2 0 1 7 tap cA l

DtfOC HOC SO 495 * NAM THl> 57 * THANG RA 1 KY * ISSN 0866 - 7861

Momordica charantia L. rA Ho Bau bi - Cucurbi taceae

CAY KHO QUA RIJNG

BO Y XUAT BAN

Dja chi T6a soan: 138A Giang V6 - Quan Ba Dinh - Ha Noi

Tel: 0243.8461430 - 0243.7368367

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 2 NGUYEN THI KIM THU, DANG KIM THU, BUI THANH TUNG:_Tac dyng quet goc ty do DPPH va ire che AchE cua cac phan do?n tir re dan sam (Salvia miltiorrhiza Bunge) a Viet Nam 5 TRAN ANH VU, HOANG THAI PHUONG CAC: Nghien ciru tic dung ha glucose huyet va doc tinh cap ciia che pham com hon djch tir cao que va kho qua loai qua nho 9 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 tp do trong nhuyen the hai manh vo bang sic ky long sieu hieu nang ket noi khoi pho 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 6 H O U 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 trong 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 trong giai doan tu nam 2012 den nam 2016 63

» TRAN HUU TAM: Xay dung thanh 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 2

» 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 5

• 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.) 9

• 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

• 00 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 THU 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 1-bromo-adamantane and acetonitrile by reactions of Ritter type 77

• Nghien cveu - Ky thuat

Khao sat tinh hinh tieu thu khang sinh carbapenem tai Benh vien Bach Mai trong 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 pho khang khuan rat rong nen chi d u g c u u tien sir dung trong t r udng hop nhiem khuan nang khi cac khang sinh khac khong co hieu qua. Tuy nhien, ty le vi khuan khang carbapenem tai Viet Nam hien nay dang tang nhanh va 6 mice dang bao dong. Bao cao ve t inh hinh sir dung khang sinh va khang khang sinh tai 15 benh vien trong ca n u d e t u giai doan 2008 - 2009 da chi ra ty le so chung Acinetobacter sp. khang carbapenem d mot so benh vien khu v u c phia Bac v u g t qua 5 0 % m . Gan day, trong mot nghien c u u tren 3287 benh nhan dieu tri tai 15 d a n vi dieu tri t ich cue, ty le khang carbapnenem cua A. baumannii phan lap d u g c t u nhung t r udng hgp nhi§m khuan benh vien da len den 89 ,2%, con doi vd i P. aeruginosa, ty le nay la 55 ,7% ( 9 ] . Mot so nghien c u u tren the gidi da cho thay m u c do tieu thu khang sinh carbapenem co anh h u d n g ro ret d£n ty le de khang cac thuoc nay [ 3 6 ] . Benh vien Bach Mai la benh vien da khoa tuyen cuoi, tiep nhan l ugng Idn benh nhan co benh canh nang va phuc tap t u cac tuyen d u d i chuyen len. Nghien c u u nay d u g c thuc hien nham khao sat l u g n g tieu thu khang sinh carbapenem tai Benh vien Bach Mai trong 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 trong 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 ngay 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 t rue 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 d iem tieu thu khang sinh carbapenem theo tha i gian.

Phuxyng p h a p n g h i e n cu>u Nghien cuu hoi c i ru ket h g p phan t ich dinh l ugng

theo chi so DDD/100 ngay nam vien theo tung thang (DDD - Defined Daily Dose: lieu xac dinh hang ngay). Chi so nay d u g c s u dung de danh gia cac m u c do 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 ngay nam vien = ^—2

DDD x so ngay nam vien Chi so DDD/100 ngay g i u d n g tinh theo cong t huc

tren. Trong do, gia tn DDD 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 dugc , To chuc Y te The gidi (WHO Collaborating Centre for Drug Statistics Methodology - W H O C C ) . Gia tri DDD s u dung trong nghien c u u vd i cac thuoc Meropenem: 2 g; Imipenem: 2 g ; Dor ipenem: 1,5 g; Er tapenem: 1 g t 1 0 ) .

X i r 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 Microsol f Excel 2010 . S u dung k iem d inh M a n n - Kendal l de phan t ich xu h u d n g t ieu thu khang sinh ca rbapenem cua toan Benh v ien cung n h u cua t u n g khoa lam sang .

T A P C H I DU'QfC H Q C - 7/2017 (SO 495 N A M 57) 63

• Nghien cCru - Ky thuat

Xu h u d n g d u p e ket luan tang neu cac chi so phan t ich S > 0 va p < 0,05, xu h u d n g d u p e ket luan g iam neu S < 0 va p < 0,05. Cac t r u d n g h g p cho ket qua phan t ich 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 inh h i n h t i eu 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 v ien t r o n g g ia i d o a n 2012-2016

Tinh hinh tieu thy khang sinh carbapenem cua toan Benh vien theo tung nam thong qua so gram va DDD/100 ngay n3m vien d u p e bieu dien trong bang 1 va hinh 1.

Bang 1. Tinh hinh tieu thu carbapenem trong toan Benh vien trong 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 trong giai doan 2012-2016

Tong l upng khang sinh carbapenm s u dung trong toan Benh vien d m d c cao va tang dan trong 5 nam, trong do, nam 2016 cd l upng tieu thu gap ddi nam 2012, khi t inh theo so gram tieu thu va DDD/100 ngay nam vien, so lieu DDD/100 ngay n£m vien t u a n g d n g trong hai nam nay la 2475,68 va 1385,33 DDD/100 ngay n^m vipn. So lieu DDD/100 ngay ndm vien cua tung Khoa lam sang, Trung tarn hoac Vien thuoc Benh vien Bach Mai d u p e trinh bay trong bang 2.

Ket q u a d j n h lu p n g t heo tCrng d e n vj Ket qua dinh l u p n g theo t u n g d a n vi t rong vien

cho thay, nhom khang sinh nay d u p e s u dung rong rai d tat ca cac Khoa lam sang , Trung tarn hoac V ien . Tuy nh ien, nhom khang sinh nay chu yeu d u p e t ieu thu bd i ba d a n vj co l u a n g s u dung nhdm khang sinh nay v u p t tren 800 DDD/100 ngay n£m vien la Khoa Hoi s u e t ich cue ( ICU), Trung tarn Ho hap va Khoa Truyen nh iem. D a c biet, Khoa ICU co tong DDD/100 ngay nam vien cua khang sinh ca rbapenem len den h a n 3000 l ieu, g i n bang 1/3 tong l u p n g s u dung cua toan Benh v ien . D ieu nay cung d u p e the hien ro ret qua xu h u d n g s u dung khang sinh ca rbapenem theo t u n g nam cua ba d a n vi nay so vd i t rung b inh toan v ien, the hien t rong h inh 2.

Bang 2. Tong lieu DDD/100 ngay nkm vien cua ung Khoa lam sang, Trung tarn hoac Vien true thuoc

Benh vien Bach Mai trong 5 ndm

77 Don vj Tong DDD/100 ngay nim vien

1 Khoa Hoi sire tich eye 3253,24

2 TT. Ho hap 945,10

3 Khoa Truyen nhiem 854,57

4 Khoa Gay me hoi sire 590,60

5 TT. Chong doc 529,71

6 Khoa Huyet hoc 517,45

7 Khoa Than kinh 407,34

8 Khoa Than - Tiet nipu 400,72

9 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.

64 T A P C H I DU'gfC H Q C - 7/2017 (SO 495 N A M 57)

• 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 3 d a n vi co l ugng tieu thu nhom khang sinh nay nhieu nhat trong 5 nam d u g c bieu di§n trong hinh 3. Ket qua cho thay, d ca ba d a n vi cd l ugng sir dung carbapenem nhieu nhat trong toan vien, meropenem deu la thuoc d u g c s d dung pho bien nhat, tiep theo la imipenem/

cilastatin (viet tdt la imipenem). Day cung la c a cau SIP dung chung cua nhom khang sinh carbapenem trong toan vien khi bieu d i l n ket qua theo t ung nam trong hinh 1. Hinh 4 the hien ro h a n xu h i rdng SIP dung cac hoat chat carbapenem trong nam t u 2012 den 2016 d u g c phan t ich bdi kiem dinh Man - Kendal l .

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 3 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 cac hoa t cha t 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 h i rdng tang SIP dung dang ke cua meropenem va ertapenem; trong khi do, imipenem khong the hien d i rge xu h i rdng thay doi trong giai doan 2012 - 2016. Doripenem bit dau d u g c dira vao di§u tri t ir nam 2016 nhirng chi chiem ty le nho va chu yeu d i rge dung d Khoa Hoi sire tich cue nen khong the hien d u g c xu h u d n g khi ap dung kiem djnh nay.

Ban luan Nhom carbapenem ngay cang d u g c s u dung pho

bien tai BV. Bach Mai khi 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 ngay n^m vien cua khang sinh carbapenem cua toan vien da v u g t qua 1300 lieu va tang gan gap ddi vao nam 2016. Nghien cuu nay khong khao sat ve chi phi dieu trj nhung no cho thay ap 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 r ieng. Vd 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 con phan anh xu h u d n g l ira chon cac thuoc nay dau tien do m u c do phuc tap cua nhiem

carbapenem theo phan tich Mann - Kendall

trung. Theo nghien c u u cua Nguyen Thj Le Minh nam 2013, tai cac Khoa Hoi sue t ich cue (ICU), Truyen nhiem va Huyet hoc cd gan 5 0 % so benh nhan d u g c chi djnh carbapenem trong phac do ban dau, trong do 5 9 , 1 % vd i imipenem va 4 1 , 9 % vd i meropenem. Carbapenem d u g c sir dung cho 9 0 % cac t r udng hgp nhiem khuan hoac cd dau hieu nhiem khuan Viec s u dung rang rai cac hoat chat nay tiem tang nguy c a nghiem trpng ve de khang khang sinh, dac biet vd i cac khang sinh "du t ru " trong 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 Nam A va Dong Nam A cho thay day la khu v u c co ty le de khang cac khang sinh nay cao nhat tren the gid i . Trong do, Viet Nam la mot trong ba n u d e co cac chung Enterobacteriaceae khang carbapenem luu hanh trong 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 Nam la 8 9 % m . Day t h y c sir la moi nguy hiem vdi sue khoe cong dong, can d u g c kiem soat b§ng mot c h u a n g tr inh quan ly khang sinh phu h g p de gidi han viec s u dung nhom khang sinh nay, qua do cai thien do nhay cam cua vi khuan vdi thudc.

Nghien c i ru da ghi nhan l u g n g tieu thu khang sinh

T A P C H I D U Q C H Q C - 7/2017 (SO 495 N A M 57) 65

• Nghien cu»u - Ky thuat

carbapenem tap trung chu y l u d ba d a n vi la Khoa H6i sue t ich cue (ICU), Trung tarn Ho h i p va Khoa Truyen n h i l m . Dae biet, Khoa ICU co tong DDD/100 ngay nam vien cua khang sinh ch iem gan 1/3 tong l ugng s u dung cua toan BV, vd i chi so nay m6i nam deu trong 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 trong Idn khong kho ly giai. Tuy nhien, khi so sanh vd i cac d a n vi dieu tri t ich cue khac tren th§ g id i , 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 tha i gian truy xuat d u lieu. Khao sat tren 530 benh vien tai Phap nam 2007 cho thay gia tri DDD/100 ngay n l m vien cua cac Khoa ICU chi dat 146,6 lieu | 2 ] . 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 6 4 % vd i imipenem va 6 2 % vd i meropenem [ 1 1 J . Da s6 cac t rudng hgp nhiem trung nay gay ra bdi vi khuan Gram am, 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 l ug t la 89 ,2%; 55 ,7% va 14,9% n . Day t huc s u thach thuc Idn doi vd i cac nha lam sang trong lua chon khang sinh t r u d c boi canh khang khang sinh ngay cang Ian tran hien nay.

Ve c a cau s u dung, trong giai doan 2012 - 2016, meropenem va er tapenem cd xu h u d n g tang s u dung trong khi 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 con la xu h u d n g chung cua toan BV. Dieu nay co the xuat phat t u dac diem ve d u g c ly cung n h u dp an toan cua cac thuoc nay tren lam sang. Trong khi imipenem co nguy c a gay doc t inh tren than kinh cao nhat trong nhom va khong hieu qua tren tu cau vang khang meuiici l in thi meropenem lai mang nhieu u u diem n h u co nguy c a dpc t inh tren t h i n kinh thap h a n va la hoat chat carbapenem duy n h l t d u g c s u dung trong dieu tri v iem mang n a o [ 6 ] . Ben canh do, t u nam 2016, hoat chat md i cua nhom carbapenem la dor ipenem bat d l u d u g c d u a vao dieu tri tai BV. Bach Mai. Vd i Igi the han so vd i meropenem tren P. aeruginosa va vi khuan Gram (+ ) ( 8 ' , dor ipenem hua hen la mot lua chpn khang sinh hieu qua trong cac t r udng hgp n h i i m khuan nang da khang cac carbapnenem khac. Tuy nhien, viec then khai c h u a n g tr inh quan ly khang sinh chat che trong 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 md i n h u dor ipenem.

Ket luan Nghien c u u da cho thay hinh anh tong the ve t inh

hinh tieu thu khang sinh carbapenem tai BV. Bach Mai trong giai doan 2012 - 2016, vd i m u c l i l u DDD/100 ngay n l m vien d m u c rat cao (tren 1000 lieu) va tang dan theo tha i gian. Khoa ICU, Trung tarn Ho hap va Khoa Truyen nhiem la ba d a n vj co l ugng tieu thu carbapenem Idn nhat trong toan BV, trong do chi rieng Khoa ICU da co tong DDD/100 ngay n l m vien cua khang sinh carbapenem gan bang 1/3 tong l u g n g s u dung nhom thuoc nay cua toan BV. Ve c a cau, meropenem va er tapenem co xu h u d n g tang len trong khi viec s u dung imipenem lai kha on djnh trong tha i 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 trong 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)

66 T A P C H I DU<?C H Q C - 7/2017 (SO 495 N A M 57)