TAP CHi Y HOC VIET HAM TAP 465 • THANG 4 - SO 2 - 2018
NGHIEN Ciru VI KHUAN HIEU KHI TRONG VIEM MUI XOANG a TRE EM TAI BENH VIEN TAI MUI HONG TRUNG UffNG
Bo Hoang Qu6c Chinh*, Nguyin Thi Khanh Van**
T 6 I V I TAT
Vi l^uan hieu khf gSp pho bien trong viem miii xoang d tre em trong nghien cilU la Haemophilus influenzae (38,2%), Coagulase negative Staphylococcus (23,81%), S. aureus va S. pneumoniae 114,28%), Streptococcus (9,52%). Khang sinh Jiinc»(icillin + Acid clavuianic con nhay cam vdi H.
ififluenzae, Coagulase negative Staphylococcus va S.
pneumoniae. Streptococcus.
SUIVIMARY
STUDY ANAEROBIC BACTERIA OF RHINOSINUSITIS I N CHILDREN I N
CENTRAL E.N.T HOSPITAL The most common anaerobic bateria in rhinosinusitis in children In this study are H. influenzae (38,2%), Coagulase negative Staphylococcus (23,81%), S.aureus and S.pneumoniae (14,28%), Streptococcus (9,52%). Amoxicillin+ Aad. clavuianic is sensitive to H.influenzae, Coagulase negative Staphylococcus and S.pneumoniae, Streptococcus.
I. DiDlT VAN E)E
Viem miji xoang d tre em thffdng khdi dau do nhiem virus, sau do tdi 80% sd viem xoang do virus phat trien thanh viem miji xoang nhiem khuan. VI khuan thudng gap trong viem mul xoang cap tfnh d tre em la phe ciau (S.pneumonia), Haemophilus influenza, M.catarrhalis va ty cau vang (S. aureus). Cung CO mpt vai loai lien cau khac va vi khuan ky khf.
Viem mui xoang man tfnh d tre em hay gap nhat la vi khuan lien cau va tu eau vang, tiep theo la phe cau (S.pneumonia), Haemophilus influenza, M.catarrhalis. VI khuan ky khf gap khoang 6%.
Tren the gidl da cd nhieu cong trinh nghien cdu ve benh viem mui xoang d tre em, cung nhff Viet Nam. Trong thffc t^, viec dteu trj vtem mul xoang tre em van cdn gap nhteu khd khan. 6 Viet Nam, trong nhffng nam gan day, eac benh ly nhiem khuan ho hap ndi ehung va benh viem mui xoang d tre em noi rieng ngay cang gia tang do moi trffdng ngay cang 6 nhiem nang ne.
OSng thdi, trong thdi dat bung no khang sinh, va
*Dal hoc Quoc Gla Ha Ndi
**Benh viin Tai MOI Hong Trung i/dng Chiu'traeh 'nhiem chfnh: Nguyen Thi Khanh Van Eniail: [email protected] Ngay nhan bai: 2.2.2018 Ngay ph^n bi^n khoa hpc: 28.3.2018 Noav duvet b&i: 20.4.2018
viec sff dung khang sinh mpt each bffa bai, tuy tien khdng dung va du lieu eua ngffdi dan Viet Nam iam cho tinh trang de khang khang sinh ngay eang nghiem trong hdn. Do do viee dieu tn eac benh ly ve nhiem khuan trong do cd viem mui xoang d tre em cang trd nen khd khan va phffe tap hdn. De gdp phan vao chan doan va dieu trj benh Viem mui xoang d tre em, chiing toi tien hanh nghien effu de tai vdi myc tieu:
Dinh danh vl khuan hiiu khf vi khang sinh do trong viem mOi xoang d tre em.
IL €)6l TU'ONG VA PHU'aNG PHAP NGHIEN CIJTJ 1 . Doi tu'dng nghien cuXi: la nhffng benh nhan dffdi 15 tuoi du'dc kham va chan doaii viem mui xoang. Benh nhan chUa dimg khang sinh hoac ngffng dung khang sinh tren 7 ngay.
2. £>|a diem n g h i i n cdu: Benh vien Tai Mui Hpng Trung U'dng
3. Thdi gian nghien cu'uitff thang 7 nam 2014 den thang 9 nam 2015.
4. Phu'dng phap nghien cu'u
Thiei ke nghien cdu. Nghien effu md ta tffng trffdng hdp.
PhUdng tien nghiin cdu:
Bp npi soi mui xoang Karl Stortz Bp dung eu thff vl khuan eiia mui xoang:
- t a m bong va dng dffng tam bong vo khuan.
- Kfnh hien vi.
-1^61 trffdng nuoi eay vi khuan: La moi tru'dng phong phil bao gom Blood agar (tao ra 2 moi trffdng thach mau va ehoeola) va I^ueller-hinton (tao ra moi trffdng thach thffdng).
- Cac khang sinh cian lam khang sinh do.
5. Phu'dng phap xu* ly so lieu:Theo phffdng phap toan thdng ke y hpc, nhap so lieu va xff ly bang chffdng trinh SPSS v.20 III. KET QUA NGHIEN CCTU VA BAN LU^N
3 . 1 . Ty le nudi cay vi khuan: Tff djch mil lay d khe giffa ciia benh nhan, tien hanh nuoi cay va dinh danh vi khuan. Ty le nuoi eay vi khuan dffdng tfnh va phan bo theo dac diem nhupm Gram dffdc trinh bay dffdi bang sau:
Bing 3.1. Ty li nudi cay vi khui'n Ket qua nuoi cS'y
Am tinh Du'dng I G r a m ( + ) "
So lu'dng
Tyle
VIETNAM MEDICAL JOURNAL H°2 - APRIL - 2018 tinh 1 G r a m ( - )
Tong
16 55
29,1 100,0
Trong so vi khuan phat hien_^ du'dc trong nghien cu'u nay co 47,3% la vi khuan Gram (+), 2 9 , 1 % la vi khuan Gram (-).
3.2.Su'phan bo cac chung vl khuan Bang 3.2. Su'phan bdcac chting vl khuan
So lu'dng
T y l e So lu'dng
T y l e Sd lu'gng
T y l e So lu'dng
Tong
Tyie
9,1 38,2
Streptococcus
.A5_
S.pneumoniae 5,5
_?i.
Coagulase negative
_?^
Staphylococcus 3,6 0,0 12,7
t^. Catarrhalis 1 1,8 0,0 1,8
Tong SO 13 23,6 27 76,4
Chimg vi khuan gap nhieu nhat la Haemophilus influenzae vdi 38,2%, tiep den la Coagulase negative Staphylococcus 12,7%. Cac chiing xuat hien vdi ty le thap la Staphylococcus aureus va Streptococcus pneumoniae deu la 9 , 1 % , Streptococcus vdi 5,5%, gap ft nhiit la M.
Catarrhalis vdi 1,8%.
Theo Le Thj Hoa (2001), ty le phan lap dffdc Streptococcus pneumoniae ia cao nhat (60%), sau dd den Moraxella catarrhalis (38,4%) va Haemophilus influenzae (31,5%) [26].
Nhff vay da cd rat nhieu tac gia nghien ciiXi ve vi khuan gay viem mul xoang tre em, nhihig ket qua thu dffdc cho thay da ed nhffng xu hffdng ehuyen dieh ve sff phan bo vi khuan trong mui hpng tre em, gop phan quan trpng trong viec chan doan va dieu trj dung benh viem mui xoang d tre em.
3.3. Mdc dp nhay cim cua vi khudn dufa iren ket qui khing sinh dd.
3.3.1. Mdc dp nhay cam vdi kharg sinh cua Tu cau tiing (Coagubse negative Staphylcxxxxus).
Bing 3.3. Mdc dp nhay cim vdi khang sinh cua Tu cau trang (n=7)
Ten khang sinh Amo+A.clavulanic Cefuroxime Cefotaxime Ceftriaxone Vancomycin Cefoperazoi Ceftazidime Cefepime Cefopime Clindamycin Erythromyclne
Ky hieu AMC CXM CRO
era
VAN Cf CAZ
O J ERY
(S) 7 7 7 1 3 7 5 3 3 1
( I )
5 2
2 (R)
1 2
2
/
Doxycyelin Ciprofloxacin
Ofloxacin Gentamycin
Amikacin Co-trimoxazol
Meropenem SXT MElvt 1
Tu rau trang cdn nhay cam vdi Amo+A.clavulanic, Cefuroxime, Cefotaxime, Cefoperazoi, Ceftazidime, Ofloxacin, IJoxycyclin.
Khang hau het vdi Erythromycineva Co- trimoxazol, Clindamycin, tham chf co nhieu chiing khang vdi vong vo khuan la khong eo nghia la khong co mdt ehut tac dung gi. Trong dd cd 2/3 chiing khang vdi Meropenem, mpt loai khang sinh rat mdi.
3.3.2. Mdc dp nhay cam vdi khing sinh cda Tu ciu vang(S. aureus)
Bing 3.4. Mdc dd nhay cam vdi khang sinh cda S. aureus : n=5
Ten khang sinh Peniciiiin Oxacillin Amplxllllne Methicillin Meropenem Cephalothin Cefuroxime Ceftazidime Ceftriaxone Cefotaxime Cefoperazoi Amo+A.davuianic Ampi+ Sulbactam Piper+Tazobactame Ervthromycine
Ky hieu PEN OXA AM FOX MEM CEF CXA CAZ CRO
era
Cf AMC SAM TZP ERY(S)
2
3 3
3 4
( I )
1 1
(R) 5 2 S S 5 2 2 4 4 1 5 5 J
TAP CHl Y HOC VIET HAM TAP 465 - THANG 4 - SO 2 - 2018 Azithromycine
Doxycycllin Clindamycin Moxifloxacin Ciprofloxacin Levofloxacin Vancomycin Gentamycin Amykacin Co-trimoxazoi
AZM DO CU MOX
ap LVX Va
SXT 2 3 3 3 2 1 3
1 2 S
2
sinh cua H. influenzae: n=21
Ty tau vang khang hau het vdi Penieillin, l^lethieiltin. Erythromycin, I^eropenem, Cephalosporin the he 1,2,3,4, Ampi+Sulbactam, Piper+Tazobactame, Clindamycin. Chi edn nhay vdt [toxycydlin va Moxtfloxacin, Ciprofloxacin, Levoftoxacln. Nhff vay, ty cau vang da khang vdi eae loai khang sinh mdi.
3.3.3. Mdc dp nhay cam vdi khing sinh aia Phe'cau (S.pneumoniae)
Bing 3.S. Mdc dp nhay dm vdi khing sinh cua S. pneumoniae: n=5
l&n khang sinh Amo+A.davuianic Cefuroxime Cefotaxime Vancomycin Ceftriaxone Cefoperazoi Ceftazidime Clindamycin Er/thromydne
Azithromycin Doxycyelin
Ofloxacin Gentamycin
Amikacin Co-trimoxazol
Ampixiiiine cephalothlne
Cefepime Tobramycine
Ky hieu AMC CXM VAN
era
CRO Cf CAZ CtJ ERY Az DO OFX GM AN SXT AM CF FEP
(S)
• *
3 3 3 3 S S 1 3 2 3 1 2
3 3
( I ) 1 2 2 1 2
2 2 3 2 2 1 2 3
(R)
1
3 2
1 1 3
3 Phe cau trong nghien ciiu nay con nhay cam vdi dong p lactam, trong do^ nhay nhat la Cefoperazoi, Ceftazidime (5/5 mau) va cung cdn nhay cam vdi Azithromycin. Khong con nhay vdi Clindamycin,Co-trimoxazot va cac khang sinh con lai cung da khang rat nhieu. Theo Tinkelman 1989 [ 6 ] , nam trong so tam chiing S.
pneumoniae la tffdng dot khang penicillin va khang vdi Trimethoprim-sulfamethoxazole.
3.3.4. Mdc dp nhay cam vdi khing sinh cua H. influenzae
Bang 3.6. Mdc dp nhay dm vdi khing
Ten khang sinh Cefuroxime Ceftazidime Ceftriaxone Cefotaxime Cefoperazone Amo+A.clavulanlc
Vancomycin Gentamydn Amikacin Ciprofloxacin
Ofloxadn Levofloxacin Moxifloxacin Chloramphenicol
Doxycyelin Erythromycine Azithromycine Clindamycin Co-trimoxazol
Meropenem Amplxllllne Cefaclor Cefepime Tobramycine
Ky hieu CXM CAZ CRO
era
CF AMC VAN GEN AN CIP OFX LVX MOX CL DO ERY AZM CLI SXT MEM AM CR FEP(S) 3 5 3 3 2
17 13 13 9 2 17 6 2 6
( I ) 4 5 5 3 10 11 13 4 3 3 5 4 5 2 2 2 6 1 1 1
(R) 14 16 14 14 IS 10 17 7 6
7 14 12 17 8 11
8 8 7 Haemc^hilus. Influenzae ktiang hau h ^ vc^
nhdm Cephalosporin va Vancomycin. Con nhay cam vdi nhdm Quinolon (gom Ciprofloxacin, OfIo)radn, Levofloxacin, l^oxiHoxaein) va Doxycyelin.
3.3.5. Mdc dp nhay cam vdi khing sinh cua Liin du (Sheptococcus)
Bing 3.7. Mdc dp nhay dm vdi khing sinh cua Sti'eptoex/ccus: n=3
Ten khang sinh Amo-t-A.davulanic Cefuroxime Cefotaxime Ceftriaxone Vancomycin Cefoperazoi Ceftazidime Clindamycin Erythromydne Azithromycine Doxycyelin
Ofloxacin Gentamycin
Amikacin Co-trimoxazol
Cefepime Tobramycine
Ky hieu AMC CXM CRO
era
VAN CT CAZ CU ERY DO OFX GM AN SXT FEP
(S) 3 3 3 3 2 3 2
2 1
1 ( I )
1 2 1 1
( R )
1 1 3 3 3
3 2 2 1
VIETHAM MEDICAL JOURNAL N°2 - APRIL - 2018 Lien cau cdn nhay cam vdi Amo+A.clavulanic,
Cefuroxime, Cefotaxime, Ceftriaxone (3/3 mau).
Da khang liau het vdi Clindamycin, Gentamycin, Amikacin (3/3 mau)
3.3.6. Mdc dp nhay dm vdi khing sinh da Moraxella catarrhalis
Bing 3.8. Mdc dp nhay dm vdi khang sinh da Moraxella catarrhalis: n=l
Ofloxacin Gentamycin
Ampixiiiine Cefopime
OFX GM AM
1 1 1
1
Ten khang sinh Amo+A.clavulanie Cefuroxime Cefotaxime Ceftriaxone Vancomycin Cefoperazoi Ceftazidime Cllndamydn Erythromydne Azithromycine Doxycyelin
K*
hieu AMC CXM CRO
era
VAN Cf CAZ CU ERY DO
(S) 1 1 1 1 1
(1) 1
1 (R)
1
1 1 1
Chi gap 01 trffdng hdp vi khuan Moraxella catarrhalis con nhay cam vdi cac ddng khang sinh mdi Amo + A.elavulanic, Cefotaxime, Ceftriaxone, Cefoperazoi, Ceftazidime, Ofloxacin, Gentamycin. Da khang vdi Erythromycin, Azithromycine, Clindamycin, Vancomycin.
IV. KET LUAN
Qua nghien ciiu tinh hinh yi khuan hieu khf ciia 55 benh nhan dffdi 15 tuoi dffcfc chan doan viem mui xoang tai benh vien Tai I^ui Hpng TW, chiing tot cd mpt so l ^ t luan nhu sau: Ty le nuoi eay vi khuan hieu khf dffdng tfnh la 76,4%.
Cac vi khuan gay viem mOi xoang tre em hay gap lan iffdt la: H. influenzae (38,2 % ) , Coaguiase negative Staphylococcus (23,81%), S.
aureus va S. pneumoniae (14,28%), Streptococcus (9,52%).
Khang sinh ^ : Chung vi Ithuan
Coagulase negative Staphylococcus
S. aureus
S. pneumoniae IH. influenzae Streptococcus
N h f y c a m Amo+A.clavulanic Cefuroxime, Cefotaxime Cefoperazoi, Ceftazidime Doxycyelin, Ofloxacin
Doxycyelin Moxifloxacin Amoeieillin+A.elavulanic, Cefoperazoi, Ceftazidime
Quinilon Doxycyelin Amociciilin + A. clavuianic Cefuroxime, Cefotaxime, Ceftriaxone
Khang Erythromycine Co-trimoxazol Menapenem, Cephalosporin the he 1-3
Amo+A.clavulanic Ampi+ Sulbactam Piper+Tazobactame. Clindamycin
Clindamycin Erythnamycin Cephalosporin the he 1-3
Vancomycin.
Clindamycin, Gentamycin Amikacin Amo+A.clavulanic con nhay cam vdi ty cau
trang, phe cau, lien cau va H. influenzae DoxycyclinviFluoroquinolon eon nhay cam vdt hau het cac chimg VK phan lap dude trong VI^X TE.
Lincosamid da bj khang hau het vdi cac chimg VK tren.
TAI Ll|U THAIVl KHAO
1. Patorn P, Pornthep K, Supawan L, et al.
(2013). Chronic rtiinosinusitls and emerging treatinent opbons, IJGM( International Joumal of General Medidne.
2. Ellen R.W. Greaorv J.M. Bowen A.D et al.
ri981V Acute Maxlllarv Sinusitis in Children, N EnglJMedl9&l, 304, pp 749-754.
3. Tinkelman D.G, Howard J.S (1989). Clinical
and Bacteriologic Features of Chronic Sinusitis in Children./l/nJCft/to; No. 143, p 938-941 4. Ramadan HH(2005]. Pediatrics sinusitis: update, J
Otolatyngol, 2005 Jun, 34 Supplement 1: pp 14-17.
5. Le Con^ Dinh (1993), Bu'dc dau tlm hiiu tinh hinh viem xoang tre em tai viin Tai Mdi Hong Trung i/dng 1987-1993, Luan van tot nghiep bae sv noi tni. Tru'dng Dai hoe Y Ha Noi. Ha Noi.
6. Chan J, Hadlev J (2001). The microbloloav of chronic rhinosinusitis: results of a community surveillance study. Ear, Nose, and Throat Journal, 80(3), 143-145.
7. Le Thj Hoa (2001) Nghien effu dp nhay cam vdi khang sinh cua Streptococcus pneumoniae, Haemo_philus influenzae va Moraxella ^^catarrhalis phan lap tff hpng mui tre em dddi 5 tuoi 6 mfit so eong dong daii eU song xa do thi, Luan van thac sy y hoc, Truftng dai hpc Y Ha Nfii.
