Acinetobacter sawv cev rau pawg kab mob uas feem ntau pom muaj nyob hauv av thiab dej ntawm ntau lub tebchaws. Thaum tag nrho cov kab mob Acinetobacter tuaj yeem ua rau muaj mob rau tib neeg, kab mob baumannii yog qhov txaus ntshai tshaj plaws thiab suav txog li 80% ntawm kev kis mob Acinetobacter. Yuav luag tag nrho cov kab mob Acinetobacter baumannii, uas nquag tshwm sim hauv lub ntsws, ntshav lossis qhov txhab, tshwm sim hauv chaw kho mob - tshwj xeeb yog cov chaw saib xyuas mob hnyav hauv tsev kho mob. Feem ntau cov kab mob Acinetobacter tiv taus ntau yam tshuaj tua kab mob sib txawv. Tiv thaiv kev kis tus kab mob Acinetobacter tsis yog ib txwm muaj peev xwm ua tau, tab sis qee cov tswv yim tau pab tau zoo thiab tej zaum yuav cawm tau txoj sia.
Cov kauj ruam
Ntu 1 ntawm 2: Tiv Thaiv Kab Mob Acinetobacter
Kauj Ruam 1. Txwv tsis pub koj kis mus rau tsev kho mob
Acinetobacter cov kab mob ua rau muaj kev pheej hmoo tsawg rau cov neeg noj qab haus huv hauv lawv lub neej ib hnub; txawm li cas los xij, cov neeg mob hnyav nyob hauv tsev kho mob, tshwj xeeb yog lawv tau ua rau lub cev tsis muaj zog, mob ntsws ntev lossis mob ntshav qab zib, muaj qhov ua rau Acinetobacter ntau dua thiab pheej hmoo tuag los ntawm kev kis tus kab mob. Xws li, lub hom phiaj yog kom tsis txhob nyob hauv chav saib xyuas mob hnyav (ICU) raws li tus neeg mob lossis tus tuaj ntsib.
- Cov neeg feem coob tau lees paub hauv ICU muaj lub sijhawm tsawg los tiv thaiv nws, tab sis ua raws cov lus qhia kho mob rau ib yam kab mob hauv lub ntsws lossis ntshav qab zib tuaj yeem tiv thaiv koj tus mob los ntawm kev tig mus rau qhov tsis zoo thiab xav tau kev saib xyuas xwm txheej ceev.
- Kev xa tawm ntawm ICU mus rau lwm qhov ntawm lub tsev kho mob kom rov zoo tuaj yeem txo qis koj txoj kev pheej hmoo kis mob Acinetobacter. Nug koj tus kws kho mob txog koj cov kev xaiv rov qab los.
- Cov neeg noj qab nyob zoo tsis yog ib txwm muaj kev pheej hmoo, tab sis mus ntsib cov txheeb ze mob hauv tsev kho mob tuaj yeem ua rau nws nce ntxiv, tshwj xeeb tshaj yog tias koj siv sijhawm tseem ceeb hauv ICU.
Kauj Ruam 2. Ntxuav koj txhais tes ntau zaus
Txoj hauv kev tseem ceeb rau txo koj txoj kev pheej hmoo ntawm kev kis tus kab mob lossis kis kab mob thaum nyob hauv tsev kho mob (lossis mus ntsib ib tus) yog ntxuav koj txhais tes kom raug thiab nquag. Ntxuav koj txhais tes tom qab mus rau chav dej thiab tom qab koj kov ib tus neeg (tus neeg mob lossis cov neeg ua haujlwm hauv tsev kho mob) lossis nto sab nraum chav dej. Ua tib zoo saib xyuas tshwj xeeb nrog lub qhov rooj, hloov lub teeb, kab hlau rhuav lub txaj, kab hlau rhuav, cov rooj saum txaj thiab txhua yam khoom siv kho mob.
- Dej sov thiab xab npum tsis tu ncua yog tej zaum txaus los ntxuav koj txhais tes los ntawm cov kab mob, tab sis xav txog kev siv tshuaj ntxuav cawv.
- Siv daim ntawv so tes uas koj tau qhuav koj txhais tes los ua ib qho thaiv thaiv cov qhov rooj thiab qhov rooj ntawm lub txaj. Thaum koj nce rov qab mus rau lub txaj (raws li tus neeg mob), pov cov ntawv so hauv lub thoob khib nyiab.
- Nco ntsoov kom muaj qee qhov tshuaj ntxuav tes kom ncav cuag koj lub txaj hauv tsev kho mob txhua lub sijhawm.
Kauj Ruam 3. Tsis txhob kov koj lub qhov muag thiab qhov ncauj
Txawm hais tias koj nquag ntxuav koj txhais tes ua tus neeg mob lossis mus ntsib tsev kho mob, sim tsis txhob kov koj lub ntsej muag (tshwj xeeb yog koj lub qhov ncauj thiab qhov muag) nrog koj txhais tes. Cov kab mob ntawm koj txhais tes feem ntau tsis muaj kev phom sij, tab sis lawv tuaj yeem nkag mus rau koj lub cev los ntawm koj lub qhov ncauj lossis qhov muag thiab ua rau kis mob. Yog li ntawd, ua tib zoo saib xyuas koj txhais tes ntawm koj ob sab lossis ntawm koj txhais ceg.
- Yog tias koj tsis hnav tsom iav, txiav txim siab tso qee qhov yas tiv thaiv qhov muag txhawm rau tiv thaiv kov lossis rub koj ob lub qhov muag.
- Yog tias koj yog poj niam, ceev faj txog kev kis cov kab mob (thiab lwm yam kab mob) thaum tso rau qhov muag pleev thiab pleev di ncauj. Yog tias koj yog tus neeg mob hauv tsev kho mob, nws muaj kev nyab xeeb dua tsis txhob pleev ib yam.
- Ua tib zoo saib lwm yam khoom uas tib neeg feem ntau tso rau hauv lawv lub qhov ncauj yam tsis xav txog, xws li cwjmem thiab cwj mem, thiab txhua yam sib koom, zoo li xov tooj lossis ua si.
Kauj Ruam 4. Tsis txhob kov cov neeg mob hauv tsev kho mob
Thaum nyob hauv tsev kho mob, nws yuav ua rau muaj kev khuv leej kov cov neeg mob, tab sis qhov ntawd ua rau koj muaj kev pheej hmoo kis mob Acinetobacter ntau dua - tshwj xeeb yog tias koj kuj yog tus neeg mob thiab mob hnyav heev. Cov neeg mob hauv tsev kho mob tuaj yeem nqa cov kab mob tiv taus tshuaj tua kab mob (xws li Acinetobacter) ntawm lawv cov tawv nqaij, khaub ncaws lossis khoom ntiag tug.
- Tham, mloog thiab txhawb nqa cov neeg mob hauv tsev kho mob yeej muaj txiaj ntsig, tab sis zam kev kov lawv, tshwj xeeb tshaj yog tias lawv nyob hauv ICU.
- Yog tias koj yog tus neeg mob hauv tsev kho mob, zam kev sib faib cov phuam da dej, phuam da dej, rab chais los yog khaub ncaws nrog lwm tus neeg mob.
- Acinetobacter kis mus rau cov neeg mob uas raug mob los ntawm ib tus neeg rau ib tus neeg lossis tiv tauj nrog cov chaw muaj kab mob sib kis.
- Yog tias koj nyob ze tus neeg mob hnoos, txiav txim siab hnav lub npog ntsej muag phais txhawm rau tiv thaiv ntxiv. Cov kab mob tuaj yeem taug kev hauv qhov quav ntawm cov qaub ncaug/hnoos qeev.
Kauj Ruam 5. Tsis txhob kov ib yam khoom lossis tshuab
Txawm hais tias koj yog tus neeg mob lossis tus tuaj ntsib, tsis txhob kov cov cuab yeej siv kho mob lossis tshuab thaum nyob hauv tsev kho mob lossis chaw kho mob, tshwj xeeb yog thaum nyob hauv ICU lossis pawg ntseeg xwm txheej ceev. Lawv feem ntau yog cov kab mob thiab lwm yam kab mob me me, thiab kov lawv kuj tseem tuaj yeem hloov pauv lawv txoj haujlwm lossis hloov chaw, uas tuaj yeem ua rau muaj kev phom sij rau lub neej. Tsis txhob cia xav paub tau qhov zoo tshaj plaws rau koj thiab tuav koj txhais tes rau koj tus kheej thiab cia cov kws tshaj lij cuam tshuam nrog thiab ntxuav cov cuab yeej siv kho mob.
- Cov cuab yeej siv kho mob feem ntau yuav kis tau cov kab mob suav nrog tso zis tso zis, cov cuab yeej tso pa tawm thiab cov hlab ua pa/cov khoom ua pa.
- Feem ntau, txhua yam khoom siv uas cuam tshuam nrog muab lossis nqa ntshav/tso zis/kua los ntawm koj yog qhov muaj kev pheej hmoo kis tus kab mob Acinetobacter thiab lwm yam kab mob me me.
Kauj Ruam 6. Thov kom cov neeg saib xyuas ntxuav lawv tes ua ntej kov koj
Ntxiv rau cov cuab yeej siv kho mob thiab lwm tus neeg mob, lwm qhov chaw ntawm Acinetobacter paug yog cov neeg ua haujlwm hauv tsev kho mob - kws kho mob, kws saib xyuas neeg mob, tus pab thiab cov kws tshaj lij. Lawv tau txais kev qhia paub yuav ua li cas tiv thaiv kev kis tus kab mob los ntawm kev ntxuav lawv txhais tes thiab ua kom huv, tab sis qee qhov muaj kev ntseeg ntau dua li lwm tus. Yog li ntawv, ceeb toom lossis thov kom txhua tus neeg ua haujlwm hauv tsev kho mob ntxuav tes thiab ntxuav lawv cov cuab yeej ua ntej kho thiab kov koj.
- Muab lawv siv koj cov tshuaj ntxuav tes uas muaj cawv raws li lawv tsis muaj. Ua siab zoo thiab sim tsis txhob ua phem rau lawv.
- Hnav cov hnab looj tes pov tseg tiv thaiv cov neeg ua haujlwm hauv tsev kho mob los ntawm cov neeg mob, tab sis hais kom cov neeg saib xyuas hloov lawv cov hnab looj tes nyob rau hauv pem hauv ntej ntawm koj rau kev tiv thaiv los ntawm Acinetobacter thiab lwm yam kab mob phem.
- Cov tsev kho mob uas tau tso cov tshuaj ntxuav tes kom yooj yim dua muaj kev ua raws kev nyiam huv ntau dua los ntawm cov neeg ua haujlwm - txog li 80% lossis ntau dua.
Kauj Ruam 7. Hais kom cov neeg saib xyuas xyaum ua cov txheej txheem aseptic
Cov txheej txheem aseptic yog txheej txheem siv hauv tsev kho mob teeb tsa kom tsis huv cov cuab yeej lossis khoom siv kho mob uas siv rau koj thaum koj nyob. Txhua yam cuab yeej kuaj mob thiab cuab yeej siv rau ntawm koj yuav tsum yog lub cim tshiab (tsis tau siv dua), ntxuav nrog cawv lossis suav nrog qee qhov kev tiv thaiv kom tsis muaj menyuam.
- Cov neeg saib xyuas yuav tsum hloov lawv lub hnab looj tes, lub qhov ncauj qhov ntswg thiab npog qhov ncauj kom huv ua ntej kho txhua tus neeg mob (tshwj xeeb hauv koj li kev xav).
- Cov neeg saib xyuas yuav tsum tsis hnav cov nplhaib, cov hniav nyiaj hniav kub thiab txawm tias saib thaum kho cov neeg mob vim tias lawv nyuaj rau ntxuav thiab ua kom huv.
Ntu 2 ntawm 2: Kho Kab Mob Acinetobacter
Kauj Ruam 1. Tsis txhob siv tshuaj tua kab mob txheem
Acinetobacter, tshwj xeeb tshaj yog cov kab mob baumannii, tau lees paub tias yog cov kab mob sib kis tau yooj yim los tiv thaiv thiab kho. Feem ntau, kev siv tshuaj tua kab mob ntau dhau nyob hauv tsev kho mob tau tsim cov tshuaj tiv thaiv kab mob no "superbugs," thiab qhov tshwm sim ntawm kev muaj peev xwm ua rau muaj kev phom sij rau lub neej Acinetobacter tau nce ntxiv.
- Xws li, thawj, thib ob, thiab thib peb tiam cephalosporins, macrolides thiab penicillins tsis muaj txiaj ntsig zoo rau kev ua haujlwm Acinetobacter thiab tuaj yeem txhawb nqa lawv txoj kev loj hlob.
- Cov teeb meem tshwm sim feem ntau tshwm sim los ntawm Acinetobacter colonization yog kab mob bacteremia (mob ntshav), mob ntsws, mob paj hlwb, tso zis tso zis thiab mob txhab.
Kauj Ruam 2. Siv cov tshuaj tua kab mob tshiab, muaj zog dua
Acinetobacter tiv taus feem ntau cov tshuaj tua kab mob, tab sis tsis yog txhua yam tshiab, muaj zog dua. Tshuaj tua kab mob feem ntau muaj txiaj ntsig zoo tiv thaiv A. baumannii suav nrog carbapenems, polymyxins E thiab B, sulbactam, piperacillin/tazobactam, tigecycline thiab aminoglycosides. Qhov twg koj tus kws kho mob pom zoo yog nyob ntawm qhov koj kis kab mob nyob qhov twg, koj lub cev tiv thaiv kab mob sib ntaus nws li cas thiab koj li kev noj qab haus huv tag nrho.
- Raws li txoj cai dav dav, carbapenems (imipenem, meropenem, doripenem) yog qhov kev xaiv saum toj kawg nkaus rau kev kho A. baumannii, txawm hais tias carbapenem-resistant Acinetobacter strains tau dhau los ntau dua hauv Asmeskas thoob ntiaj teb.
- Qee yam tshuaj uas siv tiv thaiv A. baumannii suav nrog colistin, amikacin, rifampin thiab minocycline.
Kauj Ruam 3. Xav txog kev siv tshuaj kho ua ke
Kev kho ua ke txhais tau tias siv ob lossis ntau yam tshuaj tua kab mob tib lub sijhawm hauv tus neeg mob. Nws muaj cov txiaj ntsig sib xyaw ntawm cov tshuaj thiab ua rau lawv muaj zog dua thiab muaj txiaj ntsig zoo - zoo li 1-2 punch. Txawm li cas los xij, cov kev mob tshwm sim tuaj yeem hnyav dua, thiab suav nrog teeb meem plab / hnyuv, xeev siab, ntuav thiab raws plab. Sib tham txog qhov zoo thiab qhov tsis zoo ntawm kev kho combo nrog koj tus kws kho mob.
- Feem ntau, sib txuas rifampin nrog imipenem, tobramycin lossis colistin yog qhov ua tau zoo tshaj plaws, yam tsawg kawg tiv thaiv Acinetobacter -caused pneumonia.
- Rau cov neeg mob feem ntau, kev kho mob monotherapy (siv tsuas yog ib qho tshuaj tua kab mob) zoo ib yam li kev kho ua ke, txawm hais tias yog tias tus neeg mob mob hnyav nrog lub cev tsis muaj zog tiv thaiv kab mob hnyav, kev kho mob combo feem ntau yog lawv qhov kev cia siab zaum kawg.
Lub tswv yim
- Acinetobacter kab mob tsawg tsawg tshwm sim sab nraum qhov chaw kho mob.
- Acinetobacter tuaj yeem muaj sia nyob ntawm cov txee lossis lwm qhov chaw tau ntau lub hlis. Kev tu kom huv ntawm qhov chaw thiab txhais tes yuav tsum ua kom sai li sai tau.
- Tej zaum kuj ceeb tias, cov tshuaj ntxuav tes uas muaj cawv muaj peev xwm tua tau cov kab mob tsawg dua li ntxuav kom huv nrog xab npum thiab dej tas li.
- Kev kis tus kab mob Acinetobacter feem ntau tshwm sim hauv cov neeg mob hnyav thiab tuaj yeem ua rau lossis ua rau lawv tuag.
- Ua tiav tshem tawm Acinetobacter los ntawm ib puag ncig yuav xav tau ntau yam tshuaj dawb los yog tsis muaj qhov kov qhov ua kom huv huv xws li cov pa hydrogen peroxide.
