01a1ng \u0111\u1ed1i t\u00edch c\u1ef1c t\u00ecnh h\u00ecnh ti\u00eau th\u1ee5 thu\u1ed1c ngay t\u1eeb giai \u0111o\u1ea1n 2. Sang giai \u0111o\u1ea1n 3, h\u01b0\u1edbng d\u1eabn c\u1ee5 th\u1ec3 v\u1ec1 l\u1ef1a ch\u1ecdn v\u00e0 s\u1eed d\u1ee5ng fosfomycin IV \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ed1ng nh\u1ea5t v\u00e0 ph\u1ed5 bi\u1ebfn r\u1ed9ng r\u00e3i gi\u00fap b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb
\nc\u00f3 \u0111\u1ea7y \u0111\u1ee7 th\u00f4ng tin v\u00e0 c\u01a1 s\u1edf ph\u00e1p l\u00fd \u0111\u1ec3 k\u00ea \u0111\u01a1n. Do v\u1eady, ti\u00eau th\u1ee5 fosfomycin IV t\u1ea1i c\u00e1c \u0111\u01a1n v\u1ecb H\u1ed3i s\u1ee9c ti\u1ebfp t\u1ee5c t\u0103ng, d\u1eabn \u0111\u1ebfn ti\u00eau th\u1ee5 trung b\u00ecnh to\u00e0n vi\u1ec7n t\u0103ng l\u00ean m\u1ee9c 0,457 DDD\/100 ng\u00e0y n\u1eb1m vi\u1ec7n, trong khi \u0111\u00f3 m\u1ee9c ti\u00eau th\u1ee5 \u1edf kh\u1ed1i Ngo\u1ea1i v\u00e0 kh\u1ed1i N\u1ed9i v\u1eabn duy tr\u00ec \u1edf m\u1ee9c th\u1ea5p.<\/p>\nC\u1ea3i thi\u1ec7n v\u1ec1 ch\u1ea5t l\u01b0\u1ee3ng s\u1eed d\u1ee5ng fosfomycin IV \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n c\u1ee5 th\u1ec3 d\u1ef1a tr\u00ean ph\u00e2n t\u00edch b\u1ec7nh \u00e1n. Trong giai \u0111o\u1ea1n 2 khi ch\u01b0a c\u00f3 \u201cH\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng fosfomycin IV t\u1ea1i B\u1ec7nh vi\u1ec7n\u201d, t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng fosfomycin ph\u00f9 h\u1ee3p \u0111\u00e3 t\u0103ng \u0111\u00e1ng k\u1ec3 (tr\u00ean 80 % b\u1ec7nh nh\u00e2n ph\u00f9 h\u1ee3p \u1edf c\u1ea3 5 ti\u00eau ch\u00ed ch\u00ednh). \u1ede giai \u0111o\u1ea1n 3, c\u00e1c ch\u1ec9 \u0111\u1ecbnh c\u1ee7a b\u00e1c s\u0129 v\u00e0 ho\u1ea1t \u0111\u1ed9ng duy\u1ec7t s\u1eed d\u1ee5ng thu\u1ed1c c\u1ee7a d\u01b0\u1ee3c s\u0129 ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c duy tr\u00ec v\u00e0 c\u1ee7ng
\nc\u1ed1 th\u00eam b\u1edfi s\u1ef1 th\u1ed1ng nh\u1ea5t v\u1ec1 h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng fosfomycin IV c\u1ee7a H\u0110T&\u0110T. Do \u0111\u00f3, c\u00e1c ch\u1ec9 s\u1ed1 v\u1ec1 s\u1eed d\u1ee5ng h\u1ee3p l\u00fd fosfomycin IV ph\u00f9 h\u1ee3p v\u1edbi H\u01b0\u1edbng d\u1eabn \u0111\u00e3 \u0111\u01b0\u1ee3c ban h\u00e0nh ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n so v\u1edbi giai \u0111o\u1ea1n 2, \u0111\u1eb7c bi\u1ec7t tr\u00ean ti\u00eau ch\u00ed \u201cch\u1ebf \u0111\u1ed9 li\u1ec1u\u201d v\u00e0 \u201cs\u1eed d\u1ee5ng ph\u00e1c \u0111\u1ed3 ph\u1ed1i h\u1ee3p kh\u00e1ng sinh\u201d \u0111\u00e3 \u0111\u1ea1t 100 %. \u0110\u00e2y l\u00e0 c\u00e1c c\u1ea3i thi\u1ec7n quan tr\u1ecdng nh\u1eb1m \u0111\u1ea3m b\u1ea3o hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb, gi\u1ea3m nguy c\u01a1 gia t\u0103ng c\u00e1c vi khu\u1ea9n \u0111\u1ec1 kh\u00e1ng. M\u1ed9t
\ns\u1ed1 nghi\u00ean c\u1ee9u tr\u00ean th\u1ebf gi\u1edbi c\u0169ng \u0111\u00e3 ch\u1ee9ng minh hi\u1ec7u qu\u1ea3 can thi\u1ec7p c\u1ee7a d\u01b0\u1ee3c s\u0129 l\u00e2m s\u00e0ng \u0111\u1ebfn s\u1eed d\u1ee5ng kh\u00e1ng sinh, \u0111\u1eb7c bi\u1ec7t l\u00e0 s\u1ef1 ph\u00f9 h\u1ee3p v\u1ec1 ch\u1ec9 \u0111\u1ecbnh v\u00e0 li\u1ec1u d\u00f9ng c\u0169ng nh\u01b0 t\u00ecnh h\u00ecnh ti\u00eau th\u1ee5 thu\u1ed1c [6]. Nghi\u00ean c\u1ee9u n\u00e0y m\u1ed9t l\u1ea7n n\u1eefa kh\u1eb3ng \u0111\u1ecbnh c\u00e1c t\u00e1c \u0111\u1ed9ng t\u00edch c\u1ef1c qua ch\u01b0\u01a1ng tr\u00ecnh qu\u1ea3n l\u00fd s\u1eed d\u1ee5ng fosfomycin t\u1ea1i B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n.<\/p>\nM\u1eb7c d\u00f9 \u0111\u00e3 c\u00f3 chuy\u1ec3n bi\u1ebfn t\u00edch c\u1ef1c, ch\u00fang t\u00f4i v\u1eabn ghi nh\u1eadn m\u1ed9t t\u1ef7 l\u1ec7 \u0111\u00e1ng k\u1ec3 b\u1ec7nh nh\u00e2n ch\u01b0a \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m vi sinh tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng fosfomycin IV \u1edf giai \u0111o\u1ea1n 2 (19,8 %) v\u00e0 h\u00ecnh \u1ea3nh n\u00e0y ch\u01b0a \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n \u1edf giai \u0111o\u1ea1n 3 (21,7 %). Nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 do m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng l\u1ea5y \u0111\u01b0\u1ee3c m\u1eabu b\u1ec7nh ph\u1ea9m ho\u1eb7c y l\u1ec7nh trong gi\u1edd tr\u1ef1c \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n ngay v\u00e0 kh\u00f4ng qua b\u01b0\u1edbc duy\u1ec7t s\u1eed d\u1ee5ng, \u0111\u1eb7c bi\u1ec7t t\u1ea1i c\u00e1c khoa ngo\u00e0i
\n\u0111\u01a1n v\u1ecb H\u1ed3i s\u1ee9c. \u0110\u00e2y l\u00e0 v\u1ea5n \u0111\u1ec1 c\u1ea7n \u0111\u01b0\u1ee3c l\u01b0u \u00fd v\u00e0 ti\u1ebfp t\u1ee5c c\u00f3 c\u00e1c can thi\u1ec7p ph\u00f9 h\u1ee3p \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o tu\u00e2n th\u1ee7 H\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng thu\u1ed1c, gi\u00fap chu\u1ea9n h\u00f3a quy tr\u00ecnh s\u1eed d\u1ee5ng kh\u00e1ng sinh d\u1ef1 tr\u1eef n\u00e0y. Th\u00eam v\u00e0o \u0111\u00f3, t\u1ef7 l\u1ec7 ch\u1ec9 \u0111\u1ecbnh ch\u01b0a ph\u00f9 h\u1ee3p v\u1edbi H\u01b0\u1edbng d\u1eabn \u1edf giai \u0111o\u1ea1n 3 \u0111\u00e3 kh\u00f4ng c\u1ea3i thi\u1ec7n nhi\u1ec1u, ch\u1ee7 y\u1ebfu li\u00ean quan \u0111\u1ebfn nhi\u1ec5m tr\u00f9ng \u1ed5 b\u1ee5ng v\u00e0 nhi\u1ec5m khu\u1ea9n da – m\u00f4 m\u1ec1m. M\u1eb7c d\u00f9 kh\u00f4ng n\u1eb1m trong h\u01b0\u1edbng d\u1eabn c\u1ee7a B\u1ec7nh vi\u1ec7n, c\u00e1c ch\u1ec9 \u0111\u1ecbnh n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn trong m\u1ed9t s\u1ed1 t\u00e0i li\u1ec7u kh\u00e1c, \u0111\u1ed3ng th\u1eddi k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3 c\u0169ng cho th\u1ea5y vi khu\u1ea9n \u0111\u00e3 kh\u00e1ng c\u00e1c kh\u00e1ng sinh \u01b0u ti\u00ean kh\u00e1c v\u00e0 ch\u1ec9 c\u00f2n nh\u1ea1y c\u1ea3m v\u1edbi fosfomycin [7,8].<\/p>\nK\u1ebft lu\u1eadn<\/h2>\n
C\u00e1c can thi\u1ec7p t\u1eeb H\u0110T&\u0110T \u0111\u00e3 c\u00f3 t\u00e1c \u0111\u1ed9ng t\u00edch c\u1ef1c l\u00ean ti\u00eau th\u1ee5 fosfomycin IV v\u1edbi xu h\u01b0\u1edbng h\u1ea1n ch\u1ebf s\u1eed d\u1ee5ng trong to\u00e0n B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n, \u0111\u1eb7c bi\u1ec7t l\u00e0 kh\u1ed1i ngo\u1ea1i \u0111\u1ec3 t\u1eadp trung \u01b0u ti\u00ean \u0111i\u1ec1u tr\u1ecb c\u00e1c nhi\u1ec5m khu\u1ea9n n\u1eb7ng, nhi\u1ec5m khu\u1ea9n do vi khu\u1ea9n \u0111a kh\u00e1ng th\u01b0\u1eddng g\u1eb7p t\u1ea1i c\u00e1c \u0111\u01a1n v\u1ecb H\u1ed3i s\u1ee9c. Kinh nghi\u1ec7m r\u00fat\u00a0 ra t\u1eeb nghi\u00ean c\u1ee9u n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng cho c\u00e1c ho\u1ea1t \u0111\u1ed9ng kh\u00e1c c\u1ee7a ch\u01b0\u01a1ng tr\u00ecnh qu\u1ea3n l\u00fd kh\u00e1ng sinh, gi\u00fap b\u1ea3o t\u1ed3n hi\u1ec7u l\u1ef1c c\u1ee7a c\u00e1c kh\u00e1ng sinh d\u1ef1 tr\u1eef tr\u01b0\u1edbc t\u00ecnh tr\u1ea1ng gia t\u0103ng \u0111\u1ec1 kh\u00e1ng kh\u00e1ng sinh c\u1ee7a vi khu\u1ea9n g\u00e2y b\u1ec7nh.<\/p>\n
T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n
- \n
- Bielen L., Likic R., et al. (2018), \u201cActivity of fosfomycin against nosocomial multiresistant bacterial pathogens from Croatia: A multicentric study\u201d, Croat. Med. J., 59(2), pp. 56-64.<\/li>\n
- Grabein B., Graninger W., et al. (2017), \u201cIntravenous fosfomycin-back to the future, Systematic review and metaanalysis of the clinical literature\u201d, Clin. Microbiol. Infect., 23(6), pp. 363-372.<\/li>\n
- World Health Organization (2017), \u201cWHO Model Lists of Essential Medicines\u201d, Retrieved 08\/4\/2019, from http:\/\/www. who.int\/medicines\/publications\/essentialmedicines\/en\/<\/a>.<\/li>\n
- B\u1ed9 Y t\u1ebf (2016), \u201cH\u01b0\u1edbng d\u1eabn th\u1ef1c hi\u1ec7n qu\u1ea3n l\u00fd s\u1eed d\u1ee5ng kh\u00e1ng sinh trong b\u1ec7nh vi\u1ec7n\u201d ban h\u00e0nh k\u00e8m theo Quy\u1ebft \u0111\u1ecbnh s\u1ed1 772\/Q\u0110-BYT ng\u00e0y 4\/3\/2016.<\/li>\n
- WHO Collaborating Centre for drug statistics methodology, Retrieved 08\/4\/2019, from https:\/\/www.whocc.no\/.<\/li>\n
- Seah X. F., Ong Y. L., et al. (2014), \u201cImpact of an antimicrobial stewardship program on the use of carbapenems in a tertiary women\u2019s and children\u2019s hospital, Singapore\u201d, Pharmacotherapy, 34(11), pp. 1141-50.<\/li>\n
- Kusachi S., Nagao J., et al. (2011), \u201cAntibiotic time-lag combination therapy with fosfomycin for postoperative intraabdominal abscesses\u201d, J. Infect. Chemother., 17(1), pp. 91-6.<\/li>\n
- Schintler M. V., Traunmuller F., et al. (2009), \u201cHigh fosfomycin concentrations in bone and peripheral soft tissue in diabetic patients presenting with bacterial foot infection\u201d, J. Antimicrob. Chemother., 64(3), pp. 574-8. (Ng\u00e0y nh\u1eadn b\u00e0i: 09\/03\/2019 – Ng\u00e0y ph\u1ea3n bi\u1ec7n: 10\/04\/2019 – Ng\u00e0y duy\u00ea\u0323t \u0111\u0103ng: 02\/05\/2019).<\/li>\n<\/ol>\n
Trung T\u00e2m C\u1ea3nh Gi\u00e1c D\u01b0\u1ee3c Qu\u1ed1c Gia – Trung T\u00e2m DI v\u00e0 ADR Qu\u1ed1c Gia.<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
B\u00e0i b\u00e1o: \u0110\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 can thi\u1ec7p c\u1ee7a ch\u01b0\u01a1ng tr\u00ecnh qu\u1ea3n l\u00fd kh\u00e1ng sinh v\u1edbi fosfomycin truy\u1ec1n t\u0129nh m\u1ea1ch t\u1ea1i B\u1ec7nh vi\u1ec7n Thanh Nh\u00e0n. Hi\u1ec7n nay, t\u00ecnh tr\u1ea1ng vi khu\u1ea9n \u0111\u1ec1 kh\u00e1ng kh\u00e1ng sinh ng\u00e0y c\u00e0ng gia t\u0103ng c\u00f9ng v\u1edbi h\u1ea1n ch\u1ebf trong vi\u1ec7c ph\u00e1t tri\u1ec3n c\u00e1c kh\u00e1ng sinh m\u1edbi \u0111\u00e3 g\u00e2y \u1ea3nh h\u01b0\u1edfng […]\n","protected":false},"author":1,"featured_media":9492,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-9487","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts\/9487","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/comments?post=9487"}],"version-history":[{"count":0,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/posts\/9487\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/media\/9492"}],"wp:attachment":[{"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/media?parent=9487"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/categories?post=9487"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hmm88i.com\/drug\/wp-json\/wp\/v2\/tags?post=9487"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}