Khdo sdt sir dung khdng sinh linezolid tai Benh vien Bach Mai nam 2015

• • • •

DoanThi PhPOng1, LeVan Anh2 ,Tran Nhan Thang2 , VP Oinh H6a\ Nguyen Hoang A n h 1

' Trifdng Dai hoc Dupe Ha Npi 2Khoa Dupe - Benh vien Bach Mai

SUMMARY This study aimed to explore prescribing behavior in the use of linezolid, a new antibiotic for Gram positive infections, in

Bach Mai hospital in first three quaters of 2015. A retrospective study was conducted on 311 medical records of Inpatients prescribed with linezolid admited in Bach Mai hospital from January to September of 2015. Of 311 selected medical records, 74 (23.8%) were prescribed linezolid with approved indications in which the most common was community arquired pneumoniae with 37 (11.9%>) cases. A minor number of 10 (3.2%) cases were found to have rational reason for linezolid use. Up to 237 (76.2%) patients were prescribed linezolid with off-label indications and the majority of those were for treatment or prevention of neutropenic fever which account for 44.7%>. Fourty seven pathogens were isolated including one Enterococcus spp. strain with decreased susceptiblility and one methicilin resistant Staphylococcus aureus strain with resistance to linezolid. Oral route was indicated in 95.2% of the cases. Linezolid was commonly prescribed for off-label indications or approved indications without rational reason for its use. Interventions to limit the irrational use of linezolid are required.

Ttfkhoa: chi dinh dupe phi duyet, linezolid, ly do lua chgn, viem phoi mac phai cpng dong.

Dqt van de N h i e m khuan b e n h v ien la m o t t r o n g n h d n g

nguyen nhan hang dau lam t a n g t y le mac benh va tCr v o n g t o a n cau [14]. M o t so ngh ien cub gan day chi ra rang, cac vi khuan Gram(+) ngay cang co vai t r o q u a n t r p n g t r o n g nhPng tac nhan gay n h i e m khuan benh v ien [10] , [11] . Hien nay, vancomyc in dang la t h u o c dope Ida chqn dau tay cho cac b e n h n h i e m khuan d o cac cau khuan Gram(+) dac b iet la vi khuan khang t h u o c . Tuy n h i e n , viec sCr d u n g r p n g rai v a n c o m y c i n t r o n g d ieu t r i n h i e m khuan b e n h v ien d o vi khuan Gram(+) dang lam gia tang ty le Enterococcus cung n h d t u cau khang meth ic i l in (MRSA) de khang vPi khang sinh nay [6].

TP nam 2000, m o t n h o m khang sinh mPi co tac dung tren cac chung Gram(+) da khang thuoc dope FDA phe duyet sP d u n g t ren lam sang la oxazol id inon vPi dai d ien dau t ien la l inezol id [8]. Khang sinh nay co kha nang Pc che t o n g h o p p r o t e i n cua vi khuan, co hoat t i n h t o t t ren cac vi khuan Gram (+) bao g o m ca cac chung khang thuoc

[7]. Mac du da dPpc sP d u n g P nhieu nppc tren t h e gipi t rong hdn m o t thap ky qua nhPng linezolid mPi chi dPpc dPa vao s P d u n g tai Benh vien Bach Mai tP nam 2015 va t h o n g t i n ve viec sP d u n g khang sinh nay con rat han che. Do do, c h u n g t o i t i e n hanh nghien cPu nay vPi muc t ieu khao sat dac d iem chi d i n h l inezol id cung n h u m o t so dac d i e m xet ngh iem vi sinh va dac d iem s P d u n g l inezolid t r o n g mau nghien cPu tP t h a n g 1 den thang 9 nam 2015 nham cung cap nhPng t h o n g t i n ban dau ve thpc t rang ke d o n va sP d u n g l inezol id tai Benh v ien Bach Mai.

Doi tuong va phuong phap nghien cuu Dot tUctng nghien citu

Nghien cPu tien hanh hoi cPtren cac ho so benh an cua benh nhan npi t ru tai Benh vien Bach Mai dPpc ke d o n linezolid tP 01/01/2015 - 30/9/21015. Tieu chuan Ipa chpn la tat ca cac benh an co ke don l inezolid t r o n g khoang thPi gian tP t h a n g 1 den thang 9 nam 2015 va loai trPcac benh an khong t i m dPpc t r o n g qua tr inh t h u thap d p lieu.

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BAI NGHIEN Ctfll

Phitcfng phdp nghien CLTU

Nghien cPu mo ta hoi cPu tren cac benh an co ke don linezolid t r o n g khoang thPi gian khao sat. Cac t h o n g t in co ban ve benh nhan va dac diem sP dung thuoc dupe t h u thap tP benh an g o m : chi d jnh, ly do Ipa chpn l inezolid; ket qua xet ngh iem vi sinh va khang sinh do cua cac vi khuan Gram(+); dPPng dung va thPi gian sPdung linezolid.

Khao sat chi d jnh cua linezolid bao g o m cac chi d inh da dPpc phe duyet hoac chPa dPpc phe duyet can cP vao t h o n g t in t ren tP hPPng dan sP d u n g thuoc dupe Bp Yte phe duyet cua che pham sPdung tai benh vien [2], [3]. Ben canh do, nghien cPu cung khao sat ly d o Ipa chpn linezolid t r o n g moi chi d jnh. VPi cac trPdng hop khong ghi ro chi djnh t rong benh an, chi d jnh se dope xac djnh theo t ieu chuan chan doan t r o n g cac hPPng dan dieu trj lien quan. Cu the la: Cac trPPng hop co dau hieu nhiem t r u n g dPPng ho hap (sot, ho co dPm, kho t h d , hoi chPng nhiem t r u n g (moi kho, IdPi ban, hoi thP hoi) hoi chPng dong dac P phoi) va CRP > 0,5 xuat hien t r o n g vong 48 giP dau tP khi nhap vien dPpc xac d jnh la v iem phoi cpng d o n g (3 trPPng hop) [1]. TrPPng hop co ghi chuyen tP benh vien tuyen dPPi len hoac co it nhat hai tr ieu chPng bao g o m sot t ren 3 8 ° C , bach cau t r u n g t inh tang hoac giam dPPi 4 G/L, djch t iet P phoi co m u va cac dau hieu tren xuat hien sau 48 giP nhap vien dope xac d jnh la v iem phoi benh vien (6 trPPng hop) [4]; Cac trPPng hop co bach cau t r u n g t inh tuyet doi dPPi 0,5 G/L va co sot tren 38,5°C dPpc xac d jnh la sot g iam bach cau t rung t inh (46 trPPng hop), cac trPPng hop khong co dau hieu sot cao tren 38 ,5°C va/hoac bach cau t r u n g t i n h tuyet doi dPPi 0,5 G/L nhPng co chan doan u l ympho, da u t u y x u o n g , leukemia cap hoac man) hoac sP d u n g l inezolid t r o n g thPi gian 48-72 giP sau hoa tr j lieu ung t h u dupe xac d jnh la d p p h o n g sot giam bach cau t r u n g t inh (68 trPPng hop) [12]; Cac truPng hop khong co chan doan nhiem khuan va dau hieu lam sang, can lam sang dupe xac d jnh la "khong ro". Thong t in ve dUPng d u n g va thPi gian sP d u n g linezolid cung dupe t h u thap. Cac vi khuan phan lap dupe t r o n g mau nghien cPu va dp nhay cam cua cac vi khuan Gram(+) vPi m o t so khang sinh dac hieu g o m methici l in, vancomycin/teicoplanin va linezolid cung dupe ghi nhan. Thong t in hoi cPu tP benh an dPpc t h u thap vao phieu t h u thap t h o n g t i n . DP lieu sau do dupe t o n g ket va xP ly t h o n g ke mo ta bang phan m e m Microsoft Excel 2010.

Ket qua nghien cuu Trong thPi gian khao sat, phan m e m quan ly xac

djnh dupe 375 benh nhan co sP dung l inezolid. Sau khi loai bo 64 benh an khong the t iep can tP 375 benh an tren con lai 311 benh an dupe dua vao nghien cPu. Dac diem benh nhan va phac do dieu tr j chPa linezolid dupe tr inh bay t r o n g bang 1.

Bang 1. Dgc diem phac do dieu tri chita linezolid (N=311)

Dac diem Ket qua, n (%)

Vi tri phac 66 co linezolid Phac do ban dau 195 (62,7) Phac do thay the 116(37,3)

Loai phac 66 co linezolid Phac do don doc 241 (77,5) Phac do phoi hop n 129 (41,5)

(*): Cac khang sinh phoi hpp g o m : cephalosporin (20,3%), carbapenem (15,1%), q u i n o l o n (10,0%) va aminoglycosid (chi co amikacin) (9,6%).

Cac dac diem ve chi djnh linezolid ghi nhan tP cac benh an dPpc tr inh bay t rong bang 2. Bang 2. Dgc diem chi dinh linezolid trong mau nghien cdu

(n=31l)

Dac diem n (%) Chi djnh dtlpc phe duyet 74 (23,8) Viem phoi cpng dong 37 (11,9) Viem phoi benh vien 16 (5,1) Nhiem khuan da va mo mem 13 (4,2) Viem phoi cpng dong + nhiem khuan da va mo mem 3 (1,0) Viem phoi benh vien + nhiem khuan da va mo mem 5 (1,6) Chi dinh chtia dtipephe duyet 237 (76,2) Sot giam bach cau trung tinh 71 (22,8) Du phong sot giam bach cau trung tinh 68 (21,9) Nhiem khuan huyet 5 (1,6) Viem mang nao 4 (1,3) Viem phe quan 2 (0,6) Nhiem khuan rang mieng 2 (0,6) Nhiem khuan tieu hoa("1 4 (1,3) Nhiem khuan tiet nieu 1 (0,3) Nhiem khuan Gram(-) 3 (1,0) Khong ro benh ly nhiem khuan 77 (24,8) Cac ly do Ipa chon linezolid ghi nhan difdc 10 (3,2)

Dj Png vancomycin 2 (0,6) Khong dap Png vcfi vancomycin/teicoplanin 6 (1,9) Nhiem khuan Enterococcus spp. khang vancomycin 2 (0,6)

(*) g o m ap xe gan, t ieu chay, nhiem t r u n g djch mang bung va nghi ap xe gan, t ieu chay

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Linezolid dupe dung n h u phac do ban dau 6 195 benh nhan t u o n g Png 62,7%, ty le benh an co sP d u n g l inezolid t r o n g phac d o thay the t h a p hon khoang 37,3%. Ty le benh nhan dupe nhan phac do l inezolid don doc la 77,5% va khoang 41,5% benh nhan sPdung linezolid cung khang sinh khac.

Co 74 (23,8%) benh an dPpc ke ddn theo chi dinh phe duyet va hau het khong ghi nhan dPpc ly do Ida chon linezolid. Co 10 trUdng hop (3,2%) dPa ra dPpc ly do Ipa chpn linezolid bao gom 2 trUdng hop (0,6%) di Png vancomycin, 6 (1,9%) tr i fdng hop khong dap Png dieu tri vdi khang sinh glycopeptid va 2 trUdng hop (0,6%) nhiem khuan gay ra bdi Enterococcus spp. khang vancomycin. Trong 237 trUdng hop (76,2%) sP dung linezolid v6i chi djnh chUa dupe phe duyet, pho bien nhat la chi djnh dieu trj va d p phong sot giam bach cau trung t inh vdi 139 trUdng hop (44,7%). Ben canh do, con co 77 trUdng hop (24,8%) benh nhan sP dung linezolid ma khong xac djnh ro benh ly nhiem khuan.

Thong t in ghi nhan dPpc tP cac xet ngh iem vi sinh t r o n g cac benh an t r o n g nghien cPu dPpc t h u thap va tr inh bay eg the t r o n g bang 3.

Bang 3. Dgc diem vi sinh trong mau nghien cdu

Dac diem n (%)

Benh an co xet nghiem nuoi cay vi khuan (n=311) 125 (40,2) Benh an ghi nhan phan lap dupe vi khuan (n=311) 32 (10,3) So chung vi khuan dupe phan lap ( n = 3 4 7 ) n 47 (13,5)

Gram(+) 10 (2,9) Staphylococcus aureus 6 (1,7) Tu cau khong sinh coagulase(QoNS) 1 (0,3)

Enterococcus spp. 2 (0,6) Streptococcus pneumoniae 1 (0,3)

Gram (-) 37 (10,7) Acinobacter baumannii 11 (3,2)

Pseudomonas aeruginosa 4 (1,2) Escherichia coli 7 (2,0) Klebsiella pneumoniae 6 (1,7)

Gram (-) khac 9 (2,6)

(*): Tinh tren so iPpt xet nghiem nuoi cay vi khuan dPpc chi d j n h .

Co 125 benh an dPpc lam xet nghiem nuoi cay vi khuan chiem 40,2% t r o n g do co 32 (10,3%) benh an ghi nhan ket qua dPong t i n h . Vdi 347 IPpt xet nghiem vi sinh, cd 47 chung vi khuan dPpc phan lap t r o n g do cd 37 (10,7%) trUdng hop la vi khuan Gram(-) va chi cd 10 (2,9%) t r d d n g hop la vi khuan Gram(+). Cac chung vi khuan Gram(+) phan lap dPpc g o m Staphylococcus aureus, CoNS, Enterococcus spp.

va Streptococcus pneumoniae. Cd 2 chung Enterococcus spp. dope phan lap va ca hai deu de khang vdi vancomycin, m o t chung con nhay cam vdi te icoplanin (MIC = 0,5 mcg/ml) , t r o n g khi chung E. gallinarum con lai chi con nhay cam t r u n g gian vdi linezolid. Cd m o t chung tu cau khong sinh coagulase phan lap dPpcva con nhay cam vdi cac g lycopept id cung n h u l inezolid. Cd 6 chung S.aureus dupe phan lap va dp nhay cam cua 6 chung nay m o t so khang sinh ddpc the hien t r o n g hinh 1.

Linezolid Teicoplanin

Vancomycin c Clindamycin ug Moxifloxacin

| C3G se Meropenen

Methiallin Penicillin

H Nhay cam GD Nhay cam trung gian • De khang

Linezolid Teicoplanin

Vancomycin c Clindamycin ug Moxifloxacin

| C3G se Meropenen

Methiallin Penicillin

H Nhay cam GD Nhay cam trung gian • De khang

Linezolid Teicoplanin

Vancomycin c Clindamycin ug Moxifloxacin

| C3G se Meropenen

Methiallin Penicillin

H Nhay cam GD Nhay cam trung gian • De khang

Linezolid Teicoplanin

Vancomycin c Clindamycin ug Moxifloxacin

| C3G se Meropenen

Methiallin Penicillin

H Nhay cam GD Nhay cam trung gian • De khang

Linezolid Teicoplanin

Vancomycin c Clindamycin ug Moxifloxacin

| C3G se Meropenen

Methiallin Penicillin

H Nhay cam GD Nhay cam trung gian • De khang

Linezolid Teicoplanin

Vancomycin c Clindamycin ug Moxifloxacin

| C3G se Meropenen

Methiallin Penicillin

H Nhay cam GD Nhay cam trung gian • De khang

Linezolid Teicoplanin

Vancomycin c Clindamycin ug Moxifloxacin

| C3G se Meropenen

Methiallin Penicillin

H Nhay cam GD Nhay cam trung gian • De khang

( 2 4 So chung vi khuar i

H Nhay cam GD Nhay cam trung gian • De khang

Hinh 1. Dp nhgy cam cua cac chung S. aureus phan lap dugc (n=6)

Tat ca 6 chung S.aureus deu de khang vdi penici l in, t r o n g so do 2 chung con nhay cam vdi methic i l in (MSSA) va 4 chung de khang methic i l in (MRSA). Chi cd 3 chung MRSA dude lam khang sinh do vdi cac g lycopept id va ca 3 chung nay deu con nhay cam vdi cac khang sinh nay. Cd 3 chung S.aureus dude lam khang sinh do vdi linezolid cho ket qua 1 chung MSSA de khang vdi khang sinh nay.

Linezolid dupe d u n g vdi lieu la 600 m g ngay 2 Ian. Cac dac d iem ve d u d n g d u n g va t h d i gian sd d u n g l inezolid cua cac benh an t r o n g nghien cud dupe tr inh bay t rong bang 4.

Bang 4. Cac dgc diem set dung linezolid (n = 311)

Dac diem Sd benh nhan, (%) Duong dung Llong 296 (95,2) Truyen t inh mach 15 (4,8) Truyen t inh mach va uong 0 (0) Thdi gian dung linezolid 7 ( 4 - 1 1 ) n

(*) So lieu bieu dien dudi dang t r u n g vj (khoang tu" phan vj)

Phan Idn benh nhan dupe sd d u n g l inezolid d u d n g uong (95,2%), chi 4,8% benh nhan d u n g linezolid d u d n g truyen t inh mach.Thdi gian s d d u n g linezolid cd t r u n g vj la 7 ngay va va khoang t d phan vj la t d 4 ngay den 11 ngay. Khong cd trUdng hpp nao dung linezolid qua 28 ngay.

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Ban luan Ket qua nghien cPu cua cho thay cac t r u d n g hop

ke don linezolid vdi chi d jnh chUa duqc phe duyet chiem td i 76,2%. Day la m o t ty le kha cao neu so vdi ket qua khao sat d cac co sd dieu trj tren the gidi n h u t rong bao cao nghien cPu cua Aubin va cpng sp(13,1 - 26,8%) [5] hay Cebrian va cpng sp (28,6%) [13]. Ket qua nay gpi y rang viec ke don linezolid hien tai cd the van chUa thpc sp dupe can nhac ki cang. Cd den 62,7% benh nhan dupe ke don linezolid t r o n g phac do khang sinh ban dau va cd den 77,5% trUdng hop sP dung linezolid don doc. Dieu nay gpi y rang bac si chUa coi linezolid la m o t khang sinh d p trP ma la khang sinh dau tay t rong nhieu trUdng hop chi d jnh dieu trj chUa thpc sp rd rang. Can phai lUu y linezolid la m o t khang sinh rat mdi dupe dUa vao dieu trj va viec sPdung khdng than t r p n g se la t ien de cho viec phat sinh de khang. Cu the, nghien cPu cua chung td i da ghi nhan m o t t r o n g ba chung S. aureus cd lam khang sinh do vdi l inezolid da de khang vdi khang sinh nay. De t i m hieu rd hon ve cac trPdng hop ke don khdng theo chi djnh dPpc phe duyet, trUdc tien chung td i da co gang xac d j n h t i n h t rang nhiem khuan cua benh nhan dope ghi nhan t rong benh an de tP do cd the giai th ich cho quyet d jnh ke don khang sinh cua bac si. Chi d jnh dieu tr j va d p phdng sot g iam bach cau t r u n g t i n h chiem ty le Idn vdi khoang 44,7% trPdng hop t r o n g nghien cPu nay. Theo hudng dan dieu tr j va d p phdng sot giam bach cau t r u n g t inh cua Hoi Truyen nhiem Hoa Ky (IDSA) nam 2010, l inezolid khdng cd vai t r d n h u phac do kinh nghiem cho chi d jnh nay ma chi nen sP d u n g t r o n g cac trPdng hop dac biet bao g o m cac trUdng hop nghi nhiem t r u n g catether, nhiem trung da mo m e m , viem phoi , benh nhan cd huyet ddng khdng on djnh hoac t rong cac trUdng hop da xac d jnh can nguyen vi khuan hoac s P d u n g theo kinh nghiem d benh nhan ghep te bao goc cd nhiem Enterococcus spp. khang vancomycin [9]. Theo ket qua cua chung td i , chi cd m o t trUdng hop sot giam bach cau t rung t i n h cd nh iem khuan huyet d d n g t h a i do MRSA la dupe khang d jnh nhay cam vdi cac g lycopept id va linezolid. Cac trUdng hop con lai deu khdng xac d jnh dupe can nguyen vi khuan va chi s P d u n g linezolid nhP phac do kinh nghiem. Do sp han che ve t h o n g t in hoi cPu nen chung td i chua the t i m hieu dupe ly do Ida chpn linezolid d nhPng benh nhan nay. Tham chi dang lUu y la t r o n g 76,2% trUdng hop ke d o n linezolid ngoai chi d jnh phe duyet thi cd den 24,8%

so benh nhan s P d u n g linezolid ma khdng xac d jnh dupe m o t ly do nao cd t h e lien quan den benh ly nhiem khuan.

Trong cac chi d jnh dupe phe duyet cua linezolid, v iem phdi cdng ddng la chi d jnh phd bien nhat tren cac benh nhan cua nghien cPu nay vdi 37 trUdng hop chiem 11,9%. Trong 37 trUdng hop chi d jnh cho v iem phdi cdng d d n g , cd m o t trUdng hop dj Png nang vdi vancomycin vdi bieu hien sdc phan ve va m o t trUdng hop xac d jnh dupe can nguyen vi khuan la Streptococcus pneumoniae nhay cam vdi penicil in. Tuy nhien, tat ca cac benh nhan con lai dupe chi djnh dieu trj viem phdi vdi linezolid lai khdng cd t h o n g t in vi sinh gpi y vi khuan gay benh. Do do, cd the thay rang hau het cac trUdng hop chi d jnh dieu trj viem phdi cdng d d n g la cac chi d jnh theo kinh ngh iem. Vdi quan d iem sP d u n g khang sinh than t r p n g t h i linezolid chi nen sPdung t r o n g cac trPdng hop cd ly do phu hop. Trong nghien cPu cua chung td i chi ghi nhan dupe 3,2% trUdng hop sP dung linezolid vdi ly do phu hop vdi cac khuyen cao sPdung linezolid ma m o t so qudc gia ap dung [15] bao g d m ngudi benh dj Png vancomycin, khdng dap Png vdi vancomycin/ te icoplanin va nh iem khuan do Enterococcus spp. khang vancomycin. Dieu nay gpi y co sd dieu trj nen cd cac giai phap nham quan ly t o t hon viec sP d u n g n h d m khang sinh mdi nay nham han che cac trPdng hop chi d jnh khdng phu hop. Day la yeu cau cap thiet de giam thieu kha nang phat sinh cac chung vi khuan de khang mac phai t r o n g qua tr inh dieu t r j .

Mac du linezolid dope chi d jnh t r o n g cac trUdng hop nhiem khuan do vi khuan Gram(+) nhUng ty le cac chung vi khuan Gram(+) phan lap dupe t r o n g mau nghien cPu t u o n g ddi thap va chi chiem khoang 2,9% trUdng hop. Cac chung Gram(+) phan lap dupe bao g d m S.aureus, Enterococcus spp. CoNS va S. pneumoniae. Ty le dupe chi d jnh phan lap vi khuan va d jnh danh dupe vi khuan n h u vay la kha thap. Dieu dang lUu y la da xuat h ien l chung E. gallinarum giam nhay cam va 1 chung MSSA de khang vdi l inezolid. Vdi ket qua vi sinh n h u vay, nguy ca l inezolid k h d n g phu h a p vdi tac nhan gay benh la kha cao. Khi xem xet t h e m yeu t o chi phi cung n h u ddc t i n h th i viec can nhac han nPa t r o n g ke d o n linezolid la dieu can phai t inh den. Trong quan ly sP d u n g l inezolid, quyet d jnh 772/QD-BYT cua nam 2016 ve "Hudng dan thpc hien quan ly sP d u n g khang sinh t r o n g benh v ien" quy d jnh l inezolid dPdng t iem la m o t t r o n g cac khang sinh can phai

S64+5/20161 Nghien cull difdc Thong tin thuoc 1187

duqc phe duyet trudc khi sP dung tai benh vien [1 ] . Tuy nhien, ket qua khao sat cho thay co td i 95,2% chi d inh linezolid s P d u n g che pham dPdng uong. Can Ipu y la linezolid dPdng uong cd sinh kha dung gan 100%, hoat t i n h khang khuan t i f d n g t u che pham dPdng t i e m va che dp lieu sP d u n g d o n gian. Tinh chat t h u a n t ien t r o n g sP d u n g la m o t Ou d iem cua linezolid dPdng uong nhUng cung cd the la yeu t o thuc day viec lam d u n g khang sinh nay t r o n g thpc te dieu t r j . Do do, viec xem xet dua linezolid dPdng udng vao danh muc can kiem soat sP d u n g nhP khang sinh l inezolid d u d n g t iem la kha nang nen dupe can nhac. Dieu nay cd the g iup han che viec sP d u n g l inezolid qua rang rai t ren lam sang n h u ket

qua ghi nhan dupe tP nghien cPu nay va t P d d tranh kha nang phat sinh cac chung vi khuan de khang cung n h u giam chi p h i dieu tr j va doc t i n h cd the phat sinh.

Ket lugn Nghien cPu da cho thay mot t i le Idn (76,2%) cac

trUdng hop sPdung linezolid khdng phu hop vdi chi djnh dPpc phe duyet hoac khdng cd ly do Ida chpn mot each phu hop. Tinh trang linezolid dudng udng dPpc ke don mot each phd bien (95,2%) va viec da ghi nhan mot so chung vi khuan de khang hoac giam nhay cam vdi linezolid ddi hoi can phai cd giai phap nham quan ly chat che hon viec sPdung khang sinh nay.

TAI LIEU THAM KHAO 1. Bp Y te', Hudng dan thpc hien quan ly sP d u n g khang sinh t r o n g benh v ien. Ban hanh kern theo QD

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(Ngay guri dang: 31/8/2016 - Ngay duyet dang: 18/10/2016)

1881 Nghien cufudifgcjhdng tin thuoc IS64+5/2016