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- 1. C畉P NH畉T CH畉N ON V I畛U TR畛 NHI畛M N畉M XM L畉N TS.BS. V滴 狸nh Th畉ng Tr動畛ng Khoa ICU - BV 115 Gi畉ng vi棚n BMHSCC - HYD
- 2. N畛I DUNG 1. T畛ng quan 2. i畛u tr畛 Nhi畛m N畉m X但m L畉n 3. C叩c thu畛c kh叩ng n畉m v guidelines
- 3. T畛NG QUAN
- 4. Nhi畛mN畉m Aspergilus T畛n th動董ng ho畉i t畛 N畉m tai U n畉m ph畛i D畛 畛ng Vi棚m xoang m滴i Vi棚m ph畉 qu畉n X但m l畉n H畛 h担 h畉p d動畛i H畛 TKTW H畛 tim M畉ch Candida C. albicans C. non-albicans Da Ni棚m m畉c N畉m da N畉m ni畛u d畛c N畉m h畉u h畛ng X但m l畉n Candida m叩u Candida m担 s但u (ph畛i, th畉n, gan, l叩ch,)
- 5. KHUYNH H働畛NG HI畛N NAY Gia tng TL nhi畛m Aspergilus 畛 BN b畛nh m叩u 叩c t鱈nh v gh辿p c董 quan v nhi畛m li棚n quan 畉n thu畛c d畛 ph嘆ng kh叩ng n畉m 1, 2 Gia tng t畛 l畛 nhi畛m Candida non-albican li棚n quan 畉n s畛 d畛ng Fluconazol v gia tng c叩c th畛 thu畉t x但m l畉n 3 1. Pagano L et al: The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM2004 study. Haematologica. 2006 Aug余91(8):106875. 2. Pappas PG et al: Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis. 2010;50:1101-1111. 3. Horn DL et al: Epidemiology and outcomes of candidemia in 2019 patients: data from the prospective antifungal therapy alliance registry, Clin Infect Dis. 2009;48(12):1695.
- 6. ANTIFUNGAL SUSCEPTIBILITY OF INVASIVE CANDIDA BLOODSTREAM ISOLATES FROM THE ASIA-PACIFIC REGION 60% non- albican Vietnam = Choray, Bach Mai, NDG, Ng Tri Phuong,
- 7. NHI畛M N畉M CANDIDA T叩c nh但n th動畛ng g畉p nh畉t, 70 90% c畛a IFI1 Nhi畛m candida huy畉t: 畛ng th畛 4 t畉i M畛 v th畛 7 畛 ch但u u2,3 trong c叩c BN sepsis Ty l畛 6,9/1000 BN ICU4 Ty l畛 t畛 vong: 20 49%4 1. Lamagni TL et al: Emerging trends in the epidemiology of invasive mycoses in England and Wales (1990-9). Epidemiol Infect 2001; 126:397-414 2. Wisplinghoff H et al: Nosocomial bloodstream infections in US hospitals: Analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004; 39:309-317 3. Marchetti O et al: Epidemiology of candidemia in Swiss tertiary care hospitals: Secular trends, 1991-2000. Clin Infect Dis 2004; 38:311-320 4. Cornely et al. ESCMID guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. Clin Microbiol Infect 2012; 18 (Suppl. 7): 1937
- 8. LM SNG NHI畛M CANDIDA XM L畉N S畛t v NKH ti畉n tri畛n v畛i ST m畉c d湛 c坦 i畛u tr畛 KS T畛n th動董ng da. N畛i rash d畉ng n畛t l畛n th動畛ng nh畉m v畛i d畛 畛ng thu畛c. Sinh thi畉t l畛p s但u c畛a da 畉c bi畛t v湛ng m畉ch m叩u v l畛p b狸 T畛n th動董ng m畉t (Vi棚m n畛i nh達n do Candida) 叩nh gi叩 叩y m畉t t狸m s畛 hi畛n di畛n c畛a vi棚m n畛i nh達n do Candida n棚n 動畛c th畛c hi畛n 畛 nh畛ng BN nhi畛m Candida m叩u.
- 9. I畛U TR畛 NHI畛M N畉M XM L畉N
- 10. CC KHI NI畛M I畛U TR畛 KHNG N畉M B畉ng ch畛ng vi sinh i畛u tr畛 d畛 ph嘆ng i畛u tr畛 畛nh h動畛ng i畛u tr畛 Kinh nghi畛m i畛u tr畛 M畛c ti棚u Unlikely Possible Probable Proven Y畉u t畛 nguy c董 Y畉u t畛 nguy c董 Ch畛 i畛m sinh h畛c Y畉u t畛 nguy c董 L但m sng
- 11. T畉I SAO C畉N I畛U TR畛 THEO KN? T畛 l畛 b畛nh m畛i v t畛 vong cao Ch畉n o叩n kh担ng 畉y 畛 Ph動董ng ph叩p d畛a tr棚n k畉t qu畉 c畉y Ch畛 c坦 鱈ch v畛i Candida, nh動ng c坦 畉n >10% 但m t鱈nh gi畉 H畉u nh動 ch動a bao gi畛 ch畉n o叩n 動畛c Aspergillus Ph動董ng ph叩p kh担ng d畛a tr棚n k畉t qu畉 c畉y (GM, PCR) V畉n c坦 t畛 l畛 但m t鱈nh gi畉 cao Nhi畛u tr動畛ng h畛p NNXL 動畛c qu叩 tr畛 ho畉c ch畛 sau khi autopsy i畛u tr畛 mu畛n gi畉m t畛 l畛 thnh c担ng
- 13. KHI NO NN NGHI NG畛 BN NHI畛M N畉M XM L畉N 1. BN v畉n s畛t m畉c d湛 達 d湛ng Kh叩ng sinh ph畛 r畛ng sau 4-7 ngy (quan tr畛ng nh畉t) 2. BN kh担ng t狸m th畉y nguy棚n nh但n g但y s畛t 3. BN c坦 shock nhi畛m tr湛ng/nhi畛m tr湛ng m叩u 4. BN 達 tr畉i qua 畉i ph畉u thu畉t v湛ng b畛ng 5. BN vi棚m t畛y c畉p,vi棚m t畛y ho畉i t畛 6. BN c畉y 畛nh l動畛ng m, d畛ch r畛a ph畉 qu畉n (+) n畉m 7. BN c坦 di畛n ti畉n b畛nh n畉ng Clinical Infectious Diseases Advance Access published December 16, 201
- 14. CC THU畛C KHNG N畉M & GUIDELINES
- 15. CC THU畛C KHNG N畉M V V畛 TR TC 畛NG AZOLES ITRACONAZOLE FLUCONAZOLE POSACONAZOLE POLYENS AMPHOTERICIN B - Deoxycholate - Lipid formulations ECHINOCANDINS CASPOFUNGIN
- 16. PH畛 KHNG N畉M Organism Ampho B Fluco Itra Caspo Aspergillus species + - + + A. flavus 賊 - + + A. fumigatus + - + + A. niger + - 賊 + A. terreus - - + + Candida species + + + + C. albicans + + + + C. glabrata + 賊 賊 + C. krusei + - 賊 + C. lusitaniae - + + + C. parapsilosis + + + 賊 C. tropicalis + + + +
- 17. B畉NG SO SNH CC THU畛C KHNG N畉M Ti棚u ch鱈 Fluconazole Itraconazole Amphotericin B Caspofungin Ph畛 Ch畛 c坦 Candida K辿m nh畉y C. glabrata v C. krusei Candida + Aspergillus K辿m nh畉y C. glabrata v C. krusei Candida + Aspergillus Candida + Aspergillus D畉ng s畛 d畛ng U畛ng + TM U畛ng H畉p thu 動畛ng u畛ng k辿m Truy畛n TM Truy畛n TM 畛 kh叩ng 達 畛 kh叩ng nhi畛u 畛 kh叩ng nhi畛u t b畛 畛 kh叩ng t b畛 畛 kh叩ng 畛c t鱈nh 畛c gan 畛c gan 畛c th畉n Bi畉n c畛 do ti棚m truy畛n nhi畛u Tng men gan T動董ng t叩c t t動董ng t叩c 畛c ch畉 enzym P450 Kh担ng 畛c ch畉 P450
- 18. H働畛NG D畉N IDSA 2009 HI畛P H畛I B畛NH NHI畛M TRNG HOA K畛 CID 2009: 48 (1 March). Pappas et al. I畛U TR畛 KHNG N畉M THEO KINH NGHI畛M, NGHI NG畛 NHI畛M CANDIDA XM L畉N B畛NH NHN KHNG GI畉M B畉CH C畉U TRUNG TNH L畛A CH畛N KH畛I 畉U L畛A CH畛N THAY TH畉 Caspofungin* Micafungin Anidulafungin Fluconazole (B-III) AmB d/L AmB (B-III) *働u ti棚n ch畛n echinocandins BN 達 ti畉p x炭c azoles g畉n 但y, t狸nh tr畉ng b畛nh t動董ng 畛i n畉ng n畉ng, c坦 nguy c董 nhi畛m C. glabrata ho畉c C. krusei
- 19. Clinical Infectious Diseases Advance Access published December 16, 2015 H働畛NG D畉N IDSA 2016 HI畛P H畛I B畛NH NHI畛M TRNG HOA K畛 I畛U TR畛 KHNG N畉M THEO KINH NGHI畛M, NGHI NG畛 NHI畛M CANDIDA XM L畉N B畛NH NHN KHOA H畛I S畛C TCH C畛C KHNG GI畉M B畉CH C畉U TRUNG TNH 働u ti棚n l畛a ch畛n: Caspofungin (70mg li畛u t畉i, 50mg m畛i ngy ti畉p theo), micafungin, anidulafungin (Khuy畉n c叩o m畉nh, b畉ng ch畛ng trung b狸nh) L畛a ch畛n thay th畉: Fluconazole: n畉u b畛nh nh但n kh担ng ti畉p x炭c azoles g畉n 但u v kh担ng c坦 kh炭m h坦a v畛i ch畛ng Candida 畛 kh叩ng azoles (Khuy畉n c叩o m畉nh, b畉ng ch畛ng trung b狸nh) AmB d畉ng lipid: n畉u kh担ng dung n畉p v畛i thu畛c kh叩ng n畉m kh叩c. (Khuy畉n c叩o m畉nh, b畉ng ch畛ng th畉p)
- 21. Morbidity Reduction OR Survival Improvement (Gi畉m t畛 vong ho畉c c畉i thi畛n s畛ng c嘆n) Morbidity Reduction OR Survival Improvement (Gi畉m t畛 vong ho畉c c畉i thi畛n s畛ng c嘆n) Caspofungin 70/50 mg qd A I A II Micafungin 100 mg qd A I A II Anidulafungin 200/100mg qd A I B II Liposomal amphB 3mg/kg/d B I B II Voriconazole (6 mg/kg on day 1 then 3 mg/kg/d) B I C II Fluconazole 400-800mg qd C I C I Amphotericin B lipid complex (5 mg/kg/d) C IIa C IIa Amphotericin B deoxycholate (0.7 1.0 mg/kg/d) D I D II Amphotericin B colloidal dispersion D IIa C III Itraconazole D IIa Posaconazole D III DIII Anti-Candida initial targeted treatment in Adults Non-neutropenic Neutropenic* * Refers to adults with hematological malignancies and HSCT recipients 2012 ESCMID guidelines for Candida Infections
- 22. ALGORITHM FOR THE TREATMENT OF DOCUMENTED CANDIDIASIS IN THE INTENSIVE CARE UNIT (ICU) Guery BP, et al. Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part II. Treatment. Intensive Care Med. 2009;35:206214. Adapted from: Guery BP, et al. Intensive Care Med. 2009;35:206214. LAmB = Liposomal Amphotericin B. Suggested algorithm for the treatment of documented invasive candidiasis (IC)
- 23. GUIDELINE C畛A HI畛P H畛I L畛NG NG畛C HOA K畛 i畛u tr畛 Ghi ch炭 Candidemia, L但m sng 畛n 畛nh Fluconazole; Caspofungin; Micafungin; Anidulafungin; Thay catheter TM trung t但m ho畉c 畛i v畛 tr鱈 Kh叩m chuy棚n khoa m畉t i畛u tr畛 ti畉p t畛c 2 tu畉n sau khi c畉y m叩u 但m t鱈nh N畉u t畛 l畛 ch畛ng non-albican > 10% ho畉c t畛 l畛 C.albican kh叩ng Fluconazole cao, xem x辿t d湛ng echinocandin ho畉c Ampho-B Candidemia, L但m sng kh担ng 畛n 畛nh v ch動a x叩c 畛nh loi Ampho- B/ Ampho-B d畉ng lipid; Caspofungin; Micafungin; Anidulafungin; Voriconazole; Fluconazole li畛u cao; Ampho-B + Fluconazole li畛u cao Am J Respir Crit Care Med Vol 183. pp 96128, 2011
- 24. GUIDELINES 2014- AUSTRALIA & NEW ZEALAND Khuy畉n c叩o i畛u tr畛 candidaemia ho畉c nhi畛m candida x但m l畉n Yeast treatment guidelines 2014. Internal Medicine Journal 44 (2014)
- 25. Echinocandin (ECH) l khuy畉n c叩o 畉u tay trong i畛u tr畛 nhi畛m candida theo kinh nghi畛m 畛 BN ICU
- 26. K畉T LU畉N Nhi畛m Candida x但m l畉n 畛 BN ICU ngy cng tng v ty l畛 t畛 vong cao L但m sng kh担ng 畉c hi畛u d畉n 畉n ch畉m tr畛 trong i畛u tr畛 C畉n cho thu畛c kh叩ng n畉m s畛m khi nghi ng畛 Nhi畛m Candida x但m l畉n Nh坦m Echinocandins l thu畛c ch畛n l畛a 畉u tay trong tr動畛ng h畛p nhi畛m candida x但m l畉n n畉ng
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