NGHIEN CUU Ml/C DO KHANG KHANG SINH CUA PSEUDOMONAS AERUGINOSA TAI BENH VIEN DA KHOA TRUNG UONG THAI NGUYEN
LUU TH| KIM THANH- BVBK Trung uang Thai Nguyen NGUYEN TH| HAI - DH Supham - DH Thai Nguyen TOM TAT
Tien hanh nghien cuu muc do khang khang sinh cua cac chung Pseudomonas aeruginosa phan lap tu benh nhan, tir dung cu y td va moi trudng benh vien thiy:
1, Ve ty le khang khang sinh
- 100,0% cac chung da khang khang sinh; ty le khang thap nhat vdi cac khang sinh nhdm Quinolon va nhdm Aminoglycozid (19,79% din 20,46 %) (25,26%
den 56,25%); ty le khang cao vdi cac khang sinh khac (48,91% den 100,0%).
2, Vi muc do da khang khang sinh va cac kiiu each khang khang sinh:
- Muc do da khang khang sinh: P. aeruginosa khang it nhat la 4 loai khang sinh (1,0%); khang nhiiu nhat la vdi ca 20/20 loai khang sinh (13,0%);
Tin suat khang nhiiu nhit la khang 9 den 15 loai khang sinh (10,0% - 11,0%).
- Vi kiiu each khang khang sinh: Rit da dang.
Tir khda: khang sinh, Pseudomonas aeruginosa SUMMARY
Anti - antibiotic of Pseudomonas aeruginosa which were isolated from patients, from medical equipments, from enviroment of hospital was studied. The result showed that:
1, Percentage of the anti-antibiotic:
- 100.0% of spieces anti-antibiotic; lowest is percentage of anti-antibiotic to Quinolon and Aminoglycozid (19.79% - 20.46%) (25.26% - 56.25%);
highest is percentage of anti-antibiotic to the others (48.91%-100.0%).
2. About multi-resistan and phenotyp of anti- antibiotic:
- About multi-resistan: min of anti-antibiotic of P.
aeruginosa is 4 kinds of antibiotic (1.0%); max of anti- antibiotic of P. aeruginosa is 20/20 kinds of antibiotic (13.0%);
High frequence is anti-antibitic to 9 - 15 kinds of antibitic (10.0% - 11.0%).
- About phenotype of anti-antibitic: Variety.
Keywords: Anti - antibiotic, Pseudomonas aeruginosa
DAT VAN DE
Tinh khang khang sinh ciia vi khuan mang tinh chat dich te cua tung khu vuc va bien dong theo thoi gian.
Pseudomonas aeruginosa la mot vi khuan thuong gap trong cac benh nhiem trung va tinh khang khang sinh cua chung rat can duoc quan tam toi. Chung toi tien hanh nghien cuu nay nham nhung muc tieu sau:
1, Xac dinh ty le khang khang sinh cua cac chung P.
aeruginosa;
2, Xac dinh mdc do da khang khang sinh va cac kieu each khang khang sinh cua chung.
OOl TUONG VA PHUONG PHAP NGHIEN CUU 1/ D6i tuong: cac chung P. aeruginosa phan lap ttf benh nhan va moi truong benh vien (nuoc, dung cu y te...).
21 Phirong phap nghien cuu: dich te hoc mo ta.
Ky thuat xac dinh muc dp nhay cam khang sinh ciia vi khuan: Kirby -Bauer,
Ket qua duoc xu ly bang toan thong ke.
KET QUA
Bang 1. Ty le khang khang sinh cua P. aeruginosa phan lap duoc tu benh nhan va mdi truong
STT khang sinh So lan
thi> Khang Trung gian Nhay cam
STT khang sinh So lan
thi> n % n % n %
1 Ampicilline (AM) 96 95 98,96 1 1.04
2 Piperacine (PIP) 92 45 48,91 47 51,09
3 Cefalexme () 86 86 100
4 Cefotaxime 91 71 78,02 18 19,78 2 2,20
5 Ceftriaxone 96 75 78,13 13 13,54 8 8,33
6 Cephalotme 70 70 100
7 Cefazoline 70 70 100
8 Ceftazidime 98 74 75,51 15 15,31 9 9,18
9 Gentamycine 96 54 56,25 13 13,54 29 30,21
10 Amikacme 95 24 25,26 11 11,58 60 63,16
11 Netromycine 90 37 41,11 31 34,44 22 24,45
12 Tobramycme 93 30 32,26 2 2,15 61 65,59
13 Co- trimoxazol 87 84 96,55 1 1,15 2 2,30
14 Nofloxacine 96 19 19,79 8 8,33 69 71,88
15 Ciprofloxacine 88 13 20,46 5 5,68 65 73,86
16 Pefloxacme 49 38 77,55 11 22,45
17 Doxycylme 97 96 98,97 1 1,03
18 Chloramphenicol 93 91 97,84 1 1,08 1 1,08
19 Rifamycme 74 72 97,30 2 2,70
20 Nitrofurantoin 59 59 100
S4 Y HOC THUC HANH (739) - SO 10/2010
* Nhan xet: Ket qua 0 bang tren cho thly P.
aeruginosa trong nghien ciru nay:
-100,0% cac chung da khang khang sinh;
- Cd ty le khang thap nhat vdi cac khang sinh nhdm Quinolon va nhdm Aminoglycozid (19,79% den 20,46 %) (25,26% din 56,25%);
- Cd ty le khang cao vdi cac khang sinh khac (48,91% din 100,0%).
Bang 2: Ti le da khang khang khang sinh ciia P.
aeruginosa nghien ciru Kieu each khang khang sinh cua
cac chiing P. aeruginosa Khang hoan toan cac khang sinh
da thi> nghiem (20 khang sinh) Khang 19 khang sinh Khang 18 khang sinh Khang 17 khang sinh Khang 16 khang sinh Khang 15 khang sinh
TAN XUAT XUAT HIEN
•So chung 13
Ti le % 13,00
2,00 1,00 1,00 2,00 i,00
Khang 14 khang sinh 7 7,00 Khang 13 khang sinh 10 10,00 Khang 12 khang sinh 10 10.00 Khang 11 khang sinh 9 9,00 Khang 10 khang sinh 11 11,00
Khang 9 khang sinh 10 10,00 Khang 8 khang sinh 6 6,00 Khang 7 khang sinh 5 5,00 Khang 6 khang sinh 4 4,00 Khang 4 khang sinh 1 1,00
Tong so 100 100,00
*Nhan xet: Trong si 20 khang sinh duoc thir thay:
1, P. aeruginosa khang it nhit la 4 loai khang sinh (1,0%); khang nhilu nhlt la vdi ca 20/20 loai khang sinh (13,0%).
2, Gap nhilu nhit la khang 9 din 15 loai khang sinh (10,0% - 11,0%)
Bang 3. Kilu each (phenotype) khang khang sinh cua cac chiing P.aeruginosa
So luong
KS bi khang Kilu each khang khang sinh So
chiing 20 AM+PIP+CN+CTX+CF+CZ+CAZ+CRO+GMMN+NET+SXT+TM+CIP+NOR+PEF+FT+DO+C+R^ 13 19 AM+PIP+CN+CTX+CF+CZ+CAZ+CRO+GM+NET+SXT+TM+CIP+NOR+PEF+FT+DO+C+RA 2 18 AM+PIP+CN+CTX+CF+CZ+CAZ+CRO+GM+AN+NET+SXT+TM+PEF+FT+DO+C+RA 1 17 AM+CN+CF+CZ+CAZ+CRO+GM+AN+NET+SXT+TM+CIP +PEF+FT+DO+C+RA 1 16 AM+PIP+CN+CTX+CF+CZ+CAZ+CRO+GM + NET+SXT+TM +FT+DO+C + RA 1 16 AM+PIP+CN+CTX+CF+CZ+CAZ+CRO+GM+NET+SXT+TM +PEF+DO+C+RA 1 15 AM+PIP+CF+CZ+CAZ+CRO+GM+AN + NET+SXT+TM+PEF+FT+DO+RA 1 15 AM+PIP+CN+CTX+CF+CZ+CAZ+CRO+NET+SXT +PEF+FT+DO +C+RA 1 15
AM+PIP+CN+CTX+CAZ+CRO+GM + NET+SXT+TM+CIP+NOR + DO+C+RA 1 15
AM+PIP+CN+CTX+CF+CZ+CAZ+CRO+GM+AN+NET+SXT+DO+C+RA 1 15
AM+PIP+CN+CTX+CF+CZ+CAZ+CRO+GM+SXT+PEF+FT+DO+C+RA 1 15
AM+PIP+CN+CF+CZ+CAZ+GM+AN+NET+SXT+PEF+FT+DO+C+RA 1 15
AM + PIP+CN+CTX+CF+CZ+CAZ+GM+SXT+TM+PEF+FT+DO+C+RA 1 15
AM+PIP+CN+CF+CZ+CRO+CAZ+GM+AN+NET+SXT+NOR+DO+C+RA 1
14 AM+CN+CTX+CF+CZ+CAZ+CRO+GM+AN+SXT+TM +FT+DO+C 1
14 AM+CN+CTX+CF+CAZ+GM+AN+SXT+TM+CIP+NOR +FT+DO+C 1
14
AM+PIP+CN+CTX+CF+CAZ+CRO+GM+SXT+TM+FT+DO+C + RA 1 14
AM+CN+CTX+CF+CZ+CAZ+CRO+GM + NET+SXT+FT +DO+C + RA 1 14
AM+PIP+CN+CTX+CF+CZ+CAZ+CRO+GM+NET+SXT +DO+r:+RA 1 14
AM+CN+CTX+CF+CZ+CAZ+CRO+NET+SXT+NOR+FT +DO+G+RA 1 14
AM+PIP+CN+CTX+CF+CAZ+GM+SXT+TM+PEF+FT +DO+C+RA 1
13 AM+PIP+CN+CTX+CAZ+CRO+GM+NET+SXT+TM+DO+C+RA 1
13 AM+CN+CTX+CF+CZ+CAZ+CRO+GM+SXT+FT+DO+C+RA 1
13
AM + PIP+CN+CTX+CF+CZ+CAZ+CRO+SXT+FT+DO+C+RA 1 13
AM+CN+CTX+CF+CZ+CAZ+CRO+SXT+PEF+FT+DO+C+RA 1 13
AM+PIP+CN+CTX+CF+CZ+CAZ+SXT+PEF+FT+DO+C+RA 1 13
AM+PIP+CN+CTX+CF+CZ+CRO+SXT+PEF+FT+DO+C+RA 1 13
AM+CN+CTX+CF+CZ+CAZ+CRO+SXT+PEF+FT+DO+C+RA 1 13
AM+CN+CTX+CF+CZ+CAZ+CRO+GM+NET+SXT+FT+DO+C 1 13
AM+PIP+CN+CTX+CZ+CAZ+CRO+SXT+PEF+FT+DO+C+RA 1 13
AM+CN+CTX+CF+CZ+CAZ+GM+SXT+PEF+FT+DO+C+RA 1
12 AM + PIP+CN+CZ+GM+AN+NET+SXT+PEF+DO+C+RA 1
12 AM+PIP+CN+CZ+CAZ+CRO+SXT+TM + FT+DO+C+RA 1
12
AM+PIP+CN+CTX+CF+CRO+GM+AN+SXT+FT+DO+C 1 12
AM+CN+CF+CZ+CAZ+CRO+SXT+PEF+FT+DO+C+RA 1 12
AM+CN+CTX+CF+CZ+CAZ+CRO+SXT+FT+DO+C+RA 1 12
AM+CN+CTX+CF+CZ+CAZ+SXT+PEF+FT+DO+C+RA 1 12
AM+CN+CTX+CF+CZ+GM+SXT+PEF+FT+DO+C+RA 1 12
AM+CN+CTX+CF+CZ+CRO+SXT+PEF+FT+DO+C+RA 1 12
AM+PIP+CN+CTX+CZ+CAZ+SXT+PEF+FT+DO+C+RA 1 12
AM + PIP+CN+CTX+CF+CZ+AN+CIP+NOR+PEF + DO+C 1
V HOC THUC HANH (739) - SO 10/2010 85
11 AM+CN+CTX+CF+CZ+CAZ+CRO+SXT+DO+C+RA 1
PIP+CN+CF+CZ+CAZ+CRO+CIP+PEF+FT+DO+C 1
AM+PIP+CN+CTX+CZ+CRO+SXT+FT+DO+C+RA 1
AM+CN+CTX+CZ+CAZ+CRO+GM+SXT+FT+DO+C 1
AM+CN+CTX+CZ+CRO+GM+SXT+TM+FT+DO+C 1
AM+CN+CTX+CF+CZ+CAZ+CRO+SXT+DO+C+RA 1
AM+CN+CTX+CF+CAZ+CRO+NET+SXT+DO+C+RA 1
AM+CN+CTX+CZ+CRO+SXT+PEF+FT+DO+C + RA 1
AM+CN+CF+CZ+NET+SXT+PEF+FT+DO+C+RA 1
10 AM+CN+CTX+CZ+CAZ+SXT+FT+DO+C+RA 1
10 AM+CN+CF+CZ+CRO+SXT+FT+DO+C+RA 1
AM+CN+CTX+CF+CAZ+CRO+SXT+FT+DO+C 1
AM+CN+CAZ+CRO+AN+SXT+FT+DO+C+RA 1
AM+PIP+CTX+CAZ+CRO+GM + NET+DO+C+RA 1
PIP+CN+CTX+CAZ+CRO+GM+SXT+DO+C+RA 1
AM+CN+CTX+CF+CRO+GM+SXT+DO+C+RA 1
AM+CN+CF+CZ+CAZ+CRO+SXT+NOR+DO+C 1
AM+CN+CAZ+CRO+GM+NET+SXT+DO+C+RA 1
AM+CN+CTX+CF+CZ+CAZ+CRO+FT+DO+C 1
AM+CN+CTX+CAZ+CRO+SXT+FT+DO+C+RA 1
9 AM+CF+CZ+CAZ+CRO+SXT+DO+C+RA 1
AM+CN+CTX+CRO+SXT+FT+DO+C+RA 1
AM+CN+CAZ+CRO+GM+SXT+DO+C+RA 1
AM+CN+CAZ+CRO+NET+SXT+DO+C + RA
AM+CN+CTX+CF+CAZ+CRO+SXT+DO+RA 1
AM+PIP+CN+CTX+CF+CAZ+SXT+DO+RA 1
AM+CN+CTX+CF+CZ+CAZ+SXT+DO+RA 1
AM+CN+CF+CZ+CRO+SXT+DO+C+RA 1
AM+CN+CF+CZ+NET+SXT+DO+C+RA 1
8 AM+CF+CZ+CRO+SXT+FT+DO+C 1
AM+CTX+CZ+CAZ+CRO+FT+DO+C 1
AM+PIP+CN+CTX+SXT+FT+DO+C 1
AM+CN+CAZ+CRO+GM+SXT+DO+C 1
AM+CN+CTX+CZ+SXT+DO+C+FIA 1
AM+CF+CZ+CAZ+SXT+DO+C+RA 1
7 AM+CF+CZ+CRO+FT+DO+C 1
AM+CF+CRO+GM+SXT+DO+C 1
AM+CN+CTX+CRO+FT+DO+C 1
CTX+CF+CZ+CAZ+SXT+DO+C 1
AM+CF+CZ+CAZ+FT+DO+C 1
6 AM+CF+CZ+CAZ+SXT+DO 1
CF+CZ+NET+SXT+DO+C 1
AM+CN+SXT+DO+C+RA 1
AM+CTX+CRO+SXT+DO+C 1
4 AM+SXT+DO+C 1
Tong cong 100
* Nhan xet: Ket qua 0 bang tren cho thay kieu each khang khang sinh ciia P.aeruginosa la rat 6a dang.
BAN LUAN
Qua nghien cuu tren thay khong co chung P.
aeruginosa nao d benh vien BKTUTN khong khang khang sinh; chung khang it nhat la khang 4 loai khang sinh; chung khang nhieu nhat la khang het 20/20 loai khang sinh dupe thu va ty le cua nhung chung nay la cao nhat (13,0%) (Bang 3). Ket qua tren phu hpp voi nhung nghien ciru khac or trong va ngoai nuoc (Tho NhT Ky, Dire, Thai Lan) cho thay P.aeruginosa la loai vi khuan khang khang sinh rat manh [1,2 4,6].
Trong cac khang sinh dupe nghien ciru d day thay chung co ty le khang thap nhat voi cac khang sinh nhom Quinolon va nhom Aminoglycozid (19,79% den 20,46 %) (25,26% den 56,25%); co ty le khang cao voi cac khang
sinh khac (48,91% den 100,0%)(Bang 1). Ket qua nay gop phan djnh huong cho cac bac sy sir dung khang sinh tren lam sang.
Vd kieu each khang khang sinh ciia P. aeruginosa: vi khuan nay khang nhilu khang sinh voi kieu each da dang (Bang 3). Dieu do che thay cac gen khang khang sinh khong chi nam tren 1 Plasmid ma co the nam tren nhieu clu true khac nhau (tren nhiem sic thi va tren Plasmid). Co nhung nhom nho (AM + SXT + DO + C gap voi ty le 72/ 100) gpi y chiing cd the nim tren 1 Plasmid. De khlng dinh dupe cln cd nghien cuu tiip tuc bing sinh hpc phan tir.
Khdng co chiing P. aeruginosa nao khdng khang khang sinh (Bang 2); chung khang it nhlt ia 4 loai khang sinh che tdi khang toan bp cac khang sinh dupe thu.
Tuy nhien, tin xult thudng gap nhlt la khang tu 9 den
