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» TRAN VIET HUNG, LE OiNH CHI, NGUYEN TlEN OAT: Nghien ciru chiet, phan lap va tinh chi apigenin ti> flavonoid toan phan chiet tir cue hoa vang (Chrysanthemum indicum L.) lam nguy[r]
(1)2 tap cA l
DtfOC HOC SO 495 * NAM THl> 57 * THANG RA KY * ISSN 0866 - 7861
Momordica charantia L
rA Ho Bau bi - Cucurbitaceae
CAY KHO QUA RIJNG
BO Y XUAT BAN
(2)TAP CHI D U g C HOC ISSN 0866 - 7861 7/2017 (So 495 NAM 57)
MUC LUC
NGHIEN CCfU - KY THUAT
0A0 NGUYET SUONG HUYEN, NGUYEN VAN HAl, BUI THj HONG NHUNG, NGUYEN DlNH LUYEN: Nghien CLHU tong hgp mesna tir
1,2-dicloroethan qua trung gian muoi Bunte NGUYEN THI KIM THU, DANG KIM THU, BUI THANH TUNG:_Tac dyng
quet goc ty DPPH va ire che AchE cua cac phan do?n tir re dan sam
(Salvia miltiorrhiza Bunge) a Viet Nam
TRAN ANH VU, HOANG THAI PHUONG CAC: Nghien ciru tic dung glucose huyet va doc tinh cap ciia che pham com hon djch tir cao que va
kho qua loai qua nho NGUYEN CAO TOAN, TRUONG TH| DEP LE NGQC KiNH: Nghien ciru
dac diem hinh thai va cau tao vi hpc cua cay xirong chua - Hibiscus
surattensis L, hp Bong - Malvaceae 12
VU VAN DUY, NGUYEN TH| HU&NG, NGUYEN THACH TUNG: Nghien ciru xay dpng cong thirc bao che vi nhu tuang betamethason dipropionat 17 ! T6NG TH| THANH VUQNG, TRAN THj HANG, TRAN CAO SON, 1_E
TH| HONG HAO, LE DlNH CHI: Xay dpng phaang phap djnh lirgng dong thai ba doc t6 acid okadaic, dinophysistoxin-1 va dinophysistoxin-2 a dpng nhuyen the hai manh vo bang sic ky long sieu hieu
nang ket noi khoi hai Ian (UPLC-MS/MS) 21 i HUYNH TH| MY DUYEN, BUI TH| VAN KHANH, HUYNH VAN H6A,
D O TH| HONG TUOk Khao sat hoat tinh doc te bao ung thu- da day cua vien nen noi chua curcumin tren dong te bao ung thu da day ngudi N87 24 i D HOU XUAN, PHAM VAN HIEN, CAO VAN ANH, NGUYEN TH|
THANH PHU'ONG, NGUYEN THj TUYET, DAO VAN DON: Nghien ciru djnh lupng S-allyl-L-cystein toi den bing phuang phap tao dan chat
phat huynh quang vdi Dansyl clorid 28 - HA VAN THUY, NGUYEN ANH PHU'ONG, LE THU THUY: Phan tich ca
cau thuoc sir dung tai Benh vien Phu San Ha Noi nam 2014 30 NGUYEN VIET TAN, NGUYEN VAN TAN MINH, TRUONG NGOC
TUYEN, NGUYEN DUC TUAN: Tong hpp va tieu chuan hoa tap chat
L-cystin va A/,N-diacetyl-L-cystin cua W-acetylcystein 35 » NGUYEN THj TRANG OAl, HUYNH NGOC THMY HUYNH KY: Nghien
ci>u thpc vat hpc va da dang di truyen cua Clinacanthus nutans tai Vipt
Nam 40 • NGUYEN VAN LlNH, DUONG THj HAl YEN, HOANG LE TUAN ANH,
VU MANH HUNG, PHAM THANH KY: Hai flavanonol-glucosid phan lap ti> phan tren mat dat cay tien hac thao {Aghmonia pilosa Ledeb var
pilosa) 46
» TRAN VIET HUNG, LE OiNH CHI, NGUYEN TlEN OAT: Nghien ciru chiet, phan lap va tinh chi apigenin ti> flavonoid toan phan chiet tir cue hoa vang (Chrysanthemum indicum L.) lam nguyen lieu thiet lap chat
chuan 50 • NGUYEN TlEN VUNG, VO DUC Lai: Mot so hpp chat phan lap tir la cay
gan heo (Dicliptera chinensis (L.) Nees) 54 • HA VAN OANH, VO VAN DiEN: Nghien ciru dpc tinh cip va tic dung Ipi
mat ciia bai thuoc BG 57 • LE THANH LONG, NGUYEN TRAN VAN ANH, CHUONG NGOC NAI,
HOANG DiNH HUU HANH, NGUYEN OliC TUAN: Tong hpp va xac dinh dp tinh khiet tip chat lien quan 2-azaspiro[4.5]decan-3-on cua gabapentin 60
» NGUYEN T H U MINH, NGUYEN THI TUYEN, TRAN NHAN THANG,
DUONG OUC HUNG, CAN TUYET NGA, NGUYEN TlEN PHUONG, NGUYEN MAI HOA, NGUYEN HOANG ANH: Khao sat tinh hinh tieu thu khang sinh carbapenem tii Bpnh vien Bach Mai giai doan tu nam
2012 den nam 2016 63 » TRAN HUU TAM: Xay dung phan moi trudng chua P aeruginosa
gop phan tio mau kiem chuan xet nghipm 67 • NGUYEN THj MAI: Cac hpp chat lignan glycosid tu qua cay lien kieu
(Forsythia suspensa (Thunb.) Vahl.) 70
» TRAN ANH VO, HUYNH THANH HAU: Nghien cuu dieu che cao giau hpp chat saponin tir qua kho qua (Momordica charantia L var. abbreviata
Ser.) 73
• PHAN OiNH CHAU, TRAN THj VAN, TRAN THI HANG, NGUYEN VAN
THINH, VO BiNH DUONG: Nghien cuu ve cac dan chat cua adamantan Phan X: Nghien cuu tong hpp 1-amino-adamantan hydroclorid di tir
1-bromo-adamantan va acetonitril tren ca sd phan ung kieu Ritter 77
PHARMACEUTICAL JOURNAL ISSN 0866 • 7861
7/2017 (N° 495 Vol 57) CONTENTS
RESEARCH - TECHNIQUES
»OAO NGUYET SUONG HUYEN, NGUYEN VAN HAl, BUI TH| HONG NHUNG, NGUYEN OINH LUYEN: Synthesis of mesna from
1,2-dichloroethane using Bunte salt approach » NGUYEN TH| KIM THU, OANG KIM THU, BUI THANH TUNG: DPPH
radical scavenging and acetylcholinesterase inhibitory activities of
fractions from the roots of Salvia miltiorrhiza Bunge in Vietnam • TRAN ANH VU, HOANG THAl PHUONG CAC: Hypoglycemic property
and acute toxicity of granules of condensed combined extracts of
Cinamomum (Cinnamomum obtusifolium Nees.) and wild bitter melon
(Momordica charantia L var. abbreviata Ser.)
• NGUYEN CAO TOAN, TRUONG THIDEP LE NGOC KINH: Macroscopic morphology and microscopic anatomy of the plant Hibiscus surattensis L
(Malvaceae) 12 • VO VAN DUY, NGUYEN THj HUftNG, NGUYEN THACH TUNG: Study
on preparation of dosage form containing betamethasone dipropionate in
nano-sized micro-emulsion 17 • T6NG THI THANH VUONG, TRAN THj HANG, TRAN CAO SON, LE
THj H6NG HAO, LE DiNH CHI: Simultaneous determination of the toxic residues of okadaic, dinophysistoxin-1 and dinophysistoxin-2 in bivalve
mollusk by UPLC-MS/MS 21 • HUYNH THj MY DUYEN, BUI THI VAN KHANH, HUYNH VAN H6A, DO
TH| H6NG TUOI: Cytotoxicity of the gastric floating tablets of curcumin
on the human gastric cancer line N87 24 • 0 HUU XUAN PHAM VAN HlEN, CAO VAN ANH, NGUYEN THI
THANH PHUONG, NGUYEN THj TUYET, DAO VAN DON: Preparation of the fluorescent derivative of S-allyl-L-cysteine with Dansyl chroride for subsequent quantitative determination of S-allyl-L-cysteine in black garlic
by HPLC-FLD 28 • HA VAN THUY, NGUYEN ANH PHUONG, LE THU THUY: Analysis of
the structure of drug use at Hanoi Obstetrics and Gynecology Hospital
in 2014 30 • NGUYEN VIET TAN, NGUYEN VAN TAN MINH, TRUONG NGOC
TUYEN, NGUYEN DUC TUAN: Synthesis and standardization of L-cystin
and N,N'-diacetyl-L-cystin as related N-acetylcystein impurities 35 • NGUYEN THj TRANG OAl, HUYNH NGOC THUY, HUYNH KY: Study on
botany and genetic diversity of Clinacanthus nutans in Vietnam 40 • NGUYEN VAN LlNH, DUONG THj HAl YEN, HOANG LE TUAN ANH,
VO MANH HUNG, PHAM THANH KY: Two flavononol glucosides isolated
from the aerial parts of Agrimonia pilosa Ledeb var. pilosa 46 • TRAN VIET HUNG, LE DINH CHI, NGUYEN TlEN OAT: Isolation of
apigenin from the extracts of total flavonoids from Chrysanthemum indicum L and its purification for establishment of its reference standard 50 • NGUYEN TlEN VUNG, VU DUC LOI: Some phytochemical compounds
from Dicliptera chinensis (L.) Nees 54
• HA VAN OANH, VO VAN OlEN: Choleretic activity and acute toxicity of
the herbal remedy BG 57 • LE THANH LONG, NGUYEN TRAN VAN ANH, CHUONG NGOC
NAI, HOANG DiNH HUU HANH, NGUYEN DUC TUAN: Synthesis of 2-azaspiro[4.5]decan-3-on and determination of its purity for use in
impurity control of gabapentin 60
• NGUYEN T H U MINH, NGUYEN THj TUYEN, TRAN NHAN THANG,
DUONG DUC HUNG, CAN TUYET NGA, NGUYEN TlEN PHUONG, NGUYEN MAI HOA, NGUYEN HOANG ANH: Actual use of carbapenem antibiotics in the Central Hospital of Bach Mai in the period of 2012 - 2016 63 • TRAN HUU TAM: Formulation of the medium for laboratory microscopic
examination samples of P aeruginosa 67 • NGUYEN THj MAI: Lignan glycosides from the Fmctus forsythiae of
Forsythia suspensa (Thunb.) Vahl 70
• TRAN ANH VO, HUYNH THANH HAU: Preparation of saponin-rich
extracts from the fruits of Momordica charantia L var. abbreviata Ser 73 • PHAN DiNH CHAU, TRAN THj VAN, TRAN THj HANG, NGUYEN
VAN THjNH, VU BiNH DUONG: Study on adamantine derivatives Part X: Synthesis of 1-amino-adamantane hydrochroride from
(3)• Nghien cveu - Ky thuat
Khao sat tinh hinh tieu thu khang sinh carbapenem tai Benh vien Bach Mai giai (loan
r
tir nam 2012 den nam 2016
Nguyen Thu Minh2, Nguyen Thj Tuyen1, Tran Nhan ThSng2
Diromg Dire Hung2, Can Tuyet Nga2, Nguyen Tien Phiromg2
Nguyen Mai Hoa1, Nguyen Hoang Anh'* 'Trung tarn DI va ADR Quoc gia, Tru&ng Dai hoc Dupe Ha Noi
2Benh vien Bach Mai * E-mail: anh90tk@yahoo.com Summary
The consumption of carbapenem antibiotics in Bach Mai Hospital was characterized, analysing the trend from 2012 to 2016 Dispensing data of all carbapenem prescriptions and relevant population data were collected to measure the defined daily doses (DDDs) per 100 patient-days The level of carbapenem consumption was so high in 2012 (1385 DDD/100 patient-days) continuouly increased almost two-fold in 2016 (2475 DDD/100 patient-days) The Intensive care unit, Respiratory Center and Department of Infectious Diseases were responsible for the highest carbapenem utilisation of all, especially the proportion of ICU accounting for one-third of the total hospital A significant increase in meropenem and ertapenem consumption was observed but no such trend was seen for imipenem/cilastatin In conclusion, this study may be a contribution to strict antibiotic management, and the carbapenem use in particular, in order to reduce antimicrobial resistance
K e y w o r d s : Carbapenem, DDD/100 patient-days, antibiotic consumption
O a t v a n de
Carbapenem la nhom khang sinh co khang khuan rat rong nen chi d u g c u u tien sir dung t r u d n g hop nhiem khuan nang cac khang sinh khac khong co hieu qua Tuy nhien, ty le vi khuan khang carbapenem tai Viet Nam hien dang tang nhanh va mice dang bao dong Bao cao ve tinh hinh sir dung khang sinh va khang khang sinh tai 15 benh vien ca n u d e t u giai doan 2008 - 2009 da chi ty le so chung Acinetobacter sp khang carbapenem d mot so benh vien khu v u c phia Bac v u g t qua % m Gan day, mot nghien c u u tren 3287 benh nhan dieu tri tai
15 d a n vi dieu tri tich cue, ty le khang carbapnenem cua A baumannii phan lap d u g c t u nhung t r u d n g hgp nhi§m khuan benh vien da len den 89,2%, doi vdi
P aeruginosa, ty le la 55,7% ( ] Mot so nghien c u u tren the gidi da cho thay m u c tieu thu khang sinh carbapenem co anh h u d n g ro ret d£n ty le de khang cac thuoc [ ] Benh vien Bach Mai la benh vien da khoa tuyen cuoi, tiep nhan l u g n g Idn benh nhan co benh canh nang va p h u c tap t u cac tuyen d u d i chuyen len Nghien c u u d u g c thuc hien nham khao sat l u g n g tieu thu khang sinh carbapenem tai Benh vien Bach Mai giai doan t u nam 2012 den nam 2016; t u do, dinh h u d n g cho c h u a n g trinh quan ly khang sinh Benh vien
O o i t i r o n g v a p h y e n g p h a p n g h i e n c i k i D o i t u g n g n g h i e n c u u
D u lieu thong ke ve so nam vien cua
benh nhan noi tru (luu tai Phong Ke hoach Tong hgp) va so lieu s u dung khang sinh carbapenem cua cac khoa lam sang, Trung tarn hoac Vien true thuoc BV Bach Mai (luu tai Khoa D u g c ) d u g c truy xuat theo tung thang t u nam 2012 den nam 2016 de khao sat dac diem tieu thu khang sinh carbapenem theo thai gian
Phuxyng p h a p n g h i e n cu>u
Nghien cuu hoi ciru ket h g p phan tich dinh l u g n g theo chi so DDD/100 nam vien theo tung thang (DDD - Defined Daily Dose: lieu xac dinh hang ngay) Chi so d u g c s u dung de danh gia cac m u c va xu h u d n g s u dung khang sinh nhom carbapenem theo quy mo toan benh vien va theo tung khoa, phong
r»r-.i-./^nr, - 1 Tong so gram su dung x 100
DDD/100 nam vien = ^—2
DDD x so nam vien Chi so DDD/100 g i u d n g tinh theo cong t h u c tren Trong do, gia tn D D D cua cac thuoc khang sinh d u g c tham khao tir c a s d d u lieu cua Trung tarn H g p tac ve p h u a n g phap thong ke d u g c , To c h u c Y te The gidi ( W H O Collaborating Centre for Drug Statistics Methodology - W H O C C ) Gia tri D D D s u dung nghien c u u vdi cac thuoc Meropenem: g; Imipenem: g ; Doripenem: 1,5 g; Ertapenem: gt )
Xir ly ket q u a
So lieu d u g c x u ly theo p h u a n g phap thong ke y hpc b l n g phan m e m R3.2.2 va Microsolf Excel 2010 S u dung kiem dinh M a n n - Kendall de phan tich xu h u d n g tieu thu khang sinh c a r b a p e n e m cua toan Benh vien cung n h u cua t u n g khoa lam sang
(4)• Nghien cCru - Ky thuat
Xu h u d n g d u p e ket luan tang neu cac chi s o phan tich S > va p < 0,05, x u h u d n g d u p e ket luan giam neu S < va p < 0,05 Cac t r u d n g h g p c h o ket qua phan tich co p > 0,05 d u p e ket luan khong co xu h u d n g
K e t q u a n g h i e n cu u
T i n h h i n h tieu t h u c a r b a p e n e m t r o n g t o a n B e n h vien t r o n g giai d o a n 2012-2016
Tinh hinh tieu thy khang sinh carbapenem c u a toan Benh vien theo tung n a m thong qua so gram va DDD/100 n m vien d u p e bieu dien bang va hinh
Bang 1. Tinh hinh tieu thu carbapenem toan Benh vien giai doan 2012-2016 (dv: gram) ~~~~~~ - ^ ^ ^ Nam
Hoatchat 2012 2013 2014 2015 2016 Tong
Meropenem 46.370,50 42.630,00 64.867,00 84.244,50 111.522,50 349.634,50
Imipenem 39.617,50 50.829,00 74.255,50 68.520,50 59.496,50 292.719,00
Ertapenem 1.906,00 3.328,00 4.992,00 7.606,00 10.026,00 27.858,00
Doripenem 170,50 3.798,00 3.968,50 Tong 88.064,50 96.787,00 144.114,50 160.371,00 184.843,00 674.180,00
» meropenem imipenem ertapenem • doripenem
Hinh 1. Tinh hinh tieu thu khang sinh carbapenem cua toan Benh vien giai doan 2012-2016
Tong l u p n g khang sinh carbapenm s u dung toan Benh vien d m d c cao va tang dan n a m , d o , n a m 2016 c d l u p n g tieu thu gap ddi n a m 2012, tinh theo so gram tieu thu va DDD/100 nam vien, so lieu DDD/100 n £ m vien t u a n g d n g hai nam la 2475,68 va 1385,33 DDD/100 n^m vipn So lieu DDD/100 n d m vien cua tung Khoa lam sang, Trung tarn hoac Vien thuoc Benh vien Bach Mai d u p e trinh bay bang
Ket q u a d j n h lu p n g t h e o tCrng d e n vj
Ket qua dinh l u p n g theo t u n g d a n vi vien cho thay, nhom khang sinh n a y d u p e s u dung rong rai d tat ca cac Khoa lam sang, Trung tarn hoac Vien Tuy nhien, nhom khang sinh c h u y e u d u p e tieu thu b d i ba d a n vj co l u a n g s u dung nhdm khang sinh v u p t tren 800 D D D / 0 n £ m vien la Khoa Hoi s u e tich c u e (ICU), Trung tarn H o h a p va Khoa Truyen nhiem D a c biet, Khoa ICU co tong D D D / 0 n a m vien c u a khang sinh c a r b a p e n e m len d e n h a n 3000 lieu, g i n bang 1/3 tong l u p n g s u dung cua toan Benh vien Dieu cung d u p e the hien ro ret qua x u h u d n g s u d u n g khang sinh c a r b a p e n e m theo t u n g n a m c u a ba d a n vi n a y so v d i trung binh toan vien, the hien hinh
Bang 2. Tong lieu DDD/100 nkm vien cua ung Khoa lam sang, Trung tarn hoac Vien true thuoc
Benh vien Bach Mai ndm
77 Don vj Tong DDD/100 nim vien
1 Khoa Hoi sire tich eye 3253,24 TT Ho hap 945,10 Khoa Truyen nhiem 854,57 Khoa Gay me hoi sire 590,60 TT Chong doc 529,71 Khoa Huyet hoc 517,45 Khoa Than kinh 407,34 Khoa Than - Tiet nipu 400,72 Khoa Ngoai 389,74 10 Vien Tim mach 368,97 11 Khoa Tieu hoa 334,88 12 Khoa Cap cu u 248,74 13 Khoa Noi tiet & DTD 187,72 14 TT Di i>ng & MDLS 182,46 15 TT Phuc hoi chiic nang 154,46 16 Khoa Co - Xuong - Khop 59,38 17 Khoa Dong y 41,61 18 Khoa Da lieu 39,10 19 Khoa PT- TK 29,66 20 Khoa CT- CH 25,39 21 Khoa San 14,58 22 Vien SK tarn than 5,60 23 TT YHHN & Ung birou 4,94 24 Khoa Tai Mui Hong 4,59 25 Khoa Mat 2,94 26 Khoa Rang ham mat 0,19
Chu thich: TT: Tmng tSm: DTD: Dai thao duvng; MDLS: Mien dich lam sang: PT TK: Phiu thuat Thin kinh; CT CH: Chan thuvng
-Chinh hinh: SK: Sue khoe: YHHN: Yhoc hat nhan
(5)• Nghien CIFU - Ky thuat
A/' » i , i > « * \ \\ i
Khoa Hii sire tiehci/c
2015 2016 KhoaTrvyinnhiim — • • TBto*nvi*n
Hinh 2. Xiv hirong sti dung cac hoat chit carbapenem giai doan 2012-2016
Co cau si> dung cac hoat chat carbapenem cua d a n vi co l u g n g tieu thu nhom khang sinh nhieu nhat n a m d u g c bieu di§n hinh Ket qua cho thay, d ca ba d a n vi cd l u g n g sir dung carbapenem nhieu nhat toan vien, meropenem deu la thuoc d u g c s d dung bien nhat, tiep theo la imipenem/
cilastatin (viet tdt la imipenem) D a y cung la c a cau SIP
dung chung cua nhom khang sinh carbapenem toan vien bieu d i l n ket qua theo t u n g nam hinh Hinh the hien ro h a n xu hirdng SIP dung cac hoat chat carbapenem n a m t u 2 den d u g c phan tich bdi kiem dinh Man - Kendall
3500
c '5 3000
E = 2500 > ?2000 9 ° 1500
a 1000
0
I 500
•o
co o Khoa Hoi sue tich CLTC TT.HohSp Khoa Truyen nhiism Trung binh toan vi$n
Hinh 3. Co ciu sCr dung cua don vi co luung tieu thu khang sinh carbapenem Ion nhat giai doan 2012-2016
X u h u d n g su> d u n g c a c hoat chat c a r b a p e n e m
S = 1182, p < 0,05
Xu hirdng tang S = 30, p > 0,05 Khong thay doi S = 1224, p < 0,05 Xu hudng tang
Hinh 4. Xu hudng so dung cac hoat chat
Kiem dinh thong ke da khang djnh xu hirdng tang SIP
dung dang ke cua meropenem va ertapenem; do, imipenem khong the hien dirge xu hirdng thay doi giai doan 2012 - 2016 Doripenem bit dau d u g c dira vao di§u tri tir nam 2016 nhirng chi chiem ty le nho va chu yeu dirge dung d Khoa Hoi sire tich c u e nen khong the hien d u g c xu h u d n g ap dung kiem djnh
Ban luan
Nhom carbapenem cang d u g c s u dung bien tai BV Bach Mai cac khang sinh sir dung d tuyen d u d i da khong the dem lai hieu qua cho benh nhan T i r nam 2012, lugng khang sinh va gia trj DDD/100 n^m vien cua khang sinh carbapenem cua toan vien da v u g t qua 1300 lieu va tang gan gap ddi vao n a m 2016 Nghien c u u khong khao sat ve chi phi dieu trj nhung no cho thay a p lire kinh te rat Idn cua cac khang sinh d l t tien n h u carbapenem cho ngan sach y te quoc gia noi chung cung n h u cho BV Bach Mai noi rieng V d i vai tro la benh vien tuyen cuoi, l u g n g tieu thu khang sinh carbapenem cua BV Bach Mai tang len theo tung nam phan anh xu h u d n g lira chon cac thuoc dau tien m u c phuc tap cua nhiem
carbapenem theo phan tich Mann - Kendall
trung Theo nghien c u u cua Nguyen Thj Le Minh n a m 2013, tai cac Khoa Hoi s u e tich c u e (ICU), Truyen nhiem va Huyet hoc cd gan % so benh nhan d u g c chi djnh carbapenem phac ban dau, , % vdi imipenem va , % v d i meropenem Carbapenem d u g c sir dung cho % cac t r u d n g h g p nhiem khuan hoac cd dau hieu nhiem khuan Viec s u dung rang rai cac hoat chat tiem tang nguy c a nghiem trpng ve d e khang khang sinh, dac biet v d i cac khang sinh " d u tru" C h u a n g trinh Quan ly Khang sinh Quoc gia Khao sat ve A baumannii va Enterobacteriaceae
khang carbapenem d cac n u d e N a m A va D o n g N a m
A cho thay day la khu v u c co ty le d e khang cac khang sinh cao nhat tren the gidi Trong do, Viet N a m la mot ba n u d e co cac chung Enterobacteriaceae
khang carbapenem l u u hanh moi t r u d n g va ngoai cong dong va ti le khang carbapenem d cac khoa ICU cua 14 benh vien tai Viet N a m la % m Day t h y c sir
la moi nguy hiem vdi s u e khoe cong dong, can d u g c kiem soat b§ng mot c h u a n g trinh quan ly khang sinh phu h g p de gidi han viec s u dung nhom khang sinh nay, qua cai thien nhay cam cua vi khuan vdi thudc
Nghien ciru da ghi nhan l u g n g tieu thu khang sinh
(6)• Nghien cu»u - Ky thuat
carbapenem tap trung chu y l u d ba d a n vi la Khoa H6i s u e tich c u e (ICU), Trung tarn Ho h i p va Khoa Truyen n h i l m Dae biet, Khoa ICU co tong DDD/100 nam vien cua khang sinh chiem gan 1/3 tong l u g n g s u dung cua toan BV, vdi chi so m6i nam deu khoang 500 - 700 lieu Day la d a n vi dieu tri cac benh nhan nang, nhiem trung phuc tap nen viec s u dung carbapenem chiem ty Idn khong kho ly giai Tuy nhien, so sanh vdi cac d a n vi dieu tri tich c u e khac tren th§ gidi, Khoa ICU cua BV Bach Mai co l u g n g s u dung carbapenem cao han dang ke mac du co s u khac biet ve thai gian truy xuat d u lieu Khao sat tren 530 benh vien tai Phap nam 2007 cho thay gia tri DDD/100 n l m vien cua cac Khoa ICU chi dat 146,6 lieu | ] Ben canh do, nhiem trung benh vien va khang thuoc cung la mot van de quan trgng tai cac Khoa ICU V d i cac n u d e co thu nhap trung binh - thap n h u Viet Nam, ty le nhiem trung benh vien ghi nhan tai cac Khoa ICU len den 35,2% [9) Cung theo nghien c u u cua N T L Minh nam 2013, ti le khang cua cac chung vi khuan tai cac Khoa ICU, Truyen Nhiem va Huyet hoc cua Benh vien Bach Mai da dat m u c % vdi imipenem va % vdi meropenem [ 1 J Da s6 cac trudng hgp nhiem trung gay bdi vi khuan Gram a m , vdi ty le d§ khang carbapenem rat dang luu y Ty le de khang carbapenem cua A baumannii, P aeruginosa va K pneumoniae l l n lugt la 89,2%; 55,7% va 14,9% n Day t h u c s u thach thuc Idn doi vdi cac nha lam sang lua chon khang sinh t r u d c boi canh khang khang sinh cang Ian tran hien
Ve c a cau s u dung, giai doan 2012 - 2016, meropenem va ertapenem cd xu h u d n g tang s u dung viec s u dung imipenem lai kha on dinh Meropenem la hoat chat chiem u u the khong chi d ba d a n vi cd l u g n g s u dung nhieu nhat ma day la xu h u d n g chung cua toan BV Dieu co the xuat phat t u dac diem ve d u g c ly cung n h u dp an toan cua cac thuoc tren lam sang Trong imipenem co nguy c a gay doc tinh tren than kinh cao nhat nhom va khong hieu qua tren tu cau vang khang meuiicilin thi meropenem lai mang nhieu u u diem n h u co nguy c a dpc tinh tren t h i n kinh thap h a n va la hoat chat carbapenem n h l t d u g c s u dung dieu tri viem mang n a o[ ] Ben canh do, t u nam 2016, hoat chat mdi cua nhom carbapenem la doripenem bat d l u d u g c d u a vao dieu tri tai BV Bach Mai Vdi Igi the han so vdi meropenem tren P aeruginosa va vi khuan Gram (+)( 8', doripenem hua hen la mot lua chpn khang sinh hieu qua cac t r u d n g hgp n h i i m khuan nang da khang cac carbapnenem khac Tuy nhien, viec then khai c h u a n g trinh quan ly khang sinh chat che benh vien la c l n thiet de bao ton d u g c cac khang sinh dang s u dung, dac biet la cac thuoc mdi n h u doripenem
Ket luan
Nghien c u u da cho thay hinh anh tong the ve tinh hinh tieu thu khang sinh carbapenem tai BV Bach Mai giai doan 2012 - 2016, vdi m u c l i l u DDD/100 n l m vien d m u c rat cao (tren 1000 lieu) va tang dan theo thai gian Khoa ICU, Trung tarn Ho hap va Khoa Truyen nhiem la ba d a n vj co l u g n g tieu thu carbapenem Idn nhat toan BV, chi rieng Khoa ICU da co tong DDD/100 n l m vien cua khang sinh carbapenem gan bang 1/3 tong l u g n g s u dung nhom thuoc cua toan BV Ve c a cau, meropenem va ertapenem co xu h u d n g tang len viec s u dung imipenem lai kha on djnh thai gian khao sat Nghien c u u la c a s d de then khai cac nghien c u u danh gia s u dung thuoc cung n h u c h u a n g trinh quan ly khang sinh benh vien n h l m nang cao hieu qua s u dung thuoc khang sinh
Tai lieu tham khao
1 GARP Viet Nam (2009), Bao cao st> dung khang sinh va khang khang sinh tai 15 benh vien Viet Nam nam 2008-2009, Du an Hgp tac toan cau ve khang khang sinh GARP Viet Nam va Don vj Nghien cuu Lam sang Dai hoc Oxford
2 Dumartin C , L'Heriteau F et al (2010), "Antibiotic use in 530 French hospitals: results from a surveillance network at hospital and ward levels in 2007", J Antimicrob Chemother.,
65(9), pp 2028-36
3 Guclu E., Ogutlu A etal (2017), "Antibiotic consumption in Turkish hospitals; a multi-centre point prevalence study", J Chemother., 29(1), pp 19-24
4 Hsu L.Y.,ApisarnthanarakA., etal (2017), "Carbapenem-resistant acinetobacter baumannii and enterobacteriaceae in South and Southeast Asia", Clin Microbiol Rev, 30(1), pp 1-22
5 Lai Chih-Cheng, Wang Cheng-Yi (2011), "Correlation between antibiotic consumption and resistance of Gram-negative bacteria causing healthcare-associated infections at a university hospital in Taiwan from 2000 to 2009", J of Antimicrobial Chemotherapy, doi:10.1093/jac/dkr103
6 Melanie Cupp (2007), "Comparison of carbapenem antibiotics", Pharmacist's Letter/Prescriber's Letter, 23(12), pp 231205
7 Phu V D„ Wertheim H F etal (2016), "Burden of hospital acquired infections and antimicrobial use in Vietnamese adult intensive care units", PLoS One, 11(1), pp e0147544
8 Restrepo M I (2009), "Efficacy of intravenous infusion of doripenem", Clin Infect Dis., 49 Suppl 1, pp S17-27
9 WHO (2011), Report on the Burden of Endemic Health Care-Associated Infection Worldwide:a system review of the literature
10. WHO Collaborating Centre for Drug Statistics Methodology, Retrieved 11/06/2017, from http://www.whocc no
11 Nguyln Thj Le Minh (2013), "Danh gia tinh hinh su dung khang sinh nhom carbapenem tai Benh vien Bach Mai",
Luan van Thac sTDuyc hoc, Trudng Dai hoc Dugc Ha Ngi
{Ngay nhan bai: 16/05/2017- Ngay phan bien: 06/06/2017 - Ngay duyet dang: 29/06/2017)
http://www.whocc