Y HQC VlgT NAM THAWG 5 • S 6 1(2011
GIAM SAT CAC CHUNG ACINETOBACTER BAUMANHII ^ P H A N LAP TAI KHOA HOI Sljnc TJCH CUC - BENH VIEN BACH MAI
TRONG HAI NAM 2 0 0 9 - 2 0 1 0
fioan Mai P h u ' d n g *
T 6 M TAT
Trong nhuTig nSm gin day, nhiem khu^n do Acinetobacter baumannii da de khang khang sinh dang trd thanh van de can dUpc quan tam, giai quyet. Tien hanh nghien cuU djch te hpc ve Adnetobacter baumannii Sa khang gay nhilm Ichuan benh vien, d$c biet t?i khoa Hoi sii'c tfch cUc (ICU: Intenvive care unit) de CO bien phap phong ngira la het sut can thiet.
Myc tieu nghien cuTu: Nghien cuU ve dich te hoc ciia cac chiing Adnetobacter baumannii phan lap tai khoa HOI sire tich ci/c - benh vien Bach Mat bSng phu'dng phap sinh hpc phan tii*. Doi tu'dng va phu'dng phap nghien cuti: 72 chung Adnetobacter baumannii phan lap du'dc tir cac mau benh pham lam sang ciia cac benh nhan du'dc dieu trj tai khoa Hoi sire tich ci/c - binh vien Bach Mai, thcfi gian tCf thang 09/2008 • 05/2009. Cac chiing Adnetobacter baumannii nay da duOc thir nghiem miTc dp de khang khang sinh bing phi/dng phap xac djnh nong do iTc che toi thieu (MIC:
minimal inhibitory concentration] va so sanh mire dp trung hdp ve gen bSng ky thuat dien di trUdng xung dien (PE=GE: putsed-field gel electrophoresis). K¥t qua va ket l u | n : Trong so 72 chiing Adnetobacter baumannii dUdc tien hanh nghien cihj, 88,9% phan lap dUdc tir benh pham ddm va djch hut phe quan. Ty le de khang cac khang sinh thong dung cua Adnetobacter baumannii d mire dp eao 84,7% - 97,2%. Ty le Adnetobacter baumannii da khang (MDRA8; multidrug resistant Adnetobacer baumannii) 95,7%; t / le Adnetobacter baumannii toan khang (PDRAB: pandmg resistant Adnetobacer baumannii)) 83,3%; tJ" le Aonetobacter baumannii sinh beta- lartamase pho md rong (ESBL: extended spectrum beta lactamase) 23,6%; ty le Acinetot}acter baumannii sinh metallo beta-lactamase (MBL) 2,7%.
SUMMARY
Surveillance of Adnetobacter baumannii infections in Intensive Care Unit of Bach Mai
hospital, 2009-2010
Multidrug-resistant Adnetobacter baumannii infection is prevalent in Bach Mai hospital. Examining the epidemiology, especially at the Intehsive Care Unit (ICU), is an important initial step to develop infertion control measures. Objective: To reveale the epidemiology of Adnetobacter baumannii infections in the ICU of a tertiary care hospital in norOiern Vietnam.
Methods: Patients admitted to the ICU of Bach Mai ' Khoa Visinh - Benh vien Bach Mai
Piian bign khoa hgc: GS.TS. Le Bach Quang
Hospital were surveyed from September 2009 to May 2010. Of 72 clinical isolated of Adnetobacter baumanniiwere analyzed for antibiotic susceptibility by minimal inhibitory concentration (MIC) method and genetic relatedness by pulsed-field gel electrophoresis (PFGE). Results and conclusions: Of 72 clinical isolated of Adnetobacter baumannii were analyzed, 88.9% Acinetobacter baumannii were isolated from sputums and bronchial fluids. The rate of Acinetobacter baumannii resistance to antibiotics was 84.7% - 97.2%. The rate of multi-drug resistant Adnetobacter baumannii (MDRAB) was 95.7%; the rate of pan-drug resistant Aanetqbacter baumannii (PRDAB) was 83.3%; the rate of positive Extended spedTum beta-ladamase (ESBL) Aanetrtiacter baumannii\Nd5 23.6%; the rate of positive Metallo beta-ladamase (MBL) ArmebDbacterbaumanniiviSS IT'/a.
I. O^T V A N o f
Trong nhDtig nam gan day, nhiem khuan do Acinetobacter baumannii 6a de khang khang sinh tai benh vien Bach Mai dang trd thanh van de can du'dc quan tam, giai quyet. Nhieu nghien cu'u cho thay nhiem khuan do Acinetobacter baumannii da khang thu'dng la nhO'ng vu djch nhiem khuan benh vien [ 1 ] , Tien hanh nghien ciru djch te hpc ve Acinetobacter baumannii da khang gay nhiem khuan benh vi&n, dac biet tai khoa Hoi sire tich cu'c (ICU) de co bien phap phong ngira la het su'c can thiet.
Mpt hdp tac nghien cuti giii'a Trung tam Y te qudc te Nhat ban ( I M Q : International Medical Center of Japan) va benh vien Bach Mai ve djch te hoc ciia Acinetobacter baumannii 6a dUdc tien hanii. Muc tieu nghien ciru: Nghien cu'u ve djch te hpc cua cac chiing Acinetobacter baumannii phan' lap tai khoa Hoi su'c tich cdc - benh vien Bach Mai b i n g phu'dng phap sinh hoc phan tir.
II. o o ' l TU0NG VA PHUONG PHAP NGHllN CCfU 2.1. 061 tWdng:
72 chiing Acinetobacter baumannii 6d(ic phan lap tir cac benh nhan dieu trj tai khoa Hoi sii'c ti'ch cu'c (ICU) - benh vien Bach Mai.
Y HQC VlgT NAM THANG 5 - SO 1/2011 2.2. Thdi gian: Td thang 09/2009 do de khang [ 2 ] .
05/2010 Ky thuat dien di tru'dng xung dien (PFGE:
2.3. Phu'dng phap: Xac dinh nong dp I'rc pulsed-field gel electrophoresis): so sanh mu'c dp triing che Ioi thieu (MIC) ciia 72 chung Acinetobacter hii^ veqencu3 72 chm^^ Acinetobacter baumannii.
baumannii 6o\ vdi khang sinh de danh gia miTc III. KETQUA NGHIEN COU
3.1. Phan bo cua 72 chiing A. baumannii phan lap tai khoa Hoi sii'c tich cdc (ICU) - Benh vien Bach Mai
Bieu do 1. Phan bo ciia 72 chung A. baumannii phan lap tai khoa Hoi sire tich cu'c (ICU) - Benh vien Bach Mai
Nhan xet: Ket qua nghien ciTu d bieu do 1 cho thay phan bo ciia 72 chiing A. baumannii phan lap tai khoa Hoi sire tich cu'c (ICU) - Benh vien Bach Mai. Co 66,7% A. baumannii dMc phan lap tiT benh pham ddm, 22,2% tir dich phe quan, 6,9% td mau, 2,8% tir mil, 1,4% tir benh pham dich.
3.2. Ty le de khang khang sinh Bang 1. Ty le de khanq khanq sin
Khanq sinh Piperacillin
Piperacillin +Ta;obactam Ampicillin + Sulbactam Ceftazidime Imipenem Gentamycin Amikacin CiproHoxacin Polymvcin B
ciia 72 Chung A. baumannii 1 cua 72 chunq A. baumannii
Nonq do de khang (mg/L)
> 128
> 128
> 32
> 32
> 16
> 16
> 64
> 4
> 8
Tv le de khang ( % ) 95,8 91,6 84,7 97,2 91.7 90,3 93,1 97,2 2,7
Nhan xet: Ket qua nghien ciru d bang 1 cho thay ty le de khang khang sinh ciia 72 chiing A.
baumannii phhn lap tai khoa Hoi sire tich cUc (ICU) - Benh vien Bach Mai. Ty le A. baumannii^
khang vdi cac khang sinh thong dung cao nhat la ceftazidime (97,2%) va ciprofloxacin (97,2%), thap nhat la ampicillin phoi hdp sulbactam 84,7%. Ty le de khang vdi imipenem 91,7%. Oe khang polymycin B vdi ty le 2,7%.
Hinh 1. Thir nghiem xac dmh nong do iTc che tdi thieu (MIC) Imipenem va l^eropenem ciia A. baumannii
Y HQC VlgT NAM T H A N G 5 • s61/2011
3.3. Tyiedade Ichang Ichang sinh cua 72 chung A. baumannii Bang 2. Ty le da de khanq khanq sinh ciia 72 chiinq A. baumannii
Khang sinh
Da khanq (MDR: Multl-druq resitance) Toan khanq (PDR: Pan-druq resistance) Sinh Beta-lactamase pho md ronq (ESBL) Sinh Metallo beta-lactamase (MBL)
Tv le tfe khdng (o/o) 95,8 83,3 23,6 2,7
Nhan xet: Ket qua nghien ciru d bang 2 cho thay ty le da khang khang sinh ciia 72 chiing A.
baumannii phan lap tai khoa Hoi su'c tich ci/c (ICU) - Benii vien Bach Mai. Ty le A. baumannii da khang vdi cac khang sinh thong dung la 95,8%, toan khang (PDR) la 83,3%. Ty l§ A. baumanniis\nh Beta-lactamase pho md rpng (ESBL) la 23,6%, sinh Metallo beta-lactamase (MBL) la 2,7%.
IV. BAN LUAN
4.1. Phan bo cua 72 chung A.
Itaumannii phan i$p t^i khoa Hoi sii'c tich cite (ICU) - Benh vi^n Bach Mai
Adnetobacter baumannii la cau tn/c khuan, bat mau Gram am. Chung thudng tSn tai d cac moi tru'dng am u'dt trong benh vien nhu' cac bon nj^, vol nu'dc, dung cu y te, tham chi ca d
giiTdng benh nhan. Acinetobacter baumannii lacan nguyen chinh gay nhiem triing benh vien, dac biet d cac khoa Hoi sire tich cu'c. Ngoai ra viec gay nhiem triing benh vien, A. baumannii con gay cac nhiem trimg khac 6 ngu'di nhu' viem phoi, viem npi tam mac, nhiem triing da va vet thu'dng, viem phuc mac, nhiem triing tieu, viem ket mac, viem xu'dng tiiy.
A. baumannii cd tlie gay biing phat thanh nhOtig vu dich nhilm trimg benh vien [6]. Hien nay tai benh vien Bach Mai va b?nh vien Chd Ray, A. baumannii la tac nhan gay cac nhiem triing benh vien hay gap nhat trong so cac tac nhan gay benh. Trong nam 2009, tai benh vien Bach Mai ty le phan lap vi khuan nay chiem tdi 15% tong so cac vi khuan phan lap du'dc d tat ca cac loai benh pham va chiem 30% tong so vi khuan phan lap du'dc d benh pham ddm. A.
baumannii con chiem tdi 41% vi khu^n phan lap flirijc tai khoa Hoi su'c tich cu'c, chii yeu la d nhiJng benh nhan co siT dung may thd dang nam dieu trj tai khoa [5].
4.2, TylgdS khang khang sinh ciia 72
chiing A. baumannii
Hien nay A. baumannii thddng de khang vdi nhieu loai khang sinh lam cho viec dieu tn het siJfc khd khan [3].
Trong nghien cOli nay, ty le A. baumanniidie Wiang vdi cac khang sinh thong dung rat cao, cao nhat la ceftazidime (97,2%) va ciprofloxacin (97,2%), thap nhat la ampicillin phoi hdp
sulbactam 84,7%. Nhu' vay cac khang sinh thong dung thu'dng du'dc chi dinh de dieu tri nhiem kliuan do A. baumannii hau nhu' da khong con tac dung. Ke ca imipenem, mot khang sinh nhom carbapenem trong nhu'ng nam qua da timg du'dc coi la "vu khi cuoi ciing" trong dieu trj nhiem khuan do A. baumannii nhiing hien nay ty le de khang tai cac khoa Hoi sire tfch cUc la tren 70%, trong nghien ciili nay ty le de khang vdi imipenem 91,7%. Tuy nhieh ''ket qua trong nghien ciTu nay cdn cho thay ty le A. baumannii de khang vdi polymycin B la 2,7%. Nghien cuU nay cung phii hdp vdi cac nghien cirtj ciia mpt s5 tac gia ngoai nu'dc [4]. Dieu nay cd nghTa la cac khang sinh nhom lipopeptides gom colistin va polymycin B con cd tac dung tot ddi vdi A.
baumannii. Tuy nhien hien nay d Viet nam, colistin chi con du'dc sd dung trong chan nuoi gia siic. Vi vay mpt so cd sd muon dieu trj khang sinh nay deu phai de benh nhan tir tim mua theo du'dng tu* do. Trong tu'dng lai. Bo Y te can cd sdm CO ke hoach nhap khang sinh nay theo con du'dng chinh ngach.
4.3. Ty le da de khang khang sinh cua 72 chung A. baumannii
Ty le A. baumannii da de khang trong nghien ciru nay rat cao chiem tdi 95,8%. Ty le A.
baumannii tohn khang la 83,3%.^TY le A
baumannii sinh beta-lactamase pho md rpng
(ESBL) la 23,6%, sinh metallo beta-lactamase
(MBL) la 2,7%. Nhu' vay A. baumannii hau nhir
khong con chiu su" tac dpng ciia da so cac khang
sinh [6], [7]. Nhu' vay hien nay cac khang sinh
nhom Lipopeptides gom colistin va polymycin^ B
se la lieu phap duy nhat de dieu trj cac nhiem
khuan do A. baumannii da khang (MDRAB) va
toan khang (PDRAB). Tuy nhien hien nay tai Viet
Nam cac khang sinh nay chu'a ddtfc nhap chi'nh
thu'c. Chinh vi vay viec dieu trj cac nhiem khuan
Y Hpc VI$T NAM THANS 5 - s61/2011 do A. baumannii dang phai doi mSt vdl rSt nhlSu
thacii thCrc, V. KET lUljiN
5.1. Phin bScuaA, baumannii Trong so 72 chijng nghien cirtj, 88,9% A.
baumannii phSn i^p du'dc til benh pInSm ddm v^
djch hut phe quSn
5 . 2 . M i f c af dS khing khing sinh cua A, tjaumanntt
- Ty id A. baumannii^ l<h^ng c^c khang sinh th6ng dung d mu'c dp cao 84,7% • 9 7 , 2 %
Ty le A. baumannlida khang (MDRAB) 95,7%
Ty i | A baumannltsxin khing (PDRAB) 83,3%
Ty i§ A, baumannii sinh Beta-lactamase pho md rpng (ESBL) 23,6%
Ty ie A. baumannii sinh Metallo beta- lactamase (MBL) 1^ 2,7%.
T&IU|UTHAMXHAO
1, Afzal WS. Livermors D. 0.99S), "Worldwide emergence of carbapenem-resistant Acinetobacter spp.' J Antimiaob Chemother; 41: 5 7 6 - 7 , 2. Clinical and laboratory standanls institute
(2006). "Methods for dilution antimicrobial suscephbility tests for bacteria that grow
aeroblcall/; approved standards-fifth edition. M7- A4.Wayne (PA): The Committee.
Corbella X, Montero A, Pujol M, Angeles Domlnguez M, Ayats J, Jose Argerich M, et al ( 2 0 0 0 ) . ' "Emergence and rapid spread of carbapenem resistance faring a large and sustained hospital outbreak of multiresistant Adnetobacter baumannii". J Clin MiCTObfol 2000;38:4086-9S.
Da Sllva G], Leitao ] , Peixe L. (1999),
"Emergence of carbapenem-hydrolyzing enzymes tn Acinetobacter baumannii clinical isolates". J Oin Microbiol; 37: 2109 - 1 0 ,
D o i n Mai Phuong, Nguyen XuSn Quang va CS. ( 2 0 0 8 ) , "M&c rf(5 de khang kh4ng sinh cua cic vi khuan giy b^h phSn l^p tai b^nh vien BfCh Mai tir 01/01/2006 - 30/06/2008 '. T?p chl Y hpc lim sing, HOI nghl Khoa hoc B|nh vi^n Bach Mai,
Fridkin SK, Steward CD, Edwanb JR. (1999),
"Sun/eillanoe of antxnkiabial use and aiUimioobial resistance in United States hospital: pmject ICfiltE /Jteas,?': Oin Infect Dis; 29; 245 - 52.
Hsueh PR, Chen ML, Sun CC, Chen WH, Pan H ) , Yang LS, et al. ( 2 0 0 2 ) . "Emergence of antimicrobial drug resi^nce of major pathogens causing nosocomial infecbons at a university hospital in Taiwan, 1981-1999". Emerg Infect Dis;
8: 63 - 8.
BUHfC D £ U KHAO SAT MOT SO DAC OIEM Hdi CHllMG OA Nfil TIET TUMliN TAI BENH VIEN TRUNG UtTNG HUE
Bao Thj D i i t i * , Tru'dng Hu$ N h i n *
T6M TAT
o a t vStn tfi v i niMC tieu: Kpl chuTig da n$i tiet tvr mien (HCDNTTM) du'pc die mmg b8l si/ ton thuang nhiSu tuySn npi b S qua co die t\l mien. VSn d l dieu tri tuy t h u ^ vio si/ hi$n dien cua cic b|nh If t^r miln tren tienh nhin. Myc tieu cua nghien cutj li I ) Phin loai HCDNTTM dilu trj tai binh vi|n Trung uPng Hue tir 2006 den 2010. 2) Khio sit m$t sS die di?m cua cic typ HCDNTTM.
051 tutlng v i phu'dng phip nghlSn cihi: 67 benh nhan du'pc chan doan HCDNTTM, phu'dng phip mo t i cit ngang, kham ^m sing ghi nhan cac trieu diiitig oJa HCDNTTM, djnh lupng mpt so hormone: TSH, FT4, Cortisol glucose miu, dien giii do, Ct Scan tuyen lit..,
Ket qua: HCDNTTM typ 3 chiem ty le 85,07%,
typ 2 li 10,45% v i typ 1 li 4,48%. Bpnh canh lam sing chu yeu cua HCDNTTM t ^ 1 la b<|nh Addison, nhiem nSm Candida. Bpnh cinh lam sing chinh cua typ 2 la bpnh Addison (100%). B|nh cinh lim sing did y§u cua typ 3 li bpnh tuyen giip ti/ mien.
K a lu$n: HCDNTTM typ 3 cNan uU the wS benh cinh lam sing diCi yiu li b|nh tuyen giip b/mien.
ABSTRACT
TO STUDY FEATURES OF AUTOIMMUNE POLYGLANDULAR SYNDROMES AT HUE CETRAL
HOSPITAL FROM 2005 TO 2 0 1 1 Background and Olqectlve: Autoimmune polyglandular syndromes (APS) are characterized by injuries of many poiygland v^ith autoimmune
* Benh vien Tnjng uOng Hue
Phan bISn khoa Ape; PGS.TS. Pham Nhir HISp 80
