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JÚLIO CÉSAR DE OLIVEIRA
Estudo prospectivo e randomizado de profilaxia
antimicrobiana para procedimentos cirúrgicos
em estimulação cardíaca artificial
Tese apresentada à Faculdade de Medicina da
Universidade de São Paulo para obtenção do
título de Doutor em Ciências
Área de concentração: Cardiologia
Orientador: Prof. Dr. Martino Martinelli Filho
São Paulo
2007
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Dados Internacionais de Catalogação na Publicação (CIP)
Preparada pela Biblioteca da
Faculdade de Medicina da Universidade de São Paulo
©reprodução autorizada pelo autor"
"
Oliveira, Júlio César de
Estudo prospectivo e randomizado de profilaxia antimicrobiana para procedimentos
cirúrgicos em estimulação cardíaca artificial / Júlio César de Oliveira. -- São Paulo,
2007.
Tese(doutorado)--Faculdade de Medicina da Universidade de São Paulo.
Departamento de Cardio-Pneumologia.
Área de concentração: Cardiologia.
Orientador: Martino Martinelli Filho.
Descritores: 1.Antibioticoprofilaxia 2.Marca-passo artificial 3.Infecção/prevenção
&controle 4.Endocardite bacteriana 5.Estimulação cardíaca artificial 6.Desfibriladores
implantáveis 7.Estudos prospectivos
USP/FM/SBD-225/07
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SUMÁRIO
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Uwooct{" "
30"KPVTQFWÑ’Q00000000000000000000000000000000000000000000000000000000000000000000000000000000000000 23"
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304"Fkcipôuvkeq"fc"kphgeèçq"ektûtikec00000000000000000000000000000000000000000000000000000000 27"
305"Kphgeèçq"g"ektwtikc"ectfîcec0000000000000000000000000000000000000000000000000000000000000000 28"
306"Kphgeèçq"g"rtôvgug0000000000000000000000000000000000000000000000000000000000000000000000000000000 2:"
40"TGXKU’Q"FC"NKVGTCVWTC00000000000000000000000000000000000000000000000000000000000000000 33"
403"Rcvqiípgug"fc"kphgeèçq"ektûtikec0000000000000000000000000000000000000000000000000000000 33"
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4030303"Rguuqcn000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 35"
4030304"Codkgpvg000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 37"
4030305"Ct000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 38"
404"Hcvqtgu"fg"tkueq"rctc"q"fgugpxqnxkogpvq"fg"kphgeèçq"ektûtikec000000000" 3:"
40403"Vgorq"fg"kpvgtpcèçq"rtê/qrgtcvôtkc000000000000000000000000000000000000000000000000 3:"
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40406"Vêepkec"ektûtikec000000000000000000000000000000000000000000000000000000000000000000000000000000 44"
40407"Rtgugpèc"fg"kphgeèùgu"fg"uîvkqu"tgoqvqu00000000000000000000000000000000000000000 45"
40408"Hcvqtgu"nkicfqu"cq"rcekgpvg0000000000000000000000000000000000000000000000000000000000000 46"
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40507"Rtqhknczkc"cpvkoketqdkcpc000000000000000000000000000000000000000000000000000000000000000000 49"
4050703"Eqpukfgtcèùgu"jkuvôtkecu00000000000000000000000000000000000000000000000000000000000000 49"
4050704"Rtkpeîrkqu"fc"rtqhknczkc"cpvkoketqdkcpc000000000000000000000000000000000000000000 4;"
4050705"Rtqhknczkc"cpvkoketqdkcpc"dcugcfc"go"gxkfípekc00000000000000000000000000 54"
50"QDLGVKXQU000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 5;"
503"Qdlgvkxq"rtkoâtkq000000000000000000000000000000000000000000000000000000000000000000000000000000000 5;"
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60"ECUW¯UVKEC"G"OÖVQFQU000000000000000000000000000000000000000000000000000000000000000000 62"
603"Fkpãokec"fq"guvwfq00000000000000000000000000000000000000000000000000000000000000000000000000000 64"
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6030403"Fghkpkèçq"fg"kphgeèçq"pc"nqlc"fg"octecrcuuq0000000000000000000000000000000 68"
6030404" Fghkpkèçq" fg" gpfqectfkvg" tgncekqpcfc" c" ecdqu/
gngvtqfqu000000000000000000000000"
68"
6030405"Vgtcríwvkec"fg"kphgeèçq0000000000000000000000000000000000000000000000000000000000000000 69"
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707"Cpânkug"fg"ôdkvqu000000000000000000000000000000000000000000000000000000000000000000000000000000000 97"
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80"FKUEWUU’Q00000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 99"
90"EQPENWU÷GU0000000000000000000000000000000000000000000000000000000000000000000000000000000000000 ;2"
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;0"TGHGTGPEKCU"DKDNKQITıHKECU000000000000000000000000000000000000000000000000000000 ;5"
LISTA DEABREVIATURAS
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IKK"" itwrq"KK"
UH"" Uqtq"Hkukqnôikeq"
xu"" xgtuwu"
UGPKE"" Uvwf{"qp"vjg"Ghhkece{"qh"Pquqeqokcn"Kphgevkqp"Eqpvtqn"
O∑FR"" oêfkc"ocku"qw"ogpqu"fguxkq"rcftçq"
HGXG"" htcèçq"fg"glgèçq"fq"xgpvtîewnq"guswgtfq"cq"geqectfkqitcoc"
KE"" kpvgtxcnq"fg"eqphkcpèc"
OR"" octecrcuuq"
VTE"" vgtcrkc"fg"tguukpetqpk|cèçq"ectfîcec"
EFK"" ectfkqxgtuqt/fguhkdtkncfqt"korncpvâxgn"
CX"" cvtkqxgpvtkewnct"
VI"" vtqec"fg"igtcfqt"
okp"" okpwvqu"
RC"" rôuvgtq/cpvgtkqt"
dro"" dcvkogpvqu"rqt"okpwvq"
ktro"" kpewtuùgu"tgurktcvôtkcu"rqt"okpwvq"
egnu"" eênwncu"
GVV"" geqectfkqitcoc"vtcpuvqtâekeq"
GVG"" geqectfkqitcoc"vtcpuguqhâikeq"
EH"" encuug"hwpekqpcn"
JCO" Oketqguhgtcu"fg"Cndwokpc"Jwocpc"
FRQE"" fqgpèc"rwnoqpct"qduvtwvkxc"etõpkec"
KTE"" kpuwhkekípekc"tgpcn"etõpkec"
KPT"" Kpvgtpcvkqpcn"Pqtocnk|gf"Tcvkq"
ORV"" octecrcuuq"vgorqtâtkq"
p"" pûogtq"
pu"" pçq"ukipkhkecpvg"
LISTA DE SÍMBOLOS
< ogpqt"swg""
@"" ockqt"swg"
≤ " ogpqt"qw"kiwcn"
≥ " ockqt"qw"kiwcn""
oo
5""
oknîogvtqu"eûdkequ"
?"" kiwcn"
mi"" swknqitcocu"
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j" jqtcu"
£E" Itcwu"Egnukwu"
'"" rqt"egpvq"
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LISTA DE SIGLAS
"
"
P[JC"" Pgy"[qtm"Jgcv"Cuuqekcvkqp"
EFE"" Egpvgt"hqt"Fkugcug"Eqpvtqn"cpf"Rtgxgpvkqp"
PPKU""" """"Pcvkqpcn"Pquqeqokcn"Kphgevkqp"Uwtxgknncpeg"
CUC"" " """"Cogtkecp"Uqekgv{"qh"Cpguvjgukqnqikuvu"
"
RESUMO
KPVTQFWÑ’Q< Kphgeèçq" go" ukuvgocu" fg" guvkowncèçq" ectfîcec" ctvkhkekcn"
rgtukuvg"eqoq"wo"itcxg"rtqdngoc."fgxkf q"cq"ewuvq"gngxcfq"fq"vtcvcogpvq"cq"
rqvgpekcn"rctc"gxqnwèçq"fguhcxqtâxgn."eqo"rquuîxgn"fguhgejq"hcvcn0"Q"rcrgn"fc"
rtqhknczkc"cpvkdkôvkec"pc"tgcnk|cèçq"fg"rtqegfkogpvqu"ektûtikequ"swg"gpxqnxgo"
ukuvgocu" fg" guvkowncèçq" ectfîcec" ctvkhkekcn" pçq" guvâ" ckpfc" fghkpkfq0" Cu"
rwdnkecèùgu" ekgpvîhkecu" uçq" eqpvtqxgtucu" g" nkokvcfcu" go" hwpèçq" fq" gngxcfq"
vcocpjq" coquvtcn" pgeguuâtkq" rctc" rgtokvkt" eqpenwuùgu" fghkpkvkxcu0"
QDLGVKXQU< Cxcnkct" qu" ghgkvqu" fc" rtqhknczkc" cpvkdkôvkec" rctc" rtqegfkogpvqu"
ektûtikequ" go" guvkowncèçq" ectfîcec" ctvkhkekcn" g" guvcdgngegt" eqttgncèùgu"
rtgfkvkxcu" fg" eqornkecèùgu" kphgeekqucu0" OÖVQFQU< Guvwfq" enîpkeq"
tcpfqok|cfq"*3<3+."go"nctic"guecnc."fwrnq"egiq"g"eqpvtqncfq."kpenwkw"rcekgpvgu"
uwdogvkfqu" c" rtqegfkogpvqu" ektûtikequ" go" guvkowncèçq" ectfîcec" ctvkhkekcn0"
Hqtco" eqorctcfqu<" itwrq" fg" rcekgpvgu" uwdogvkfqu" ä" rtqhknczkc" cpvkdkôvkec"
fqug" ûpkec" fg" eghc|qnkpc" *3i+" kpvtcxgpquc" *IK+." xgtuwu" r ncegdq" *IKK+."
cfokpkuvtcfqu"kogfkcvcogpvg"cpvgu"fc"ektwtikc0"Q"ugiwkogpvq"hqk"tgcnk|cfq"32"
g" 52" fkcu." 5" g" 8" ogugu" crôu" c" ektwtikc0" Q" fguhgejq" enîpkeq" hqk" rtgugpèc" fg"
ukpcku" fg" kphgeèçq" pc" kpekuçq." nqlc" qw" kphgeèçq" ukuvíokec" tgncekqpcfc" cq"
rtqegfkogpvq0" Q" eânewnq" fq" vcocpjq" coquvtcn" guvkoqw" 3222" rcekgpvgu."
eqpukfgtcpfq"rtgxkuçq"fg"kpekfípekc"fg"kphgeèçq"fg"4'."gttq" α = 5% e poder
guvcvîuvkeq"fg";2'0"C"cpânkug"guvcvîuvkec"wvknk|qw"vguvg"swk/swcftcfq."gzcvq"fg"
Hkujgt."v"fg"Uvwfgpv."Ykneqzqp"g"tgitguuçq"nqiîuvkec0"TGUWNVCFQU< Q"eqokví"
fg" ugiwtcpèc" eqorquvq" rqt" 7" ogodtqu" pçq" gpxqnxkfqu" pc" cxcnkcèçq" fqu"
rcekgpvgu"kpvgttqorgw"q"guvwfq"crôu"kpenwuçq"fg"86;"rcekgpvgu"*IK"?"536"g"
IKK"?"557+"rgnc"ockqt"qeqttípekc"fg"kphgeèçq"pq"IKK"*33"ecuqu"⁄"5.4:'+."go"
tgncèçq" cq" IK" *4" ecuqu" ⁄" 2.85'+" TT" ?" 2.3;" g" r?" 2.2380" Cu" ectcevgtîuvkecu"
enîpkeq/grkfgokqnôikecu" dcucku" fqu" itwrqu" hqtco" ugognjcpvgu" g" c" cpânkug"
wpkxctkcfc" fgoqpuvtqw" qu" ugiwkpvgu" octecfqtgu" fg" kphgeèçq<" pçq" wuq" fg"
rtqhknczkc" cpvkdkôvkec." rtqegfkogpvqu" fg" korncpvgu" *go" tgncèçq" äu" vtqecu" fg"
igtcfqtgu"⁄"r?2.24+."qeqttípekc"fg"jgocvqoc"fg"nqlc"*r?2.25+"g"fwtcèçq"fq"
rtqegfkogpvq" *r?2.22;+0" C" cpânkug" ownvkxctkcfc" kfgpvkhkeqw" pçq" wuq" fg"
rtqhknczkc" cpvkdkôvkec" *r?2.25+" g" jgocvqoc" fg" nqlc" *r?2.24+" eqoq" rtgfkvqtgu"
kpfgrgpfgpvgu" fg" kphgeèçq0" Qeqttgtco" 37" ôdkvqu." pgpjwo" rqt" ecwuc"
kphgeekquc0"EQPENWU÷GU< Rtqhknczkc"cpvkdkôvkec"tgfw|kw"ukipkhkecvkxcogpvg"cu"
eqornkecèùgu"kphgeekqucu"go"rtqegfkogpvqu"fg"guvkowncèçq"ectfîcec"ctvkhkekcn0"
C"qeqttípekc"fg"jgocvqoc"fg"nqlc"fgvgtokpqw"ockqt"kpekfípekc"fg"kphgeèùgu0"
"
"
"
"
SUMMARY
KPVTQFWEVKQP< Cpvkdkqvke"rtqrj{nczku"tgncvgf"vq"rcegocmgt"cpf"fghkdtknncvqt"
uwtigtkgu" ku" cp" wpuqnxgf" swguvkqp0" Vjgtg" ctg" hgy" rwdnkujgf" fcvc." qpeg"
fghkpkvkxg"eqpenwukqpu"tgswktg"c"nctig"rqrwncvkqp"rtqvqeqn0"Eqphnkevkpi"tguwnvu"qh"
uocnn" uvwfkgu" ctg" kpuwhhkekgpv" vq" guvcdnkuj" cp" gxkfgpeg/dcugf" enkpkecn"
qtkgpvcvkqp0" QDLGEVKXGU< Vq" gxcnwcvg" vjg" ghhgevu" qh" rtgxgpvkxg" cpvkdkqvke"
cfokpkuvtcvkqp" rtgxkqwu" vq" uwtikecn" rtqegfwtgu" tgncvgf" vq" ectfkce" ctvkhkekcn"
uvkowncvkqp" cpf" vq" fgvgtokpg" gxgpvwcn" rtgfkevkxg" eqttgncvkqpu0" OGVJQFU<"
Rcvkgpvu" ykvj" kpfkecvkqp" qh" rcegocmgt" qt" korncvcdng" ectfkqxgtvgt" fghkdtknncvqt"
korncpvcvkqp" ygtg" ugngevgf" vq" c" nctig" uecng." fqwdng" dnkpf." tcpfqok|gf" *3<3+"
vtkcn0"Vyq"itqwru"ygtg"eqorctgf<"IK"⁄"Eghc|qnkpg"*302"i"⁄"qpg"fqug+"xgtuwu"
IKK"⁄"rncegdq"*ucnkpg"uqnwvkqp"20;'+0"Vjg"xgpqwu"cfokpkuvtcvkqp"ycu"rgthqtogf"
koogfkcvgn{"dghqtg"vjg"uwtigt{0"Vjg"hqnnqy/wr"ycu"rgthqtogf"chvgt"32"cpf"52"
fc{u." 3" cpf" 5" o qpvju" chvgt" jqurkvcn" fkuejctig0" Vjg" rtkoct{" gpf" rqkpv" ycu"
kphgevkqwu" ukipcnu" cv" uwtikecn" kpekukqp." kp" vjg" rwnug" igpgtcvqt" rqemgv." qt"
u{uvgoke" rtqegfwtg" tgncvgf" kphgevkqp0" Vjg" ecnewncvgf" rqrwncvkqp" ycu" qpg"
thousand, considering incidence estimative of 2%, α/gttqt"qh"7'"cpf"rqygt"qh"
;2'0" Vjg" tguwnvu" ygtg" cpcn{|gf" ceeqtfkpi" vq" vjg" ejk/uswctg" vguv." Hkujgt‚u"
gzcev" vguv." v/Uvwfgpv‚u" cpf" Ykneqzqp‚u" vguv" hqt" vjg" wpkxctkcvg" cpcn{uku" cpf"
nqikuvke" tgitguukqp" hqt" vjg" ownvkxctkcvg" cpcn{uku0" TGUWNVU< Vjg" ugewtkv{"
eqookvvgg" kpvgttwrvgf" vjg" vtkcn" chvgt" vjg" kpenwukqp" qh" 86;" rcvkgpvu" dgecwug" qh"
vjg" fkhhgtgpeg" dgvyggp" vjg" itqwru" *IK" ykvj" 536" rcvkgpvu" cpf" IKK" ykvj" 557"
rcvkgpvu+"kp"hcxqt"vq"vjg"cpvkdkqvke"cto"*IK<"4"rcvkgpvu"kphgevgf"⁄"2.85'="IKK<"33"
rcvkgpvu" kphgevgf" ⁄" 5.4:'=" TT?2.3;=" r?2.238+0" Vjg" enkpkecn" h gcvwtgu" ygtg"
ukoknct" dgvyggp" vjg" itqwru" cpf" vjg" hqnnqykpi" octmgtu" ygtg" kpfgpvkhkgf" d{"
wpkxctkcvg" cpcn{uku<" pqp/wug" qh" rtgxgpvkxg" cpvkdkqvke" *r?2.238+=" korncpv "
rtqegfwtgu" *xgtuwu" igpgtcvqt" tgrncegogpv<" r?2.24+=" rtgugpeg" qh" rquv/
qrgtcvkxg"jcgocvqoc"*r?2.25+="rtqegfwtg"fwtcvkqp"*r?2.22;+0"Vjg"ownvkxctkcvg"
cpcn{uku" kfgpvkhkgf" vjg" pqp/wug" qh" cpvkdkqvke" *r?2.25+" cpf" vjg" rquv/qrgtcvkxg"
jcgocvqoc" *r?2.24+" cu" kpfgrgpfgpv" rtgfkevqtu" qh" kphgevkqp0" Hkhvggp" fgcvju"
qeewttgf." pqpg" tgncvgf" vq" kphgevkqpu0" EQPENWUKQP< Cpvkdkqvke" rtqrj{nczku"
tgfwegu"ukipkhkecpvn{"kphgevkqwu"eqornkecvkqpu"kp"uwtigtkgu"qh"ectfkce"uvkowncvkqp"
korncpvcdng" fgxkegu0" Nqecn" jcgocvqoc" fghkpgu" c" jkijgt" kpekfgpeg" qh" rquv/
qrgtcvkxg"kphgevkqpu0"
1
1. INTRODUÇÃO
"
"
1.1. Infecção e cirurgia
Cpvgu" fg" ogcfqu" fq" uêewnq" 3;." rcekgpvgu" ektûtikequ" eqowogpv g"
fgugpxqnxkco" ›hgdtg" kttkvcvkxcfi" rôu/qrgtcvôtkc." eqoq" gtco" ejcocfcu" cu"
kphgeèùgu" fq" uîvkq" ektûtikeq." ugiwkfc" rqt" ftgpcigo" rwtwngpvc" fc" kpekuçq."
ugrug"itcxg"g"htgs°gpvgogpvg"oqtvg0"Kuuq"qeqttgw"cvê"3:82."swcpfq"Lqugrj"
Nkuvgt" kpvtqfw|kw" qu" rtkpeîrkqu" fc" cpvkuugrukc." tgfw|kpfq" c" oqtdkfcfg"
kphgeekquc" rôu/qrgtcvôtkc" uwduvcpekcnogpvg0" Q" vtcdcnjq" fg" Nkuvgt" owfqw"
tcfkecnogpvg" qu" rtqegfkogpvqu" ektûtikequ." rcuucpfq" fg" cvkxkfcfgu"
cuuqekcfcu"eqo"kphgeèçq"g"ôdkvq"rctc"woc"fkuekrnkpc"swg"eqogèqw"c"gnkokpct"
q"uqhtkogpvq"g"rtqnqpict"c"xkfc
3
0"
C" fgurgkvq" fqu" cxcpèqu" pcu" vêepkecu" qrgtcvôtkcu." ognjqt"
gpvgpfkogpvq" fc" rcvqiípgug" fc" kphgeèçq" fc" hgtkfc" ektûtikec" g" q" wuq"
fkuugokpcfq" fc" rtqhknczkc" cpvkdkôvkec." c" kphgeèçq" fq" uîvkq" ektûtikeq" eqpvkpwc"
ugpfq"c"ockqt"ecwuc"fg"oqtdkfcfg"g"oqtvcnkfcfg"rctc"rcekgpvgu"uwdogvkfqu"
c"rtqegfkogpvqu"ektûtikequ0"Guvkoc/ug"swg"kphgeèçq"fq"uîvkq"ektûtikeq"qeqttg"
go"4"c"7'"fqu"swcug"52"oknjùgu"fg"rcekgpvgu"uwdogvkfq"c"rtqegfkogpvqu"
ektûtikequ" c" ecfc" cpq" pqu" Guvcfqu" Wpkfqu
4.5.6
0" Uçq" tgurqpuâxgku" rqt" 36" c"
38'" fg" vqfcu" kphgeèùgu" pquqeqokcku." vtcpuhqtocpfq" q" uîvkq" ektûtikeq" pc"
ugiwpfc" ecwuc" fg" kphgeèçq" pquqeqokcn." ugpfq" uwrgtcfq" crgpcu" rgnc"
kphgeèçq"fq"vtcvq"wtkpâtkq
7
0"Dcugcfq"pq"Uvwf{"qp"vjg"Ghhkece{"qh"Pquqeqokcn"
Kphgevkqp" Eqpvtqn" *UGPKE+" rgnq" Egpvgt" hqt" Fkugcug" Eqpvtqn" cpf" Rtgxgpvkqp"
2
*EFE+." ecnewnc/ug" swg" ocku" fg" 7220222" kphgeèùgu" fq" uîvkq" ektûtikeq" qeqttc"
gpvtg"cfwnvqu"c"ecfc"cpq"pqu"Guvcfqu"Wpkfqu
8
0"Guvcu"kphgeèùgu"rtqnqpico"c"
rgtocpípekc"jqurkvcnct"rqt"woc"oêfkc"fg"9.6"fkcu."igtcpfq"wo"ewuvq"gzvtc"
fg"&5.9"oknjùgu"g"&3.8"dknjùgu"go"icuvqu"gzvtc/jqurkvcnctgu
9.:.;.32
0"Q"ewuvq"
rqt" rcekgpvg" rqfg" ugt" ockqt" swg" &52222" rctc" rcekgpvgu" uwdogvkfqu" ä"
ektwtikc"ectfîcec"qw"qtvqrêfkec
33.34
0"
C"kpekfípekc"fg"kphgeèçq"fq"uîvkq"ektûtikeq"vgo"ukfq"vtcfkekqpcnogpvg"
guvtcvkhkecfc"rgnq"vkrq"fg"jqurkvcn"g"ugtxkèq"ektûtikeq0"Q"Pcvkqpcn"Pquqeqokcn"
Kphgevkqp"Uwtxgknncpeg"*PPKU+"u{uvgo"fq"EFE"ectcevgtk|qw"qu"jqurkvcku"rgnq"
vcocpjq"g"chknkcèçq"c"gueqncu"oêfkecu0"Gpvtg"3;:2"g"3;:4."q"PPKU"tgrqtvqw "
woc" htgs°ípekc" fg" kphgeèçq" ektûtikec" fg" 6.8." 8.6" g" :.4" rqt" 30222" cnvcu" go"
jqurkvcku"pçq"nkicfqu"ä"gueqnc."rgswgpqu"jqurkvcku"gueqncu"*>"722"ngkvqu+."g"
itcpfgu" jqurkvcku" gueqncu" *≥ 500 leitos), respectivamente
35
0" Q" PPKU"
tgrqtvqw" vcodêo" ockqt" htgs°ípekc" fg" kphgeèçq" ektûtikec" pqu" itcpfgu"
jqurkvcku" gueqncu." swcpfq" eqorctcfqu" eqo" vqfqu" qu" qwvtqu" vkrqu" fg"
jqurkvcku."pq"rgtîqfq"fg"lcpgktq"fg"3;;4"cvê"lwpjq"fg"4226
36
0"
Q"tkueq"fg"fgugpxqnxkogpvq"fg"kphgeèçq"fq"uîvkq"ektûtikeq"ê"chgvcfq"
rgnq" itcw" fg" eqpvcokpcèçq" oketqdkcpc0" W o" ukuvgoc" corncogpvg" cegkvâxgn"
fg" encuukhkecèçq" fg" eqpvcokpcèçq" fq" uîvkq" ektûtikeq" hqk" fgugpxqnxkfq" rgnc"
Pcvkqpcn" Tgugctej" Eqwpekn
37
0" Guvc" encuukhkecèçq." fg" hqtoc" oqfkhkecfc." ê" c"
ugiwkpvg<"
•" Ektwtikc"nkorc<"Uçq"uîvkqu"ektûtikequ"pqu"swcku"pçq"jâ"kphncocèçq"g"qu"
vtcvqu"tgurktcvôtkqu."cnkogpvct."igpkvcn"g"wtkpâtkq"pçq"uçq"ceguucfqu0"Go"
cfkèçq." hgtkfcu" nkorcu" uçq" rtkoctkcogpvg" hgejcfcu" g." ug" pgeguuâtkq."
ftgpcfcu"eqo"ftgpcigo"hgejcfc0""
3
•" Ektwtikc" nkorc/eqpvcokpcfc<" Ektwtikcu" pqu" swcku" qu" vtcvqu" tgurktcvôtkq."
cnkogpvct."igpkvcn"qw"wtkpâtkq"uçq"gpxqnxkfqu"uqd"eqpvtqncfcu"eqpfkèùgu"
g"ugo"qeqttípekc"fg"qwvtc"eqpvcokpcèçq"kpeqowo0"
•" Ektwtikc"eqpvcokpcfc<"Kpenwgo"hgtkfcu"cekfgpvcku"cdgtvcu"tgegpvgogpvg"
qw" qrgtcèùgu" eqo" itcpfgu" xkqncèùgu" fc" vêepkec" fg" guvgtknk|cèçq." qw"
itcpfgu" xc|cogpvqu" fg" ugetgèçq" fq" vtcvq" icuvtqkpvguvkpcn0" Uîvkqu"
ektûtikequ" pqu" swcku" gzkuvgo" cdqtfcigpu" fq" vtcvq" igpkvq/wtkpâtkq" eqo"
wtkpc" kphgevcfc." qw" vtcvq" dknkct" eqo" dkng" kphgevcfc" g" cswgngu" pqu" swcku"
kphncocèçq" ciwfc." pçq" rwtwngpvc." ê" gpeqpvtcfc." hc|" rctvg" fguuc"
ecvgiqtkc0"
•" Ektwtikc" uwlc" g" kphgevcfc<" Kpenwgo" hgtkfcu" vtcwoâvkecu" cpvkicu." eqo"
vgekfq" fguxkvcnk|cfq" tgvkfq." eqtrq" guvtcpjq" qw" eqpvcokpcèçq" hgecn0"
Uîvkqu" ektûtikequ" qpfg" woc" xîuegtc" rgthwtcfc" qw" rwu" ê" gpeqpvtcfq"
fwtcpvg"c"qrgtcèçq"ug"gpswcftco"pguuc"ecvgiqtkc0"
Q"guvwfq"fg"Etwug"g"Hqqtf
38
"oquvtqw"swg"ektwtikc"gpxqnxgpfq"uîvkqu"
ektûtikequ" nkorqu." nkorqu/eqpvcokpcfqu." eqpvcokpcfqu" g" uwlqu" vío"
htgs°ípekc" fg" kphgeèçq" fg" 3.7'." 9.9'." 37.4'" g" 62'" t gurgevkxcogpvg0" C"
htgs°ípekc"fg"kphgeèçq" ektûtikec" rgnq"guvwfq" fc" National Research Council"
eqqrgtcvkxc" hqk" fg" 5.5'" rctc" ektwtikcu" nkorcu." eqo" vêepkecu" tghkpcfcu" fg"
guvgtknk|cèçq." 9.6'" rctc" qwvtqu" uîvkqu" nkorqu." 38.6'" rctc" ektwtikcu"
eqpvcokpcfcu." g" 4:.8'" rctc" ektwtikcu" uwlcu
37
0" Ocku" tgegpvgogpvg." gpvtg"
:608;3" ektwtikcu" swg" hqtco" tgrqtvcfcu" rqt" jqurkvcku" rctc" q" PPKU." c"
htgs°ípekc"fg"kphgeèçq"rqt"vkrq"fg"uîvkq"ektûtikeq"hqk"c"ugiwkpvg<"nkorc"4.3'="
nkorc/eqpvcokpcfc"5.5'="eqpvcokpcfc"8.6'="g"uwlc/kphgevcfc"9.3'
39
0""
4
C" eqttgncèçq" fc" encuukhkecèçq" fq" vkrq" fg" ektwtikc" eqo" q" tkueq" fg"
kphgeèçq" ektûtikec" uwigtg" swg" c" eqpvcokpcèçq" fq" uîvkq" ektûtikeq" fgxg" ugt"
eqttgncekqpcfc"eqo"q"tkueq"fg"uwdugs°gpvg"kphgeèçq0"Gpvtgvcpvq."tguwnvcfqu"
eqphnkvcpvgu"hqtco"qdvkfqu"swcpfq"c"oketqdkqnqikc"fq"uîvkq"fg"eqpvcokpcèçq"
kpvtc/qrgtcvôtkq" hqk" gzcokpcfc" g" eqttgncekqpcfc" eqo" q" oketqqticpkuoq"
kuqncfq"pq"kpvtc/qrgtcvôtkq"fg"ektwtikcu"kphgevcfcu0"Fg"ceqtfq"eqo"Dctvngvv"gv"
cn0
3:
" kuqnctco" dcevêtkc" fg" 65" fg" ;3" *69'+" uîvkqu" ektûtikequ" fwtcpvg" q" cvq"
qrgtcvôtkq0"Gpvtgvcpvq."pçq"gpeqpvtctco"fkhgtgpèc"ukipkhkecvkxc"pc"htgs°ípekc"
fg" uwdugs°gpvg" kphgeèçq" ektûtikec" gpvtg" cswgngu" rcekgpvgu" eqo" g" ugo"
ewnvwtc"rqukvkxc0""Cnêo"fkuuq."pçq"jqwxg"eqttgncèçq"gpvtg"c"eqpegpvtcèçq"fg"
dcevêtkc" pq" uîvkq" g" q" uwdugs°gpvg" fgugpxqnxkogpvq" fg" kphgeèçq0" Go"
eqpvtcuvg." Ictkdcnfk" g" Ewujkpi
3;
" gpeqpvtctco" woc" eqttgncèçq" gpvtg" c"
eqpvcokpcèçq"kpvtc/qrgtcvôtkc"g"q"ockqt"tkueq"fg"kphgeèçq"fq"uîvkq"ektûtikeq."
oguoq" crôu" clwuvg" rgnc" kphnwípekc" fg" qwvtcu" xctkâxgku" rqt" tgitguuçq"
nqiîuvkec" *Tc|çq" fg" Ejcpeg" 5.2" ⁄" KE" 4.2/6.8" ⁄" r>2.223+0" C" tgurgkvq" fc"
cuuqekcèçq."gngu"gpeqpvtctco"swg"q"wuq"enîpkeq"fguuc"kphqtocèçq"ê"nkokvcfq."
rqku"q"xcnqt"rtgfkvkxq"fg"woc"ewnvwtc"rqukvkxc"kpvtc/qrgtcvôtkc"pguvg"guvwfq"hqk"
dckzq" *54'+" g" c" htgs°ípekc" fg" ewnvwtc" hcnuq/rqukvkxc" hqk" cnvc" *:8'+0" Gngu"
vcodêo" pqvctco" swg" c" eqpeqtfãpekc" gpvtg" q" oketqqticpkuoq" kuqncfq" fq"
uîvkq" fwtcpvg" q" cvq" qrgtcvôtkq" g" q" rcvôigpq" tgurqpuâxgn" rgnc" kphgeèçq"
ektûtikec"hqk"dckzq"*63'+0"
Rqtvcpvq."guvâ"enctq"swg"c"encuu khkec èçq"fq"vkrq"fg"ektwtikc"ê"uqogpvg"
wo" oqfgtcfq" rtgfkvqt" fg" tkueq" kphgeekquq." rqtswg" c" gzkuvípekc" fg" qwvtcu"
xctkâxgku" vcodêo" kphnwgpekco" q" tkueq." vcku" eqoq" hcvqtgu" tgncekqpcfqu" cq"
rcekgpvg."vêepkec"qrgtcvôtkc"g"q"wuq"fg"rtqhkncz kc"cpvkoketqdkcpc0"Go"cfkèçq."
5
ecwucu" gzôigpcu." eqoq" q" rguuqcn" gpxqnxkfq" pq" rtqegfkogpvq."
rqvgpekcnogpvg"eqpvtkdwgo"rctc"c"eqpvcokpcèçq"fq"uîvkq"qrgtcvôtkq."g"guvcu"
ecwucu"pçq"uçq"kpenwîfcu"pq"guswgoc"fg"encuukhkecèçq"fq"uîvkq."q"swcn" tghngvg"
ncticogpvg" q" itcw" fg" eqpvcokpcèçq" dcevgtkcpc" fg" ecwucu" gpfôigpcu."
kpenwkpfq"oketqqticpkuoqu"fc"rgng"fq"rcekgpvg"qw"xîuegtc"qrgtcfc0"
"
1.2. Diagnóstico da infecção cirúrgica
C" kfgpvkhkecèçq" fc" kphgeèçq" tgncekqpcfc" cq" rtqegfkogpvq" ektûtikeq"
gpxqnxg" kpvgtrtgvcèçq" fqu" cejcfqu" enîpkequ" g" ncdqtcvqtkcku." g" ê" etwekcn" swg"
fghkpkèùgu" eqpukuvgpvgu" g" rcftqpk|cfcu" uglco" guvcdgngekfcu0" Q" PPKU" fq"
EFE"fgugpxqnxgw"etkvêtkqu"rcftqpk|cfqu"rctc"fghkpkèçq"fg"Kphgeèçq"fq"Uîvkq"
Ektûtikeq
37
0" Rqt" guugu" etkvêtkqu." cu" kphgeèùgu" fq" uîvkq" ektûtikeq" uçq"
encuukhkecfcu" eqoq" kpekukqpcn" qw" ôtiçq1gurcekcn0" Kphgeèçq" fq" uîvkq" ektûtikeq"
kpekukqpcn" ê" ckpfc" fkxkfkfc" pcswgncu" gpxqnxgpfq" uqogpvg" c" rgng" g" vgekfq"
uwdewvãpgq" *kpekukqpcn" uwrgthkekcn+" qw" cswgncu" gpxqnxgpfq" vgekfq" htqwzq"
rtqhwpfq" fc" kpekuçq" *kpekukqpcn" rtqhwpfc+0" łtiçq1gurcekcn" gpxqnxg" swcnswgt"
qwvtc"rctvg"fc"cpcvqokc"gz0"ôtiçq"qw"gurcèq"swg"fgrqku"fg"wnvtcrcuucfcu"
cu" ecocfcu" fc" rctgfg" fq" eqtrq." hqk" cdgtvc" qw" ocpkrwncfc" fwtcpvg" c"
qrgtcèçq" *Cpgzq" C+0" Rqt" gzgornq." wo" rcekgpvg" swg" hqk" uwdogvkfq" c" woc"
crgpfkegevqokc" g" uwdugs°gpvgogpvg" fgugpxqnxgw" wo" cdueguuq" kpvtc/
cdfqokpcn" pçq" ftgpcpfq" cvtcxêu" fc" kpekuçq." c" kphgeèçq" fgxg" ugt" tgncvcfc"
eqoq"uîvkq"fg"kphgeèçq"ektûtikec"ôtiçq1gurcekcn"pq"uîvkq"kpvtc/cdfqokpcn
42.43
0"""
Q"tkueq"fg"kphgeèçq"fq"uîvkq"ektûtikeq"rqfg"ugt"eqpegkvwcfq"fg"ceqtfq"
eqo"c"ugiwkpvg"tgncèçq
44.45
<"
"
6
Fqug"fg"eqpvcokpcèçq"dcevgtkcpc"Z"xktwnípekc"?"Tkueq"fg"kphgeèçq"ektûtikec"
""""""""""""""""Tgukuvípekc"fq"rcekgpvg""
"
Swcpvkvcvkxcogpvg." lâ" hqk" fgoqpuvtcfq" swg" ug" wo" uîvkq" ektûtikeq" ê"
eqpvcokpcfq" eqo" @32
7"
oketqqticpkuoqu" rqt" itcoc" fg" vgekfq." q" tkueq" fg"
kphgeèçq" ektûtikec" ê" octecfcogpvg" cwogpvcfq
46
0" Gpvtgvcpvq." c" fqug" fg"
oketqqticpkuoqu" eqpvcokpcpvgu" tgswgtkfqu" rtc" rtqfw|kt" kphgeèçq" rqfg" ugt"
owkvq"ogpqt"swcpfq"wo"eqtrq"guvtcpjq"*eqoq"woc"rtôvgug+"guvâ"rtgugpvg"
pq"uîvkq"*kuvq"ê"322"guvchknqeqewu"rqt"itcoc"fg"vgekfq+
47.48.49
0"
"
1.3. Infecção e cirurgia cardíaca
Ektwtikc"ectfîcec." kpenwkpfq" tgxcuewnctk|cèçq"okqeâtfkec" g" ektwtikcu"
fg"xânxwncu." ê"wo"fqu" rtqegfkogpvqu"ektûtikequ"ocku"eqowpu" pqu"Guvcfqu"
Wpkfqu."eqo"crtqzkocfcogpvg"82:0222"rcekgpvgu"qrgtcfqu"rqt"cpq
4:
0"
Kphgeèçq"fq"uîvkq"ektûtikeq"ê"woc"eqornkecèçq"htgs°gpvg"go"ektwtikc"
ectfîcec
4;
0" Rctvkewnctogpvg" c" kphgeèçq" guvgtpcn" rtqhwpfc" g" ogfkcuvkpkvg." cu"
swcku"qeqttgo"go"2.47"c"4'"fqu"rcekgpvgu"u wdogvkfqu"ä"ektwtikc"ectfîcec
52
0"
Guucu" eqornkecèùgu" uçq" cuuqekcfcu" eqo" vczc" fg" oqtvcnkfcfg" ockqt" swg"
52'
53
" g" q" v tcvcogpvq" htgs°gpvgogpvg" tgswgt" tgkpvgtxgpèçq" ektûtikec." dgo"
eqoq" woc" vgtcríwvkec" cpvkdkôvkec" rtqnqpicfc." cnêo" fg" ugtgo" cuuqekcfcu"
eqo" wo" uwduvcpekcn" cwogpvq" pq" rgtîqfq" fg" rgtocpípekc" jqurkvcnct
54.55
"g"
ewuvq"fqu"ewkfcfqu
33/56
0"
Q"wuq"fg"rtqhknczkc"cpvkdkôvkec"crtqrtkcfc"vgo"oquvtcfq"woc"tgfwèçq"
pc" kpekfípekc" fg" kphgeèçq" fq" uîvkq" ektûtikeq" crôu" ektwtikc" ectfîcec
57.58.59
0" C"
gueqnjc" fq" ognjqt" cpvkoketqdkcpq" rctc" rtqhknczkc" fg" kphgeèçq" go" ektwtikc"
7
ectfîcec"eqpvkpwc"ugpfq"woc"âtgc"cvkxc"fg"rguswkuc."swg"hqk"tguwokfc."go"
3;;4." rqt" woc" ogvcpânkug" swg" cxcnkqw" 4:" guvwfqu" rtqurgevkxqu."
tcpfqok|cfqu" g" eqpvtqncfqu" eqorctcpfq" 4" qw" ocku" cigpvgu
5:
0" Qu"
tguwnvcfqu" hqtco" kpeqtrqtcfqu" g" cu" tgeqogpfcèùgu" dgo" cegkvcu" rctc"
rtqhknczkc"cpvkoketqdkcpc"go"ektwtikc"ectfîce c."cu"swcku"ceqpugnjco"q"wuq"fg"
woc"eghcnqurqtkpc"fg"rtkogktc"qw"ugiwpfc"igtcèçq
5;
0""
Wo" e tguegpvg" cwogpvq" pc" htgs°ípekc" fg" uwtikogpvq" fg"
ownvkttgukuvípekc" fg" rcvôigpqu" itco/rqukvkxqu" äu" ftqicu" pcu" ûnvkocu" fwcu"
fêecfcu" vgo" rtqxqecfq" woc" vgpfípekc" go" tgeqpukfgtct" guucu"
tgeqogpfcèùgu
62
0" Staphylococcus aureus"g"Sthaphylococcus epidermidis
uçq"qu"ocku"eqowpu"rcvôigpqu"gpeqpvtcfqu"go"kphgeèçq"rôu/guvgtpqvqokc."
ugpfq"tgurqpuâxgku"rqt"56'"c"76'"g"34'"c"66'"fcu"kphgeèùgu"rtqhwpfcu."
tgurgevkxcogpvg
63.64.65.66.67.68
0" Gzkuvg" cnvc" rtgxcnípekc" fg" tgukuvípekc" c" β/
ncevãokequ" gpvtg" guugu" qticpkuoqu0" Pc" xgtfcfg." qticpkuoqu" kuqncfqu" fg"
kphgeèçq" guvgtpcn" uwrgthkekcn" qw" rtqhwpfc" vío" oquvtcfq" tgukuvípekc" ä"
ogvkeknkpc."c"swcn"vqtpc"q"vtcvcogpvq"qw"rtqhknczkc"eqo"cigpvgu"β/ncevãokequ"
kpghkec|gu
68.69.6:
0"
Rqt" ecwuc" fg" uwc" cvkxkfcfg" eqpvtc" qticpkuoqu" tgukuvgpvgu."
cpvkdkôvkequ"inkeqrgrvîfgqu."vcku"eqoq"c"xcpeqokekpc"g"vgkeqrncpkpc."vío"ukfq"
tgeqogpfcfqu"eqoq"cigpvgu"rtqhknâvkequ"cnvgtpcvkxqu0"Go"4226"Dqnqp"gv"cn0
6;
"
tgcnk|ctco"woc"ogvcpânkug"rctc"fghkpkt"ug"c"vtqec"fg"cigpvgu"β/ncevãokequ"
rqt"inkeqrgrvîfgqu"rctc" rtqhknczkc" fg" kphgeèçq" go" ektwtikc"ectfîcec"fgxgtkc"
ugt" ceqpugnjcfc0" Tguwnvcfqu" fg" 9" gpuckqu" enîpkequ" tcpfqok|cfqu" *70983"
rtqegfkogpvqu+"swg"eqorctcxco"c"kpekfípekc"fg"kphgeèçq"fq"uîvkq"ektûtikeq"
go" rcekgpvgu" swg" tgegdgtco" rtqhknczkc" eqo" inkeqrgrvîfgqu" eqo" qu" swg"
8
tgegdgtco"cigpvgu"β/ncevãokequ"hqtco"cpcnkucfqu0"Pgpjwo"cigpvg"rtqxqw"
ugt"uwrgtkqt"rctc"rtgxgpèçq"fg"qeqttípekc"f g"kphgeèçq"fq"uîvkq"ektûtikeq"cqu"
52"fkcu"rôu/qrgtcvôtkq"*TT."3.36=";7'"fg"KE."2.;3"⁄"3.64+0"Go"uwdcpânkugu. "
β/ncevãokequ" hqtco" uwrgtkqtgu" cqu" inkeqrgrvîfgqu" rctc" rtgxgpèçq" fg"
kphgeèçq"fq"uîvkq"ektûtikeq"vqtâekeq"*TT."3.69=";7'"KE."3.33"⁄"3.;7+"g"jqwxg"
vgpfípekc"ä"uwrgtkqtkfcfg"rctc"rtgxgpèçq"fg"kphgeèùgu"vqtâekecu"rtqhwpfcu"
*TT."3.55=";7'"KE."2.;3"⁄"3.;6+"g"kphgeèùgu"ecwucfcu"rqt"dcevêtkcu"itco/
rqukvkxcu" *TT." 3.58=" ;7'" KE." 2.;:" ⁄" 3.;3+0" Inkeqrgrvîfgqu" oquvtctco"
vgpfípekc"ä"uwrgtkqtkfcfg"go"tgncèçq" cqu"β/ncevãokequ"rctc" rtgxgpèçq"fg"
kphgeèùgu"fg"uîvkqu"ektûtikequ"go"ogodtqu"kphgtkqtgu"*TT."2.99=";7'"KE."2.7:"
⁄" 3.23+" g" hqtco" uwrgtkqtgu" rctc" rtgxgpèçq" fg" kphgeèùgu" ecwucfcu" rqt"
dcevêtkcu" itco/rqukvkxcu" ogvkeknkpq" tgukuvgpvgu" *TT." 2.76=" ;7'" KE." 2.55" ⁄"
2.;2+0" Uwigtkpfq" swg" c" rtqhknczkc" rcftçq" rctc" ektwtikcu" ectfîcecu" fgxg"
eqpvkpwct"ugpfq"qu"cigpvgu"β/ncevãokequ"pc"ockqtkc"fcu"ektewpuvãpekcu0""
"
1.4. Infecção e prótese
Egtec"fg"ogvcfg"fqu"4"oknjùgu"fg"ecuqu"fg"kphgeèçq"jqurkvcnct"swg"
qeqttgo"cpwcnogpvg"pqu"Guvcfqu"Wpkfqu"fc"Coêtkec"guvçq"tgncekqpcfcu"ä"
rtgugpèc"fg"rtôvgugu"korncpvâxgku
72
0"
Q"fkcipôuvkeq"fg"kphgeèçq"cuuqekcfc"c"rtôvgugu"fgxg"ugt"hgkvq"eqo"
owkvc"ecwvgnc0"Cniwocu."ocu"pgo"vqfcu"cu"kphgeèùgu"fg"hgtkfcu"ektûtikecu."
chgvco"c"rtôvgug
73
0"Rqtvcpvq."eqnqpk|cèçq"dcevgtkcpc"fg"korncpvgu"ektûtikequ"
pçq" pgeguuctkcogpvg" kpfkec" kphgeèçq0" Pc" xgtfcfg." c" ockqtkc" fcu" rtôvgugu"
eqnqpk|cfcu"pçq"ug"vqtpc"kphgevcfc0"Q"fkcipôuvkeq"fg"kphgeèçq"tgncekqpcfc"ä"
9
rtôvgug"tgswgt"c"rtgugpèc"fg"ocpkhguvcèùgu"enîpkecu."ukpcku"kpvtc/qrgtcvôtkqu"
fg" kphgeèçq" cflcegpvg" cq" korncpvg" g" q" etguekogpvq" fg" rcvôigpqu" go"
ewnvwtcu" fg" gurêekogu" ektûtikecu0" Rctc" clwfct" c" gxkvct" c" tgkpvgtxgpèçq"
ektûtikec"go"wo"rcekgpvg"swg"rqfg"pçq"vgt"kphgeèçq"cuuqekcfc"ä"rtôvgug."ê"
pgeguuâtkq" wo" fkcipôuvkeq" eqphktocfq" rqt" gzcogu" fg" kocigo" g"
oketqdkqnqikc0" Godqtc" jgoqewnvwtc" rqukvkxc" uglc" wo" hqtvg" octecfqt" fg"
gpfqectfkvg"tgncekqpcfc"ä"rtôvgug"xcnxct"g"cniwocu"kphgeèùgu"cuuqekcfcu"ä"
tgxcuewnctk|cèçq" ectfîcec." guvcu" uçq" pgicvkxcu" pc" ockqtkc" fcu" kphgeèùgu"
cuuqekcfcu"eqo"ukuvgocu"fg"guvkowncèçq"ectfîcec"ctvkhkekcn"*gzegvq"ug"gzkuvg"
gpfqectfkvg+0" Ewnvwtc" fg" ocvgtkcn" eqnjkfq" fq" nqecn" fg" kphgeèçq." pçq"
ektwtikecogpvg."xctkc"pc"uwc"ugpukdknkfcfg"rctc"fgvgevct"kphgeèçq"cuuqekcfc"
eqo"rtôvgugu
73
0"Q"geqectfkqitcoc"vtcpuguqhâikeq"ê"owkvq"ocku"ugpuîxgn"swg"
q"vtcpuvqtâekeq"rctc"kfgpvkhkect"xgigvcèùgu"tgncekqpcfcu"ä"rtôvgug"ectfîcec"g"
ecdqu/gngvtqfqu" fg" octecrcuuq0" Rqtvcpvq." q" fkcipôuvkeq" fg" kphgeèçq"
tgncekqpcfc"ä"rtôvgug"fgxg"ngxct"go"eqpukfgtcèçq"c"uqoc"fg"kphqtocèùgu"
enîpkecu"g"fg" fkxgtuqu"gzcogu."gxkvcpfq" kpvgtxgpèùgu"fgupgeguuâtkcu"g"fg"
cnvq"ewuvq0" Rqt"qwvtq" ncfq."rgtokvkt"woc"fgekuçq"ugiwtc"fc"ocpwvgpèçq"fc"
rtôvgug."ugo"eqnqect"go"tkueq"c"xkfc"fq"rcekgpvg
73
0"
Q" wuq" fg" rtôvgugu" ectfîcecu" vgo" ug" vqtpcfq" ecfc" xg|" ocku"
htgs°gpvg" pc" oqfgtpc" ogfkekpc" ectfkqxcuewnct0" Fgufg" q" kpîekq" fq" wuq" fg"
rtôvgugu" xcnxctgu." g o" 3;75
74
." rctc" q" vtcvcogpvq" fg" kpuwhkekípekc" côtvkec."
qwvtcu"rtôvgugu"ectfîcecu"rgtocpgpvgu."kpenwkpfq"octecrcuuqu
75
."crctgnjqu"
rctc" cuukuvípekc" xgpvtkewnct" guswgtfc
76
" g" ectfkqxgtuqtgu/fguhkdtkncfqtgu"
korncpvâxgku
77
" vío" oquvtcfq" ugtgo" ghkec|gu" go" ognjqtc" fg" uqdtgxkfc."
tgfwèçq"fg" ukpvqocu."qw"codqu0"Q"pûogtq" fg"korncpvgu" fg"rtôvgugu" xgo"
10
cwogpvcpfq" rtqitguukxcogpvg." fg" ceqtfq " eqo" q" cwogpvq" fg" kpfkecèùgu"
dcugcfcu"go"gxkfípekcu0"Godqtc"rtôvgugu"ectfîcecu"vgpjco"rtqnqpicfq"c"
xkfc" fg" wo" itcpfg" pûogtq" fg" rcekgpvgu." gncu" vcodêo." rctcfqzcnogpvg"
eqnqeco"guugu"rcekgpvgu"uqd"tkueq"fg"wo"itcpfg"pûogtq"fg"eqornkecèùgu"
tgncekqpcfcu" cq" ugw" wuq0" C" qeqttípekc" fg" kphgeèçq" vgo" cwogpvcfq"
rctcngncogpvg"cq"kpetgogpvq"pq"pûogtq"fg"korncpvgu
:7
."igtcpfq"wo"itcpfg"
kpvgtguug" pq" fgugpxqnxkogpvq" fg" vêepkecu" fg" rtgxgpèçq" g" vt cvcogpvq"
cfgswcfqu." xkucpfq" tgfw|ktgo" c" oqtdkfcfg." oqtvcnkfcfg" g" ewuvqu"
cuuqekcfqu"c"guuc"eqornkecèçq0"
"
"
"
"
"
11
2. REVISÃO DA LITERATURA
Pcu" fwcu" ûnvkocu" fêecfcu" xâtkqu" guvwfqu" hqtco" fgugpxqnxkfqu"
dwuecpfq" wo" ognjqt" gpvgpfkogpvq" fc" rcvqiípgug" fc" kphgeèçq" ektûtikec."
rgtokvkpfq." cuuko." c" cfqèçq" fg" ogfkfcu" fg" eqpvtqng" g" xkiknãpekc." cnêo" fg"
kpvgtxgpèùgu"swg"tgfw|co"c"qeqttípekc"fguuc"eqornkecèçq0""
"
2.1. Patogênese da infecção cirúrgica
Rcvôigpqu"swg"ecwuco"kphgeèçq"ektûtikec"rqfgo"ugt"cfswktkfqu"fg"
fwcu"hqtocu<"gpfôigpcogpvg"*hnqtc"fq"rtôrtkq"rcekgpvg+"qw"gzôigpcogpvg"
*eqpvcvq"eqo"rtqhkuukqpcku"fc"ucnc"fg"ektwtikc"qw"fq"codkgpvg+0"Cetgfkvc/ug"
swg."egtec"fg"46"j"crôu"q"vêtokpq"fg"wo"rtqegfkogpvq"ektûtikeq."c"ockqtkc"
fcu"hgtkfcu"ektûtikecu"guvçq"uwhkekgpvgogpvg"hgejcfcu."c"ogpqu"swg"c"hgtkfc"
hqk"hgejcfc"ugewpfctkcogpvg"qw"gpxqnxg"c"eqnqecèçq"fg"ftgpqu."vqtpcpfq/ug"
tgukuvgpvg" rctc" kpqewncèçq" g" kphgeèçq0" Gpvçq." c" ockqtkc" fqu" rcvôigpqu."
cfswktkfqu" gpfqigpcogpvg" qw" gzqigpcogpvg" fgxgo" vgt" ukfq" korncpvcfqu"
fwtcpvg" q" cvq" ektûtikeq
79
0" " Vgqtkecogpvg." q" uîvkq" ektûtikeq" rqfg" ugt"
eqpvcokpcfq" pq" rôu/qrgtcvôtkq" rqt" xkc" jgocvqiípkec" qw" nkphâvkec" qw" rgnc"
kpqewncèçq" fktgvc" pq" uîvkq" qrgtcvôtkq" hgejcfq." ocu" vcku" ogecpkuoqu" fg"
cswkukèçq" qeqttgo" kphtgs°gpvgogpvg
79
0" Gjtgpmtcp|" g" Rhchh
7:
." gpvtgvcpvq"
fguetgxgtco"wo"itwrq"fg"kphgeèçq"guvgtpcn"swg"qeqttgw"pq"rôu/qrgtcvôtkq"g"
hqk"rtgegfkfq"rqt"kphgeèçq"ecwucfc"rgnq"oguoq"oketqqticpkuoq"go"wo"uîvkq"
tgoqvq"*rpgwoqpkcu"g"dcevgtgokcu+0"Go"wo"uwtvq"fg"kphgeèçq"guvgtpcn"rqt"
Legionella fguetkvq" rqt" Nqyt{" gv" cn
7;
." qu" rcekgpvgu" hqtco" gzrquvqu" ä" âiwc"
12
eqpvgpfq" Legionella" fwtcpvg" q" dcpjq" g" vtqec" fg" tqwrcu" crôu" ugtgo"
uwdogvkfqu" c" ektwtikcu" ectfîcecu0" Rqtvcpvq." gzkuvgo" gxkfípekcu" uwhkekgpvgu"
uwigtkpfq" swg" c" kpqewncèçq" g" kphgeèçq" rqfgo" qeqttgt" qecukqpcnogpvg" pq"
rôu/qrgtcvôtkq0" Gpvtgvcpvq." q" rgtîqfq" fg" ockqt" tkueq" rctc" kphgeèçq"
rgtocpgeg" ugpfq" q" vgorq" gpvtg" c" cdgtvwtc" g" q" hgejcogpvq" fq" uîvkq"
ektûtikeq0""
"
2.1.1. Patógenos adquiridos endogenamente
Igtogu" fc" hnqtc" fq" rtôrtkq" rcekgpvg." nqecnk|cfqu" rtôzkoq" qw" pq"
rtôrtkq" uîvkq" e ktûtikeq" uçq" tgurqpuâxgku" rgnc" ockqtkc" fcu" kphgeèùgu"
ektûtikecu
82
0""S. aureus g"Staphyloccoccus"eqciwncug"pgicvkxq."q"rtkogktq"g"
q" ugiwpfq" ockqtgu" cigpvgu" gvkqnôikequ." uçq" tgukfgpvgu" fc" rgng" g"
rtguwokxgnogpvg" uçq" kpqewncfqu" fktgvcogpvg" pq" uîvkq" ektûtikeq" fwtcpvg" c"
kpekuçq"g"uwdugs°gpvg"ocpkrwncèçq0"Jkikgpk|cèçq"cfgswcfc"g"q"wuq"fg"wo"
cigpvg"fgigtocpvg"rctc"rgng"fwtcpvg"c"rtgrctcèçq"fq"uîvkq"qrgtcvôtkq"uçq"
tqvkpgktcogpvg" tgcnk|cfqu." dwuecpfq" c" tgfwèçq" fc" rqrwncèçq" fguugu"
oketqqticpkuoqu" pc" uwrgthîekg0" Gpvtgvcpvq." swcpfq" c" rgng" ug" vqtpc"
hqtvgogpvg"eqnqpk|cfc"/"rqt"gzgornq."eqoq"tguwnvcfq"fg"woc"fgtocvkvg"⁄"c"
hnqtc" tgukfgpvg" rqfg" rgtukuvkt" g" ugt" ecttgcfc" rtc" q" uîvkq" qrgtcvôtkq0" Hnqtcu"
gpfôigpcu" fkuvcpvgu" pq" rtôrtkq" rcekgpvg" vcodêo" rqfgo" ugt" ecwucu" fg"
kphgeèçq" ektûtikec0" Ykng{" g" Jâ‚gtk
83"
pqvctco" swg" Oketqguhgtcu" fg" Cndwokpc"
Jwocpc"*JCOu+"gtco"ugognjcpvgu"c"guecocu"fc"rgng"jwocpc"g"rqfgtkco"
ugt"wucfcu"eqoq"rctvîewncu"octecfqtcu0"Swcpfq"crnkectco"JCO"pc"rgng"fq"
rcekgpvg"go"nqecku"fkuvcpvgu"fc"kpekuçq."gngu"fgoqpuvtctco"swg"c"rctvîewnc"
13
octecfqtc"rqfgtkc"ugt"hceknogpvg"tgewrgtcfc"fq"uîvkq"ektûtikeq"*go"62"fg"62"
ektwtikcu"qtvqrêfkecu+."uwigtkpfq"swg"c"oketqhnqtc"fg"uwrgthîekg"rqfg"okitct"
fg" uîvkqu" fkuvcpvgu" g" ugt" gpeqpvtcfc" pq" uîvkq" ektûtikeq." c" fgurgkvq" fc"
fkuvãpekc." fq" wuq" fg" tqwrcu" g" ewtcvkxqu0" Hkpcnogpvg." oketqqticpkuoqu"
ecwucfqtgu" fg" kphgeèçq" go" uîvkqu" tgoqvqu" rqfgo" icpjct" ceguuq" cq" uîvkq"
qrgtcvôtkq" cvtcxêu" fc" xkc" jgocvqiípkec" g1qw" nkphqiípkec0" Kphgeèùgu" pçq"
vtcvcfcu" fq" vtcvq" wtkpâtkq." tgurktcvôtkq" g" rgng" uçq" cu" vtíu" kphgeèùgu" ocku"
eqowogpvg"cuuqekcfcu"eqo"kphgeèçq"fg"uîvkqu"ektûtikequ"fkuvcpvgu
72.84
0""
2.1.1.1."Pessoal
Cu"oçqu" fc"gswkrg"ektûtikec"cdtkico"oketqqticpkuoqu"swg"rqfgo"
eqpvcokpct" q" uîvkq" ektûtikeq" rgnc" kpqewncèçq" fktgvc" fwtcpvg" q"
rtqegfkogpvq
85.86.87
0" Kuuq" ngxqw" cq" wuq" fg" nwxcu" ektûtikecu" eqoq" dcttgktc"
rctc" c" vtcpuhgtípekc" fg" oketqqticpkuoqu" g" rctc" c" jkikgpg" fcu" oçqu."
tgfw|kpfq" c" rqrwncèçq" oketqdkcpc" fc" rgng" fcu" oçqu0" Kpkekcnogpvg" wucfc"
eqoq" wo" ogkq" fg" rtqvgèçq" rctc" c" gswkrg" ektûtikec" eqpvtc" fgtocvkvg" rqt"
cpvkuuêrvkeq."cu"nwxcu"ektûtikecu"vgo"ug"vqtpcfq"wo"kpuvtwogpvq"rcftqpk|cfq"
pc" rtâvkec" eqoq" oêvqfq" fg" rtgxgpèçq" fc" rcuucigo" fg" oketqqticpkuoqu"
fcu"oçqu"fq"ektwtikçq"rctc"q"uîvkq"ektûtikeq"fq"rcekgpvg0"C"ghkeâekc"fcu"nwxcu"
ektûtikecu" eqoq" dcttgktc" vgo" ukfq" swguvkqpcfc." woc" xg|" swg" guvwfqu" vío"
fgoqpuvtcfq" swg" rgthwtcèçq" fc" oguoc" qeqttg" go" 315" fqu" rtqegfkogpvqu"
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38.87
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c" swcpvkfcfg" fg" oketqqticpkuoqu" pcu" oçqu" fq" ektwtikçq." pçq" gzkuvg"
gxkfípekc"swg"vcn"rgthwtcèçq"fc"nwxc"vgpjc"ukipkhkecfq"enîpkeq0"Fqffu"gv"cn0
88"
14
pçq"gpeqpvtctco"fkhgtgpèc"pc"htgs°ípekc"fg"kphgeèçq"fq"uîvkq"ektûtikeq"gpvtg"
322"jêtpkcu"qrgtcfcu"swg"hqtco."qw"pçq."cuuqekcfcu"eqo"rgthwtcèùgu"fcu"
nwxcu0""
Cnêo" fcu" oçqu." qwvtqu" nqecku" fq" eqtrq" fqu" ogodtqu" fc" gswkrg"
ektûtikec"rqfgo"ugt"hqpvgu"fg"eqpvcokpcèçq"gzôigpc"fq"uîvkq"qrgtcvôtkq0"Q"
ecdgnq" g" eqwtq" ecdgnwfq" fq" ektwtikçq." dgo" eqoq" fq" rtôrtkq" rcekgpvg." vío"
ukfq"fgoqpuvtcfqu"eqoq"cdtkiq"rctc"dcevêtkcu"rqvgpekcnogpvg"rcvqiípkecu."
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oketqqticpkuoqu"swg"uçq" gpeqpvtcfqu"pq"uîvkq" qrgtcvôtkq0" Oketqguhgtcu"fg"
cndwokpc" jwocpc" crnkecfcu" pc" ecdgèc" g" rgueqèq" fg" ektwtikùgu" hqtco"
tgewrgtcfcu" fc" hgtkfc" qrgtcvôtkc" go" 42 " fqu" 42" gzrgtkogpvqu0" C" fgurgkvq"
fguucu"qdugtxcèùgu."uqogpvg"rqwequ"ecuqu"fg"kphgeèçq"fq"uîvkq"qrgtcvôtkq"
hqtco" eqttgncekqpcfqu" eqo" qu" igtogu" fq" ecdgnq" qw" eqwtq" ecdgnwfq" fqu"
ogodtqu"fc"gswkrg"ektûtikec
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Q"pctk|"g"c"qtqhctkpig"fqu"ogodtqu"fc"gswkrg"ektûtikec"vcodêo"uçq"
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kuqnctco"S. aureus."S. epidermidis, e streptococcus htgs°gpvgu"
fc" pcuqhctkpig" fqu" ogodtqu" fc" gswkrg" ektûtikec" g" tgewrgtqw" qu" oguoqu"
oketqqticpkuoqu" fq" gzuwfcvq" fg" hgtkfcu" kphgevcfcu0" Godqtc" c" ukownvãpgc"
tgewrgtcèçq" fq" oguoq" oketqqticpkuoq" fc" pcuqhctkpig" g" uîvkqu" ektûtikequ"
kphgevcfqu" pçq" rtqxg" swg" c" pcuqhctkpig" ê" c" hqpvg." guvwfqu" eqo" rctvîewncu"
octecfcu" vío" fgoqpuvtcfq" swg" kuuq" rqfg" qeqttgt0" Jâ‚gtk" g" Ykng{
8:
"
crnkectco" oketqguhgtcu" fg" cndwokpc" octecfcu" pc" uwrgthîekg" kpvgtpc" fcu"
oâuectcu"hcekcku"ektûtikecu"g"tgewrgtctco"cu"oguocu"fg"hqtoc"eqpukuvgpvg"
15
pq"uîvkq"ektûtikeq."woc"xg|"swg"qu"xc|cogpvqu"cvtcxêu"fcu"oâuectcu"hqtco"
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tgewrgtctco"fg"uîvkqu"ektûtikequ" ukowncfqu."rctvîewncu"octecfcu"
swg" vkpjco" ukfq" dqttkhcfcu" pc" hceg" g" pctkpc" fqu" ogodtqu" fc" gswkrg"
ektûtikec0"Gngu"vcodêo"pqvctco"swg"swcpfq"qu"ogodtqu"fc"gswkrg"ektûtikec"
hcncxco" fwtcpvg" q" rtqegfkogpvq" cwogpvcxc" q" pûogtq" fg" oketqguhgtcu"
tgewrgtcfcu."uwigtkpfq"swg"c"eqpxgtucèçq"eqpvtkdwk"rctc"cgtquqnk|cèçq"fc"
dcevêtkc"fc"qtqhctkpig0"
"
2.1.1.2."Ambiente
Qu" oketqqticpkuoqu" swg" uçq" kuqncfqu" fc" ucnc" fg" ektwtikc" uçq"
wuwcnogpvg" eqpukfgtcfqu" pçq" rcvqiípkequ" qw" eqogpucku." tctcogpvg"
cuuqekcfqu" eqo" kphgeèùgu
94
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tgewrgtcfcu" fq" rô" jqurkvcnct" g" uçq" tctcogpvg" kpetkokpcfcu" go" kphgeèùgu"
ektûtikecu0"Pqu"ecuqu"fg"kphgeèçq"fgxkfc"c"M. fortuitum"g"M. chelonae"swg"
ug" ugiwkw" ä" ektwtikc" fg" vtqec" xcnxct" g" ocoqrncuvkc
95.96.97
." egtc" fg"quuq"qw"
uqnwèçq"fg"xkqngvc"igpekcpc"hqtco"ocku"kpetkokpcfcu"swg"q"codkgpvg"fc"ucnc"
fg" ektwtikc0" Gurqtqu" fg" Clostridium perfringens vío" ukfq" kuqncfqu" fg"
ukuvgocu" fg" xgpvkncèçq" g" rkuqu" fcu" ucncu" fg" ektwtikcu
98
." ocu" swcpfq"
kpxguvkicfqtgu"rtqewtctco"rgnc"rqvgpekcn"hqpvg"ecwucfqtc"fguuc"fgxcuvcpvg"
kphgeèçq" ektûtikec." eqpenwîtco" swg" C. perfringens hqk" cfswktkfq" fg" fwcu"
hqtocu." gpfqigpcogpvg" fc" hnqtc" icuvtqkpvguvkpcn" fq" rtôrtkq" rcekgpvg" g"
gzqigpcogpvg" fg" kpuvtwogpvqu" ektûtikequ" eqpvcokpcfqu" swg" vkpjco" ukfq"
kpcfgswcfcogpvg"guvgtknk|cfqu
99
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16
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kpetkokpcfcu."c"hqpvg"gtc."pc"xgtfcfg."uqnwèùgu"eqpvcokpcfcu."cpvkuuêrvkequ."
qw"xguvkogpvcu0"Tqwrcu" gnâuvkecu"eqpvcokpcfcu"vgo" ukfq" kornkecfcu" eqoq"
ecwuc"fg"kphgeèçq"ektûtikec"ecwucfc"rqt"Rhizopus
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Pseudomonas aeruginosa, P. multivorans g Serratia marcescens
:4.:5.:6
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Pc"rtâvkec."tqvkpgktcogpvg."qu"rkuqu"fcu"ucncu"fg"ektwtikc"uçq"nkorqu"
eqo" wo" fgukphgvcpvg" gpvtg" woc" ektwtikc" g" qwvtc0" Cuuqekcfq" eqo" woc"
ewkfcfquc" nkorg|c" fcu" ucncu" g" eqttgfqtgu" fq" egpvtq" ektûtikeq" fwtcpvg" c"
pqkvg." cetgfkvc/ug" swg" guuc" tqvkpc" rtqrkekc" wo" codkgpvg" uwhkekgpvgogpvg"
nkorq" rctc" okpkok|ct" q" tkueq" fg" gpxqnxkogpvq" fcu" uwrgthîekgu" g" rkuqu" fcu"
ucncu"eqoq"hqpvg"fg"kphgeèçq"ektûtikec0"
"
2.1.1.3."Ar
"
Q"rcrgn"fq"ct"fc" ucnc"fg"ektwtikc"eqoq"woc"hqpvg"fg"kphgeèçq" g"c"
pgeguukfcfg"fg"wo"ukuvgoc"gurgekcn"fg" xgpvkncèçq"vío"ukfq"qdlgvqu"fg"owkvq"
fgdcvg0" C" rtkpekrcn" hqpvg" fg" eqpvcokpcèçq" oketqdkcpc" cêtgc" uçq" qu"
ogodtqu"fc"gswkrg"ektûtikec
93.94
0"Cetgfkvc/ug"swg"q"oketqqticpkuoq"rcuuc"c"
ektewnct" rgnq" ct" eqoq" tguwnvcfq" fc" eqpxgtucèçq." c" swcn" gnkokpc" rctvîewncu"
eqo"dcevêtkcu"fq" vtcvq"tgurktcvôtkq."qw" eqoq"tguwnvcfq"fq"fgurtgpfkogpvq"fq"
ecdgnq" qw" rgng" gzrquvc0" Guvwfqu" wvknk|cpfq" oketqguhgtcu" fg" cndwokpc"
jwocpc" octecfcu" uwigtgo" swg" qu" oketqqticpkuoqu" cêtgqu" fq" vtcvq"
tgurktcvôtkq" qw" ecdgèc" g" rgueqèq" fg" ogodtqu" fc" gswkrg" ektûtikec" rqfgo"
ugt" kuqncfqu" fq" uîvkq" ektûtikeq
83.8:.93
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17
rqwec"gxkfípekc"fg"swg"c"eqpvcokpcèçq"rqt"oketqqticpkuoqu"fq"ct"eqpvtkdwk"
ukipkhkecpvgogpvg"rctc"kphgeèçq"ektûtikec0"Gxkfípekc"fg"swg"c"eqpvcokpcèçq"
cêtgc" eqpvtkdwk" ukipkhkecpvgogpvg" rctc" kphgeèçq" ektûtikec" ê" dcugcfc" go"
uwtvqu"fg"kphgeèçq"fg"uvtgrvqeqeewu"β/jgoqnîvkequ"fq"itwrq"C"tgrqtvcfqu"pc"
nkvgtcvwtc
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0" Pguvgu" ecuqu." c" gxkfípekc" fc" vtcpuokuuçq" cêtgc" hqk"
eqphktocfc" fc" ugiwkpvg" hqtoc<" rtkogktq." q" guvtgrvqeqeq" eqo" q" oguoq"
uqtqvkrq" fq" kuqncfq" fq" uîvkq" fg" kphgeèçq" ektûtikec" hqk" kuqncfq" fq" uîvkq" fg"
eqnqpk|cèçq" *cpcn." xcikpcn" qw" qtqhctîpigq+" go" rguuqcu" gpxqnxkfcu" pq"
rtqegfkogpvq"ektûtikeq="ugiwpfq."q"uîvkq"fc"eqpvcokpcèçq"*cpcn"qw"xcikpcn+"
pçq" vkpjc" rquukdknkfcfg" fg" eqpvcvq" fktgvq" eqo" q" uîvkq" qrgtcvôtkq0" Cnêo" f q"
ocku."cniwocu"fguucu"rguuqcu"eqpvcokpcfcu"pçq"vtcdcnjcxco"fktgvcogpvg"
pq" ecorq" qrgtcvôtkq0" Hkpcnogpvg." swcpfq" ogkqu" fg" eqnqpk|cèçq" hqtco"
wucfqu"fwtcpvg"guuc"kpxguvkicèçq."q"oketqqticpkuoq"go"swguvçq"rqfg"ugt"
tgewrgtcfq"fq"ct"fwtcpvg"c"cvkxkfcfg"fcu"rguuqcu"eqpvcokpcfcu0""
Q" guvwfq" fq" Pcvkqpcn" Tgugctej" Eqwpekn
;2
" cxcnkqw" q" ghgkvq" fc"
kttcfkcèçq"wnvtcxkqngvc"pc"eqpvcokpcèçq"oketqdkcpc"fq"ct"fc"ucnc"ektûtikec"g"
pc" kpekfípekc" fc" kphgeèçq" fq" uîvkq" ektûtikeq0" Qu" tguwnvcfqu" kpfkectco" swg"
ektwtikcu"nkorcu"vkpjco"ukipkhkecpvgogpv g"ogpqu"rquukdknkfcfg"fg"eqornkect"
eqo"kphgeèçq"swcpfq"hqtco"tgcnk|cfcu"go"ucncu"knwokpcfcu"eqo"kttcfkcèçq"
wnvtc/xkqngvc."eqorctcfcu"eqo"ektwtikcu"t gcnk|cfcu"go"ucncu"eqo"xgpvkncèçq"
rcftçq0" Wo" ugiwpfq" guvwfq" gwtqrgw" ownvkeípvtkeq" eqorctqw" c" htgs°ípekc"
fg" kphgeèçq" gpvtg" ektwtikcu" fg" tgrqukèçq" vqvcn" fg" swcftkn" g" lqgnjq" eqo"
rtôvgugu"swg"hqtco"tgcnk|cfcu"go"ucncu"eqo"ct"›wnvtc/nkorqufi."eqo"ukuvgoc"
gurgekcn" fg" xgpvkncèçq." eqo" rtqegfkogpvqu" tgcnk|cfqu" go" ucncu" eqo"
xgpvkncèçq"eqpxgpekqpcn
;3
0"Go"ucncu"eqo"ukuvgocu"fg"xgpvkncèçq"gurgekcn."c"
18
swcpvkfcfg"fg"eqpvcokpcèçq"fq"codkgpvg"cêtgq"ogfkfc"rqt"coquvtcu"fq"ct."
c"swcpvkfcfg"fg"oketqqticpkuoqu"kuqncfqu"pq"ncxcfqu"fc"hgtkfc"ektûtikec."g"
c"htgs°ípekc"fg"kphgeèçq"fq"uîvkq"ektûtikeq"hqtco"ukipkhkecvkxcogpvg"ogpqtgu"
swg"äu"eqttgurqpfgpvgu"ogfkfcu"go"ucncu"eqo"xgpvkncèçq"eqpxgpekqpcn0"
"
2.2. Fatores de risco para o desenvolvimento de infecção cirúrgica
Go" 3;87." Cnvgogkgt" g" Ewndgtvuqp
45
" chktoctco" swg" q" tkueq" fg" woc"
kphgeèçq" fg" uîvkq" ektûtikeq" xctkc<" c+" fktgvcogpvg" rtqrqtekqpcn" ä" fqug" fg"
eqpvcokpcèçq" dcevgtkcpc=" d+" fktgvcogpvg" rtqrqtekqpcn" ä" xktwnípekc" fq"
oketqqticpkuoq="g"e+"kpxgtucogpvg"rtqrqtekqpcn"ä"tgukuvípekc"fq"jqurgfgktq."
swg"ê"c"ecrcekfcfg"fg"tgurquvc"fq"qticpkuoq"fq"rcekgpvg"ä"eqpvcokpcèçq"
oketqdkcpc0"Qu"rtkpekrcku"hcvqtgu"fg"tkueq"gpxqnxkfqu"pq"fgugpxqnxkogpvq"fg"
kphgeèçq" ektûtikec" uçq<" vgorq" fg" kpvgtpcèçq" rtê/qrgtcvôtkc." cpvkuugrukc" fq"
uîvkq" ektûtikeq." fwtcèçq" fq" rtqegfkogpvq." vêepkec" ektûtikec." rtgugpèc" fg"
kphgeèùgu"fg"uîvkqu"tgoqvqu"g"hcvqtgu"nkicfqu"cq"rcekgpvg0"
"
2.2.1. Tempo de internação pré-operatória
Cq"nqpiq"fqu"cpqu."qu"guvwfqu"v ío"fgoqpuvtcfq."eqpukuvgpvgogpvg."
wo" ghgkvq" cfxgtuq" fq" vgorq" rtqnqpicfq" fg" rgtocpípekc" jqurkvcnct" rtê/
qrgtcvôtkc" pc" htgs°ípekc" fg" kphgeèçq" fq" uîvkq" ektûtikeq0" The National
Research Council study" gpeqpvtqw" swg" c" htgs°ípekc" fg" kphgeèçq" fq" uîvkq"
ektûtikeq"cwogpvqw"fg"8'"rctc"woc"rgtocpípekc"jqurkvcnct"rtê/qrgtcvôtkc"
fg"3"fkc."rctc"36.9'"swcpfq"c"rgtocpípekc"jqurkvcnct"rtê/qrgtcvôtkc"hqk"fg"
43"fkcu"qw"ocku
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38
"gpeqpvtctco"woc"kpekfípekc"fg"3.3'"fg"
19
kphgeèçq" ektûtikec" rctc" rcekgpvgu" swg" rgtocpgegtco" kpvgtpcfqu" rqt" 3" fkc"
cpvgu" fq" rtqegfkogpvq" ektûtikeq" g" 4.3'" rctc" qu" swg" rgtocpgegtco"
kpvgtpcfqu"rqt"3"ugocpc"cpvgu"fq"rtqegfkogpvq0"Guugu"cejcfqu"rqfgo"ugt"
etkvkecfqu." rqku" c" kphnwípekc" fg" qwvtqu" korqtvcpvgu" hcvqtgu" pçq" hqtco"
eqpukfgtcfqu" pc" cpânkug0" Qwvtqu" guvwfqu." gpvtgvcpvq." hqtco" wucfqu" go"
cpânkug"ownvkxctkcfc"rctc"clwuvg"fg"rquuîxgku"xctkâxgku"fg"eqphwuçq
3;.;4.;5.;6
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Guugu" guvwfqu" eqphktoctco" c" korqtvãpekc" fc" rgtocpípekc" jqurkvcnct"
rtqnqpicfc"cpvgu"fc"ektwtikc"eqoq"hcvqt"fg" tkueq"kpfgrgpfgpvg"rctc"kphgeèçq"
ektûtikec0""
Q"ogecpkuoq"rgnq"swcn"c"rgtocpípekc"jqurkvcnct"rtqnqpicfc"cpvgu"
fc" ektwtikc" cwogpvc" q" tkueq" fg" kphgeèçq" ê" fgueqpjgekfq0" Gpvtgvcpvq."
cetgfkvc/ug" swg" c" rgtocpípekc" jqurkvcnct" rtê/qrgtcvôtkc" rtqnqpicfc"
rtqoqxg" rtqnkhgtcèçq" fg" oketqqticpkuoqu" gpfôigpqu." qu" swcku" rqfgo"
cwogpvct" c" ejcpeg" fg" eqpvcokpcèçq" fq" uîvkq" ektûtikeq." rqfgpfq" rtqoqxgt"
vcodêo"c"cswkukèçq"fg"rcvôigpqu"jqurkvcnctgu"ownvkttgukuvgpvgu0"Fwtcpvg"c"
rgtocpípekc" pq" jqurkvcn" qu" rtqegfkogpvqu" g" kpvgtxgpèùgu" rqfgo" ecttgct"
oketqqticpkuoqu" rctc" q" eqtrq" fq" rcekgpvg" *rqtvcu" fg" gpvtcfcu+0" Cniwocu"
ftqicu" wucfcu" pq" codkgpvg" jqurkvcnct" rqfgo" cnv gtct" c" tgukuvípekc" äu"
kphgeèùgu"*eqoq"eqtvkequvgtôkfgu+"qw"uwc"hnqtc"pqtocn"*eqoq"cpvkdkôvkequ+0""
"
2.2.2. Antissepsia do sítio cirúrgico
" Go"3;93."Ugtqrkcp"g"Tg{pqnfu
;7"
eqorctctco"c"htgs°ípekc"fg"kphgeèçq"
fq"uîvkq"ektûtikeq"gpvtg"628"rcekgpvgu"ektûtikequ" tcpfqok|cfqu"rctc"tgoqèçq"
fqu" rgnqu" eqo" nãokpc" qw" rqt" cigpvg" fgrkncvôtkq0" C" htgs°ípekc" fg" kphge è çq"
crôu" tgoqèçq" fqu" rgnqu" e qo" nãokpc" hqk" 7.8'" eqorctcfq" eqo" 2.8'" eqo" q"
20
wuq"fg"cigpvg"fgrkncvôtkq"*r>2.24+0"C"htgs°ípekc"fg"kphgeèçq"swcpfq"qu"rgnqu"
pçq"hqtco"tgoqxkfqu"hqk"2.8'0"Pguvg" guvwfq." q" vgorq" gpvtg"c"tgoqèçq" fqu"
rgnqu"g"c"ektwtikc"vcodêo"kphnwgpekqw"pc"htgs°ípekc"fg"kphgeèçq0"C"kpekfípekc"
fg"kphgeèçq"hqk"5.3'"swcpfq"c"tgoqèçq"fqu"rgnqu"hqk"tgcnk|cfc"kogfkcvcogpvg"
cpvgu"fq"rtqegfkogpvq" ektûtikeq."g"9.3'" swcpfq"hqk"tgcnk|cfc" fgpvtq" fcu"46"
jqtcu"cpvgu"fc"ektwtikc0"C"kpekfípekc"fg"kphgeèçq"hqk"ockqt"swg"42'"swcpfq"c"
tgoqèçq" fqu" rgnqu" hqk" tgcnk|cfc" o cku" swg" 46" jqtcu" cpvgu" fc" ektwtikc0" Pq"
guvwfq"fg"Etwug"g"Hqqtf
38
."hqtco"qdvkfqu"tguwnvcfqu"ukoknctgu0"Rcekgpvgu"swg"
hqtco" uwdogvkfqu" ä" tgoqèçq" fqu" rgnqu" eqo" woc" nãokpc" vkxgtco" ockqt"
kpekfípekc" fg" kphgeèçq" *4.7'+0" Rcekgpvgu" swg" vkxgtco" ugwu" rgnqu" eqtvcfqu" g"
pçq"tgoqxkfqu."c"kphgeèçq"hqk"fg"3.9'0"Rcekgpvgu"uwdogvkfqu"ä"tgoqèçq"fqu"
rgnqu" eqo" wo" vtkeqvqok|cfqt" gnêvtkeq" vkxgtco" woc" kpekfípekc" fg" kphgeèçq" fg"
3.6'" 0" Pqu" ecuqu" go" swg" qu" rgnqu" pçq" hqtco" tgoqxkfqu" qw" eqtvcfqu." c"
kpekfípekc"fg"kphgeèçq"hqk"fg"2.;'0""
" Pgo" vqfqu" qu" guvwfqu" fgoqpuvtctco" swg" c" htgs°ípekc" fg" kphgeèçq"
ektûtikec" xctkc" eqo" q" oêvqfq" fg" tgoqèçq" fqu" rgnqu
;8.;9.;:
0" Q" pûogtq" fg"
rcekgpvgu" k penwîfqu" pguugu" guvwfqu." gpvtgvcpvq." hqk" rgswgpq." nkokvcpfq" uwcu"
jcdknkfcfgu" rctc" fgvgevct" rgswgpcu." ocu" xgtfcfgktcu" fkhgtgpècu" gpvtg" qu"
itwrqu0"Guvwfqu"tgcnk|cfqu"rqt"Okujtkmk"gv"cn0
;6
"g"Ogjvc"gv"cn0
;;
"g"eqttqdqtctco"
qu"tguwnvcfqu"fg"Ugtqrkcp"g"Tg{pqnfu
;7
0"
" Jcoknvqp"g"Nqpg
322
"wu ctco"oketqueqrkc"gngvtõpkec"rctc"gzcokpct"c"rgng"
crôu"tgoqèçq"fqu"rgnqu"eqo"woc"nãokpc."vtkeqvqok|cfqt"gnêvtkeq"g"wo"cigpvg"
fgrkncfqt0" Uwcu" hqvqitchkcu" fgoqpuvtctco" swg" c" nãokpc" ecwuqw" nguùgu"
ewvãpgcu"itquugktcu."q"vtkeqvqok|cfqt"gnêvtkeq"ecwuqw"ogpqt"kplûtkc"g"q"cigpvg"
fgrkncfqt" pçq" ecwuqw" kplûtkc" ä" rgng0" Gpvçq." q" cwogpvq" pc" kpekfípekc" fg"
21
kphgeèçq"fq"uîvkq"ektûtikeq"rqfg"tguwnvct"fg"twrvwtc"pc"dcttgktc"fc"rgng"ecwucfc"
rgnc" nãokpc." rgtokvkpfq" wo" cwogpvq" pc" eqnqpk|cèçq" qw" kpxcuçq" fg"
oketqqticpkuoqu"tgukfgpvgu"qw"gzôigpqu"pq"uîvkq"fc"kpekuçq0""
""""""""""
"
2.2.3. Duração do procedimento cirúrgico
C"fwtcèçq"fq"rtqegfkogpvq"ektûtikeq"vgo"wo"korqtvcpvg"rcrgn."eqoq"
hcvqt" fg" tkueq" rctc" c" qeqttípekc" fg" kphgeèçq" fq" uîvkq" ektûtikeq0" Etwug" g"
Hqqtf
38"
gpeqpvtctco" woc" tgncèçq" fktgvc" gpvtg" fwtcèçq" fc" ektwtikc" g" c"
kpekfípekc" fg" kphgeèçq0" Gpvtg" cu" ektwtikcu" nkorcu." c" kpekfípekc" fg" kphgeèçq"
rqt"fwtcèçq"fq"rtqegfkogpvq"fg"3."4"g"5"j"hqk"tgurgevkxcogpvg"3.5'."4.9'"g"
5.8'0"Q"guvwfq"UGPKE"fgoqpuvtqw"swg"fwtcèçq"fq"rtqegfkogpvq"ockqt"swg"
4" j" tgrtgugpvcxc" wo" fqu" swcvtq" hcvqtgu" fg" tkueq" swg" rgtocpgekco"
ukipkhkecpvgu"swcpfq"vêepkec" fg"tgitguuçq"nqiîuvkec"hqk"crnkecfc"pqu"hcvqtgu"
cpcnkucfqu
8
0""
C" hqtoc" gzcvc" fg" eqoq" c" fwtcèçq" fq" rtqegfkogpvq" ektûtikeq"
cwogpvc" q" tkueq" fg" kphgeèçq" fq" uîvkq" ektûtikeq" rgtocpgeg" gurgewncvkxc0"
Etwug" g" Hqqtf
38
" nkuvctco" swcvtq" rquuîxgku" gzrnkecèùgu<" c+" wo" cwogpvq" pc"
eqpvcokpcèçq"fq"uîvkq"eqo"qrgtcèùgu"rtqnqpicfcu="d+"wo"cwogpvq"pq"fcpq"
vgekfwcn"fgxkfq"cq"tguugecogpvq."tgvtcèçq"rtqnqpicfc"g"ocpkrwncèçq="e+"wo"
cwogpvq" pc" swcpvkfcfg" fg" uwvwtc" g" gngvtqeqciwncèçq." cu" swcku" rqfgo"
tgfw|kt" c" tgukuvípekc" nqecn=" f+" ockqt" uwrtguuçq" fc" fghguc" fq" rcekgpvg" rgnc"
rgtfc" fg" ucpiwg" g" ejqswg0" " Ictkdcnfk" g" Ewujkpi
3;
" cfkekqpctco" swg" c"
fwtcèçq"fc"ektwtikc"rqfg"ugt"wo"octecfqt"rctc"hcvqtgu"swg"uçq"fkhkeknogpvg"
kpeqtrqtcfqu"go"oqfgnqu"ownvkxctkcfqu."vcku"eqoq"c"jcdknkfcfg"fq"ektwtikçq"
g"c"eqorngzkfcfg"fc"ektwtikc0"Ujcrktq"gv"cn0
323
"uwigtktco"swg"q"cwogpvq"pc"
22
kpekfípekc"fg"kphgeèçq"crôu"jkuvgtgevqokcu"rtqnqpicfcu"rqfg"ugt"q"tguwnvcfq"
fg" fkokpwkèçq" fq" ghgkvq" fc" rtqhknczkc" cpvkdkôvke c" eqo" c" fwtcèçq" fq"
rtqegfkogpvq0" Guvg" ê" q" tcekqpcn" rctc" tgrgvkt" c" fqug" fq" cpvkoketqdkcpq" go"
woc"ektwtikc"swg"fwtc"ocku"fg"4"qw"5"j0"
"
2.2.4. Técnica cirúrgica
C"jcdknkfcfg"fq"ektwtikçq"vgo"wo"korqtvcpvg"rcrgn"pc"kpekfípekc"fg"
kphgeèçq" fq" uîvkq" ektûtikeq0" C" vêepkec" chgvc" fktgvcogpvg" q" itcw" fg"
eqpvcokpcèçq"fq"uîvkq"ektûtikeq"cvtcxêu"fg"swgdtcu"pc"vêepkec"qw"rgpgvtcèçq"
kpcfxgtvkfc" go" woc" xîuegtc0" C" jcdknkfcfg" fq" ektwtikçq" vcodêo" chgvc" cu"
eqpfkèùgu"fq" uîvkq"ektûtikeq"g." rqtvcpvq."uwc"tgukuvípekc"ä" kphgeèçq0"Q"tkueq"
fg" kphgeèçq" ê" okpkok|cfq" rgnq" eqpvtqng" fq" ucpitcogpvq." uwcxkfcfg" fc"
vtcèçq"g"ocpkrwncèçq"fq"vgekfq."tgoqèçq"fq"vgekfq"pgetôvkeq"g"gttcfkecèçq"
fq"gurcèq"oqtvq0"Hkpcnogpvg"q"ektwtikçq"jcdknkfquq"rqfg"tgfw|kt"c"fwtcèçq"
fc"ektwtikc."c"swcn"chgvc"q"tkueq"fg"kphgeèçq"ektûtikec0""
C"swcnkfcfg"vêepkec"fq"ektwtikçq"pçq"rqfg"ugt"hceknogpvg"ceguucfc"
ugo"qdugtxcèçq" fktgvc."gpvçq" q"korcevq"fc"jcdknkfcfg"vêepkec"fq" ektwtikçq"
pc" kphgeèçq" fq" uîvkq" ektûtikeq" pçq" vgo" ukfq" cxcnkcfq." gzegvq" kpfktgvcogpvg0"
Hctdgt"gv" cn0
324
"wuctco" wo"rtqitcoc" guvcvcn"fg" xkiknãpekc" rctc"gzcokpct" c"
tgncèçq"gpvtg"xqnwog"ektûtikeq"g"c"kpekfípekc"fg"kphgeèçq"fq"uîvkq"ektûtikeq0"
Gngu"gpeqpvtctco"woc"eqttgncèçq"ukipkhkecpvgogpvg"cnvc"gpvtg"wo"rgswgpq"
pûogtq" fg" rtqegfkogpvqu" tgcnk|cfqu" rgnqu" ektwtikùgu" g" woc" cnvc" vczc" fg"
kphgeèùgu" go" crgpfkegevqokcu." jgtpkqttchkcu." eqngekuvgevqokcu." tguugeèùgu"
fg" eônqpu" g" jkuvgtgevqokcu" cdfqokpcku0" Woc" rquuîxgn" gzrnkecèçq" ê" swg"
ockqt" xqnwog" fg" ektwtikc" cectt gvc" ockqt" gzrgtkípekc" g" ektwtikùgu" ocku"
23
gzrgtkgpvgu." igtcnogpvg." cfswktgo" ognjqtgu" vêepkecu0" O knngt" gv" cn0
325
"
cxcnkctco"c"tgncèçq"gpvtg"q"pîxgn"fg"vtgkpcogpvq"fq"ektwtikçq"g"c"kpekfípekc"
fg"gpfqogvtkvg"crôu"ugeèçq"rctc"eguctkcpc0"Gpvtg"37"x ctkâxgku"gzcokpcfcu"
rqt" cpânkug" fg" tgitguuçq" nqiîuvkec." uqogpvg" c" rtgugpèc" fg" wo" t gukfgpvg"
eqoq" q" rtkpekrcn" ektwtikçq" hqk" cuuqekcfc" eqo" wo" ockqt" tkueq" rctc"
gpfqogvtkvg0" Q" tgukfgpvg" fg" ektwtikc " rtguwokxgnogpvg" vkpjc" ogpqu"
gzrgtkípekc"swg"qu"oêfkequ"cuukuvgpvgu0""
"
2.2.5. Presença de infecções de sítios remotos
C"rtgugpèc"fg"wo"uîvkq"fg"kphgeèçq"tgoqvq"pq"oqogpvq"fc"ektwtikc"
cnvgtc"c"kpekfípekc"fg"kphgeèçq0"Pq"guvwfq"fc"Pcvkqpcn"Tgugctej"Eqwpekn
;2
."c"
rtgugpèc"fg"kphgeèçq"fg"uîvkq"tgoqvq"cwogpvqw"c"kphgeèçq"fq"uîvkq"ektûtikeq"
4.9" xg|gu" *3:.6'" xgtuwu" 8.9'+0" Gfyctfu
84
" qdugtxqw" swg." gpvtg" 5:5"
rcekgpvgu"swg"vkpjco"ukfq"uwdogvkfqu"ä"eqngvc"fg"ocvgtkcn"rctc"ewnvwtc"fc"
kphgeèçq"fq"uîvkq"ektûtikeq"g"fg"uîvkqu"tgoqvqu."77'"fcu"kphgeèùgu"ektûtikecu"
hqtco"rtgegfkfcu"rqt"kphgeèùgu"fq"vtcvq"wtkpâtkq"qw"vtcvq"tgurktcvôtkq"dckzq."
eqo" qu" oguoqu" oketqqticpkuoqu0" Pq" guvwfq" fg" Ictkdcnfk" g" Ewujkpi
3;
." c"
rtgugpèc"fg"kphgeèçq"go" uîvkq" tgoqvq" hqk" ukipkhkecpvgogpvg" cuuqekcfc" eqo"
wo"cwogpvq"pc"vczc"fg"kphgeèçq"go"cpânkug"wpkxctkcfc"*Tc|çq"fg"Ejcpeg"
4.:=" KE" 3.7" ⁄" 7.5+0" Gpvtgvcpvq." swcpfq" q" cwvqt" wuqw" cpânkug" fg" tgitguuçq"
nqiîuvkec" rctc" clwuvct" rgnc" kphnwípekc" fg" qwvtcu" xctkâxgku." c" rtgugpèc" fg"
kphgeèçq"fg"uîvkq" tgoqvq"pçq"hqk" ukipkhkecvkxcogpvg" cuuqekcfc"eqo" kphgeèçq"
fq"uîvkq"ektûtikeq0""
"
24
2.2.6. Fatores ligados ao paciente
Kpvwkvkxcogpvg."uwuegrvkdknkfcfg"fq" jqurgfgktq."swg"ê" c" ecrcekfcfg"
kpvtîpugec" fq" rcekgpvg" rctc" c" fghguc" rtôrtkc" eqpvtc" kpxcuçq" rqt"
oketqqticpkuoqu."fgxg"ugt"wo"korqtvcpvg"fgvgtokpcpvg"fq"tkueq"fg"kphgeèçq"
crôu" ektwtikc0" Cq" nqpiq" fqu" cpqu"xâtkqu"hcvqtgu"nkicfqu" cqu" rcekgpvgu" vío"
ukfq" guvwfcfqu" rctc" fgvgtokpct" uwcu" kphnwípekcu" pc" kpekfípekc" fg" kphgeèçq"
fq"uîvkq"ektûtikeq." kpenwkpfq"hcvqtgu"eqoq" kfcfg."qdgukfcfg."guvcfq"pwvtkekqpcn"
g"c"rtgugpèc"fg"cniwocu"fqgpècu"fg"dcug."vcku"eqoq"fkcdgvgu"g"pgqrncukcu0""
Fguugu" hcvqtgu." kfcfg" cxcpècfc" vgo" ukfq" eqpukuvgpvgogpvg"
gpeqpvtcfc" eqoq" wo" hcvqt" fg" tkueq" rctc" kphgeèçq" ektûtikec
38." ;2.;6.;;.326.327
0""
Ictkdcnfk"g"Ewujkpi
3;
"pçq"gpeqpvtctco"kfcfg"eqoq"hcvqt"fg"tkueq0"Pq"guvwfq"
fgngu."c"rgtfc"fguuc"cuuqekcèçq"fgxg"vgt"qeqttkfq"fgxkfq"ä"kpenwuçq"fg"wo"
qwvtq" octecfqt" pq" oqfgnq" fg" tgitguuçq" nqiîuvkec." q" guvcfq" hîukeq" rgnc"
Coêtkecp"Uqekgv{"qh"Cpguvjgukqnqikuvu"*CUC+."c"swcn"h qk"wo"ognjqt"rtgfkvqt"
fg"uwuegrvkdknkfcfg"fq"rcekgpvg"swg"c"kfcfg" kuqncfc0"
Etwug" g" Hqqtf
38
" tgrqtvctco" ockqt" vczc" fg" kphgeèçq" ektûtikec" go"
ugwu" rcekgpvgu" eqo" fkcdgvgu." cuuko" eqoq" Pcicejkpvc" gv" cn0
;5
" go" guvwfq"
rtqurgevkxq"fg"322;"rcekgpvgu"uwdogvkfqu"ä"ektwtikc"ectfîcec0"Pguvg"ûnvkoq."
cpânkug" fg" tgitguuçq" nqiîuvkec" fgvgtokpqw" fkcdgvgu" ognnkvwu" g" qdgukfcfg"
eqoq"qu"4"hcvqtgu"swg"rgtocpgegtco"kpfgrgpfgpvgogpvg"cuuqekcfqu"eqo"
kphgeèçq"ektûtikec" guvgtpcn"qw" ogfkcuvkpcn0" Nkfitgp
328
"g"Okujtkmk" gv"cn0
;6
."go"
eqpvtcuvg." pçq" gpeqpvtctco" fkhgtgpèc" ukipkhkecpvg" pc" vczc" fg" kphgeèçq"
ektûtikec"gpvtg"fkcdêvkequ"g"p çq"fkcdêvkequ0"C"cuuqekcèçq"gpvtg"qdgukfcfg"g"
vczc" fg" kphgeèçq" rctgeg" ugt" ognjqt" guvcdgngekfc0" Q" Pcvkqpcn" Tgugctej"
Eqwpekn
;2
." Pcicejkpvc" gv" cn0
;5
." Nknkgphgnf" gv" cn0
329
"g"P{uvtqo"gv"cn0
32:
"
25
fgoqpuvtctco" woc" ockqt" kpekfípekc" fg" kphgeèçq" gpvtg" rcekgpvgu" qdguqu"
uwdogvkfqu"ä"ektwtikc0"Cndwokpc"dckzc."fgupwvtkèçq."rgtfc"fg"rguq"tgegpvg."
eãpegt"g"vgtcrkc"kowpquuwrtguuqtc."vcku"eqoq"guvgtôkfgu"uçq"qwvtqu"hcvqtgu"
swg" vío" ukfq" cxcnkcfqu
38.;2.;6.32;/334
0" Q" rcrgn" fguugu" eqoq" hcvqtgu" fg" tkueq"
rctc"kphgeèçq."godqtc"uwiguvkxq."ckpfc"pçq"guvâ"dgo"guvcdgngekfq0""
2.3. Prevenção da infecção cirúrgica
Ogfkfcu" kpvgtxgpekqpcku" rctc" rtgxgpkt" kphgeèçq" fq" uîvkq" ektûtikeq"
rqfgo"ugt"ecvgiqtk|cfcu"eqoq"fktgekqpcfcu"rctc"woc"fcu"vtíu"guvtcvêikcu<"
c+" tgfw|kt" c" swcpvkfcfg" g" vkrq" eqpvcokpcèçq" oketqdkcpc=" d+" ognjqtct" cu"
eqpfkèùgu"fq"uîvkq"ektûtikeq"pq"hkpcn"fc"ektwtikc"cvtcxêu"fg"woc"dqc"vêepkec"
ektûtikec="g"e+"ognjqtct"cu"fghgucu"fq"rcekgpvg."swg"ê"uwc"ecrcekfcfg"rctc"
tgcikt" ä" eqpvcokpcèçq" oketqdkcpc0" C" ockqtkc" fqu" gxgpvqu" etîvkequ" swg"
kpkekco"q"rtqeguuq."ngxcpfq"ä"kphgeèçq."qeqttg"pq"rtê"qw"pq"kpvtc/qrgtcvôtkq."
rqtvcpvq."c"ockqtkc"fguucu"ogfkfcu"fg"eqpvtqng"ê"crnke cfc"cpvgu"qw"fwtcpvg"
c"ektwtikc."ocu"cniwocu"uçq"crnkecfcu"crôu"c"qrgtcèçq"qw"oguoq"crôu"q"
rcekgpvg"tgegdgt"cnvc"jqurkvcnct
38
0"Qu"rtkpekrcku"ogfkfcu"rtê/qrgtcvôtkcu"uçq"
fguetkvcu"c"ugiwkt0"
"
2.3.1. Permanência hospitalar
Godqtc" c" rtqnqpicfc" rgtocpípekc" jqurkvcnct" rquuc" cwogpvct" q"
tkueq"rctc"eqnqpk|cèçq."pçq"gzkuvg"ckpfc"gxkfípekc"swg"guvc"ngxc"fktgvcogpvg"
ä"kphgeèçq"fq"uîvkq"ektûtikeq"qw"swg"woc"tgfwèçq"pc"rgtocpípekc"ngxctkc"ä"
tgfwèçq"fc"vczc"fg"kphgeèçq0"Rqtêo."rctgeg"rtwfgpvg"ocpvgt"q"rcekgpvg"go"
26
codkgpvg"jqurkvcnct"q"ogpqt"vgorq"rquuîxgn"cpvgu"fc"ektwtikc0"Q"kfgcn"rctc"
qrgtcèùgu"gngvkxcu"ugtkc"cfokvkt"q"rcekgpvg"pc"ocpjç"fc"ektwtikc."qw"pq"fkc"
cpvgtkqt"ä"qrgtcèçq
38.";2
0""
"
2.3.2. Fatores ligados ao paciente
Xâtkqu"hcvqtgu"nkicfqu"cq"rcekgpvg"fgvgtokpco"uwc"uwuegrvkdknkfcfg"
ä" kphgeèçq0" Kphgnk|ogpvg." c" ockqtkc" fguugu" hcvqtgu" pçq" guvâ" uwlgkvq" ä"
oqfkhkecèçq0" Rqt" gzgornq." kfcfg" cxcpècfc" pçq" rqfg" u gt" cnvgtcfc0"
Qdgukfcfg."fkcdgvgu"g"fgupwvtkèçq"vío"ukfq"kornkecfcu"eqoq"cwogpvcpfq"q"
tkueq" rctc" kphgeèçq" ektûtikec
328." 329.32:
0" Godqtc" pgpjwoc" fguucu" eqpfkèùgu"
vgpjc"ukfq"eqorngvcogpvg"eqortqxcfc"eqoq"hcvqt"fg"tkueq."rctgeg"tc|qâxgn"
guvct" cvgpvq" rctc" q" eqpvtqng" fc" inkegokc." ognjqtc" fq" guvcfq" pwvtkekqpcn." g"
tgfwèçq"fg"rguq"go"qdguqu"oôtdkfqu"pq"rtê/qrgtcvôtkq0"Kphgeèùgu"go"uîvkqu"
tgoqvqu"fgxgo"ugt"vtcvcfcu"cpvgu"fc"ektwtikc0"
"
2.3.3. Antissepsia pré-operatória
Dcpjq" pq" rtê/qrgctcvôtkq." eqo" qw" ugo" rtqfwvqu" cpvkoketqdkcpqu"
vgo" ukfq" rtgeqpk|cfq" eqoq" woc" ogfkfc" rctc" tgfwèçq" fc" eqnqpk|cèçq" fc"
rgng"rqt"dcevêtkcu"swg"rqfgo"eqpvcokpct"q"uîvkq"ektûtikeq0"Etwug"g"Hqqtf
38"
tgrqtvctco"swg"vczc"fg"kphgeèçq"fq"uîvkq"ektûtikeq"rctc"ektwtikcu"nkorcu" hqk"fg"
4.5'"rctc"rcekgpvgu"ugo"dcpjq."4.3'"rctc"rcekgpvgu"uwdogvkfqu"c"dcpjq"
eqo"ucdçq."g" 3.5'"rctc"cswgngu" uwdogvkfqu" c"dcpjq"eqo" jgzcenqtqhgpq0"
Guvwfqu"fg"Ykjndqti
335"
g"Jc{gm"gv"cn0
336
"rctgego"eqphktoct"cu"qdugtxcèùgu"
fg"Etwug"g"Hqqtf
38
0"Gpvtgvcpvq."qwvtqu"guvwfqu"hcnjctco"go"fgoqpuvtct"woc"
27
ukipkhkecpvg" fkhgtgpèc" pc" vczc" fg" kphgeèçq" fq" uîvkq" qrgtcvôtkq" swcpfq"
fkhgtgpvgu" oêvqfqu" fg" dcpjq" hqtco" gortgicfqu0" Ictkdcnfk" gv" cn0
337
"pçq"
gpeqpvtctco" fkhgtgpèc" ukipkhkecpvg" pc" vczc" fg" kphgeèçq" gpvtg" rcekgpvgu"
ektûtikequ" swg" hqtco" uwdogvkfqu" c" dcpjq" eqo" enqtgzgfkpg" g" c swgngu" swg"
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2.3.4. Remoção dos pelos
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2.3.5. Profilaxia Antimicrobiana
2.3.5.1. Considerações históricas
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2.3.5.2 Princípios da profilaxia antimicrobiana
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kpekuùgu"uçq"hgkvcu"go"vgekfqu"pqtocku."pcu"swcku"pgpjwoc" xîuegtc"ê"cdgtvc."
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rcekgpvgu"eqo"kpfkecèçq"fg"rtqegfkogpvq"ektûtikeq"gngvkxq"rctc"korncpvg"qw"
34
vtqec"fg"igtcfqt"fg"octecrcuuq"fghkpkvkxq0""Hqtco"tcpfqok|cfqu"fg"hqtoc"
rtqurgevkxc." rctc" tgegdgt" qw" pçq" rtqhknczkc" cpvkoketqdkcpc." eqo" enqzceknkpc"
3i" ocku" coqzkeknkpc" 3i" xkc" kpvtcxgpquc" woc" jqtc" cpvgu" fc" ektwtikc" g"
cuuqekcèçq"corkeknkpc"g"hnwenqzceknkpc"722oi"rqt"xkc"qtcn"c"ecfc"8"jqtcu"rqt"
6:" jqtcu." kpke kcpfq" 3" j" crôu" q" rtqegfkogpvq0" Tgegdgtco" rtqhknczkc"
cpvkoketqdkcpc" 466" rcekgpvgu." eqpvtc" 478" swg" pçq" tgegdgtco0" Wo"
cpvkoketqdkcpq" pc" hqtoc" fg" ›urtc{fi" eqpvgpfq" pgqokekpc" *7220222" W+."
dcekvtcekpc" *390722" W+" g" rqnkokzkpc" *3720222" W+" hqk" crnkecfq" pc" nqlc" fq"
octecrcuuq"cpvgu"fc"kpugtèçq"fq"igtcfqt0"Qeqttgtco"2:"ecuqu"fg"kphgeèùgu"
tgncekqpcfcu"cq"rtqegfkogpvq"ektûtikeq"pq"itwrq"swg"tgegdgw"rtqhknczkc"*28"
uwrgthkekcku"g"24"fg"nqlc+"g"35"kphgeèùgu"pq"itwrq"swg"pçq"tgegdgw"rtqhknczkc"
*34" uwrgthkekcku" g" 23" fg" nqlc+." pçq" jcxgpfq" fkhgtgpèc" ukipkhkecvkxc" pc"
kpekfípekc"fg"kphgeèçq"*r?2078"⁄"vguvg"swk/swcftcfq+0"Qu"cwvqtgu"eqpenwîtco"
swg"kphgeèçq"fg"nqlc"fg"octecrcuuq"ê"rqweq"htgs°gpvg"swcpfq"wo"rtgrctq"
ewkfcfquq" fc" rgng" ê" tgcnk|cfq" pq" rtê/qrgtcvôtkq." cnêo" fq" wuq" fg"
cpvkoketqdkcpq" vôrkeq." rtguekpfkpfq" fq" wuq" fc" rtqhknczkc" cpvkoketqdkcpc"
ukuvíokec0"
Dnwjo
365
" cxcnkqw." fg" hqtoc" tgvtqurgevkxc" c" ghkeâekc" fc" rtqhknczkc"
cpvkoketqdkcpc" go" rtqegfkogpvqu" fg" guvkowncèçq" ectfîcec" ctvkhkekcn0" Hqtco"
cpcnkucfqu"494"rcekgpvgu"uwdogvkfqu"c"525"rtqegfkogpvqu"eqpugewvkxqu0"Q"
vgorq" fg" ugiwkogpvq" hqk" fg" 46" c" 55" ogugu0" Rtqhknczkc" cpvkoketqdkcpc" hqk"
gortgicfc"go"vqfqu"qu"ecuqu0"C"vczc"vqvcn"fg"kphgeèçq"hqk"6'0"C"kpekfípekc"
crôu"pqxqu"korncpvgu"hqk"5.:'."vtqecu"fg"igtcfqtgu"4.6'."v tqecu"fg"ecdqu/
gngvtqfqu"37'"g"tgqrgtcèùgu"rtgeqegu"6.4'0"C" ûpkec" fkhgtgpèc" guvcvîuvkec"
qeqttgw" gpvtg" vtqecu" fg" igtcfqtgu" g" ecdqu/gngvtqfqu0" Q" kpvgtxcnq" gpvtg" q"
35
rtqegfkogpvq"g"q"uwtikogpvq"fc"kphgeèçq"xctkqw"fg"25"fkcu"c"3:"ogugu0"Q"
cigpvg" ecwucn" fc" kphgeèçq" hqk" Staphylococcus epidermidis ogvkeknkpq"
tgukuvgpvg"go"26"rcekgpvgu." Staphylococcus epidermidis ogvkeknkpq" ugpuîxgn"
go" 3" rcekgpvg" g" S. aureus ogvkeknkpq" ugpuîxgn" go" 250" Wo" itco/rqukvkxq"
cpcgtôdkeq"hqk"kuqncfq"go"wo"rcekgpvg"g"wo"itco/pgicvkxq"pçq"gpvêtkeq"go"
qwvtq0" 7" kphgeèùgu" hqtco" ewtcfcu" rgnq" vtcvcogpvq" eqo" cpvkdkôvkeq"
kuqncfcogpvg." ocu." go" 9" ecuqu" hqk" pgeguuâtkc" c" tgoqèçq" ektûtikec" fq"
ukuvgoc" fg" guvkowncèçq" ectfîcec0" C" kpekfípekc" fg" kphgeèçq" hqk"
ukipkhkecpvgogpvg"cwogpvcfc"swcpfq"rqvgpekcku"hcvqtgu"fg"rtgfkurqukèçq" ⁄"
diabetes mellitus, postoperative hematoma"g"wuq"fg"gngvtqfq"vgorqtâtkq"/"
guvcxco"rtgugpvgu0" Q"cwvqt" chktoqw"go"uwcu" eqpenwuùgu"swg<" 3+"rtqhknczkc"
cpvkdkôvkec"pçq"hqk"vqvcnogpvg"ghgvkxc="4+"kphgeèùgu"eqo"dcevêtkcu"ogvkeknkpq/
tgukuvgpvgu" eqpuvkvwgo" wo" rtqdngoc." tgswgtgpfq" wo" ugiwkogpvq" eqpvîpwq="
5+"c"kphgeèçq"eqo"dcevêtkc"ugpuîxgn"cq"cpvkoketqdkcpq"gphcv k|c"swg"rtqhknczkc"
eqpvtc" kphgeèçq" rôu/qrgtcvôtkc" pçq" eqpukuvg" uqogpvg" go" ugngekqpct" q"
cpvkoketqdkcpq" crtqrtkcfq=" 6+" qdugtxcèçq" rqt" vgorq" rtqnqpicfq" rctc"
fkcipôuvkeq"fg"kphgeèçq"vctfkc"ê"vcodêo"guugpekcn0"
Oqpug{" gv" cn0
366"
tgcnk|ctco" wo" gpuckq" enîpkeq" rtqurgevkxq."
tcpfqok|cfq" g" cdgtvq" fg" hnwenqzceknkpc" xgtuwu" pçq" wuq" fg" rtqhknczkc"
cpvkoketqdkcpc"go"woc"eqqtvg"fg"rcekgpvgu"uwdogvkfqu"c"rtkogktq"korncpvg"
fg"wo"ukuvgoc"fg"octecrcuuq"fghkpkvkxq"fwtcpvg"39"ogugu0"Cpvkoketqdkcpq"
kpvtcxgpquq"hqk"cfokpkuvtcfq"pq"oqogpvq"fq"korncpvg"g"eqpvkpwcfq"rqt"6:"j0"
Q"fguhgejq"rtkoâtkq"hqk"pqxc"qrgtcèçq"rqt"woc"eqornkecèçq"kphgeekquc0"Wo"
vqvcn"fg"695"rcekgpvgu"hqtco"cfokvkfqu"pq"guvwfq."446"tgegdgtco"rtqhknczkc"
cpvkoketqdkcpc"g"46;"pçq"tgegdgtco0"Cnêo"fkuuq."3:5"rcekgpvgu"pçq"hqtco"
36
tcpfqok|cfqu."ocu"hqtco"vtcvcfqu"fg"ceqtfq"eqo"c"rtghgtípekc"fq"qrgtcfqt"
*86" eqo" cpvkoketqdkcpq" g" 33;" ugo" cpvkoketqdkcpq+." guvgu" hqtco" kpenwîfqu"
uqogpvg"pc"cpânkug"fg"rtgfkvqtgu"fg"kphgeèçq0"Qu"rcekgpvgu"hqtco"ugiwkfqu"
rqt"woc"oêfkc"fg"3;∑7"ogugu0"Gpvtg"qu"rcekgpvgu" fq"itwrq"tcpfqok|cfq"
qeqttgtco" ;" kphgeèùgu." tgswgtgpfq" pqxc" kpvgtxgpèçq" ektûtikec." vqfqu" pq"
itwrq" swg" pçq" tgegdgw" cpvkoketqdkcpq" *r?2.225+" Pq" vqvcn" fg" rcekgpvgu" fc"
eqqtvg."qeqttgtco"35"kphgeèùgu."ugpfq"uqogpvg"woc"pq"itwrq"swg"tgegdgw"
cpvkoketqdkcpq" *r?2.228+0" Pqxg" fq" rcekgpvgu" kphgevcfqu" crtgugpvctco"
gzvtwuçq"fq"igtcfqt"qw"gngvtqfq."5"ugrvkegokc"ugewpfâtkc"c"Staphylococcus
auerus g" 3" e" cdueguuq" fg" nqlc" ugewpfâtkq" c" Staphylococcus epidermidis."
Kphgeèçq" hqk" ukipkhkecvkxcogpvg" ocku" eqowo" swcpfq" q" qrgtcfqt" gtc"
kpgzrgtkgpvg" *≤ 100 procedimentos prévios), cirurgia prolongada, ou após
woc" qrgtcèçq" tgrgvkfc" rqt" eqornkecèçq" pçq" kphgeekquc" *rtkpekrcnogpvg"
fgurqukekqpcogpvq" fg" gngvtqfq+0" Kphgeèçq" pçq" hqk" ukipkhkecvkxcogpvg" ocku"
eqowo"go"rcekgpvgu"kfgpvkhkecfqu"pq"rtê/qrgtcvôtkq"eqoq"fg"cnvq"tkueq"*rqt"
gzgornq." rcekgpvgu" e qo" fkcdgvgu" ognnkvwu" qw" tgegdgpfq" vtcvcogpvq"
rtqnqpicfq" eqo" eqtvkeôkfg+." godqtc" vgpjc" jcxkfq" woc" vgpfípekc" pguuc"
fktgèçq0" Qu" cwvqtgu" eqpenwîtco" swg" rtqhknczkc" cpvkoketqdkcpc" tgfw|kw"
ukipkhkecvkxcogpvg" c" kpekfípekc" fg" eqornkecèùgu" kphgeekqucu." tgswgtgpfq"
woc" tgkpvgtxgpèçq" ektûtikec." crôu" korncpvg" fg" octecrcuuq" fghkpkvkxq0"
Uwigtkpfq"swg"rtqhknczkc"cpvkoketqdkcpc"fgxc"ugt"wucfc"tqvkpgktcogpvg0"
Fc"Equvc"gv"cn0
367"
rwdnkectco"woc"ogvcpânkug"eqo"vqfqu"qu"gpuckqu"
enîpkequ"swg"cxcnkctco"c"ghkeâekc"fc"rtqhknczkc"cpvkoketqdkcpc"rctc"tgfw|kt"c"
htgs°ípekc" fg" kphgeèçq" crôu" rtqegfkogpvqu" ektûtikequ" go" guvkowncè çq"
ectfîcec" ctvkhkekcn0" " Hqtco" kfgpvkhkecfqu" 37" guvwfqu." pqu" swcku" rtqhknczkc"
37
cpvkoketqdkcpc"ukuvíokec"hqk"vguvcfc0"Qkvq"2:"hqtco"gzenwîfqu"rgncu"ugiwkpvgu"
tc|ùgu<"7"pçq"gtco"tcpfqok|cfqu."q"fgugpjq"fq"guvwfq"pçq"gtc"tgngxcpvg"
go" 4" *eqorctcèçq" fg" fqku" fkhgtgpvgu" rtqvqeqnqu" fg" cpvkoketqdkcpqu+." g"
eqorctcèçq" fg" rtqhknczkc" cpvkdkôvkec" nqecn" eqo" ukuvíokec" go" 3" guvwfq0"
Tguvcpfq" ugvg" guvwfqu" swg" cxcnkcxco" q" korcevq" fq" wuq" fg" rtqhknczkc"
cpvkoketqdkcpc" ukuvíokec" pq" tkueq" fg" kphgeèçq" tgncekqpcfc" cq" octecrcuuq0"
Uqogpvg"3"guvwfq."swg"tgrtgugpvcxc"crgpcu"7'"fqu"rcekgpvgu"kpenwîfqu"gtc"
fwrnq/egiq"g"rncegdq"eqpvtqncfq0"Qu"guvwfqu"ugngekqpcfqu"vqvcnk|ctco"4245"
rcekgpvgu." fqu"swcku"3233" tgegdgtco" rtqhknczkc" cpvkoketqdkcpc" g"3234"pçq"
tgegdgtco0"C"kpekfípekc"fg"kphgeèçq"xctkqw"fg"2"c"34'"gpvtg"qu"guvwfqu0"Q"
tguwnvcfq"uwigtkw"wo"eqpukuvgpvg"ghgkvq"rtqvgvqt"fc"rtqhknczkc"cpvkoketqdkcpc"
*r?2.2268="Tc|çq"fg"Ejcpeg<"2.478.";7'"KE<"2.32"c"2.878+0"Q"cwvqt"tguucnvc"
cu" nkokvcèùgu" eqowpu" c" vqfcu" ogvcpânkugu0" Qu" fkhgtgpvgu" guvwfqu"
crtgugpvcxco" fkhgtgpvgu" vêepkecu" ektûtikecu." cpvkuugrukc" fc" rgng."
cpvkoketqdkcpq"wucfq."oqogpvq"fg"uwc"crnkecèçq"g"vgorq"fg"wuq."cnêo"fg"
etkvêtkqu" fkcipôuvkequ" fkhgtgpvgu0" Woc" qwvtc" korqtvcpvg" nkokvcèçq" fguuc"
ogvcpânkug"ê"swg"ug"dcugqw"go"kphqtocèùgu"fq"rcuucfq."swg"rqfg"ngxct"c"
eqpenwuùgu" swg" uçq" eqttgvcu." ocu" pçq" ocku" tgngxcpvgu" pqu" fkcu" cvwcku."
eqpukfgtcpfq"q"rtqitguuq"vgepqnôikeq"g"vgtcríwvkeq0""
Qu" tguwnvcfqu" fguuc" ogvcpânkug" uwigtgo" swg" rtqhknczkc"
cpvkoketqdkcpc" ukuvíokec" tgfw|" c" kpe kfípekc" fg" eqornkecèùgu" kphgeekqucu"
crôu" rtqegfkogpvqu" gpxqnxgpfq" guvkowncèçq" ectfîcec" ctvkhkekcn." rqtêo" q"
cwvqt" chktoc" swg" wo" guvwfq" tcp|qok|cfq." rtqurgevkxq." eqpvtqncfq." fwrnq/
egiq"g"go"nctic"guecnc"ugtkc"ckpfc"pgeguuâtkq"rctc"eqphktoct"vcn"jkrôvgug0"
38
Eqo"guug"rtqrôukvq."hqk"fgugpjcfq"guvg"guvwfq"go"4225."eqo"woc"
nctic"guecnc"fg"rcekgpvgu"g"rtqegfkogpvqu"ektûtikequ"swg"gpxqnxgo"vêepkecu"
ocku" oqfgtpcu" g" eqorngzcu" fg" guvkowncèçq" ectfîcec." eqoq" korncpvgu" fg"
ectfkqxgtuqtgu/fguhkdtkncfqtgu"g"tguukpetqpk|cfqtgu"ectfîcequ0""
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3. OBJETIVOS
3.1. Objetivo primário
" Cxcnkct" c" ghkeâekc" fc" rtqhknczkc" cpvkoketqdkcpc" rctc" rtgxgpkt"
eqornkecèùgu" kphgeekqucu" go" rtqegfkogpvqu" ektûtikequ" fg" guvkowncèçq"
ectfîcec"ctvkhkekcn0"
"
3.2. Objetivo secundário
" Guvcdgngegt"eqttgncèùgu"rtgfkvkxcu"fg"eqornkecèùgu"kphgeekqucu"
pguvgu"vkrqu"fg"rtqegfkogpvqu0"
"
40
4. CASUÍSTICA E MÉTODOS
Hqtco"kpenwîfqu"pq"guvwfq."rtqurgevkxcogpvg."fg"oqfq"eqpugewvkxq"
g" tcpfqok|cfq" qu" rcekgpvgu" uwdogvkfqu" c" rtqegfkogpvqu" ektûtikequ" go"
ukuvgocu"fg"guvkowncèçq"ectfîcec"ctvkhkekcn" pq"Kpuvkvwvq"fq"Eqtcèçq"c"rctvkt"fg"
23"fg"lwnjq"fg"42250""Q"pûogtq"fg"rcekgpvgu"c"ugtgo"kpenwîfqu"pq"guvwfq"hqk"
ecnewncfq" dcugcfq" pc" kpekfípekc" ogfkc" fg" kphgeèçq" pguvg" vkrq" fg"
rtqegfkogpvqu"gpeqpvtcfc"pc"nkvgtcvwtc."eqpukfgtcpfq"woc"rtqdcdknkfcfg"fg"
kphgeèçq"fg"4'."eqo"gttq" α = 5% e poder estatîuvkeq"fg";2'0"Ejgicpfq"c"
wo" p" ecnewncfq" fg" 3222" rcekgpvgu" swg" ugtkco" tcpfqok|cfqu" go" fqku"
itwrqu<""
" Itwrq" K" /" Korncpvg" qw" vtqec" fg" octecrcuuq." ectkqxgtuqt/
fguhkdtkncfqt."tguukpetqpk|cfqt"g1qw"ecdqu/gngvtqfqu"eqo"rtqhknczkc"cpvkdkôvkec"
*Eghc|qnkpc"3i+"⁄"itwrq"vtcvcfq0"
" Itwrq" KK" /" Korncpvg" qw" vtqec" fg" octecrcuuq." ectfkqxgtuqt/
fguhkdtkncfqt."tguukpetqpk|cfqt"g1qw"ecdqu/gngvtqfqu"ugo"rtqhknczkc"cpvkdkôvkec"
*Uqnwèçq"ucnkpc"2.;'+"⁄"itwrq"eqpvtqng0"
Hqtco"fghkpkfqu"qu"ugiwkpvgu"etkvêtkqu"fg"gzenwuçq<"
" Wuq"fg"cpvkkoketqdkcpq"rqt"swcnswgt"qwvtq"oqvkxq=
" Rcekgpvgu" fg" nqecnkfcfgu" fkuvcpvgu." swg" fkhkewnvctkc" q"
ceqorcpjcogpvq"rôu/qrgtcvôtkq=
" Kfcfg"ogpqt"swg"3:"cpqu=
" Rcekgpvgu"uwdogvkfqu"ä"vqtceqvqokc"rctc"korncpvg"fg"gngvtqfq"
go"xgpvtîewnq"guswgtfq=
41
" Ektwtikc"rtêxkc"tgegpvg"*ûnvkoqu"52"fkcu+=
" Kphgeèçq"vtcvcfc"tgegpvg"*ûnvkoqu"52"fkcu+=
" Qwvtc"kpfkecèçq"rctc"rtqhknczkc"cpvkdkôvkec"*gz0"rtôvgug"xcnxct+0
Q"guvwfq"hqk"kpvgttqorkfq"rtgeqegogpvg"rgnq"eqokví"fg"ugiwtcpèc."
eqo"48.7"ogugu"fg"tcpfqok|cèçq."vgpfq"kpenwîfq"86;"rcekgpvgu."ugpfq"536"
pq" itwrq" eghc|qnkpc" g" 557" pq" itwrq" rncegdq." ewlcu" ectcevgtîuvkecu" enîpkeq/
grkfgokqnôikecu"dcucku"guvçq"fgoqpuvtcfcu"pc"Vcdgnc"30"
Tabela 1. Características Clínico-Epidemiológicas Basais
xctkâxgku"
Total"
Itwrq"K"
*Eghc|qnkpc+
Itwrq"KK"
*Rncegdq+"
"
"
n=649" n=314" n=335"
r"
Idade (M±DP)" 64.2±15.3" 64.1±15.9" 64.3±14.8" 0.831
Sexo M (n/%)" 303/46.7" 140/44.6" 163/48.6" 0.290
Classe NYHA (I/II/III/IV)" 292/247/43/1 157/112/16/0 135/135/27/1" 0.052
FEVE (% - M±SD)" 57.2±26.3" 57.4±15.2" 56.8±33.4" 0.826
Diabetes (n/%) 101/15.5 44/14.0" 57/17.0" 0.292
Hipotireoidismo 29/4.4 13/4.1 16/4.8 0.695
Doença Pulmonar Crônica (n/%) 10/1.5 5/1.6 5/1.5 0.53
Terapia com Corticóide (n/%) 6/0.9 3/0.9 3/0.9 1.000
Terapia Anticoagulante (n/%) 51/7.8 15/4.7 36/10.7 0.005
MP temporário (n/%) 88/13.5 38/12.1 50/14.9 0.294
Implante/Troca(n) 303/346 140/174 163/172 0.299
MP/TRC/CDI/Outros(n) 585/8/50/6 283/2/25/4 302/6/25/2 0.439
Duração Procedimento –
min (M±DP)
70.5±34.8 67.5±26.8 73.3±40.8 0.094
"
42
Eqphqtog"fgoqpuvtcfq"pc"Vcdgnc"3."qu"itwrqu"h qtco"ugognjcpvgu."
crtgugpvcpfq" fkhgtgpèc" ukipkhkecvkxc" uqogpvg" pq" wuq" fg" vgtcrkc"
cpvkeqciwncpvg."swg"hqk"ockqt"pq"itwrq"rncegdq0"
"
4.1. Dinâmica do estudo
Qu"rcekgpvgu" hqtco" kpenwîfqu"pq" guvwfq." uqd"eqpugpvkogpvq"nkxtg" g"
fqewogpvcfq." g" uwdogvkfqu" cq" rtqegfkogpvq" ektûtikeq" kpfkecfq." crôu"
tgegdgt" xkc" kpvtcxgpquc." eghc|qnkpc" 3i." qw" kiwcn" xqnwog" fg" uqnwèçq" ucnkpc"
2.;'." eqphqtog" tcpfqok|cèçq." kogfkcvcogpvg" cpvgu" fq" rtqegfkogpvq."
cfokpkuvtcfq" rgnq" oêfkeq" cpguvgukuvc0" Qu" oêfkequ" gpxqnxkfqu" pq"
rtqegfkogpvq"g"pq"ceqorcpjcogpvq"fq"rcekgpvg"g"q"rtôrtkq"rcekgpvg"pçq"
vqocxco"eqpjgekogpvq" fc"kphqtocèçq" uqdtg"swcn"uwduvãpekc"hqtc"crnkecfc"
*fwrnq/egiq+0"C"gueqnjc"fc"eghc|qnkpc"eqoq"cpvkoketqdkcpq"hqk"dcugcfc"go"
gzrgtkípekc"rtêxkc"fc"uwdeqokuuçq"fg"kphgeèçq"jqurkvcnct"fc"kpuvkvwkèçq0"
Qu" rcekgpvgu" hqtco" uwdogvkfqu" cqu" ugiwkpvgu" gzcogu" rtê/
qrgtcvôtkqu."cpvgu"fc"tcpfqok|cèçq<"
•" Jgoqitcoc"eqorngvq"
•" Eqciwnqitcoc"
•" Wtêkc1etgcvkpkpc"
•" Inkegokc"fg"lglwo"
•" Wtkpc"vkrq"K"*rcekgpvgu"eqo"swgkzc"enîpkec"uwiguvkxc"fg"kphgeèçq"
qw"cpvgegfgpvgu"fg"rcvqnqikc"wtqnôikec+"
•" Tcfkqitchkc"fg"vôtcz"*RC"g"Rgthkn+"
43
4.1.1. Procedimentos cirúrgicos
Qu" rtqegfkogpvqu" hqtco" tgcnk|cfqu" go" egpvtq" ektûtikeq." eqo"
cpguvgukc" nqecn" eqo" nkfqecîpc" c" 4'" g" ugfcèçq." eqpfw|kfc" rgnq" oêfkeq"
cpguvgukuvc0" Rcekgpvgu" uwdogvkfqu" c" korncpvg" fg" EFK" qw" tguukpetqpk|cfqt"
ectfîceq"tgegdgtco"cpguvgukc"igtcn"g"xgpvkncèçq"ogeãpkec"kpxcukxc0"
Vqfqu" qu" rcekgpvgu" hqtco" uwdogvkfqu" ä" vtkeqvqokc" g" ncxcigo" fc"
âtgc" c" ugt" qrgtcfc" eqo" inweqpcvq" fg" enqtgzgfkpc" fgigtocpvg" c" 6'" pc"
gphgtoctkc."cpvgu"fg"ugtgo"gpecokpjcfqu"cq"egpvtq"ektûtikeq0""
C" gueqxcèçq" fcu" oçqu" fqu" ektwtikùgu" hqk" tgcnk|cfc" wvknk|cpfq"
gueqxcu"godgdkfcu"eqo"inweqpcvq"fg"enqtgzkfkpc"fgigtocpvg"c"6'0"
C" cpvkuugrukc" fc" rgng" fq" rcekgpvg" hqk" ghgvwcfc" eqo" inweqpcvq" fg"
enqtgzgfkpc"fgigtocpvg"6'."ugiwkfq"fg"inweqpcvq"fg"enqtgzgfkpc"cneqônke c"
c"2.7"'."kogfkcvcogpvg"cpvgu"fq"kpîekq"fq"rtqegfkogpvq0"
Ecdqu/gngvtqfqu" vtcpuxgpququ" rcftùgu" hqtco" kpvtqfw|kfqu" rqt"
fkuugeèçq"fg"xgkc"eghânkec"g1qw"rwpèçq"fg"xgkc"uwdenâxkc"qw"lwiwnct0"
Qu"igtcfqtgu"fg"octecrcuuqu"qw"EFKu"hqtco"korncpvcfqu"go"nqlcu"
uwdewvãpgcu" qw" uwdowuewnctgu." pc" fgrgpfípekc" fq" dkqvkrq" fq" rcekgpvg" g"
rtghgtípekc"fq"qrgtcfqt0"
Pçq"hqk"wucfq" swcnswgt"cigpvg"vôrkeq"rctc"rtqhknczkc"fg"kphgeèçq"pqu"
rcekgpvgu"kpenwîfqu"pq"guvwfq0"
Q" vgekfq" egnwnct" uwdewvãpgq" fc" nqlc" fq" octecrcuuq" qw" EFK" hqk"
hgejcfq" cvtcxêu" fg" rqpvqu" eqpvîpwqu" go" fqku" rncpqu." wvknk|cpfq" hkqu" fg"
rqnkx{etkn."C"rgng"hqk"hgejcfc"eqo"rqpvqu"ugrctcfqu."wvknk|cpfq"hkqu"fg"p{nqp"
7020"
44
Qu" ewtcvkxqu" hqtco" tgcnk|cfqu" eqo" ic|g" guvêtkn" g" hckzcu" cfgukxcu"
*oketqrqtg+"g"ocpvkfqu"rqt"46"j"crôu"q"rtqegfkogpvq0"
Qu" rcekgpvgu" uwdogvkfqu" ä" vtqec" fg" igtcfqt" tgegdgtco" cnvc"
jqurkvcnct" egtec" fg" 8" jqtcu" crôu" q" rtqegfkogpvq=" pq" ecuq" fg" korncpvg" fg"
pqxq" ukuvgoc." vtqec" qw" tgrqukekqpcogpvq" fg" ecdqu/gngvtqfqu." crôu" 46" j 0"
Rcekgpvgu" uwdogvkfqu" ä" tguukpetqpk|cèçq" ectfîcec" rgtocpgegtco"
kpvgtpcfqu"rqt"6:"j"crôu"c"ektwtikc0"Vqfqu"qu"rcekgpvgu"hqtco"uwdogvkfqu"ä"
kpurgèçq"fc"nqlc"g"cxcnkcèçq"fc"tcfkqitchkc"fg"vôtcz"cpvgu"fc"cnvc"jqurkvcnct0"
Rcekgpvgu"uwdogvkfqu"ä"vtqec"fg"igtcfqt"pçq"tgcnk|ctco"tcfkqitchkc"fg"vôtcz"
cpvgu"fc"cnvc0"
Qu" rcekgpvgu" swg" wucxco" cpvkeqciwncpvg" qtcn" h qtco" uwdogvkfqu" ä"
uwduvkvwkèçq"rqt"jgrctkpc"fg"dckzq"rguq"owuewnct"*23"i"rqt"mi"fg"rguq+."xkc"
uwdewvãpgq." cpvgu" fq" rtqegfkogpvq." cvê" swg" q" KPT" cvkpikuug" c" hckzc" kfgcn"
*KPT" >" 3.7+" rctc" ugtgo" uwdogvkfqu" ä" ektwtikc0" " C" cpvkeqciwncèçq" qtcn" hqk"
tgkpvtqfw|kfc"6:"j"crôu"q"rtqegfkogpvq."ocpvgpfq"jgrctkpc"fg"dckzq"rguq"
oqngewnct."pc"fqug"ekvcfc"cekoc."cvê"swg"q"KPT"cvkpikuug"pqxcogpvg"c"hckzc"
cfgswcfc0"
""
4.1.2. Seguimento clínico
Qu"rcekgpvgu"hqtco"cxcnkcfqu" eqphqtog" c" tqvkpc"fq"codwncvôtkq" fg"
octecrcuuq"fc"kpuvkvwkèçq0"
Cxcnkcèçq"enîpkec"*kpenwkpfq"hgtkfc"ektûtikec"g"nqlc"fq"octecrcuuq+"g"
gngvtõpkec"pqu"ugiwkpvgu"rgtîqfqu<"
•"Crôu"32"fkcu"*fwtcpvg"c"tgvktcfc"fg"rqpvqu"fc"kpekuçq"ektûtikec+="
45
•"52"fkcu."25"g"28"ogugu"crôu"q"rtqegfkogpvq0"
Eqpfwvcu"fkcpvg"fg"kpvgteqttípekcu<"
•"Ug"hgdtg"@"5:√E."ugo"ukpcku"fg"kphgeèçq"pc"nqlc"fq"octecrcuuq="
Gzcogu"uqnkekvcfqu<"
•"Jgoqitcoc="
•"Wtkpc"K="
•"Tcfkqitchkc"fg"Vôtcz="
•"Jgoqewnvwtc"* 24"coquvtcu+."eqo"kpvgtxcnq"fg"37"okpwvqu"gpvtg"cu"
eqngvcu="
•"Qwvtqu"gzcogu."c"etkvêtkq"enîpkeq0"
"Ug" ukpcku" fg" kphgeèçq" pc" nqlc" g1qw" ukpcku" enîpkequ" fg" Gpfqectfkvg"
Kphgeekquc<"
•"Kpvgtpcèçq="
•"Kpxguvkicèçq"Enîpkec<"
/Jgoqitcoc"
/Wtkpc"K"
/"Tcfkqitchkc"fg"Vôtcz"
/"Geqectfkqitcoc"Vtcpuguqhâikeq"
/" Jgoqewnv wtc" *4" coquvtcu+." eqo" kpvgtxcnq" fg" 37" okpwvqu" gpvtg" cu"
eqngvcu="
"/"Gzrncpvg"fq"ukuvgoc"*eqphqtog"etkvêtkqu"fguetkvqu"c"ugiwkt+"
"/"Eqngvc"fg"ocvgtkcn"rctc"ewnvwtc"igtcn"*iwkcfq"rqt"wnvtc/uqpqitchkc"
swcpfq"pgeguuâtkq+0"
"
46
4.1.2.1. Definição de infecção na loja de marcapasso
♦" Ftgpcigo"rwtwngpvc="
♦" Kuqncogpvq"fg"oketqqticpkuoq"fg"vgekfq"qw"hnwkfq."eqnjkfq"rqt"
curktcfq"cuugrvkecogpvg"fg"woc"hgtkfc"uwrgthkekcn"qw"fg"woc"eqngèçq="
♦" Rgnq"ogpqu"fqku"fqu"ugiwkpvgu"ukpcku "g1qw"ukpvqocu<"fqt."ecnqt."
jkrgtgokc"qw"hnwvwcèçq"nqecn="
♦" Fgkueípekc" fg" hgtkfc" qrgtcvôtkc" g." rgnq" ogpqu" wo" fqu"
ugiwkpvgu"ukpcku"g1qw"ukpvqocu<"hgdtg"*@5:°E+."fqt"qw"hnwvwcèçq"nqecnk|cfc="
♦" Fkcipôuvkeq" fg" kphgeèçq" hgkvq" rqt" oêfkeq" fq" ugtxkèq" fg"
octecrcuuq0"
"
4.1.2.2. Definição de endocardite relacionada a cabos-eletrodos
Hqtco"wucfqu"qu"etkvêtkqu"oqfkhkecfqu"fg"Fwmg
368
<"
Endocardite Definida
"Etkvêtkqu"Rcvqnôikequ<"
Oketqqticpkuoqu<"fgoqpuvtcfqu"rqt"ewnvwtc"qw"gzco g"jkuvqnôikeq"fg"
xgigvcèçq." go" woc" xgigvcè çq" swg" hqk" godqnk|cfc." qw" cdueguuq"
kpvtcectfîceq."qw"Oketqqticpkuoq"fgoqpuvtcfq"rqt"ewnvwtc"fg"gngvtqfq0"
"Etkvêtkqu"Enîpkequ"*wucpfq"fghkpkèùgu"gurgeîhkecu."eqoq"nkuvcfcu"pq"
Cpgzq"D+<"
Fqku"etkvêtkqu"ockqtgu."qw"wo"etkvêtkq"ockqt"g"vtíu"ogpqtgu."qw"ekpeq"
etkvêtkqu"ogpqtgu0"
"
Possível Endocardite:
47
" Cejcfqu"eqpukuvgpvgu"eqo"gpfqectfkvg"swg"pçq"rtggpejgo"qu"
etkvêtkqu"rctc"kphgeèçq"fghkpkfc."ocu"swg"pçq"rqfg"ugt"fguectvcfc0"
Endocardite Descartada:
"Qwvtq" fkcipôuvkeq" hktocfq" swg" gzrnkswg" cu" gxkfípekcu" fg"
gpfqectfkvg" kphgeekquc." qw" Tguqnwèçq" fc" uîpftqog" fg" gpfqectfkvg." eqo"
cpvkdkôvkeqvgtcrkc"rqt"rgtîqfq"≤"6"fkcu, qw"Cwuípekc"fg"gxkfípekc"rcvqnôike c"
fg"gpfqectfkvg"kphgeekquc"go"ektwtikc"qw"cwvqrukc."eqo"cpvkdkqvkeqvgtcrkc"rqt"
rgtîqfq"≤ 6"fkcu0"
4.1.2.3. Terapêutica de infecção
•" Kphgeèçq" uwrgthkekcn" ⁄" kphncocèçq" fc" kpekuçq" eqo" ugetgèçq"
rwtwngpvc<""
@"52"fkcu"crôu"ektwtikc"a"eghcngzkpc"xkc"qtcn."rqt"32"fkcu0"
>"52"fkcu"crôu"ektwtikc"⁄"ekrtqhnqzcekpc"xkc"qtcn."rqt"32"fkcu0"
•" Kphgeèçq"fg"nqlc<""
@"52"fkcu"crôu"ektwtikc"⁄"eghcnqvkpc"kpvtcxgpquc."rqt"36"fkcu0"
>"52"fkcu"crôu"ektwtikc"⁄"enkpfcokekpc"kpvtcxgpquc."rqt"36"fkcu0"
•" Kphgeèçq" fg" nqlc" eqo" tgrgtewuuçq" ukuvíokec" qw" Gpfqectfkvg<"
xcpeqokekpc"kpvtcxgpquc."rqt"43"fkcu0"
•" C"vgtcrkc"cpvkdkôvkec"hqk"kpkekcfc"ugortg"crôu"eqngvc"fg"ocvgtkcn"
rctc"ewnvwtc"igtcn0"
"
4.1.2.4. Critérios para explante de sistema
•" Eqngèçq"rwtwngpvc"go"nqlc="
48
•" Kuqncogpvq" fg" oketqqticpkuoq" go" ocvgtkcn" eqnjkfq"
cuugrvkecogpvg"fg"woc"eqngèçq"pçq"rwtwngpvc"fg"nqlc="
•" Gpfqectfkvg"fghkpkfc"rqt"etkvêtkqu"oqfkhkecfqu"fg"Fwmg
368
="
•" Rquuîxgn"Gpfqectfkvg"rqt"etkvêtkqu"oqfkhkecfqu"fg"Fwmg
368
."eqo"
gxkfípekcu"fg"kphgeèçq"fg"nqlc="
•" Gzvtwuçq" fg" igtcfqt" qw" ecdqu/gngvtqfqu." eqo" kuqncogpvq" fg"
oketqqticpkuoq="
C"fkpãokec"fq"guvwfq"guvâ"fgoqpuvtcfc"pc"Hkiwtc"30"
"
Figura 1. Dinâmica do Estudo
"
"
Randomização 1:1
Cirurgia
Seguimento Ambulatorial
(10 e 30 dias, 3 e 6 meses)
Infecção superficial
Cultura Secre
ç
ão/Hemocultura/ECO
GI – Cefazolina 1g
GII - Placebo (SF 0,9%)
Infecção loja Infecção sistêmica
Seguimento
Ambulatorial
Internação
Antibióticoterapia
Explante do Sistema de Estimulação
Cultura Secreção/Antibióticoterapia
49
4.1.2.5. Avaliação clínica
Qu"rcekgpvgu"hqtco" cxcnkcfqu"codwncvqtkcnogpvg."fg" ceqtfq"eqo" c"
tqvkpc" fq" codwncvôtkq" fg" octecrcuuq" fc" kpuvkvwkèçq0" Cnêo" fc" cpcopgug" g"
cxcnkcèçq" ectfkqxcuewnct" igtcn." hqtco" uwdogvkfqu" ä" cxcnkcè çq" fcu"
ectcevgtîuvkecu"fc"hgtkfc"qrgtcvôtkc"g"nqlc"fq"octecrcuuq0"Guuc"cxcnkcèçq"hqk"
tgcnk|cfc" eqo" c" hkpcnkfcfg" fg" fkcipquvkect" rquuîxgku" eqornkecèùgu"
tgncekqpcfcu"cq"rtqegfkogpvq."vcku"eqoq"jgocvqoc"fg"nqlc"g"kphgeèçq0""
C"kphgeèçq"fq"uîvkq"ektûtikeq"hqk"encuukhkecfc"fc"ugiwkpvg"hqtoc<"
" Kphgeèçq" uwrgthkekcn<" Kphgeèçq" fc" hgtkfc" qrgtcvôtkc." eqo"
rtgugpèc"fg"ukpcku"kphncocvôtkqu"nqecku"ocku"ugetgèçq"rwtwngpvc"pc"kpekuçq."
ugo"gxkfípekc"fg"ceqogvkogpvq"fc"nqlc"qw"ocpkhguvcèùgu"ukuvíokecu="
" Kphgeèçq" fg" nqlc< Kphgeèçq" nkokvcfc" ä" nqlc." ugo" gxkfípekc" fg"
ocpkhguvcèùgu"ukuvíokecu="
" Kphgeèçq"ukuvíokec<"Kphgeèçq"fg"nqlc"cuuqekcfc"ä"gxkfípekcu"fg"
ocpkhguvcèùgu"ukuvíokecu="
" Gpfqectfkvg<"Wvknk|coqu"qu"etkvêtkqu"oqfkhkecfqu"fg"Fwmg
368
."lâ"
fguetkvqu0"
Hqtco" eqpukfgtcfqu" rcekgpvgu" eqo" ocpkhguvcèùgu" ukuvíokecu" qu"
swg"crtgugpvcxco"rgnq"ogpqu"24"fqu"ugiwkpvgu"etkvêtkqu<"
•" Hgdtg"*vgorgtcvwtc"eqtrqtcn"@5:√E+"qw"jkrqvgtokc"*vgorgtcvwtc"
eqtrqtcn>58√E+="
•" Vcswkectfkc"⁄"htgswípekc"ectfîcec"@;2"dro="
•" Vcswkrpêkc"⁄"htgswípekc"tgurktcvôtkc"@42"ktro="
•" Ngweqekvqug"qw"ngweqrgpkc"⁄"Ngweôekvqu"@340222"egnu1oo5"qw"
>60222"egnu1oo5."qw"rtgugpèc"fg"@32'"fg"hqtocu"lqxgpu"*dcuvùgu+0"
50
Qu"rcekgpvgu"eqo"uwurgkvc"fg"jgocvqoc"fg"nqlc."kphgeèçq"qw"hgdtg."
c" guenctgegt." hqtco" cxcnkcfqu" rqt" wo" ûpkeq" oêfkeq." q" eqqtfgpcfqt" fq"
guvwfq." swg" wvknk|cxc" qu" etkvêtkqu" fguetkvqu" cekoc" rctc" q" fkcipôuvkeq" g"
eqpfwvc0""
"
4.1.2.6. Avaliação eletrônica
Hqk"tgcnk|cfc" go"vqfcu"cu" eqpuwnvcu."ugiwkpfq"vcodêo"c"tqvkpc"fq"
codwncvôtkq"fg"octecrcuuq0"Hqtco"cxcnkcfqu"qu"ugiwkpvgu"rctãogvtqu<"
•" Gngvtqectfkqitcoc"fg"vtíu"fgtkxcèùgu"*FK."FKK"g"FKKK+="
•" Vgngogvtkc"g"kpvgttqicèçq"fq"crctgnjq"fg"guvkowncèçq"ectfîcec="
•" Cxcnkcèçq" fqu" rctãogvtqu" gngvtõpkequ<" xqnvcigo" g" korgfãpekc"
fc" dcvgtkc." korgfãpekc" fqu" ecdqu/gngvtqfqu." nkokctgu" fg" ugpukdknkfcfg" g"
ecrvwtc" cvtkcku" g" xgpvtkewnctgu." cpânkug" fcu" guvcvîuvkecu" tgikuvtcfcu" rgnq"
crctgnjq="
•" Tgrtqitcocèçq" fg" rctãogvtqu" gngvtõpkequ" eqphqtog" c"
pgeguukfcfg"fg"ecfc"ecuq="
•" Kpvgtpcèçq"g"tgkpvgtxgpèçq"ektûtikec"swcpfq"pgeguuâtkq0"
Qu" rcekgpvgu" uwdogvkfqu" c" tgkpvgtxgpèçq" ektûtikec" fwtcpvg" qu" 28"
ogugu" fg" ugiwkogpvq." rqt" swcnswgt" oqvkxq." gzegvq" kphgeèçq." hqtco"
gzenwîfqu"fq"guvwfq0""
"
4.1.2.7. Ecocardiograma transesofágico
" Qu" rcekgpvgu" swg" crtgugpvcxco" kphgeèçq" fg" nqlc" qw" hgdtg" ewlc" ecwuc"
pçq"gtc"guenctgekfc"rgnc"cxcnkcèçq"enîpkec."tcfkqitchkc"fg"vôtcz"g"wtkpc"K."hqtco"
51
uwdogvkfqu" c" geqectfkqitcoc" vtcpuguqhâikeq" rctc" kpxguvkicèçq" fkcipôuvkec"
fg"gpfqectfkvg"kphgeekquc0"
""
4.1.2.8. Isolamento do agente infeccioso
Q" kuqncogpvq" fq" cigpvg" gvkqnôikeq" fq" rtqeguuq" kphgeekquq" hqk"
tgcnk|cfq" cvtcxêu" fg" eqngvc" fg" ugetgèçq" rctc" ewnvwtc" igtcn." pq" ecuq" fg"
kphgeèçq"uwrgthkekcn0""
Qu" rcekgpvgu" eqo" kphgeèçq" fg" nqlc" hqtco" uwdogvkfqu" ä" eqngvc" fg"
ugetgèçq"fc"nqlc" rctc"ewnvwtc" igtcn." jgoqewnvwtc"*4"coquvtcu+" g"ewnvwtc"fc"
rqpvc"fq"gngvtqfq."crôu"gzrncpvg"fq"ukuvgoc0""
Rcekgpvgu" eqo" hgdtg" c" guenctgegt" hqtco" uwdogvkfqu" ä" eqngvc" fg"
ucpiwg" rctc" jqoqewnvwtc" *4" coquvtcu+." crôu" gzenwuçq" fg" qwvtqu" hqequ" fg"
kphgeèçq0"
"
4.1.3. Comitê de segurança
Rctc" cpânkug" fqu" tguwnvcfqu." hqk" etkcfq" wo" eqokví" fg" ugiwtcpèc."
eqorquvq" rqt" 27" ogodtqu." pçq" gpxqnxkfqu" pc" cxcnkcèçq" g" ugiwkogpvq" fqu"
rcekgpvgu." swg" ug" tgwpkco" ugoguvtcnogpvg0" Hqk" guvcdgngekfq" swg" q" guvwfq"
ugtkc"kpvgttqorkfq"cq"cvkpikt"fkhgtgpèc"guvcvîuvkec"ukipkhkecvkxc"pc"kpekfípe kc"fg"
kphgeèçq"gpvtg"qu"fqku"itwrqu"*eqo"g"ugo"rtqhknczkc"cpvkdkôvkec+."eqpukfgtcpfq"
eqoq"ukipkhkecvkxq"q"xcnqt"fg"r">"2.270"
"
"
52
4.2. Variáveis submetidas à análise estatística
Cnêo"fc"eqorctcèçq"fc"kpekfípekc"fg"kphgeèçq"gpvtg"qu"itwrqu"*eqo"
g"ugo"rtqhknczkc"cpvkdkôvkec+."hqtco"eqpukfgtcfqu"rctc"cpânkug"guvcvîuvkec"go"
dwucec"fg"hcvqtgu"rtgfkvqtgu"fg"kphgeèçq"cu"ugiwkpvgu"xctkâxgku<"
30" Ugzq."eqphqtog"fkuvtkdwkèçq"fq"itwrq="
40" Kfcfg"*cpqu+="
50" Ectfkqrcvkc"fg"dcug"
60" Encuug"hwpekqpcn"fg"kpuwhkekípekc"ectfîcec"rgnc"Pgy"[qtm"Jgctv"
Cuuqekcvkqp="
70" Htcèçq"fg"glgèçq"fq"xgpvtîewnq"guswgtfq."rgnq"geqectfkqitcoc."
oêvqfq"fg"Ukoruqp0"
80" Fkcdgvgu"Ognnkvwu="
90" Jkrqvktgqkfkuoq="
:0" Fqgpèc"Rwnoqpct"Qduvtwvkxc"Etõpkec="
;0" Jkrgtvgpuçq"Ctvgtkcn"Ukuvíokec="
320" Kpuwhkekípekc"Tgpcn"Etõpkec="
330" Wuq"fg"eqtvkequvgtôkfg"rqt"swcnswgt"oqvkxq="
340" Wuq"fg"cpvkeqciwncpvgu="
350" Wuq"fg"octecrcuuq"vgorqtâtkq="
360" Vkrq"fg"rtqegfkogpvq<"vtqec"qw"korncpvg="
370" Eqorngzkfcfg" fq" rtqegfkogpvq<" octecrcuuq" eqpxgpekqpcn."
tguukpetqpk|cfqtgu" ectfîcequ." ectfkqfguhkdtkncfqtgu." rtqegfkogpvqu" go"
ecdqu/gngvtqfqu="
380" Fwtcèçq"fq"rtqegfkogpvq="
390" Jgocvqoc"fg"nqlc0"
53
4.3. Análise estatística
Cu" xctkâxgku" encuukhkecvôtkcu" hqtco" crtgugpvcfcu" go" vcdgncu" g"
itâhkequ" eqpvgpfq" htgs°ípekcu" cduqnwvcu" g" tgncvkxcu" g" eqorctcfcu" eqo" q"
vguvg" swk/swcftcfq" qw" vguvg" gzcvq" fg" Hkujgt" *ugzq." ectfkqrcvkc" fg" dcug."
encuug"hwpekqpcn"fg"kpuwhkekípekc"ectfîcec."fkcdgvgu"ognnkvwu."jkrqvktgqkfkuoq."
fqgpèc" rwnoqpct" qduvtwvkxc" etõpkec." jkrgtvgpuçq" ctvgtkcn" ukuvíokec."
kpuwhkekípekc"tgpcn"etõpkec."wuq"fg"eqtvkequvgtôkfgu."wuq"fg"cpvkeqciwncpvgu."
wuq" fg" octecrcuuq" vgorqtâtkq." wuq" fg" rtqhknczkc" cpvkdkôvkec." vkrq" fg"
rtqegfkogpvq."eqorngzkfcfg"fqu"rtqegfkogpvqu"g"qeqttípekc"fg"jgocvqoc"
fg"nqlc+0"Cu"xctkâxgku"swcpvkvcvkxcu"hqtco"crtgugpvcfcu"eqoq"oêfkc"∑"fguxkq"
rcftçq" g" eqorctcfcu" eqo" vguvg" v" fg" Uvwfgpv" qw" uqoc" fg" rquvqu" fg"
Ykneqzqp" *kfcfg." htcèçq" fg" glgèçq" fq" xgpvtîewnq" guswgtfq" g" fwtcèçq" fq"
rtqegfkogpvq+0" Cu" xctkâxgku" swg" crtgugpv ctco" ukipkhkeãpekc" guvcvîuvkec" pc"
cpânkug" wpkxctkcfc" hqtco" wvknk|cfcu" pq" clwuvg" fq" oqfgnq" fg" tgitguuçq"
nqiîuvkec" oûnvkrnc" *›uvgrykug fi+0" Qu" xcnqtgu" fg" r>2.27" hqtco" eqpukfgtcfqu"
guvcvkuvkecogpvg"ukipkhkecpvg
369
0""
"
"
5. RESULTADOS
Q" guvwfq" hqk" kpvgttqorkfq" crôu" 48.7" ogugu" fg" tcpfqok|cèçq." rqt"
crtgugpvct" fkhgtgpèc" ukipkhkecvkxc" pc" kpekfípekc" fg" kphgeèçq." eqo" crgpcu" 24"
ecuqu"pq"itwrq"swg"tgegdgtc"eghc|qnkpc"3i"kpvtcxgpquc"*2.86'+"g"33"ecuqu"fg"
kphgeèçq" pq" itwrq" rncegdq" *uqnwèçq" ucnkpc" 2.;'" kpvtcxgpquc." kiwcn" xqnwog+."
eqphqtog" cpcnkucfq" rgnq" vguvg" swk/swcftcfq" *r?2.238+." fgoqpuvtcfq" pq"
Itâhkeq"30"
"
5.1. Variáveis Analisadas
Qu"tguwnvcfqu"fcu"xctkâxgku"cpcnkucfcu"hqtco"qu"ugiwkpvgu<"
0,64
3,28
0
0,5
1
1,5
2
2,5
3
3,5
porcentagem de pacientes
infectados (%)
Gráfico 1. Incidência de infecção por grupo
Cefazolina Placebo
p=0,016
55
5.1.1. Sexo
Hqtco"kpenwîfqu"568"rcekgpvgu"fq"ugzq"hgokpkpq"*75.53'+"g"525"fq"
ugzq" ocuewnkpq." ugpfq" 396" rcekgpvgu" fq" ugzq" hgokpkpq" pq" itwrq" swg"
tgegdgw" eghc|qnkpc" g" 394" pq" itwrq" swg" tgegdgw" rncegdq0" Pçq" qeqttgw"
fkhgtgpèc" guvcvîuvkec" go" tgncèçq" cq" ugzq" gpvtg" qu" 24" itwrqu0 " Fq" oguoq"
oqfq." c" cpânkug" fc" kphnwípekc" fq" ugzq" pc" kpekfípekc" fg" kphgeèçq." rgnq"
oêvqfq" swk/swcftcfq." pçq" oquvtqw" cuuqek cèçq" ukipkhkecpvg" fguuc" xctkâxgn"
*r?2.76:+."eqphqtog"fgoqpuvtcfq"pq"Itâhkeq"40"
"
"
"
"
"
"
"
"
"
5.1.2. Idade
C"kfcfg"xctkqw"fg"3;"c";8"cpqu"*O"?"86.4"∑"37.5+."oêfkc"86.3∑"
37.;" pq" itwrq" eghc|qnkpc" g" 86.5" ∑" 36.:" pq" itwrq" rncegdq." pçq" jcxgpfq"
fkhgtgpèc"guvcvîuvkec"gpvtg"qu" itwrqu0" Fq" oguoq" oqfq" pçq" jqwxg" fkhgtgpèc"
1,65
2,31
0
0,5
1
1,5
2
2,5
porcentagem de pacientes
infectados (%)
Gráfico 2. Incidência de infecção por sexo
Masculino Feminino
p=0,54
56
ukipkhkecvkxc" pc" kpekfípekc" fg" kphgeèçq" eqo" tgncèçq" ä" kfcfg" rgnq" vguvg" v" fg"
Uvwfgpv"*r?2.47+."eqphqtog"fgoqpuvtcfq"pq"Itâhkeq"50"
"
"
"
5.1.3. Cardiopatia de base
Cu" ectfkqrcvkcu" ocku" htgs°gpvgu" hqtco<" ejciâukec" *3:.3:'+."
kuswíokec" *:.54'+." jkrgtvgpukxc" *5.2:'+" fkncvcfc" *6.84'+" g" jkrgtvtôhkec"
*3.76'+0"Pçq"qeqttgw"fkhgtgpèc"ukipkhkecvkxc"pc"kpekfípekc"fg"ectfkqrcvkc"gpvtg"
qu" fqku" itwrqu0" Pçq" jqwxg" kphnwípekc" guvcvkuvkecogpvg" ukipkhkecvkxc" fc"
ectfkqrcvkc"fg"dcug"pc"kpekfípekc"fg"kphgeèçq"*r?2.38+."eqphqtog"Itâhkeq"260"
"
70,1
89,6
0
20
40
60
80
100
tempo (min)
Gráfico 3. Incidência de infecção por duração do
procedimento
Não Infectado Infectado
p=0,25
57
"
5.1.4. Classe funcional de insuficiência cardíaca
" Pq" oqogpvq" fg" kpenwuçq" pq" guvwfq" 4;4" rcekgpvgu" *66.;;'+" guvcxco""
go"EH"K"*P[JC+."469"*5:.27'+""go"EH"KK."65"*8.84'+"go"EH"KKK"g"crgpcu"23"
rcekgpvg"*2.37'+"guvcxc""go"EH"KX0"Pçq"jqwxg"fkhgtgpèc"ukipkhkecvkxc"gpvtg"qu"
itwrqu" eghc|qnkpc" g" rncegdq" swcpvq" ä" encuug" hwpekqpcn" fg" kpuwhkekípekc"
ectfîcec0"C"encuug"hwpekqpcn"fg"kpuwhkekípekc"ectfîcec"pçq"eqttgncekqpqw"eqo"c"
kpekfípekc" fg" kphgeèçq" rgnq" vguvg" swk/swcftcfq" *r?2.8:+." fgoqpuvtcfq" pq"
Itâhkeq"70"
0
0
2
4
6
8
10
porcentagem de pacientes
infectados (%)
Grafico 4. Incidência de infecção por cardiopatia
de base
Chagásica Isquêmica Hipertensiva
Dilatada Hipertrófica Outras
p=0,16
58
5.1.5. Fração de ejeção do ventrículo esquerdo
C"htcèçq"fg"glgèçq"fq"xgpvtîewnq"guswgtfq"oêfkc"*HGXG+"hqk"fg"79.4"∑"
45."ugpfq"79.6"∑"37.4" pq"itwrq"eghc|qnkpc" g" 78.:" ∑" 55.6" pq" itwrq" rncegdq0"
Pçq" jqwxg" fkhgtgpèc" guvcvkuvkecogpvg" ukipkhkecvkxc" gpvtg" qu" fqku" itwrqu0" C"
htcèçq" fg" glgèçq" pçq" kphnwgpekqw" pc" kpekfípekc" fg" kphgeèçq" rgnq" vguvg" v" fg"
Uvwfgpv"*r?2.32+."fgoqpuvtcfq"pq"Itâhkeq"80"
"
"
"
"
"
0
2
4
6
8
10
porcentagem de pacientes
infectados(%)
Gráfico 5. Incidência de infecção por classe
funcional de insuficiência cardíaca (NYHA)
I II III IV
p=0,68
59
"
"
5.1.6. Diabetes mellitus
Pq" oqogpvq" fc" tcpfqok|cèçq" 323" rcekgpvgu" *37.78'+" vkpjco" q"
fkcipôuvkeq" fg" fkcdgvgu" ognnkvwu0" C" rtgxcnípekc" fg" rcekgpvgu" fkcdêvkequ" hqk"
36.23'" pq" itwrq" eghc|qnkpc" g" 39.23'" pq" itwrq" rncegdq." pçq" jcxgpfq"
fkhgtgpèc" guvcvkuvkecogpvg" ukipkhkecvkxc0 " C" rtgugpèc" fg" fkcdgvgu " pçq"
eqttgncekqpqw" eqo" ockqt" kpekfípekc" fg" kphgeèçq" rgnq" vguvg" gzcvq" fg" Hkujgt"
*r?2.34+."eqphqtog"Itâhkeq"90"
57,3
50,2
46
48
50
52
54
56
58
porcentagem de pacientes
infectados(%)
Gráfico 6. Incidência de infecção por função
ventricular esquerda - FEVE (%)
Não Infectado Infectado
p=0,10
60
5.1.7. Hipotireoidismo
Jkrqvktgqkfkuoq" guvgxg" rtgugpvg" go" 4;" rcekgpvgu" *6.68'+." 35"
rcekgpvgu" *6.36'+" pq" itwrq" eghc|qnkpc" g" 38" *6.99'+" pq" itwrq" rncegdq0" Pçq"
jqwxg"fkhgtgpèc"ukipkhkecvkxc"pc"rtgxcnípekc"fg"jkrqvktgqkfkuoq"gpvtgu"qu"fqku"
itwrqu0" Pq" Itâhkeq" :." guvâ" fgoqpuvtcfc" c" cwuípekc" fg" eqttgncèçq" gpvtg"
jkrqvktgqkfkuoq"g"c"kpekfípekc"fg"kphgeèçq"rgnq"vguvg"gzcvq"fg"Hkujgt"*r?2.33+0"
1,64
3,96
0
1
2
3
4
porcentagem de pacientes
infectados (%)
Gráfico 7 Incidência de infecção em relação a
presença de diabetes mellitus
Não diabéticos Diabéticos
p=0,12
61
"
"
"
"
"
"
"
"
"
"
"
5.1.8. Doença pulmonar obstrutiva crônica
Hqtco" kpenwîfqu" pq" guvwfq" 32" rcekgpvgu" *3.76'+" eqo" fqgpèc"
rwnoqpct" qduvtwvkxc" etõpkec." ugpfq" 28" *3.;3'+" pq" itwrq" eghc|qnkpc" g" 26"
*3.3;'+"pq"itwrq"rncegdq0"Pçq"jqwxg"fkhgtgpèc"guvcvkuvkecogpvg"ukipkhkecvkxc"
gpvtgu" qu" fqku" itwrqu" swcpvq" ä" qeqttípekc" fg" fqgpèc" rwnoqpct" qduvtwvkxc"
etõpkec0"C"cpânkug"fc"eqttgncèçq"gpvtg"kphgeèçq"g"fqgpèc"rwnoqpct"qduvtwvkxc"
etõpkec" pçq" hqk" guvcvkuvkecogpvg" ukipkhkecvkxc." rgnq" vguvg" gzcvq" fg" Hkujgt"
*r?2.3:+0"Fgoqpuvtcfc"pq"Itâhkeq";0"
"
"
1,77
6,89
0
1
2
3
4
5
6
7
porcentagem de pacientes
infectados (%)
Gráfico 8. Incidência de infecção em relação a
presença de hipotireoidismo
Sem Hipotireoidismo Com Hipotireoidismo
p=0,11
62
"
"
5.1.9. Hipertensão arterial sistêmica
Jkrgtvgpuçq" ctvgtkcn" ukuvíokec" *JCU+" guvcxc" rtgugpvg" go" 622"
rcekgpvgu"*83.85'+."ugpfq" 3;;"*85.59'+"pq" itwrq"eghc|qnkpc"g" 423"*82.2'+"
pq" itwrq" rncegdq0" C" htgs°ípekc" fg" jkrgtvgpuçq" ctvgtkcn" ukuvíokec" hqk"
guvcvkuvkecogpvg" ugognjcpvg" gpvtg" qu" fqku" itwrqu0" Eqoq" rqfgoqu" qdugtxct"
pq" Itâhkeq" 32." pçq" jqwxg" eqttgncèçq" gpvtg" rtgugpèc" fg" jkrgtvgpuçq" ctvgtkcn"
ukuvíokec"g"kpekfípekc"fg"kphgeèçq"rgnq"vguvg"gzcvq"fg"Hkujgt"*r?3.2+0"
"
"
1,88
10
0
2
4
6
8
10
porcentagem de pacientes
infectados (%)
Gráfico 9. Incidência de infecção em relação a
presença de DPOC
Sem DPOC Com DPOC
p=0,18
63
"
"
"
"
"
"
"
"
"
"
"
"
"
5.1.10. Insuficiência renal crônica
Pqxg" rcekgpvgu" *3.5:'+" vkpjco" fkcipôuvkeq" fg" kpuwhkekípekc" tgpcn"
etõpkec" pq" oqogpvq"fg"kpenwuçq" pq" guvwfq." ugpfq" 26" rcekgpvgu" *3.49'+" pq"
itwrq" eghc|qnkpc" g" 27" *3.6;'+" pq" itwrq" rncegdq0" Pçq" jqwxg" fkhgtgpèc"
guvcvîuvkec"gpvtg"qu"itwrqu0"C"cpânkug"rgnq"vguvg"gzcvq"fg"Hkujgt"pçq"oquvtqw"
eqttgncèçq" gpvtg" kpuwhkekípekc" tgpcn" etõpkec" g" kphgeèçq" *r?3.2+." fgoqpuvtcfc"
pc"Itâhkeq"330"
"
"
2
2
0
0,5
1
1,5
2
porcentagem de pacientes
infectados (%)
Gráfico 10. Incidência de infecção em relação à
presença de HAS
Sem HAS Com HAS
p=1,0
64
"
"
5.1.11. Uso de corticosteróides
Ugku"rcekgpvgu"*2.;4'+"fqu"rcekgpvgu"kpenwîfqu"pq"guvwfq"hc|kco"wuq"
fg"eqtvkequvgtôkfgu"etqpkecogpvg."ugpfq"25"*2.;7'+"pq"itwrq"eghc|qnkpc"g"26"
*2.:;'+" pq" itwrq" rncegdq0" Pçq" jcxgpfq" fkhgtgpèc" guvcvkuvkecogpvg"
ukipkhkecvkxc"gpvtg"qu"fqku"itwrqu0"Q"wuq"fg"eqtvkequvgtôkfg"pçq"kphnwgpekqw"pc"
kpekfípekc" fg" kphgeèçq." eqphqtog" cpânkug" rgnq" vguvg" gzcvq" fg" Hkujgt" *r?3.2+."
fgoqpuvtcfq"pq"Itâhkeq"340"
"
"
"
"
"
2,03
0
0
0,5
1
1,5
2
2,5
porcentagem de pacientes
infectados (%)
Gráfico 11. Incidência de infecção em relação a
presença de IRC
Sem IRC Com IRC
p=1,0
65
"
"
"
"
"
5.1.12. Uso de anticoagulante
Hqtco"kpenwîfqu"73"rcekgpvgu"*9.:8'+"go"wuq"fg"cpvkeqciwncpvg"qtcn0""
Q" wuq" fg" cpvkeqciwncpvg" qtcn" hqk" guvcvkuvkecogpvg" ocku" htgs°gpvg" pq" itwrq"
rncegdq." 58" rcekgpvgu" *32.96'+" swg" pq" itwrq" eghc|qnkpc." 37" rcekgpvgu"
*6.99'+." rgnq" vguvg" swk/swcftcfq" *r?2.227+0" Gpvtgvcpvq." q" wuq" fg"
cpvkeqciwncpvg" pçq" eqttgncekqpqw" eqo" c" kpekfípekc" fg" kphgeèçq" rgnq" vguvg"
gzcvq"fg"Hkujgt"*r?2.29+."eqphqtog"fgoqpuvtcfq"pq"Itâhkeq"350"
"
2,02
0
0
0,5
1
1,5
2
2,5
porcentagem de pacientes
infectados (%)
Gráfico 12. Incidência de infecção em relação ao
uso de corticosteróides
Sem Corticosteróides Com Costicosteróides
p=1,0
66
"
"
"
"
"
"
"
"
"
5.1.13. Uso de marcapasso temporário
Pq" oqogpvq" fc" kpenwuçq" pq" guvwfq" ::" rcekgpvgu" *35.78'+" guvcxco"
go" wuq" fg" octecrcuuq" vgorqtâtkq" jâ" rgnq" ogpqu" 46" j0" Q" pûogtq" fg"
rcekgpvgu"go"wuq"fg"octecrcuuq"vgorqtâtkq"hqk"guvcvkuvkecogpvg"ugognjcpvg."
5:" rcekgpvgu" *34.3'+" pq" itwrq" eghc|qnkpc" g" 72" *36.;4'+" pq" itwrq" rncegdq0"
Eqphqtog"qdugtxcfq"pq"Itâhkeq"36."q"wuq"fg"octecrcuuq"vgorqtâtkq"pçq"ug"
eqttgncekqpqw" eqo" c" kpekfípekc" fg" kphgeèçq" rgnq" vguvg" gzcvq" fg" Hkujgt" *r?"
2.62+0"
"
0,17
5,88
0
1
2
3
4
5
6
porcentagem de pacientes
infectados (%)
Gráfico 13. Incidência de infecção em relação ao
uso de anticoagulantes
Sem Anticoagulante Com Anticoagulante
p=0,07
67
"
"
"
"
"
"
"
"
"
"
"
"
5.1.14. Tipo de procedimento
Fwtcpvg" q" rgtîqfq" fg" kpenwuçq" fq" guvwfq" hqtco" tgcnk|cfqu" 525"
korncpvgu"*68.8:'+"g"568"vtqecu"fg"igtcfqtgu"*75.53'+0"Q"pûogtq"fg"vtqecu"
pq" itwrq" eghc|qnkpc" hqk" 396" *77.63'+" g" pq" itwrq" rncegdq" hqk" 394" *73.56'+."
pçq" jcxgpfq" fkhgtgpèc" guvcvkuvkecogpvg" ukipkhkecvkxc0" Go" cpânkug" wpkxctkcfc."
rgnq" vguvg" swk/swcftcfq." jqwxg" ockqt" kpekfípekc" fg" kphgeèçq" pqu" rcekgpvgu"
uwdogvkfqu"c"korncpvg"*32"ecuqu+"swg"pqu"r cekgpvgu"uwdogvkfqu"äu"vtqecu"fq"
igtcfqtgu"*5"ecuqu+"*r?2.24+."eqphqtog"fgoqpuvtcfq"pq"Itâhkeq"370"
"
1,78
3,41
0
0,5
1
1,5
2
2,5
3
3,5
porcentagem de pacientes
infectados (%)
Gráfico 14. Incidência de infecção em relação ao
uso de marcapasso temporário
Sem MPT Com MPT
p=0,40
68
"
"
"
5.1.15. Complexidade dos procedimentos
Hqtco"tgcnk|cfqu"7:7"rtqegfkogpvqu"go"octecrcuuqu"eqpxgpekqpcku"
*;2.36'+." 72" go" ectfkqxgtuqtgu" fguhkdtkncfqtgu" korncpvâxgku" *9.92'+." :" go"
tguukpetqpk|cfqtgu"ectfîcequ"*3.45'+"g"28"qwvtqu"vkrqu"fg"rtqegfkogpvqu"swg"
gpxqnxkco" uqogpvg" vtqec" qw" tgrqukekqpcogpvq" fg" ecdqu/gngvtqfqu" *2.;4'+0"
Pçq" jqwxg" fkhgtgpèc" guvcvkuvkecogpvg" ukipkhkecvkxc" gpvtg" qu" itwrqu" swcpvq" ä"
eqorngzkfcfg" fqu" rtqegfkogpvqu0" Eqoq" rqfgoqu" pqvct" pq" Itâhkeq" 38." c"
eqorngzkfcfg" fqu" rtqegfkogpvqu" pçq" eqttgncekqpqw" eqo" c" kpekfípekc" fg"
kphgeèçq" rgnq" v guvg" swk/swcftcfq" *r?2.;2+0" Qu" rtqegfkogpvqu" fg" vtqecu" qw"
tgrqukekqpcogpvqu" fg" ecdqu/gngvtqfqu" hqtco" eqpukfgtcfqu" eqoq" korncpvgu"
rctc"c"tgcnk|cèçq"fg"cpânkug"guvcvîuvkec0"
"
0,87
3,3
0
0,5
1
1,5
2
2,5
3
3,5
porcentagem de pacientes
infectados (%)
Gráfico 15. Incidência de infecção por tipo de
procedimento
Troca Implante
p=0,027
69
"
"
"
"
"
"
"
"
"
5.1.16. Duração do procedimento
C" fwtcèçq" oêfkc" fqu" rtqegfkogpvqu" hqk" fg" 92.7" ∑" 56.:" okpwvqu."
ugpfq"89.7"∑"48.:"okpwvqu"pq"itwrq"eghc|qnkpc"g"95.5"∑"62.:"okpwvqu" pq"itwrq"
rncegdq0"C"fwtcèçq"hqk"guvcvkuvkecogpvg"ugognjcpvg"gpvtg"qu"fqku"itwrqu0"Qu"
rtqegfkogpvqu" eqo" fwtcèçq" ocku" rtqnqpicfc" crtgugpvctco" kpekfípekc" fg"
kphgeèçq" guvcvkuvkecogpvg" ocku" gngxcfc" go" cpânkug" wpkxctkcfc." rgnq" vguvg" fc"
uqoc" fg" rquvqu" fg" Ykneqzqp" *r?2.22;+." ugpfq." rqtvcpvq." wo" octecfqt" fg"
2,05
0
1
0
0,5
1
1,5
2
2,5
porcentagem de pacientes
infectados (%)
Gráfico 16. Incidência de infecção em relação à
complexidade dos procedimentos
Marcapasso Ressincronizador CDI
p=0,90
70
qeqttípekc" fg" kphgeèçq." eqphqtog" fgoqpuvtcfq" pq" Itâhkeq" 390"
"
5.1.17. Hematoma de loja
Jgocvqocu" fg" nqlcu" pq" rôu/qrgtcvôtkq" qeqttgtco" go" 38" rcekgpvgu"
*4.68'+."ugpfq"7"*2.38'+"pqu"rcekgpvgu"fq"itwrq"eghc|qnkpc"g"33"*5.4:'+"pqu"
rcekgpvgu" fq" itwrq" rncegdq0" Pçq" jqwxg" fkhgtgpèc" guvcvkuvkecogpvg"
ukipkhkecvkxc" pc" qeqttípekc" fg" jgocvqoc" gpvtg" qu" itwrqu0" C" rtgugpèc" fg"
jgocvqoc" fg" nqlc" h qk" wo" octecfqt" fg" ockqt" qeqttípekc" fg" kphgeèçq" go"
cpânkug" wpkxctkcfc." rgnq" vguvg" gzcvq" fg" Hkujgt" *r?2.25:+." eqphqtog"
fgoqpuvtcfq"pq"Itâhkeq"3:0""
70,1
89,6
0
20
40
60
80
100
tempo (min)
Gráfico 17. Incidência de infecção por duração do
procedimento
Não Infectado Infectado
p=0,009
71
"
"
"
"
"
"
"
"
"
"
"
"
"
"
"
"
"
"
"
5.2. Análise multivariada
C" cpânkug" ownvkxctkcfc." cvtcxêu" fg" tgitguuçq" nqiîuvkec"
*›uvgrykugfi+." hqk" tgcnk|cfc" eqpukfgtcpfq" vqfcu" xctkâxgku" fghkpkfcu" eqoq"
octecfqtgu"fg"kphgeèçq"rgnc"cpânkug"wpkxctkcfc<"wuq"fg"rtqhknczkc"cpvkdkôvkec."
fwtcèçq" fq" rtqegfkogpvq." vkrq" fg" rtqegfkogpvq" *korncpvg" qw" vtqec+" g"
rtgugpèc"fg"jgocvqoc"fg"nqlc0"Q"tguwnvcfq"guvâ"fgoqpuvtcfq"pc"Vcdgnc"40"
1,74
12,5
0
2
4
6
8
10
12
14
porcentagem de pacientes
infectados (%)
Gráfico 18. Incidência de infecção por ocorrência
de hematoma de loja
Sem hematoma Com hematoma
p=0,038
72
Tabela 2. Análise multivariada
Variáveis Razão de Chance IC (95%) p
Profilaxia
Antibióticaa
(não/sim)
60;7" 302:" 4408:"
0.0391
Hematoma
(sim/não)
8094" 3054" 56026"
0.0214
Q" pçq" wuq" fg" rtqhknczkc" cpvkoketqdkcpc" g" c" rtgugpèc" fg"
jgocvqoc" fg" nqlc" hqtco" fghkpkfqu" eqoq" rtgfkvqtgu" kpfgrgpfgpvgu" fg"
kphgeèçq0" Q" pçq" wuq" fg" rtqhknczkc" cpvkoketqdkcpc" cwogpvc" go" 6.;7" xg|gu" c"
ejcpeg"fg"qeqttípekc"fg"kphgeèçq"go"rtqegfkogpvqu"f g"guvkowncèçq"ectfîcec"
ctvkhkekcn0" C" rtgugpèc" fg" jgocvqoc" fg" nqlc" cwogpvc" go" 8.94" xg|gu" c"
qeqttípekc"fguuc"eqornkecèçq0"
5.3. Análise descritiva dos casos de infecção
Cu" ectcevgtîuvkecu" enîpkecu" g" oketqdkqnôikecu" fqu" ecuqu" fg"
kphgeèçq"guvçq" fgoqpuvtcfcu"pc" Vcdgnc"50"Qdugtxcoqu"swg"vqfqu"qu"ecuqu"
fg"kphgeèçq"qeqttgtco"cvê"q"55£"fkc"crôu"q"rtqegfkogpvq0"Go"vqfqu"qu"ecuqu"
hqk"kuqncfq" Staphylococcus" eqoq" q"cigpvg"gvkqnôikeq0"Go"6"rcekgpvgu." vqfqu"
fq"itwrq"rncegdq."hqtco"kuqncfqu"Staphylococcus qzceknkpq"tgukuvgpvgu."ugpfq"
4" eqo" S. epidermidis, 3" S. aureus"g"3"S. simulans." 4" fguugu" rcekgpvgu"
crtgugpvctco" ocpkhguvcèùgu" ukuvíokecu." rqtêo" gxqnwîtco" ugo" swcnswgt"
eqornkecèçq"eqo"q"wuq"fg"xcpeqokekpc"kpvtcxgpquc"rqt"43"fkcu0"""
73
"
Tabela 3. Características clínicas e microbiológicas dos casos infectados"
"
Idade/
Sexo"
Procedimento/
Duração (min)"
Tempo (dias ):
procedimento até
infecção"
Etiologia" Tipo de
Infecção"
Profilaxia"
1" 77/M" Impl MP AV/55" 13" S. aureus" Loja/sistêmic
a
Cefazolina
2" 52/F" Impl MP AV/80" 29" S. aureus" loja" Cefazolina
3" 78/F" Impl MP AV/65" 11" S. aureus*" loja/sistêmica" Placebo"
4" 48/M" Impl MP AV/110" 13" S. aureus" superficial" Placebo"
5" 45/F" Impl MP AV/90" 33" S. aureus" superficial" Placebo"
6" 28/F" Impl MP AV/105" 14" S. aureus" loja" Placebo"
7" 55/F" TG MP AV/50" 27" S. epidermidis" loja" Placebo"
8" 55/F" TG MP AV/90" 30"
S. coagulase
negativo" superficial" Placebo"
9" 74/F" Impl MP V/120" 21" S. epidermidis*" loja" Placebo"
10" 65/F" Impl MP AV/75" 12" S. simulans*" superficial" Placebo"
11" 75/M" TG CDI AV/90" 12" S. aureus" loja/sistêmica" Placebo"
12" 66/M" Impl MP AV/160" 20" S. aureus" loja/sistêmica" Placebo"
13" 66/M" Impl MP AV/55" 11" S. epidermidis*" loja/sistêmica" Placebo"
"
,"
qzceknkpq"tgukuvgpvgu" "/"Korn"OR"CX"?"Korncpvg"fg"octecrcuuq"Cvtkqxgpvtkewnct" /VI"
OR"CX"?"Vtqec"fg"igtcfqt"fg"octecrcuuq"Cvtkqxgpvtkewnct" /VI" EFK" CX" ?" Vtqec" fg"
igtcfqt"fg"Ectfkqfguhkdtkncfqt"Cvtkqxgpvtkewnct
"
"
5.4. Evolução clínica dos casos de infecção
C" gxqnwèçq" enîpkec" fqu" ecuqu" fg" kphgeèçq" guvâ" fgoqpuvtcfc" pq"
fkcitcoc"fc"Hkiwtc"40"Qeqttgtco"7"ecuqu"fg"kphgeèçq"uwrgthkekcn."6"fg"nqlc"g"
6" ukuvíokec." rqtêo" wo" rcekgpvg" eqo" kphgeèçq" uwrgthkekcn" gxqnwkw" rctc"
kphgeèçq" fg" nqlc." c" fgurgkvq" fq" vtcvcogpvq" enîpkeq." ugpfq" pgeguuâtkq" c"
74
kpvgtpcèçq." tgoqèçq" ektûtikec" g" tg/korncpvg" fq" ukuvgoc" fg" guvkowncèçq"
ectfîcec0" C" ewnvwtc" fg" ugetgèçq" hqk" rqukvkxc" go" vqfqu" qu" rcekgpvgu0" Q"
geqectfkqitcoc" vtcpuguqhâikeq" tgxgnqw" kocigo" hkncogpvct" cfgtkfc" cq"
gngvtqfq"xgpvtkewnct"go"uqogpvg"wo"ecuq."rqtêo"pçq"rtggpejgw"qu"etkvêtkqu"
fg"Fwmg
368
"rctc"q"fkcipôuvkeq"fg"gpfqectfkvg"kphgeekquc0"Woc"rcekgpvg"eqo"
kphgeèçq"fg"nqlc"fg"octecrcuuq"pçq"cegkvqw"kpvgtpcèçq"rctc"uwdogvgt/ug"cq"
rtqegfkogpvq"ektûtikeq"fg"gzrncpvg"fq"ukuvgoc."rgtocpgegw"go"vtcvcogpvq"
enîpkeq" fqokeknkct." go" wuq" fg" ekrtqhnqzcekpc" rqt" 36" fkcu" eqo" qdvgpèçq" fg"
tguqnwèçq" eqorngvc" fq" swcftq" kphgeekqu q0" C" ewnvwtc" fg" rqpvc" fg" ecdq/
gngvtqfq"hqk"pgicvkxc"go"crgpcu"wo"ecuq."swg"crtgugpvcxc"kphgeèçq"fg"nqlc"
eqo"ocpkhguvcèçq"ukuvíokec0""
Fwtcpvg" q" vtcvcogpvq" fq" swcftq" kphgeekqu q." wo" rcekgpvg" fq" itwrq"
swg"tgegdgw"eghc|qnkpc"rtqhknâvkec."crtgugpvqw"kphgeèçq"fg"nqlc"rqt"S aureus"
ugpuîxgn"ä"qzceknkpc."gxqnwkw"eqo"swcftq"fg"ejqswg"uêrvkeq." pgeguukvcpfq"fq"
wuq"fg"ftqicu"xcuqcvkxcu."cnêo"fq"vtcvcogpvq"eqo"cpvkdkôvkeq"rqt"43"fkcu0"
Jqwxg" vcodêo" wo" ecuq" fg" kpuwhkekípekc" tgpcn" ciwfc." pgeguukvcpfq" fg"
jgoqfkânkug."pwoc"rcekgpvg"eqo"kphgeèçq"fg"nqlc"rqt"S aureus"tgukuvgpvg"ä"
qzceknkpc."fq"itwrq"rncegdq0"Guvc"rcekgpvg"crtgugpvqw"jgoqewnvwtc"pgicvkxc."
ugpfq"q"oketqqticpkuoq"kuqncfq"go"ewnvwtc"fg"ugetgèçq"fg"nqlc"g"rqpvc"fg"
ecdq/gngvtqfq0" Codqu " crtgugpvctco" gxqnwèçq" ucvkuhcvôtkc" eqo" vtcvcogpvq"
enîpkeq"crôu"tgoqèçq"eqorngvc"fq"ukuvgoc"fg"guvkowncèçq"ectfîcec0"
75
"
"
"
"
"
"
"
"
"
"
"
"
"
"
"
"
"
5.5. Análise de óbitos
Qeqttgtco"37"ôdkvqu"*4.53'+"fwtcpvg"q"ugiwkogpvq."vqfqu"fg"ecwuc"
pçq"kphgeekquc"g"pçq"tgncekqpcfqu"cq"rtqegfkogpvq"ektûtikeq"go" guvkowncèçq"
ectfîcec"ctvkhkekcn0"Hqtco"8"ôdkvqu"pq"itwrq"eghc|qnkpc"*2.3;'+"g";"pq"itwrq"
rncegdq"*2.49'+0"Pçq"jcxgpfq"fkhgtgpèc"guvcvkuvkecogpvg"ukipkhkecvkxc"gpvtg"
Superficial 5 (38,4) Loja 4 (30,7)
(
+
) 4 (100)
(
+
) 5 (100)
(
+
) 4 (100)
Figura 2. Evolução dos Pacientes infectados
(
-
) 4 (80)
(
+
)2(50)
(
+
)1(20)
(
-
) 2 (50)
(
-
) 4 (100)
(
+
)1
¤
(20)
(
-
) 4 (80)
4 (100)
1 (100)
3 (75)
¥
Loja/sistêmica 4 (30,7)
Hemocultura
Ecocardiograma
Transesofágicoco
Explante do
Sistema
Cultura do Eletrodo
(
+
)4 (100)
(
+
)3 (75)
(
-
)1 (25)
1*
* infecção superficial que evoluiu para infecção de loja
¥ 1 paciente recusou explante do sistema
¤ não preencheu critérios para endocardite
(-) negativo
(+) positivo
n(%)
Tipo de
Infecção
Cultura
Secreção
76
qu"fqku"itwrqu"rgnq"vguvg"swk/swcftcfq"*r?2.73+."eqphqtog"fgoqpuvtcfq"pq"
itâhkeq"3;0"
"
"
"
"
"
"
"
"
"
"
"
"
5.6. Perda de seguimento clínico
Fwtcpvg" q" guvwfq" jqwxg" rgtfc" fg" ugiwkogpvq" fg" 33" rcekgpvgu"
*3.9'+" cpvgu" fg" eqorngvct" qu" 8" ogugu" fg" cxcnkcèçq" rtê/qrgtcvôtkc0" Guugu"
rcekgpvgu"pçq"crtgugpvcxco"ukpcku"qw"ukpvqocu"fg"kphgeèçq"cvê"uwc"ûnvkoc"
cxcnkcèçq0""
0,19
0,27
0
0,05
0,1
0,15
0,2
0,25
0,3
porcentagem de óbitos (%)
Gráfico 19. Incidência de óbitos por grupo
Cefazolina Placebo
p=0,51
6. DISCUSSÃO
Guug"guvwfq"rtqurgevkxq"hqk"rtqlgvcfq"go"4225."rctc"fghkpkt"q"rcrgn"
fc"rtqhknczkc"cpvkoketqdkcpc"pc"kpekfípekc"fg"kphgeèçq"go"rtqegfkogpvqu"fg"
guvkowncèçq" ectfîcec" ctvkhkekcn." swg" ug" eqpuvkvwk" pwo" itcxg" rtqdngoc." eqo"
itcpfg"korcevq"uôekq"geqpõokeq." e qphqtog"lâ"fgoqpuvtcfq"rqt"Fctqwkejg"gv"
cn0
72"
go" 4226." cnêo" fg" vtc|gt" eqoq" eqpugs°ípekcu" eqornkecèùgu"
rqvgpekcnogpvg"hcvcku"eqoq"gpfqectfkvg"kphgeekquc"g"ugrug0""
C"ogvqfqnqikc"gortgicfc"pguvg"guvwfq."fwrnq"egiq."tcpfqok|cfq"g"
eqpvtqncfq."vgxg"eqoq"qdlgvkxq"pçq"rgtokvkt"kphnwípekc"fg"swcnswgt"xkêu"swg"
rwfguug"eqnqect"go"fûxkfc"c"ngikvkokfcfg"fqu"tguwnvcfqu"gpeqpvtcfqu0"Eqo"
c"hkpcnkfcfg"êvkec"fg"gxkvct" q"rtqnqpicogpvq"fg"wo"guvwfq."pq"swcn"wo"itwrq"
rwfguug" ugt" rtglwfkecfq" rqt" woc" kpekfípekc" gngxcfc" fg" eqornkecèùgu"
tgncekqpcfcu" ä" ogvqfqnqikc" fq" guvwfq" hqk" etkcfq" wo" eqokví" fg" ugiwtcpèc."
eqorquvq" rqt" 7" ogodtqu" pçq" gpxqnxkfqu" pc" cxcnkcèçq" fqu" rcekgpvgu0" Qu"
etkvêtkqu"rctc"kpvgttwrèçq"fq"guvwfq"hqtco"rtê/guvcdgngekfqu"g"ugiwkfqu"fg"
hqtoc"tkiqtquc0""
Hqtco" kpenwîfqu" vqfqu" qu" rcekgpvgu" uwdogvkfqu" c" rtqegfkogpvqu"
ektûtikequ"go"guvkowncèçq"ectfîcec"ctvkhkekcn"pwo"jqurkvcn" fg"pîxgn"vgtekâtkq."
swg" eqttgurqpfg" gzcvcogpvg" ä" tqvkpc" fg" wo" ugtxkèq" fguug" rqtvg0" Qu"
rtqegfkogpvqu"hqtco"tgcnk|cfqu"go"codkgpvg"ektûtikeq."ugiwkpfq"c"tqvkpc"fq"
ugtxkèq"fg"guvkowncèçq"ectfîcec."rqt"rtqhkuukqpcku"gzrgtkgpvgu."qw"rqt"cnwpqu"
fg"gurgekcnk|cèçq"go"guvkowncèçq"ectfîcec."uqd"c"qtkgpvcèçq"g"uwrgtxkuçq"
fqu"rtqhkuukqpcku"ekvcfqu0"
78
C"cfokpkuvtcèçq"rtqhknâvkec"fq" cpvkoketqdkcpq"qw"rncegdq." eqphqtog"
tcpfqok|cèçq." hqtc" tgcnk|cfc" kogfkcvcogpvg" cpvgu" fq" kpîekq" fq"
rtqegfkogpvq." ugiwkpfq" qu" rtkpeîrkqu" fc" rtqhknczkc" cpvkoketqdkcpc."
cfokpkuvtcèçq"fc"fqug"kpkekcn"fq"cigpvg"cpvkoketqdkcpq"pq"vgorq"cfgswcfq."
fg" hqtoc" swg" c" eqpegpvtcèçq" uêtkec" g" vgekfwcn" dcevgtkekfc" fc" ftqic" hquug"
guvcdgngekfc" pq" oqogpvq" fc" kpekuçq" pc" rgng." eqphqtog" tgeqogpfcèçq" fg"
Encuugp" gv" cn0
353
0" Q" cigpvg" cpvkoketqdkcpq" wvknk|cfq" hqk" woc" eghcnqurqtkpc."
swg"ê"q"cigpvg"cpvkoketqdkcpq"rtqhknâvkeq"ocku"guvwfcfq
357
0"Go"rctvkewnct"c"
eghc|qnkpc"swg"ê"corncogpvg"wucfc"g"igtcnogpvg"cegkvc"eqoq"q"cigpvg"fg"
rtkogktc"gueqnc"rctc"rtqhknczkc"go"ektwtikcu"nkorcu
34;
0"
Q" ugiwkogpvq" fqu" rcekgpvgu" qeqttgw" eqphqtog" c" tqvkpc" fq"
codwncvôtkq" fg" guvkowncèçq" ectfîcec" ctvkhkekcn" fc" kpuvkvwkèçq." ugpfq" q"
fkcipôuvkeq" fg" kphgeèçq." swcpfq" uwurgkvcfq" rgnq" oêfkeq" fq" codwncvôtkq."
ewkfcfqucogpvg" eqphktocfq" rqt" wo" ûpkeq" qdugtxcfqt." tgurqpuâxgn" rgnq"
rtqvqeqnq."wvknk|cpfq"etkvêtkqu"rtê/guvcdgngekfqu0""
Qu" guvwfqu" tgcnk|cfqu" cvê" q " oqogpvq." swg" vgpvcxco" fghkpkt" c"
wvknkfcfg"fc"rtqhknczkc"cpvkoketqdkcpc"rctc"guugu"vkrqu"fg"rtqegfkogpvqu."go"
uwc" ockqtkc." pçq" crtgugpvcxco" ogvqfqnqikc" cfgswcfc" qw" fgugpjq"
tgngxcpvg0" Eqorctcxco" q" wuq" fg" rtqhknczkc" cpvkoketqdkcpc" qtcn" eqo"
ukuvíokec." wvknk|cxco" cigpvgu" cpvkoketqdkcpqu" rqt" vgorq" rtqnqpicfq."
fgutgurgkvcpfq" qu" rtkpeîrkqu" rctc" q" cfgswcfq" wuq" fg" rtqhknczkc"
cpvkoketqdkcpc."qw"wvknk|cxco"cigpvgu"rtqhknâvkequ"vôrkequ0"Fc"Equvc"gv"cn0
367"
ugngekqpctco"9"guvwfqu"swg"eqpukfgtctco"tgngxcpvgu."gpvtg"37"gpeqpvtcfqu"
pc" nkvgtcvwtc." rctc" tgcnk|cèçq" fg" woc" ogvcpânkug." c" swcn" xkucxc" fghkpkt" c"
wvknkfcfg" fc" rtqhknczkc" cpvkoketqdkcpc" rctc" rtqegfkogpvqu" go" guvkowncèçq"
79
ectfîcec0" Rqtêo." fgxkfq" ä" jgvgtqigpgkfcfg" fqu" guvwfqu." swg" wvknk|cxco"
fkhgtgpvgu" cpvkoketqdkcpqu." go" fkhgtgpvgu" rgtîqfqu." etkvêtkqu" fkcipôuvkequ"
pçq" jqoqiípgqu." kpenwuçq" fg" crgpcu" wo" guvwfq" fwrnq" egiq." q" swcn"
eqpvtkdwîc" eqo" crgpcu" 7'" fqu" rcekgpvgu." qu" rtôrtkqu" cwvqtgu" eqpenwîtco"
swg"ckpfc"gtc"pgeguuâtkq"wo"guvwfq"eqo"fgugpjq"tgngxcpvg."swg"kpenwîuug"
wo" pûogtq" uwhkekgpvg" fg" rcekgpvgu" rctc" fghkpkt" q" rcrgn" fc" rtqhknczkc"
cpvkoketqdkcpc"pguug"vkrq"fg"rtqegfkogpvq0""
Dgtvcinkc"gv"cn0
36:"
cxcnkctco"go"wo"guvwfq"rtqurgevkxq"qdugtxcekqpcn"
c"ugiwtcpèc"g"ghkeâekc"c"nqpiq"rtc|q"fq"wuq"fg"eghc|qnkpc"rctc"rtqhknczkc"go"
rtqegfkogpvqu" ektûtikequ" gpxqnxgpfq" ukuvgocu" fg" octecrcuuq." cnêo" f c"
cpânkug" rctc" kfgpvkhkect" rquuîxgku" rtgfkvqtgu" fg" eqornkecèùgu" kphgeekqucu" c"
nqpiq"rtc|q0"Hqtco"kpenwîfqu":74"rcekgpvgu"qrgtcfqu"pq"rgtîqfq"fg"qwvwdtq"
fg" 3;;:" c" lwnjq" fg" 42230" Vqfqu" rcekgpvgu" tgegdgtco" 4" i" fg" eghc|qnkpc"
kpvtcxgpquc"42" okpwvqu"crôu"q"kpîekq"fq" rtqegfkogpvq0"Qeqttgtco" 8"ecuqu"
fg"eqornkecèùgu"kphgeekqucu"*2.9'+"pq"ugiwkogpvq"c"nqpiq"rtc|q"g"pgpjwo"
ecuq" fg" kphgeèçq" rtgeqeg" *cvê" 4" ogugu+." gpfqectfkvg" hqk" qdugtxcfc" go" 3"
rcekgpvg"eqo"rtôvgug" xcnxct" côtvkec0"Go"cpânkug" wpkxctkcfc"qu"octecfqtgu"
fg" kphgeèçq" hqtco<" q" ugzq" ocu ewnkpq." rtqegfkogpvqu" fg" ogpqt" fwtcèçq."
vtqec" fg" igtcfqt" go" tgncèçq" cq" korncpvg0" Jgocvqoc" fg" nqlc" pçq" ug"
eqttgncekqpqw"eqo"eqornkecèùgu"kphgeekqucu"c"nqpiq"rtc|q0"Ukpcku"ogpqtgu"
fg"kphgeèçq"eqoq"jkrgtgokc"g"hgdtg"hqtco"vqfqu"vtcvcfqu"eqo"cpvkdkôvkeq"fg"
hqtoc" gorîtkec" g" vcodêo" pçq" crtgugpvctco" eqttgncèçq" eqo" kphgeèçq" c"
nqpiq"rtc|q0"Fwtcpvg"q"ugiwkogpvq"*oêfkq"fg"47.8∑33"ogugu."xctkcpfq"fg"
34"c"77"ogugu+"3;4"rcekgpvgu"oqttgtco"*44.7'+."pgpjwo"fg"eqornkecèçq"
kphgeekquc0"
80
Pquuq" guvwfq" hqk" kpkekcfq" eqo" q" qdlgvkxq" fg" guenctgegt" fg" hqtoc"
fghkpkvkxc" c" wvknkfcfg" g" ugiwtcpèc" fq" wuq" fg" rtqhknczkc" cpvkoketqdkcpc" rctc"
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."
gpswcpvq" swg" c" gpfqectfkvg" rqfg" qeqttgt" fg" fkhgtgpvgu" hqtocu." kpenwkpfq"
eqpvcokpcèçq"fq"ecdq/gngvtqfq"fwtcpvg"q" korncpvg."rgnc"fkuugokpcèçq"fqu"
oketqqticpkuoqu"cq"nqpiq"fq"ecdq/gngvtqfq"c"rctvkt"fc"kphgeèçq"fg"nqlc."qw"
rqt" eqpvcokpcèçq" xkc" jgocvqiípkec" fwtcpvg" dcevgtgokcu
378.393
0" Ecowu" gv"
cn0
378
." go" wo" guvwfq" swg" cxcnkqw" c" rtgugpèc" fg" dcevgtgokc" rqt"
staphylococcus go" rcekgpvgu" eqo" octecrcuuq." kfgpvkhkectco" c" nqlc" fq"
87
octecrcuuq"eqoq"c"rqtvc"fg"gpvtcfc"go"7;'"*35"fg"44+0""Kphgeèçq"fc"nqlc"
fq" octecrcuuq" vcodêo" rqfg" qeqttgt" xkc" jgocvqiípkec" c" rctvkt" fg" uîvkqu"
tgoqvqu." ceqpvgegpfq"swcug"ugortg"fg"hqtoc"vctfkc0"Pq"guvwfq"tgcnk|cfq"
rqt" Ejcoku" gv" cn0
394
" 82'" fqu" ecuqu" fg" kphgeèçq" fg" octecrcuuq" g" EFK"
qeqttgtco" rqt" fkuugokpcèçq" jgocvqiípkec" c" rctvkt" fg" wo" uîvkq" tgoqvq"
fgueqpjgekfq0" " Qu" ecuqu" fg" kphgeèçq" go" pquuq" guvwfq" qeqttgtco" vqfqu"
rtgeqegogpvg." cvê" q" 55£" fkc" rôu/qrgtcvôtkq." uwigtkpfq" hqtvgogpvg" c"
eqpvcokpcèçq"fq"uîvkq"ektûtikeq"eqoq"c"ocku"rtqxâxgn"hqpvg"fg"kphgeèçq0""
Fwtcpvg" q" rgtîqfq" fg" ugiwkogpvq" fqu" rcekgpvgu." pçq" vkxgoqu"
pgpjwo"ecuq"fg"gpfqectfkvg"qw"ôdkvq"tgncekqpcfq"ä"kphgeèçq."uwigtkpfq"swg"
q" fkcipôuvkeq" rtgeqeg" g" q" vtcvcogpvq" cfgswcfq" fguugu" rcekg pvgu." eqo"
tgoqèçq" eqorngvc" fq" ukuvgoc" fg" guvkowncèçq" ectfîcec" vtc|go" ôvkoqu"
tguwnvcfqu."eqo"tguqnwèçq"eqorngvc"fqu"swcftqu"kphgeekququ0"
Fgpvtg" qu" 7" rcekgpvgu" swg" crtgugpvctco" kphgeèçq" uwrgthkekcn."
crgpcu" 3" gxqnwkw" eqo" kphgeèçq" fg" nqlc." c" fgurgkvq" fq" vtcvcogpvq"
cpvkoketqdkcpq"xkc"qtcn."pgeguukvcpfq"fg"tgoqèçq"eqorngvc"fq"ukuvgoc"g"wuq"
fg"cpvkoketqdkcpq"xkc"kpvtcxgpquc0"Uwigtkpfq."rqtvcpvq."c"ghkeâekc"fq"wuq"fg"
vtcvcogpvq"cpvkoketqdkcpq"xkc"qtcn"g"codwncvqtkcn."pguug"vkrq"fg"kphgeèçq0""
Pgpjwo"ecuq"fg"kphgeèçq"uwrgthkekcn"qeqttgw"gpvtg"qu"rcekgpvgu"swg"
tgegdgtco"rtqhknczkc"cpvkoketqdkcpc."guuc"kphqtocèçq"guvâ"fg"ceqtfq"eqo"qu"
tguwnvcfqu" qdvkfqu" rqt" Oqwpug{" gv" cn0
366
." swg" gpe qpvtqw" gtquçq" fg" rgng"
eqoq" c"ecwuc"ocku"eqowo"fg"kphgeèçq"g"guvc"pwpec"qeqttgw"crôu"rtqhknczkc"
cpvkoketqdkcpc0"
Qu" oketqqticpkuoqu" ecwucfqtgu" fg" kphgeèçq" go" ukuvgocu" fg"
guvkowncèçq"ectfîcec"ctvkhkekcn"rqfgo"ugt"kuqncfqu"go"ewnvwtcu"fg"ugetgèçq"
88
fg"nqlc."jgoqewnvwtcu"qw"ewnvwtcu"fg"htciogpvqu"fq"ukuvgoc"fg"guvkowncèçq"
eqoq."rqt"gzgornq." qu"ecdqu/gngvtqfqu
377
0"Qu"rcvôigpqu"ocku"eqowogpvg"
gpeqpvtcfqu" uçq" qu " rgtvgpegpvgu" ä" hnqtc" fc" rgng." gurgekhkecogpvg."
Staphylococcus aureus, staphylococcus eqciwncug/pgicvkxq." kpenwkpfq"
Staphylococcus epidermidis"g"dceknqu"itco/pgicvkxqu
382.393.394
0"Pguvg"gpuckq"
enîpkeq" eqpugiwkoqu" kuqnct" q" rquuîxgn" rcvôigpq" ecwucfqt" fc" kphgeèçq" go"
vqfqu"qu"ecuqu0"Staphylococcus"hqk"q"oketqqticpkuoq"gpeqpvtcfq"go"vqfcu"
cu"ewnvwtcu."jcxgpfq"woc"eqpeqtfãpekc"eqo"c"nkvgtcvwtc0"
Staphylococcus simulans hqk"q"oketqqticpkuoq"kuqncfq"fc"ewnvwtc"fg"
ugetgèçq"fg"woc"rcekgpvg"eqo"kphgeèçq"uwrgthkekcn."fq"itwrq"rncegdq0"Guvg"
igtog" ê" wo" ogodtq" fq" itwrq" eqciwncug/pgicvkxq." swg" vtcpukvqtkcogpvg"
eqnqpk|c" c" rgng" jwocpc
397
0" Ö" cfswktkfq" rtkoctkcogpvg" fg" cpkocku"
fqoêuvkequ" g" ugwu" rt qfwvqu
397
0" Eqpuvkvwg/ug" pwoc" ecwuc" tctc" fg" kphgeèçq"
go"ugtgu"jwocpqu."rqtêo."gurqtcfkecogpvg"vgo"ukfq"fguetkvq"eqoq"ecwuc"
fg" gpfqectfkvg" go" xânxwncu" pcvkxcu." kphgeèçq" fq" vtcvq" wtkpâtkq" g"
ugrug
398.399.39:.39;.3:2
0" Wo" ecuq" fg" quvgqokgnkvg" g" ugrug." swg" qeqttgw"
kogfkcvcogpvg"crôu"tgfwèçq"cdgtvc"g"hkzcèçq"kpvgtpc"fg"woc"htcvwtc"hgejcfc"
fg"vqtpq|gnq
3:3
"g"wo"ecuq"fg"quvgqokgnkvg"rûdkec"eqo"dcevgtgokc
39:
"hqtco"
fguetkvqu0"C"tctkfcfg"fg"tgncvqu"fg"kphgeèçq"go"jwocpqu"rqt"S. simulans ê."
rtqxcxgnogpvg."wo"tghngzq"fc"qeqttípekc"rqweq"htgs°gpvg"fguvc"gurêekg"fg"
eqciwncug/pgicvkxq" eqoq" wo" eqnqpk|cfqt" fc" rgng" jwocpc." cnêo" fc"
fkhkewnfcfg" v êepkec" fqu" ncdqtcvôtkqu" fg" oketqdkqnqikc" rctc" kfgpvkhkect"
tqvkpgktcogpvg" guvg" oketqqticpkuoq0" Wucpfq" oqfgnqu" cpkocku." xâtkqu"
kpxguvkicfqtgu" vío" fgoqpuvtcfq" swg" S. simulans guvâ" htgs°gpvgogpvg"
cuuqekcfq" eqo" kphgeèçq" enîpkec" rgtukuv gpvg." ockqt" tgurquvc" kphncocvôtkc."
89
ockqt" xktwnípekc" swcpfq" eqorctcfq" eqo" qwvtqu" eqciwncug/
pgicvkxqu
3:4.3:5.3:6
0" " Cfkekqpcnogpvg." S. simulans" rtqfw|" eqpukfgtâxgn"
ecocfc" oweôkfg." c" swcn" hceknkvc" uwc" cfgtípekc" c" eqtrqu" guvtcpjqu." eqoq"
rtôvgugu
3:7
0"
Pquuqu" cejcfqu" kpfkeco" q" dgpghîekq" g" ugiwtcpèc" fq" wuq" fg"
rtqhknczkc" cpvkoketqdkcpc" rctc" rtqegfkogpvqu" ektûtikequ" go" rtqegfkogpvqu"
gpxqnxgpfq"ukuvgocu"fg"guvkowncèçq"ectfîcec."eqo"fqug"ûpkec"fg"eghc|qnkpc"
*3i+." rqt" xkc" kpvtcxgpquc." kogfkcvcogpvg" cpvgu" fq" kpîekq" fq" rtqegfkogpvq0"
Guug" tguwnvcfq." qdvkfq" cvtcxêu" fg" wo" guvwfq" fwrnq" egiq." tcp|qok|cfq" g"
eqpvtqncfq." kpenwkpfq" wo" itcpfg" pûogtq" fg" rcekgpvgu." eqphktoc"
fghkpkvkxcogpvg"q"tguwnvcfq"uwigtkfq"rgnc"ogvcpânkug"fg"Fc"Equvc"gv"cn0"go"
3;;:0"
"
"
"
"
"
"
"
"
"
"
"
7. CONCLUSÕES
30" Q" wuq" rtqhknczkc"cpvkoketqdkcpc."eqo"fqug" ûpkec" fg" eghc|qnkpc"
*3i+."cfokpkuvtcfc"rqt"xkc"kpvtcxgpquc."kogfkcvcogpvg"cpvgu"fc"tgcnk|cèçq"fg"
ektwtikcu" gpxqnxgpfq" ukuvgocu" fg" guvkowncèçq" ectfîcec" ctvkhkekcn" tgfw|"
ukipkhkecvkxcogpvg" c" kpekfípekc" fg" eqornkecèùgu" kphgeekqucu" tgncekqpcfcu" c"
guvgu"rtqegfkogpvqu0"
40" C"fwtcèçq"rtqnqpicfc"fc"ektwtikc."rtqegfkogpvqu"fg"vtqecu"fg"
igtcfqtgu" g" rtgugpèc" fg" jgocvqoc" fg" nqlc" pq" rôu/qrgtcvôtkq" hqtco"
ukipkhkecvkxcogpvg"cuuqekcfqu"eqo"ockqt"qeqttípekc"fg"kphgeèçq0""
50" Q"pçq"wuq"fg"rtqhknczkc"cpvkoketqdkcpc"cwogpvc"go"swcug"ekpeq"
xg|gu" c" kpekfípekc" fg" kphgeèçq" go" rtqegfkogpvqu" ektûtikequ" gpxqnxgpfq"
guvkowncèçq" ectfîcec" ctvkhkekcn" C" rtgugpèc" fg" jgocvqoc" fg" nqlc" pq" rôu/
qrgtcvôtkq" guvâ" cuuqekcfc" c" wo" cwogpvq" fg" swcug" 9" xg|gu" pc" kpekfípekc"
fguuc"eqornkecèçq0"Kpfgrgpfgpvg"fc"rtgugpèc"fg"qwvtqu"hcvqtgu"fg"tkueq0
"
"
"
"
"
"
"
"
"
91
8. ANEXOS
Anexo A.
"Critérios para diagnóstico de um Sítio de Infecção Cirúrgica*.
Infecção Incisional Superficial
Kphgeèçq"qeqttg"cvê"52"fkcu"crôu"c"ektwtikc"g"gpxqnxg"uqogpvg"rgng"qw"vgekfq"uwdewvãpgq"fc"kpekuçq"g"
rgnq"ogpqu"wo"fqu"ugiwkpvgu<"
30" Fguectic"rwtwngpvc."eqo"qw"ugo"eqphktocèçq"ncdqtcvqtkcn."fc"kpekuçq"uwrgthkekcn0"
40" Qticpkuoqu"kuqncfqu"fg"woc"ewnvwtc"qdvkfc"cuugrvkecogpvg"fq"hnwîfq"qw"vgekfq"fc"kpekuçq"
uwrgthkekcn0"
50" Rgnq"ogpqu"wo"fqu"ugiwkpvgu"ukpcku"qw"ukpvqocu"fg"kphgeèçq<"fqt."gfgoc"nqecn."jkrgtgokc."qw"
ecnqt"g"kpekuçq"uwrgthkekcn"fgnkdgtcfcogpvg"cdgtvc"rgnq"ektwtikçq."c"ogpqu"swg"c"ewnvwtc"fc"
kpekuçq"uglc"pgicvkxc0"
60" Fkcipôuvkeq"fg"kphgeèçq"kpekukqpcn"rgnq"ektwtikçq"qw"ogfkeq"fq"rcekgpvg0"
Pçq"tgrqtvct"cu"ugiwkpvgu"eqpfkèùgu"eqoq"kphgeèçq"kpekukqpcn"uwrgthkekcn<"
30" Cdueguuq"pqu"rqpvqu"*kphncocèçq"oîpkoc"g"fguectic"eqphkpcfc"rctc"qu"rqpvqu"fg"rgpgvtcèçq"
fc"uwvwtc+"
40" Kphgeèçq"fg"woc"grkukqvqokc"qw"ukvkq"fg"ektewpekuçq""
50" Hgtkfc"fg"swgkocfwtc"kphgevcfc"
60" Kphgeèçq"kpekukqpcn"uwrgthkekcn"swg"ug"guvgpfg"rctc"ecocfc"owuewnct"g"hcuekcn"*xgt"kphgeèçq"
kpekukqpcn"rtqhwpfc+"
Pqvg<"Etkvêtkqu"gurgeîhkequ"uçq"wucfqu"rctc"kfgpvkhkect"kphgeèçq"go"grkukqvqokc."ektewpekuùgu"g"hgtkfcu"f
g
swgkocfwtcu0"
"
Infecção Incisional Profunda
Kphgeèçq"qeqttg"cvê"52"fkcu"crôu"c"ektwtikc"ug"pgpjwoc"rtôvgug
φ
"ê"korncpvcfc"pq"nqecn"qw"cvê"3"cpq"ug"
korncpvcfq"rtôvgug"g"c"kphgeèçq"rctgeg"ugt"tgncekqpcfc"ä"qrgtcèçq"g"gpxqnxg"vgekfqu"rtqhwpfqu"htqwzqu"
*gz<"ecocfcu"owuewnct"qw"hcuekcn+"fc"kpekuçq"g"rgnq"ogpqu"wo"fqu"ugiwkpvgu<"
30" Ftgpcigo"rwtwngpvc"fc"kpekuçq"rtqhwpfc."ocu"pçq"fq"eqorqpgpvg"ôtiçq1gurcèq"fq"uîvkq"
ektûtikeq0"
40" Woc"fgkueípekc"gurqpvãpgc"fc"kpekuçq"rtqhwpfc"qw"cdgtvwtc"fgnkdgtcfc"rgnq"ektwtikçq"swcpfq"q"
rcekgpvg"vgo"rgnq"ogpq"wo"fqu"ugiwkpvgu"ukpcku<"hgdtg"*@5:£E+."fqt"nqecnk|cfc."c"ogpqu"swg"c"
ewnvwtc"fq"uîvkq"ê"pgicvkxc0"
50" Wo"cdueguuq"qw"qwvtc"gxkfípekc"fg"kphgeèçq"gpxqnxgpfq"c"kpekuçq"rtqhwpfc"ê"gpeqpvtcfq"
cvtcxêu"fq"gzcog"fktgvq."fwtcpvg"tgqrgtcèçq."qw"rqt"gzcog"jkuvqrcvqnôikeq"qw"tcfkqnôikeq0"
60" Fkcipôuvkeq"fg"woc"kphgeèçq"kpekukqpcn"rtqhwpfc"rqt"wo"ektwtikçq"qw"oêfkeq"fq"rcekgpvg0"
Pqvg<"
30" Tgrqtvct"kphgeèçq"swg"gpxqnxg"codqu"qu"uîvkqu"*uwrgthkekn"g"rtqhwpfq+"eqoq"kpekukqpcn"rtqhwpfq0
40" Tgrqtvct"woc"kphgeèçq"kpekukqpcn"ôtiçq1gurcèq"swg"ftgpc"cvtcxêu"fc"kpekuçq"eqoq"kpekukqpcn"
rtqhwpfc0"
"
Infecção Órgão/Espaço
Kphgeèçq"qeqttg"cvê"52"fkcu"crôu"c"qrgtcèçq"ug"pgpjwoc"rtôvgug
φ
"ê"korncpvcfc"pq"nqecn."qw"cvê"3"cpq"
ug"korncpvcfq"rtôvgug"g"c"kphgeèçq"rctgeg"ugt"tgncekqpcfc"ä"ektwikc"g"gpxqnxg"swcnswgt"rctvg"fc"
cpcvqokc"*gz<"ôtiçqu"qw"gurcèq+."qwvtq"swg"c"kpekuçq."q"swcn"hqk"cdgtvq"qw"ocpkrwncfq"fwtcpvg"c"ektwtikc"
g"rgnq"ogpqu"wo"fqu"ugiwkpvgu<"
30" Fguectic"rwtwngpvc"fg"wo"ftgpq"eqnqecfq"cvtcxêu"fg"wo"qwvtq"hgtkogpvq"rgthwtcpvgæ"fgpvtq"fg"
wo"ôtiçq"qw"gurcèq"
40" Qtcpkuoqu"kuqncfqu"fg"woc"ewnvwtc"qdvkfc"cuugrvkecogpvg"fg"hnwîfq"qw"vgekfq"pq"ôtiçq1gurcèq0
50" Wo"cdueguuq"qw"qwvtc"gxkfgpekc"fg"kphgeèçq"gpxqnxgpfq"q"ôtiçq1gurcèq"swg"ê"gpeqpvtcfq"
cvtcxêu"fg"gzcog"fktgvq."fwtcpvg"tgqrgtcèçq."qw"rqt"gzcog"jkuvqrcvqnôikeq"qw"tcfkqnôikeq0"
60" Fkcipôuvkeq"fg"woc"kphgeèçq"ôtiçq1gurcèq"rqt"wo"ektwtikçq"qw"oêfkeq"fq"rcekgpvg0""
,"Jqtcp"VE"gv"cn
32"
φ
"Fghkpkfq"rgnc"Pcvkqpcn"Pquqeqokcn"Kphgevkqp"Uwtxgknncpeg<"woc" rtôvgug"korncpvâxgn"fg"qtkigo"pçq"jwocpc" *gz<"rtôvgugu"xcnxct" ectfîcec."gpzgtvq"
xcuewnct"pçq"jwocpq."eqtcèçq"ogeãpkeq"qw"rtôvgug"fg"swcftkn+"swg"ê"rgtocpgpvgogpvg""
æ"Ug"c"âtgc"cq"tgfqt"fq"qtkhîekq"fq"ftgpq"ug"vqtpc"kphgevcfc."gnc" pçq"ê"eqpukfgtcfc" wo"uîvkq"fg"kphgeèçq"ektûtikec0"Ö"eqpukfgtcfc"kphgeèçq"fg"rgng"qw"
fg"vgekfq"uwdewvãpgq."fgrgpfgpfq"fg"uwc"rtqhwpfkfcfg0"
"
92
Anexo B - Definição de termos usados como critérios clínicos"
Critérios Maiores
" Hemocultura positiva para endocardite infecciosa:
" Oketqqticpkuoqu"vîrkequ"fg"gpfqectfkvg"kphgeekquc."kuqncfqu"go"24""
coquvtcu"kuqncfcu"fg"jgoqewnvwtc"/"Uvtgrvqeqeewu"xktkfcpu."Uvtgrvqeqeewu"dqxku.""
itwrq"JCEGM."qw"
" Uvcrj{nqeqeewu"cwtgwu"qw"gpvgtqeqeewu"cfswktkfqu"pc"eqowpkfcfg."pc"cwuípekc""
fg"wo"hqeq"rtkoâtkq."qw"
" Jgoqewnvwtc"rgtukuvgpvgogpvg"rqukvkxc"rctc"oketqqticpkuoq"eqpukuvgpvg"eqo""
gpfqectfkvg"kphgeekquc."go"coquvtcu"eqnjkfcu"eqo"kpvgtxcnqu"@"34"jqtcu."qw"
" Vqfcu"cu"vtíu"qw"c"ockqtkc"fg"swcvtq"qw"ocku"coquvtcu"kuqncfcu"fg"jgoqewnvwtc"rqukvkxcu.
"eqo"kpvgtxcnq"oîpkoq"gpvtg"c"eqngvc"fc"rtkogktc"g"c"ûnvkoc"coquvtc"fg"3"jqtc"
" Evidência de envolvimento endocárdico
" Geqectfkqitcoc"rqukvkxq"rctc"gpfqectfkvg"kphgeekquc"
" Ocuuc"quekncpvg"kpvtcectfîcec."go"ecdqu/gngvtqfqu"qw"go"guvtwvwtc"gpfqeâtfkec"g
go"eqpvcvq"eqo"ecdqu/gngvtqfqu"
" Cdueguuq"go"eqpvcvq"eqo"ecdqu/gngvtqfqu"
Critérios Menores
" Febre
≥
38
°
C
" Fenômenos vasculares: embolia arterial, infarto pulmonar séptico, aneurisma
micótico, hemorragia intracraniana, lesões de Janeway
" Fenômenos imunológicos: glomerulonefrite, nódulos de Osler, manchas de Roth
" Ecocardiograma: consistente com endocardite infecciosa, mas não definido como
critério maior, como descrito previamente
" Evidência microbiológica: hemocultura positiva, mas não definida como critério
maior, como descrito previamente
"
"
9. REFERÊNCIAS BIBLIOGRÁFICAS
30" Ocpitco"CL."Jqtcp"VE."Rgctuqp"ON."Uknxgt"NE."Lctxku"YT0"Iwkfgnkpg"
hqt"rtgxgpvkqp"qh"uwtikecn"ukvg"kphgevkqp."3;;;0"AJIC"3;;;=49*4+<;9/3540"
40" Itcxgu"GL0"Pcvkqpcn"jqurkvcn"fkuejctig"uwtxg{<"cppwcn"uwooct{"3;:90"
Pcvkqpcn"Egpvgt"hqt"jgcnvj"Uvcvkuvkeu0"Vital Stat"3;:;=35<330"
50" Etwug"R0"Yqwpf"kphgevkqp"uwtxgknncpeg0"Rev Infect Dis"3;:3=6<956/9590"
60" Pcvkqpcn" Pquqeqokcn" Kphgevkqpu" Uwtxgknncpeg" *PPKU+0" Fcvc" uwooct{"
htqo" Qevqdgt" 3;:8" ⁄" Crtkn" 3;;8." kuuwgf" Oc{" 3;;8<" c" tgrqtv" htqo" vjg"
Pcvkqpcn"Pquqeqokcn"Kphgevkqpu"Uwtxgknncpeg"*PPKU+"U{uvgo0"Am J Infect
Control"3;;8=46<5:2/5::0"
70" Jwijgu" LO." Ewnxgt" FJ." Yjkvg" LY0" Pquqeqokcn" kphgevkqp" uwtxgknncpeg."
3;:2/3;:40"MMWR"3;:5=54*uwrrn+<3/380"
80" Jcng{" TY." Ewnxgt" FJ." Yjkvg" LY." Oqticp" YO." Goqtk" VI." Owpp" XR."
Jqqvqp"VO0"Vjg"ghhkece{"qh"kphgevkqp"uwtxgknncpeg"cpf"eqpvtqn"rtqitcou"
kp" rtgxgpvkpi" pquqeqokcn" kphgevkqpu" kp" vjg" W0U0" jqurkvcnu0" AM J
Epidemiol"3;:7=343<3:4/4270"
90" Jcng{"TY."Uejcdgti"FT."Etquung{"MD."Xqp"Cnnogp"UF."OeIqycp"LG"
Lt0" Gzvtc" ejctigu" cpf" rtqnqpicvkqp" qh" uvc{" cvvtkdwvcdng" vq" pquqeqokcn"
kphgevkqpu<" c" rtqurgevkxg" kpvgtjqurkvcn" eqorctkuqp0" Am J Med
3;:3=92<73/7:0"
:0" Rkppgt"TY."Jcng{"TY."Dnwogpuvgkp"DC."Uejcdgti"FT."Xqp"Cnnogp"UF. "
OeIqycp" LG" Lt0" Jkij" equv" qh" pquqeqokcn" kphgevkqpu0" Infect Control"
3;:4=5<365/3690"
94
;0" Itggp"LY."Ygp|gn"TR0"C"eqpvtqnngf"uvwf{"qh"vjg"kpetgcugf"fwtcvkqp"qh"
jqurkvcn"uvc{"cpf"fktgev"equv"qh"jqurkvcnk|cvkqp0"Ann Surg"3;99=3:7<486/
48:0"
320"Octvqpg" YL." Pkejqnu" TN0" Tgeqipkvkqp." rtgxgpvkqp." uwtxgknncpeg." cpf"
ocpcigogpv"qh"UUK0"Enkp"Kphgev"Fku"4223=55<u89/:0"
330"Lgppg{"CY."Jcttkpivqp"IC."Twuuq"TN."Urgnocp"FY0"Equv"qh"uwtikecn"
ukvg"kphgevkqpu"hqnnqykpi"eqt qpct{"ctvgt{"d{rcuu"uwtigt{0"Aust N Z J Surg"
4223=93<884/8860"
340"Yjkvgjqwug"LF."Htkgfocp"PF."Mktmncpf"MD."Tkejctfuqp"YL."Ugzvqp"FL0"
Vjg"korcev"qh" uwtikecn/ukvg"kphgevkqpu"hqnnqykpi" qtvjqrgfke"uwtigt{"cv" c"
eqoowpkv{" jqurkvcn" cpf" c" wpkxgtukv{" jqurkvcn<" cfxgtug" swcnkv{" qh" nkhg."
gzeguu" ngpivj" qh" uvc{." cpf" gzvtc" equv0" Infect Control Hosp Epidemiol"
4224=45<3:5/3:;0"
350"Egpvgtu" hqt" Fkugcug" Eqpvtqn0" Pquqeqokcn" kphgevkqp" uwtxgknncpeg." 3;:2/
3;:40"CDC Surveillance Summaries"3;:5=35:<353/3570"
360"Pcvkqpcn" Pquqeqokcn" K phgevkqpu" Uwtxgknncpeg" *PPKU+" U{uvgo" Tgrqtv."
fcvc"uwooct{" htqo"Lcpwct{" 3;;4"vjtqwij" Lwpg"4226." kuuwgf"Qevqdgt"
42260"C"tgrqtv"htqo"vjg"PPKU"U{uvgo0"Am J Infect Control 4226=54<692/
6:70"
370"Jqtcp" VE." Ic{pgu" TR." Octvqpg" YL." Lctxku" YT." Goqtk" VI." EFE"
fghkpkvkqpu"qh"pquqeqokcn"uwtikecn"ukvg"kphgevkqpu."3;;4<"c"oqfkhkecvkqp"qh"
EFE" fghkpkvkqpu" qh" uwtikecn" yqwpf" kphgevkqpu0" Kphgev" Control Hosp
Epidemiol"3;;4=35*32+<828/:0"
380"Etwug" RLG."Hqqtf"T0" Vjg" grkfgokqnqi{" qh" yqwpf" kphgevkqp0" C"32/{gct"
rtqurgevkxg"uvwf{"qh"840;5;"yqwpf0"Surg Clin North Am"3;:2=82<49/620"
95
390"Ewnxgt"FJ."Jqtcp"VE."Ic{pgu"TR."Octvqpg"YL."Lctxku"YT."Goqtk"VI."
Dcpgtlgg"UP."Gfyctfu"LT."Vqnuqp"LU."Jgpfgtuqp"VU0"Uwtikecn"yqwpf"
kphgevkqp" tcvgu" d{" yqwpf" encuu." qrgtcvkxg" rtqegfwtg." cpf" rcvkgpv" tkum"
kpfgz0"Am J Med"3;;3=;3"*uwrrn"5D+<374/3790"
3:0""Dctvngvv"LI."Eqpfqp"TG."Iqtdcej"UN."Enctmg"LU."Pkejqnu"TN."Qejk"U0"
Xgvgtcpu" Cfokpkuvtcvkqp" eqqrgtcvkxg" uvwf{" qp" dqygn" rtgrctcvkqp" hqt"
gngevkxg" eqnqtgevcn" qrgtcvkqpu<" korcev" qh" qtcn" cpvkdkqvke" tgikogp" qp"
eqnqpke" hnqtc." yqwpf" kttkicvkqp" ewnvwtgu" cpf" dcevgtkqnqi{" qh" ugrvke"
eqornkecvkqpu0"Ann Surg"3;9:=3::<46;/4760"
3;0"Ictkdcnfk"TC."Ewujkpi"F0"Tkum"hcevqtu"hqt"rquvqrgtcvkxg"kphgevkqp0"Am J
Med"3;;3=;3*uwrrn"5D+<37:U/385U0"
420"Gjtgpmtcp|"PL."Tkejvgt"GK."Rjknnkru"RO."Uejnv|"LO0"Cp"crrctgpv"gzeguu"
qh" qrgtcvkxg" ukvg" kphgevkqpu<" cpcn{ugu" vq" gxcnwcvg" hcnug/rqukvkxg"
fkcipqugu0"Infect Control Hosp Epidemiol"3;;7<38*34+<934/80"
430"Vc{nqt" I." OeMgp|kg" O." Mktmncpf" [." Ykgpu" T0" Ghhgev" qh" uwigqp‚u"
fkcipquku" qp" uwtikecn" yqwpf" kphgevkqp" tcvgu0" Am J Infect Control"
3;;2=3:*7+<4;7/;0"
440"Etwug" RL." Uwtikecn" yqwpf" kphgevkqp" Kp<" Yqpukgyke|" OL." gf0" Kphgevkqw u"
Fkugcug0"Rjkncfgnrjkc<"Y0D0"Ucwpfgtu"Eq0"3;;40r097:/860"
450"Cnvgogkgt" YC." Ewndgtvuqp" YT0" Uwtikecn" kphgevkqp0" Kp<" Oq{gt" EC."
Tjqcfu"LG."Cnngp"LI."Jctmkpu"JP."gfu0"Uwtigt{."rtkpekrngu"cpf"rtcvkeg0"
5
tf
"gf0"Rjkncfgnrjkc<"LD"Nkrrkpeqwvv=3;870r073/990"
460"Mtk|gm"VL."Tqduqp"OE0"Gxqnwvkqp"qh"swcpvkvcvkxg"dcevgtkqnqi{"kp"yqwpf"
ocpcigogpvg0"Am J Surg"3;97<352<79;/:60"
96
470"Gngm" UF." Eqpgp" RG0" Vjg" xktwngpeg" qh" Staphylococcus pyogenes"hqt"
ocp<" c" uvwf{" qh" rtqdngou" ykvj" yqwp f" kphgevkqp0" Br J Exp Pathol"
3;79=5:<795/:80"
480"Pqdng"YE0"Vjg"rtqfwevkqp"qh"uwdewvcpgqwu"uvcrj{nqeqeewu"umkp"ngukqpu"
kp"okeg0"Br J Exp Pathol"3;87=68<476/840"
490"Lcogu"TE."OceNgqf" EL0"Kpvtqfwevkqp"qh"uvcrj{nqeqeecn" kpvgtcevkqpu"kp"
okeg" ykvj" uocnn" kpqewnc" kpvtqfwegf" qp" uwvwtgu0" Br J Exp Pathol"
3;79=64<488/990"
4:0"Cogtkecp"Jgctv"Cuuqekcvkqp0"Jgctv"Fkugcug"cpf"Uvtqmg"Uvcvkuvkeu<"4227"
Wrfcvg0"Fcnncu."Vgz<"Cogtkecp"Jgctv"Cuuqekcvkqp="42270"
4;0"Hgttc|"GO."Dcegnct"VU."Ciwkct"LN."Hgttc|"CC."Rcipquukp"I."Dcvkuvc"LY0"
Yqwpf" kph gevkqp" tcvgu" kp" engcp" uwtigt{<" c" rqvgpvkcnn{" okungcfkpi" tkum"
encuukhkecvkqp0"Infect Control Hosp Epidemiol"3;;4=35<679/840"
520"Pcvkqpcn" Pquqeqokcn" K phgevkqpu" Uwtxgknncpeg" *PPKU+" U{uvgo" Tgrqtv."
fcvc"uwooct{"htqo"Lcpwct{"3;;4"vq" Lwpg" 4224." kuuwgf"Cwiwuv"42240"
Am J Infect Control"4224=52<67:/970"
530"Okncpq"EC."Mgungt"M."Ctejkdcnf"P."Ugzvqp"FL."Lqpgu"TJ0"Ogfkcuvkpkvku"
chvgt" eqtqpct{" ctvgt{" d{rcuu" itchv" uwtigt{<" tkum" hcevqtu" cpf" nqpi" vgto"
uwtxkxcn0"Circulation"3;;7=;4<4467/730"
540"Mcrruvgkp" L." Uejwnigp" I." Htcgftkej" I." Uejnquugt" X." Uejwocejgt" O."
Fcuejpgt" HF0" Cffgf" jqurkvcn" uvc{" fwg" vq" yqwpf" kphgevkqpu" hqnnqykpi"
ectfkce"uwtigt{0"Thorac Cardiovasc Surg"3;;4=62<36:/730"
550"Cugpukq" C." Vqttgu" L0" Swcpvkh{kpi" gzeguu" ngpivj" qh" rquvqrgtcvkxg" uvc{"
cvvtkdwvcdng" vq" kphgevkqpu<" c" eqorctkuqp" qh" ogvjqfu0" J Clin Epidemiol"
3;;;=74<346;/780"
97
560"Jqnngpdgcm" EU." Owtrj{" F." Fwpcicp" YE." Htcugt" XL0" Pqptcpfqo"
ugngevkqp" cpf" vjg" cvvtkdwvcdng" equv" qh" uwtikecn/ukvg" kphgevkqpu0" Infect
Control Hosp Epidemiol"4224=45<39/:40""
570"Iqqfocp" LU." Uejchhpgt" Y ." Eqnnkpu" JC." Dcvvgtud{" GL." Mqgpki" OI0"
Kphgevkqp" chvgt" ectfkqxcuewnct" uwtigt{<" enkpkecn" uvwf{" kpenwfkpi"
gzcokpcvkqp"qh"cpvkoketqdkcn"rtqrj{nczku0"N Engl J Med"3;8:=49:<339/
450"
580"Hgmgv{"HT"Lt."Enwhh"NG."Ucdkuvqp"FE"Lt."Ugkfn"NI."Uokvj"LY."Vjqdwtp"T0 "
C"uvwf{"qh"cpvkdkqvke" rtqrj{nczku"kp"ectfkce"uwtigt{0"J Thorac Cardiovasc
Surg"3;8;=79<979/850"
590"Hqpi"KY."Dcmgt"ED."OeMgg"FE0"Vjg"xcnwg"qh"rtqrj{ncevke"cpvkdkqvkeu"kp"
cqtvc/eqtqpct{" d{rcuu" qrgtcvkqpu<" c" fqwdng/dnkpf" tcpfqok|gf" vtkcn0" J
Thorac Cardiovasc Surg"3;9;=9:<;2:/350"
5:0"Mtgvgt"D."Yqqfu"O0"Cpvkdkqvke"rtqrj{nczkc"hqt"ectfkqvjqtceke"qrgtcvkqpu"
ogvc/cpcn{uku"qh"vjktv{"{gctu"qh"enkpkecn"vtkcnu0"J Thorac Cardiovasc Surg"
3;;4=326<7;2/;0"
5;0"Cpvkoketqdkcn"rtqrj{nczku"kp"uwtigt{0"Med Lett Drugs Ther"4223=65<;4/
;90"
620"Pcvkqpcn" Pquqeqokcn"Kphgevkqpu"Uwtxgknncpeg"*PPKU+"U{uvgo"Tgrqtv"fcvc"
uwooct{"htqo"Lcpwct{"3;;4"⁄"Lwpg"4223."kuuwgf"Cwiwuv" 42230"Am J
Infect Control"4223=4;<626/430"
630"Qnugp" OC."Nqem/Dwemng{"R."Jqrmkpu"F."Rqnkuj"ND."Uwpfv"VO."Htcugt"XL0"
Vjg" tkum" hcevqtu" hqt" fggr" cpf" uwrgthkekcn" ejguv" uwtikecn/ukvg" kphgevkqpu"
chvgt" eqtqpct{" ctvgt{" d{rcuu" itchv" uwtigt{" ctg" fkhhgtgpv0" J Thorac
Cardiovasc Surg"4224=346<358/670"
98
640"Dqtigt"OC." Tcq"X."Ygkugn"TF."Kxcpqx"L"Eqjgp"I."Uewnn{"JG."Fcxkf"VG0"
Fggr" uvgtpcn" yqwpf" kphgevkqp<" tkum" hcevqtu" cpf" qwveqogu0" Ann Thorac
Surg 3;;:=87<3272/80"
650"Itquuk"GC."Ewnnkhqtf"CV."Mtkigt"MJ."Mnqvj"F."Rtguu"T."Dcwocpp"HI."
Urgpegt" HE0" C" uwtxg{" qh" 99" oclq" kphgevkqwu" eqornkecvkqpu" qh" ogfkcp"
uvgtpqvqo{<"c"tgxkgy"qh"9.;6;"eqpugewvkxg"qrgtcvkxg"rtgqegfwtgu0"Ann
Thorac Surgery 3;:7=62<436/450""
660""Owpq|"R."Ogpcucnxcu"C."Dgtpcnfq"fg"Swktqu"LE."Fgueq"O."Xcnnglq"LN."
Dqw|c" G0" Rquvuwtikecn" ogfkcuvkpkvku<" c" ecug/eqpvtqn" uwvwf{0" Clin Infect
Dis"3;;9=47<3282/60"
670"Tkffgtuvqnrg" N." Iknn" J." Itcphgnfv" J." Cjnhgnfv" J." Twvdgti" J0" Uwrgthkekcn"
cpf" fggr" uvgtpcn" yqwpf" eqornkecvkqpu<" kpekfgpeg." tkum" hcevqtu" cpf"
oqtvcnkv{. Eur J Cardiothorac Surg"4223=42<338:/970"
680"Ycpi"HE."Ejcpi"EJ0"Tkum"hcevqtu"qh"fggr"uvgtpcn"yqwpf"kphgevkqpu"kp"
eqtqpct{" ctvgt{" d{rcuu" itchv" uwtigt{0" J Cardiovasc Surg"*Vqtkpq+"
4222=63<92;/350"
690"N‚Gew{gt"RD."Owtrj{"F."Nkvvng"LT."Htcugt"XL0"Vjg"grkfgokqnqi{"qh"ejguv"
cpf" ngi" yqwpf" kphgevkqpu" hqnnqykpi" ectfkqvjqtceke" uwtigt{0" Clin Infect
Dis"3;;8=44<646/;0"
6:0"Oquucfc"UD."Ugtmg{"LO."Nqpiyqtvj"FN."Equitqxg"FO"5
tf
." Iqtfqp"UO0"
Eqciwncug/pgicvkxg"uvcrj{nqeqeecn"uvgtpcn"yqwpf"kphgevkqpu"chvgt"qrgp"
jgctv"qrgtcvkqpu0"Ann Thorac Surg"3;;9=85<5;7/6230"
6;0"Dqnqp" OM." Oqtnqvg" O." Ygdgt" UI." Mqrncp" DM." Ectognk" [." Ytkijv" UD0"
In{eqrgrvkfgu" ctg" pq" oqtg" ghhgevkxg" vjcp" β/ncevco" cigpvu" hqt"
99
rtgxgpvkqp" qh" uwtikecn" ukvg" kphgevkqp" chvgt" ectfkce" uwtigt{<" C" Ogvc/
cpcn{uku0"Clin Infect Dis 4226=5:<3579/850"
720"Fctqwkejg" TQ0" Fgxkeg/cuuqekcvgf" kphgevkqpu<" c" ocetqrtqdngo" vjcv"
uvctvu"ykvj"okftqcfjgtgpeg0"Clin Infect Dis"4223=55<3789/940"
730"Fctqwkejg" TQ0" Vtgcvogpv" qh" kphgevkqpu" cuuqekcvgf" ykvj" uwtikecn"
korncpvu0"N Engl J Med"4226=572<3644/;0"
740"Jctmgp" FY." Uqtqhh" JU." Vc{nqt" YL." gv" cn0" Rctvkcn" cpf" eqorngvg"
rtquvjgugu" kp" cqtvke" kpuwhhkekgpe{0" J Thorac Cardiovasc Surg"
3;82=62<966/840"
750"Ejctfcm" YO." Icig" CC." Itgcvdcej" Y0" Eqttgevkqp" qh" eqorngvg" jgctv"
dnqem"d{"c"ugnh/eqpvckpgf"cpf"uwdewvcpgqwun{"korncpvgf"rcegocmgt0"J
Thorac Cardiovasc Surg"3;83=64<:36/470"
760"Iqnfuvgkp" FL." Q|" OE." Tqug" GC0" Ogfkecn" rtqitguu<" korncpvcdng" nghv "
xgpvtkewnct"cuukuv"fgxkegu0"N Engl J Med"3;::=55;<3744/550"
770"""Oktqyumk"O."Tgkf"RT."Oqygt"OO."Ycvmkpu"N."Iqvv"XN."Uejcwdng"LH."
Ncpigt" C." Jgknocp" OU." Mqngpkm" UC." Hkuejgnn" TG." Ygkuhgnfv" ON0"
Vgtokpcvkqp" qh" ocnkipcpv" xgpvtkewnct" cttj{vjokcu" ykvj" cp" korncpvgf"
cwvqocvke"fghkdtknncvqt"kp"jwocp"dgkpiu0"N Eng J Med"3;:2=525<544/60"
780"Ecdgnn"EJ."Jgkfgptgkej"RC."Ejw"XJ. "Oqqtg"EO."Uvt{lgyumk"OG."Eqtg{"
IT."Hqyngt"XI"Lt0"Kpetgcukpi"tcvgu"qh"ectfkce"fgxkeg"kphgevkqpu"coqpi"
Ogfkectg"dgpghkekctkgu<"3;;2/3;;;0"Am Heart J"4226=369<7:4/80"
790"Mgtpqfng" FU." Mckugt" CD0" Rquvqrgtcvkxg" kphgevkqpu" cpf" cpvkoketqdkcn"
rtqrj{nczku0" Kp<" Ocpfgnn" IN." Dgppgv" LG." Fqnkp" T." gfu0" Rtkpekrngu" cpf"
rtcvkeg"qh"kphgevkqwu"fkugcug."7
vj
"gf0"Rjkncfgnrjkc<"Ejwtejknn"Ngxkpiuvqpg."
4222<5399/53;30"
100
7:0"Gjtgpmtcp|"LG."Rhchh"UL0"Ogfkcuvkpkvku"eqornkecvkpi"ectfkce"qrgtcvkqpu<"
gxkfgpeg"qh"rquvqrgtcvkxg"ecwucvkqp0"Rev Infect Dis"3;;3=35<:25/:360"
7;0""Nqyt{" RY ." Dncpmgpujkr" TL." Itkfng{" Y." Vtqwr" PL." Vqormkpu" NU0" C"
enwuvgt" qh" ngikqpgnnc" uvgtpcn/yqwpf" kphgevkqpu" fwg" vq" rquvqrgtcvkxg"
vqrkecn" gzrquwtg" vq" eqpvcokpcvgf" vcr" ycvgt0" N Engl J Med"
3;:;=546<32;/3350"
820"Cnvgogkgt" YC." Ewndgtvuqp"YT."Jwoogn" TR0" Uwtikecn" eqpukfgtcvkqp" qh"
gpfqigpqwu" kphgevkqpu" uqwtegu." v{rgu." cpf" ogvjqfu" qh" eqpvtqn0" Surg
Clin North Am"3;8:=6:<449/4620"
830"Ykng{" CO." Jc‚gtk" ID0" Tqwvgu" qh" kphgevkqp0" C" uvwf{" qh" wukpi" vtcegt"
rctvkengu" kp" vjg" qtvjqrgfke" qrgtcvkpi" tqqo0" Clin Orthop" 3;9;=35;<372/
3770"
840"Gfyctfu"NF0"Vjg"grkfgokqnqi{"qh"4278"tgoqvg"ukvg"kphgevkqpu"cpf"3;88"
uwtikecn"yqwpf"kphgevkqpu"qeewttkpi"kp"3:87"rcvkgpvu<"c"hqwt/{gct"uvwf{"
qh" 620;45" qrgtcvkqpu" cv" Twuj/Rtgud{vgtkcp/Uv0" Nwmgu‚u" Jqurkvcn."
Ejkeciq0"Ann Surg"3;98=3:6<97:/9880"
850"Fgxgpkuj" GC." Okngu" CC0" Eqpvtqn" qh" Staphylococcus aureus kp" cp"
qrgtcvkxg"vjgcvtg0"Lancet"3;5;=32::/32;60"
860"Nqydwt{" GLN." Nknn{" JC0" Fkukphgevkqp" qh" vjg" jcpfu" qh" uwtigqpu" cpf"
pwtugu0"Br Med J"3;82=3<3667/36720"
870"Ycnvgt"EY."Mwpfukp"TD0"Vjg"dcevgtkqnqike"uvwf{"qh"uwtikecn"inqxgu"htqo"
472"qrgcvkqpu0"Surg Gynecol Obstet"3;8;=34;<;6;/;740"
880""Fqffu"TF."Iw{"RL."Rgceqem"CO."Fwhh{"UT."Dctmgt"UI."Vjqocu"OJ0"
Uwtikecn"inqxg"rgthqtcvkqp0"Br J Surg"3;::=97<;88/;8:0"
101
890"Fkpggp" R." Ftwukp" N0" Grkfgokeu" qh" rquvqrgtcvkxg" yqwpf" kphgevkqpu"
cuuqekcvgf"ykvj"jckt"ecttkgtu0"Lancet 3;95=4<3379/337;0"
8:0"Jc‚gtk"ID."Ykng{"CO0"Vjg"ghhkece{"qh"uvcpfctf"uwtikecn"hceg"ocumu<"cp"
kpxguvkicvkqp"wukpi"vtcegt"rctvkengu0"Clin Orthop"3;:2=36:<382/3840"
8;0""Ocuvtq" VF." Hctng{" VC." Gnnkqvv" LC." Hcemnco" TT." Rgtmu" LT." Jcfngt" LN."
Iqqf" TE." Urkmc" LU0" Cp" qwvdtgcm" qh" uwtikecn/yqwpf" kphgevkqp" fwg" vq"
itqwr" C" uvtgrvqeqeewu" ecttkgf" qp" vjg" uecnr0" N Engl J Med"
3;;2=545<;8:/;940"
920"Hqtf"ET."Rgvgtuqp"FG."Okvejgnn"ET0"Cp"crrtckucn"qh"vjg"tqng"qh"uwtikecn"
ocumu0"Am J. Surg"3;89=335<9:9/9;20"
930"Ngvvu"TO."Fqgtogt"G0"Eqpxgtucvkqp"kp"vjg"qrgtcvkpi"vjgcvgt"cu"c"ecwug"
qh" cktdqtpg" dcevgtkcn" eqpvcokpcvkqp0" J Bon Joint Surg" 3;:5=87C<579/
5840"
940"Ycnvgt"EY."Mwpfukp"TD0"Vjg"hnqqt"cu"c"tgugtxqkt"qh"jqurkvcn"kphgevkqpu0"
Surg Gynecol Obstet"3;82=333<3/90"
950""Engii" JY." Hquvgt" OV." Ucpfgtu" YG" Lt." Dckpg" YD0" Kphgevkqp" fwg" vq"
qticpkuou"qh"vjg"Mycobacterium fortuitum eqorngz"chvgt"cwiogpvcvkqp"
ocoocrncuv{<" enkpkecn" cpf" grkfgokqnqike" hgcvwtgu0" J Infect Dis"
3;:5=369<649/6550"
960"Uchtcpgm" VL." Lctxku" YT." Ectuqp" NC." Ewukem" ND." Dncpf" NC." Uygpuqp"
LO."Ukneqz"XC0" Mycobacterium chelonae yqwpf"kphgevkqpu"chvgt"rncuvke"
uwtigt{"gornq{kpi"eqpvcokpcvgf"igpvkcp"xkqngv"umkp/octmkpi"uqnwvkqp0"P"
Engl J Med"3;:9=539<3;9/4230"
970"Ycnnceg"TL"Lt."Owuugt"LO."Jwnn"UK."Ukneqz"XC."Uvggng"NE."Hqttguvgt"IF."
Ncdkfk" C." Ugncpfgt" TM0" Fkxgtukv{" cpf" uqwtegu" qh" tcrkfn{" itqykpi"
102
o{eqdcevgtkc" cuuqekcvgf" ykvj" kphgevkqpu" hqnnqykpi" ectfkce" uwtigt{0" J
Infect Dis"3;:;=37;<92:/9380"
980"Nqydwt{"GLN."Nknn{"JC0"Vjg"uqwtegu"qh"jqurkvcn"kphgevkqp"qh"yqwpfu"ykvj"
Clostridium welchii0"J Hyg"3;7:=78<38;/3:40"
990"Gkemjqhh" VE0" Cp" qwvdtgcm" qh" uwtikecn" yqwpf" kphgevkqpu" fwg" vq"
Clostridium perfringens0"Uwti"I{pgeqn"Qduvgv"3;84=336<3324/332:0"
9:0"Ictvgpdgti" I." Dqvvqp" GL." Mgwuej" IV." Ygkv|ocp" K0" Jqurkvcn/ceswktgf"
oweqto{equku" * Rhizopus rhizopodiformis+" qh" umkp" cpf" uwdewvcpgqwu"
vkuuwg0" Grkfgokqnqi{." o{eqnqi{" cpf" vtgcvogpv0" N Engl J Med"
3;9:=4;;<3337/333:0"
9;0"Ujgnfqp"FN."Lqjpuqp"YE0"Ewvcpgqwu"oweqto{equku0"Vyq"fqewogpvgf"
ecugu"qh"uwurgevgf"pquqeqokcn"ecwug0"JAMA"3;9;=463<3254/32560"
:20"Gxgtgvv" GF." Rgctuqp" U." Tqigtu" Y0" Tjk|qrwu" uwtikecn" yqwpf"kphgevkqp"
cuuqekcvgf" ykvj" gncuvkek|gf" cfjgukxg" vcrg" ftguukpiu0" Arch Surg"
3;9;=336<95:/95;0"
:30"Rgctuqp"TF."Xcngpvk"YO."Uvgkidkign"TV0"Clostridium perfringens"yqwpf"
kphgevkqp"cuuqekcvgf"ykvj"gncuvke"dcpfcigu0"JAMA"3;:2=466<334:/33520"
:40"Dcuugv" FEL." Uvqmgu" ML." Vjqocu" YTI0" Yqwpf" kphgevkqp" ykvj"
Pseudomonas multivorans0" C" ycvgt" dqtpg" eqpvcokpcpv" qh" fkukphgevcpv"
uqnwvkqpu0"Lancet"3;92=3<333:/333;0"
:50"Vjqocu" OGO." Rkrgt" G." Ocwtgt" KO0" Eqpvcokpcvkqp" qh" cp" qrgtcvkpi"
vjgcvtg" d{" itco/pgicvkxg" dcevgtkc0" Gzcokpcvkqp" qh" ycvgt" uwrrnkgu."
engcpkp"ogvjqfu."cpf"yqwpf"kphgevkqpu0"J Hyg"3;94=92<85/8:0"
:60""Gjtgpmtcp|" PL."Dqn{ctf"GC."Ykgpgt" O." Engct{"VL0" Cpvkdkqvke/ugpukvkxg"
Serratia marcescens" kphgevkqpu" eqornkecvkpi" ectfkqrwnoqpct{"
103
qrgtcvkqpu<" eqpvcokpcvgf" fkukphgevcpv" cu" c" tgugtxqkt0" Lancet
3;:2=4<34:;/34;40"
:70"OeKpv{tg" FO0" Cp" grkfgoke" qh" Uvtgrvqeqeewu" r{qigpgu" rwgtrgtcn" cpf"
rquvqrgtcvkxg" ugruku" ykvj" cp" wpwuwcn" ecttkgt" ukvg" /" vjg" cpwu0" Am J
Obstet Gynecol 3;8:=323<52:/5360"
:80"Uejchhpgt" Y." Nghmqykv|" ND" Lt." Iqqfocp" LU." Mqgpki" OI0" Jqurkvcn"
qwvdtgcm" qh" kphgevkqpu" ykvj" itqwr" C" uvtgrvqeqeek" vtcegf" vq" cp"
cu{orvqocvke"cpcn"ecttkgt0"N Engl J Med"3;8;=4:2<3346/33470"
:90"It{umc" RH." Q‚Fgc" CG0" Rquvqrgtcvkxg" uvtgrvqeqeecn" yqwpf" kphgevkqp0"
Vjg"cpcvqo{"qh"cp"grkfgoke0"LCOC"3;92=435<33:;/33;30"
::0"Uvcoo"YG."Hggn{"LE."Hcemnco" TT0"Yqwpf"kphgevkqpu" fwg"vq"itqwr"C"
Uvtgrvqeqeewu" vtcegf" vq" c" xcikpcn" ecttkgt0" J Infect Dis" 3;9:=35:<4:9/
4;40"
:;0"Dgtmgnocp"TN."Octvkp"F."Itcjco"FT."Oqyt{"L."Htgkugo"T."Ygdgt"LC."
Jq"LN."Cnngp"LT00" Uvtgrvqeqeecn" yqwpf" kphgevkqpu" ecwugf" d{"c"xcikpcn"
ecttkgt0"JAMA"3;:4=469<48:2/48:40"
;20"Pcvkqpcn" Cecfgo{" qh" Uekgpegu" Pcvkqpcn" Tgugctej" Eqwpekn0"
Rquvqrgtcvkxg"yqwpf"kphgevkqpu<"vjg"kphnwgpeg"qh"wnvtcxkqngv"kttcfkcvkqp"qh"
vjg" qrgtcvkpi" tqqo" cpf" qh" xctkqwu" qvjgt" hcevqtu0" Ann Surg"
3;86=382*uwrrn"4+<3/3540"
;30"Nkfygnn" QO." Nqydwt{" GL." Yj{vg" Y." Dnqygtu" T." Uvcpng{" UL." Nqyg" F0"
Cktdqpg"eqpvcokpcvkqp"qh"yqwpfu"kp"lqkpv"tgrncegogp v u"qrgtcvkqpu<"vjg"
tgncvkqpujkr"vq"ugruku"tcvgu0"J Hosp Infect"3;:5=6<333/3530"
104
;40"Dtwwp"LP."Rqu/qrgtcvkxg"yqwpf"kphgevkqp0"Rtgfkurqukpi"hcevqtu"cpf"vjg"
ghhgev" qh" c" tgfwevkqp" kp" vjg" fkuugokpcvkqp" qh" uvcrj{nqeqeek0" Acta Med
Scand"3;92=736*uwrrn+<3/:;0"
;50"Pcicejkpvc"V."Uvgrjgpu"O."Tgkv|"D."Rqnm"DH0"Tkum"hcevqtu"hqt"uwtikecn/
yqwpf" kphgevkqp" hqnnqykpi" ectfkce" uwtigt{0" J Infect Dis" 3;:9=378<;89/
;950"
;60"Okujtkmk" UH." Ncy" FLY." Lghhtg{" RL0" Hcevqtu" chhgevkpi" vjg" kpekfgpeg" qh"
rquvqrgtcvkxg"yqwpf"kphgevkqp0"J Hosp Infect"3;;2=38<445/4520"
;70"Ugtqrkcp" T." Tg{pqnfu" DO0" Yqwpf" kphgevkqpu" chvgt" rtgqrgtcvkxg"
fgrkncvqt{"xgtuwu"tc|qt"rtgrctcvkqp0"Am J Surg"3;93=343<473/4760"
;80"Rqyku"ULC."Ycvgtyqtvj"Vco"Ctmgnn"FI0"Rtgqrgtcvkxg"umkp"rtgrctcvkqp<"
enkpkecn"gxcnwcvkqp"qh"fgrkncvqt{"etgco0"Br Med J"3;98=4<3388/338:0"
;90"Dcnvjc|ct" GT." Eqnv" LF." Pkejqnu" TN0" Rtgqrgtcvkxg" jckt" tgoqxcn<" c"
tcpfqok|gf"rtqurgevkxg"uvwf{"qh"ujcxkpi"x gtuwu"enkrrkpi0"South Med J"
3;:4=97<9;;/:230"
;:0""Cngzcpfgt" LY." Hkuejgt" LG." Dq{clkcp" O." Rcnoswkuv" L." Oqttku" OL0" Vjg"
kphnwgpeg" qh" jckt/tgoqxcn" ogvjqfu" qp" yqwpf" kphgevkqpu0" Arch Surg"
3;:5=33:<569/5740"
;;0"Ogjvc"I."Rtcmcuj"D."Mctoqmgt"U0"Eqorwvgt"cuukuvgf"cpcn{uku"qh"yqwpf"
kphgevkqp"kp"pgwtquwtigt{0"J Hosp Infect"3;::=33<466/4740"
3220" Jcoknvqp" YJ." Nqpg" HL0" Rtgqrgtcvkxg" jckt" tgoqxcn0" Can J Surg"
3;99=42<48;/4970"
3230" Ujcrktq"OD."Owpq|"C."Vcigt"KD0"Tkum"hcevqtu"hqt"kphgevkqp"cv"vjg"
qrgtcvkxg" ukvg" cnvgt" cdfqokpcn" qt" xcikpcn" j{uvgtgevqo{0" N Engl J Med"
3;:4=529<3883/38880"
105
3240" Hctdgt"DH."Mckugt"FN."Ygp|gn"TR0"Tgncvkqpujkr"dgvyggp"uwtikecn"
xqnwog" cpf" kpekfgpeg" qh" rquqrgtcvkxg" yqwpf" kphgevkqp0" N Engl J Med"
3;:3=527<422/4260""
3250" Oknngt" RL." Ugcte{" OC." Mckugt" FN." Ygp|gn" TR0" Vjg" tgncvkqpujkr"
dgvyggp" uwtigqp" gzrgktgpeg" cpf" gpfqogvtkvku" chvgt" eguctgcp" ugevkqp0"
Surg Gynecol Obstet"3;:9=387<757/75;0"
3260" Ukoejgp"G."Uvgkp"J."Ucemu"VI."Ujcrktq"O."Okejgn"L0"Owvkxctkcvg"
cpcn{uku"qh"fgvgtokpcpvu"qh"rquvqrgtcvkxg"yqwpf"kphgevkqp"kp"qtvjqrcgfke"
rcvkgpvu0"J Hosp Infect"3;:6=7<359/3680"
3270" Nwdqyumk" F." Jwpv" FT0" Cdfqokpcn" yqwpf" ftckpcig" ⁄"c"
rtqurgevkxg."tcpfqok|gf"vtkcn0"Med J Aust"3;:9=368<355/3570"
3280" Nkfitgp" N0" Rquvqrgtcvkxg" qtvjqrcgfke" kphgevkqpu" kp" rcvkgpvu" ykvj"
fkcdgvgu"ognnkvwu0"Acta Orthop Scand"3;95=66<36;/3730"
3290" Nknkgphgnf"FG."Xncjqx"F."Vgpp{"LJ."OceNcwijnkp"LU0"Qdgukv{"cpf"
fkcdgvgu"cu"tkum"hcevqtu"hqt"rquvqrgtcvkxg"yqwpf"kphgevkqpu"chvgt"ectfkce"
uwtigt{0"Am J Infect Control"3;::=38<5/80"
32:0" P{uvtqo"R."Lqpuvco"C."Jqlgt"J."Nkpi"N0"Kpekukqpcn"kphgevkqp"chvgt"
eqnqtgevcn" uwtigt{" kp" qdgug" rcvkgpvu0" Acta Chir Scand" 3;:9=375<447/
4490"
32;0" Encguuqp" DGD." Jqnonwpf" FGY0" Rtgfkevqtu" qh" kpvtcqrgtcvkxg"
dcevgtkcn"eqpvcokpcvkqp"cpf"rquvqrgtcvkxg"kphgevkqp"kp"gngevkxg"eqnqtgevcn"
uwtigt{0"J Hosp Infect"3;::=33<349/3570"
3320" Ykpfuqt"LC."Jknn"IN0"Ygkijv"nquu"ykvj"rj{ukqnqike"korcktogpv0"C"
dcuke"kpfkecvqt"qh"uwtikecn"tkum0"Ann Surg"3;::=429<4;2/4;80"
106
3330" Ikn/Gigc"OL."Rk/Uwp{gt"OV."Xgtfciwgt"C."Ucp|"H."Ukvigu/Ugttc"
C."Gngk|giwk" NV0"Uwtikecn" yqwpf"kphgevkqpu<" rtqurgevkxg"uvwf{" qh"6.68:"
engcp"yqwpfu0"Infect Control"3;:9=:<499/4:20"
3340" Jwejetqhv" UC." Pkeqng" NG." Etwug" RLG0" Uwtikecn" yqwpf" kphgevkqp"
cpf" ecpegt" coqpi" vjg" gnfgtn{<" c" ecug" eqpvtqn" uvwf{0" J Surg Oncol"
3;;2=67<472/4780"
3350" Ykjndqti" Q0" Vjg" ghhget" qh" ycujkpi" ykvj" ejnqtjgzkfkpg" uqcr" qp"
yqwpf" kphgevkqp" tcvg" kp" igpgtcn" uwtigt{0" Ann Chir Gynaecol"
3;:9=98<485/4870"
3360" Jc{gm"NL."Gogtuqp"LO."Ictfpgt"COP0"C"rncegdq/eqpvtqnngf"vtkcn"
qh" vjg" ghhgev" qh" vyq" rtgqrgtcvkxg" dcvju" qt" ujqygtu" ykvj" ejnqtjgzkfkpg"
fgvgtigpv" qp" rquvqrgtcvkxg" yqwpf" kphgevkqp" tcvgu0" J Hosp Infect"
3;:9=32<387/3940"
3370" Ictkdcnfk"TC."Umqnpkem"F."Ngtgt"V."Rqktqv"C."Itcjco"L."Mtkuwkpcu"
G."N{qpu"T0"Vjg"korcev"qh"rtgqrgtcvkxg"umkp"fkukphgevkqp"qp"rtgxgpvkpi"
kpvtqrgtcvkxg" yqwpf" eqpvcokpcvkqp0" Infect Control Hosp Epidemiol"
3;::=;<32;/3350"
3380" Tqvvgt"ON."Nctugp"UQ."Eqqmg"GO."Fcpmgtv"L."Fcuejpgt"H."Itgeq"
F."Itqptquu"R."Lgrugp"QD."N{uvcf"C."P{uvtqo"D0"C"eqorctkuqp"qh"vjg"
ghhgevu" qh" rtgqrgtcvkxg" yjqng/dqf{" dcvjkpi" ykvj" fgvgtigpv" cnqpg" cpf"
ykvj" fgvgtigpv" eqpvckpkpi" ejnqtjgzkfkpg" inweqpcvg" qp" vjg" htgswgpe{" qh"
yqwpf"kphgevkqpu"chvgt"engcp"uwtigt{0"L"Jqur"Kphgev"3;::=33<532/5420"
3390" Dwtmg" LH0" Vjg" ghhgevkxg" rgtkqf" qh" rtgxgpvkxg" cpvkdkqvke" cevkqp" kp"
gzrgtkogpvcn"kpekukqp"cpf"fgtocn"ngukqpu0"Surgery 3;83=72<3830"
107
33:0" Dgtpctf"JT."Eqng"YT0"Vjg"rtqrj{nczku"qh"uwtikecn"kphgevkqp<"vjg"
ghhgev" qh" rtqrj{ncevke" cpvkoketqdkcn" ftwiu" qp" vjg" kpekfgpeg" qh" kphgevkqp"
hqnnqykpi"rqvgpvkcnn{"eqpvcokpcvgf"qrgtcvkqpu0"Surgery"3;86=78<3730"
33;0" Pkejqnu"TN0"Uwtikecn"dcevgtkqnqi{<"cp"qxgtxkgy0"Kp<"P{jwu"NO."gf0"
Uwtigt{"cppwcn."xqn"350"Pgy"[qtm<"Crrngvqp/Egpvwt{/Etqhvu."3;:3<427/
45:0"
3420" Pkejqnu"TN."Jqnogu"LY0"Rtqrj{nczku"kp"dqygn"uwtigt{0"Curr Clin
Top Infect Dis 3;;7=37<98/;80"
3430" Ucpfgtuqp" RL0" Cpvkoketqdkcn" rtqrj{nczku" kp" uwtigt{<"
oketqdkqnqikecn"hcevqtu0"J Antimicrog Chmother"3;;5=53*Uwrrn"D+<3/;0"
3440" Xgicu"CC."Lqftc"XO."Ictekc"ON0"Pquqeqokcn"kphgevkqp"kp"uwtigt{"
yctfu<" c" eqpvtqnngf" uvwf{" qh" kpetgcugf" fwtcvkqp" qh" jqurkvcn" uvc{u" cpf"
fktgev"equv"qh"jqurkvcnk|cvkqp0"Eur J Epidemiol"3;;5=;*7+<726/7320"
3450" Pqq{gp" UO." Qxgtdggm" DR." Dtwvgn" fg" nc" Tkxkgtg" C." Uvqto" CL."
Ncpigog{gt" LL0" Rtqurgevkxg" tcpfqok|gf" eqorctkuqp" qh" ukping/fqug"
xgtuwu" ownvkrng/fqug" eghwtqzkog" rqt" rtqrj{nczku" kp" eqtqpct{" ctvgt{"
d{rcuu"itchvkpi0"Eur J Clin Microbiol Infect Dis"3;;6=35<3255/32590"
3460" Rcig"ER."Dqjpgp"LO."Hngvejgt"LT."OeOcpwu"CV."Uqnqomkp"LU."
Ykvvocpp"FT0"Cpvkoketqdkcn"rtqrj{nczku"hqt"uwtikecn"yqwpfu0"Iwkfgnkpgu"
hqt"enkpkecn"ectg0"Arch Surg"3;;5=34:<9;/::0"
3470" Dq{eg" L." Rqvvgt/D{pqg" I." F|kqdgm" N0" Jqurkvcn" tgkodwtugogpv"
rcvvgtpu"coqpi"rcvkgpvu"ykvj" uwtikecn" yqwpf" kphgevkqpu" hqnnqykpi" qrgp"
jgctv"uwtigt{0"Infect Control Hosp Epidemiol"3;;2=33<:;/;50"
108
3480" Tqcej" C." Mgtpqfng" F." Mckugt" C0" Ugngevkpi" equv/ghhgevkxg"
cpvkoketqdkcn" rtqrj{nczku" kp" uwtigt{<" ctg" yg" igvvkpi" yjcv" yg" rc{" hqtA"
DICP Ann Pharmacother"3;;2=46<3:5/3:70"
3490" Iqtdcej" UN." Eqpfqp" TG." Eqpvg" LG" Lt." Mckugt" CD." Ngfigt" YL."
Pkejqnu" TN0" Gxcnwcvkqp" qh" pgy" cpvk/kphgevkxg" ftwiu" hqt" uwtikecn"
rtqrj{nczku0"Kphgevkqwu"Fkugcugu"Uqekgv{"qh"Cogtkec"cpf"vjg"Hqqf"cpf"
Ftwi"Cfokpkuvtcvkqp0"Clin Infect Dis"3;;4=37*uwrrn"3+<U535/5:0"
34:0" Uejgt"MU0"Uvwfkgu"qp"vjg"fwtcvkqp"qh"cpvkdkqvke"cfokpkuvtcvkqp"hqt"
uwtikecn"rtqrj{nczku0"Am Surg"3;;9=85<7;/840"
34;0" Pkejqnu" TN0" Cpvkdkqvke" rtqrj{nczku" kp" uwtigt{0" J Chemother"
3;:;=3*5+<392/39:0"
3520" Gjtgpmtcp|" PL0" Cpvkoketqdkcn" rtqrj{nczku" kp" uwtigt{<"
ogejcpkuou." okueqpegrvkqpu." cpf" okuejkgh0" Infect Control Hosp
Epiedmiol"3;;5=36*4+<;;/3280"
3530" Encuugp" FE." Gxcpu" TU." Rguvqvpkm" UN." Jqtp" UF." Ogpnqxg" TN."
Dwtmg"LR0"Vjg"vkokpi"qh"rtqrj{ncevke"cfokpkuvtcvkqp"qh"cpvkdkqvkeu"cpf"vjg"
tkum"qh"uwtikecn/yqwpf"kphgevkqp0"N Engl J Med"3;;4=548*7+<4:3/4:80"
3540" Oc{jcnn"EI."Uwtikecn"kphgevkqpu"kpenwfkpi"dwtpu0"Kp<" Ygp|gn"TR."
gf0" Rtgxgpvkp" cpf" eqpvtqn" qh" Pquqeqokcn" Kphgevkqpu0" 4
pf
" gf0" Dcnvkoqtg<"
Yknnkcou"("Yknmkpu0"3;;5=r0836/8860"
3550" Ngg" LV0" Uwtikecn" yqwpf" kphgevkqpu<" uwtxgknncpeg" hqt" swcnkv{"
kortqxgogpv0" Kp<" Ht{" FG." gf0" U wtikecn" Kphgevkqpu0" Dquvqp<" Nkvvng" Dtqyp"
cpf"Eq=3;;70r0367/37;0"
3560" Rncvv" T0" Iwkfgnkpgu" hqt" rgtkqrgtcvkxg" cpvkdkqvke" rtqrj{nczku0" Kp<"
Cdtwv{p" G." Iqnfocpp" FC." Uejgemngt" YG." gfu0" Ucwpfgtu" kphgevkqp"
109
eqpvtqn" tghgtgpeg" ugtxkeg0" Rjkncfgnrjkc<" Y0D0" Ucwpfgtu" Eq=" 3;;90" r0"
44;/560"
3570" Pkejqnu" TN0" Uwtikecn" cpvkdkqvke" rtqrj{nczku0" Med Clin North Am"
3;;7=9;*5+<72;/440"
3580" Jktuejocpp" LX0" Cpvkdkqvkeu" kp" vjg" rtgxgpvkqp" qh" kphgevkqp"
cuuqekcvgf" ykvj" rtquvjgvke" fgxkegu0" Kp<" Uwictocp" D." [qwpi" GL."
gfu0Kphgevkqpu"cuuqekcvgf"ykvj"rtquvjgvke"fgxkegu0"Dqec"Tcvqp."HN<"ETE"
Rtguu."3;:5<48;/49:0"
3590" Jknn" E." Hncocpv" T." Oc|cu" H." Gxtctf" L0" Rtqrj{ncevke" eghc|qnkp"
xgtuwu"rncegdq"gp"vqvcn"jkr"tgrncegogpv0"Tgrqtv"qh"c"ownvkegpvtg"fqwdng/
dnkpf"tcpfqok|gf"vtkcn. Lancet"3;:3=3<9;7/9;80"
35:0" Nkfygnn"QO."Nqydwt{"GL."Yj{vg"Y."Dnqygtu"T."Uvcpng{"UL."Nqyg"
F0"Ghhgev"qh"wnvtcengcp"ckt"kp"qrgtcvkpi"tqqou"qp"fggr"ugruku"kp"vjg"lqkpv"
chvgt" vqvcn" jkr" qt" mpgg" tgrncegogpv<" c" tcpfqok|gf" uvwf{0" BMJ
3;:4=4:7<32/360"
35;0" Nkfygnn"QO."Gnuqp"TC."Nqydwt{"GL."Yj{vg"Y."Dnqygtu"T."Uvcpng{ "
UL." Nqyg" F0" Wnvtcengcp" ckt" cpf" cpvkdkqvkeu" hqt" rtgxgpvkqp" qh"
rquvqrgtcvkxg" kphgevkqp0" C" ownvkegpvgt" uvwf{" qh" :.274" lqkpv" tgrncegogpv"
qrgtcvkqpu0"Acta Orthop Scand"3;:9=7:<6/350"
3620" Mngpgtocp"N."Ugcn"F."Uwnngpu"M0"Eqodkpgf"rtqrj{ncevke"ghhgev"qh"
wnvtcengcp"ckt"cpf"eghwtqzkog"hqt"tgfwekpi"kphgevkqp"kp"rtquvjgvke"uwtigt{0"
Acta Orthop Belg"3;;3=79<3;/460"
3630" Owgtu" OH." Ctpqnf" CI." Ungkijv" R0" Rtqrj{ncevke" cpvkdkqvkeu" hqt"
ectfkce" rcegocmgt" korncpvcvkqp0" C" rtqurgevkxg" vtkcn0" Br Heart J"
3;:3=68<75;/660"
110
3640" Tcoufcng"FT."Ejctngu"TI."Tqyncpfu"FD0"Cpvkdkqvke"Rtqrj{nczku"
hqt" Rcegocmgt" Korncpvcvkqp<" C" Rtqurgevkxg" Tcpfqo k|gf" Vtkcn0" PACE
3;:6=9<:66/:6;0"
3650" Dnwjo" IN0" Rcegocmgt" Kphgevkqpu0" C" 4/[gct" Hqnnqy/wr" qh"
Cpvkdkqvke" Rtqrj{nczku0" Scand J Thor Cardiovasc Surg" 3;:7=3;<" 453/
4570"
3660" Oqwpug{" LR." Itkhhkvj" OL." V{pcp" O0" Cpvkdkqvke" rtqrj{nczku" kp"
rgtocpgpv"rcegocmgt" korncpvcvkqp<"c"rtqurgevkxg"tcpfqok|gf"vtkcn0"Br
Heart J"3;;6=94<55;/5650"
3670" Fc"Equvc"C."Mktmqtkcp"I."Ewejgtcv"O."Fgncjc{g"H."Ejgxcnkgt"R."
Egtkukgt" C." Kucc|" M." Vqwdqwn" R0" Cpvkdkqvke" Rtqrj{nczku" hqt" Rgtocpgpv"
Rcegocmgt" Korncvcvkqp0" C" Ogvc/Cpcn{uku0" Circulation" 3;;:=;9<39;8/
3:230"
3680" Fwtcem" FV." Nwmgu" CU." Dtkijv" FM0" Pgy" etkvgtkc" hqt" fkcipquku" qh"
kphgevkxg"gpfqectfkvku<"wvknk|cvkqp"qh" urgekhke"gejqectfkqitcrjke"hkpfkpiu0"
Fwmg"Gpfqectfkvku"Ugtxkeg0"Am J Med 1994=";8<422/;0"
3690"Tqupgt" D0" Hwpfcogpvcnu" qh" Dkquvcvkuvkeu0" Fwzdwt{" Rtguu." 6
vj
" gfkvkqp"
Pgy"[qtm."3;;6."rr0"8:40"
36:0"Dgtvcinkc" G." \gtdq" H." \ctfq" U." gv" cn0" Cpvkdkqvke" Rtqrj{nczku" ykvj" c"
Ukping"Fqug"qh"Eghc| qnkp"Fwtkpi"Rcegocmgt"Korncpvcvkqp<"K pekfgpeg"qh"
Nqpi/Vgto"Kphgevkxg"Eqornkecvkqpu0"PACE"4228=4;<4;/550"
36;0"Ncmmktgff{" F." Xcncuctgffk" U." T{uejqp" M0" Vjg" Korcev" qh" Rqxkfqpg/
Kqfkpg"Rqemgv"Kttkicvkqp"Wug"qp"Rcegocmgt"cpf"Fghkdtknncvqt"Kphgevkqpu0"
PACE"4227=4:<9:;/9;60"
111
3720"Oquu" C." Jcnn" L." Ecppqo" F0" Kortqxgf" uwtxkxcn" ykvj" cp" korncvgf"
fghkdtknncvqt"kp"rcvkgpvu"ykvj"eqtqpct{"fkugcug"cv"jkij"tkum"qh"xgpvtkewnct"
cttj{vjokcu0"N Engl Med"3;;8="557<3;55/620"
3730"Jncvm{"OC."Uc{pkpc"Q."OeFqpcnf"MO0"Wvknk|cvkqp"cpf"qwveqogu"qh"vjg"
korncpvcdng" ctfkqxgtvgt" fghkdtknncvqt." 3;:9/3;;70" Am Heart J"
4224=366<5;9/6250"
3740"Ec|gcw" U." Ngengtes" E." Ncxgtipg" V0" Ghhgevu" qh" ownvkukvg" dkxgpvtkewnct"
rcekpi" kp" rcvkgpvu" ykvj" jgctv" hcknwtg" cpf" kpvtcxgpvtkewnct" eqpfwevkqp"
fgnc{0"N Engl J Med"4223=566<:95/:20"
3750"Itcu"F."Ngengtes"E."Vcpi" CU0"Ectfkce" Tgu{pejtqpk|cvkqp" vjgtcr{"kp"
cfxcpegf" jgctv" hcknwtg<" Vjg" ownvkegpvgt" KpU{pe" enkpkecn" uvwf{0" Eur J
Heart Fail"4224=6<533/420"
3760"Engncpf" LI." Fcwdgtv" LE." Gtfocpp" G." Htggocpvng" P." Itcu" F."
Mcrrgpdgtigt" N." Vcxc||k" N=" Ectfkce" Tgu{pejtqpk|cvkqp/Jgctv" Hcknwtg"
*ECTG/JH+"Uvwf{"Kpxguvkicvqtu0"Vjg"Ghhgev"q h"ectfkce"tgu{pejtqpk|cvkqp"
qp" oqtdkfkv{" cpf" oqvcnkv{" kp" jgctv" hcknwtg0" New Engl J Med"
4227=574<375;/376;0"
3770"Mnwi" F." Ncetqkz" F." Ucxq{g" E0" U{uvgoke" K phgevkqp" Tgncvgf" vq"
Gpfqectfkvku" qp" Rcegocmgt" Ngcfu0" Enkpkecn" Rtgugpvcvkqp" cpf"
Ocpcigogpv0"Circulation 3;;9=;7<42;:/43290"
3780"Ecowu"E."Ngrqtv"E."Tchhk"H."Okejgngv"E."Ectvkgt"H."Xknfg"LN0"Uwuvckpgf"
dcevgtgokc" kp" 48" rcvkgpvu" ykvj" c" rgtocpgpv" gpfqectfkcn" rcegocmgt<"
cuuguuogpv"qh"yktg"tgoqxcn0"Clin Infect Dis"3;;5=39<68/770"
112
3790"Rhgkhhgt"F."Lwpi"Y."Hgjumg"Y."Mqtvg"V."Ocp|"O."Oqqufqth"T."Nwfgtkv|"
D0" Eqornkecvkqpu" qh" rcegocmgt/fghkdtknncvqt" fgxkegu<" fkcipquku" cp f"
ocpcigogpv0"Am Heart J"3;;6=349<3295/:20"
37:0"Xqiv"RT."Ucifke"M."Ncejcv"O."Tkuvk"D."xqp"Ugitguugt"NM."Vwtkpc"OK0"
Uwtikecn" " ocpcigogpv" qh" kphgevgf" rgtocpgpv" vtcpuxgpqwu" rcegocmgt"
u{uvgo<"vgp"{gct"gzrgtkgpeg0"J Card Surg"3;;8=33<3:2/80"
37;0"Ejcoku" C N." Rgvgtuqp" IG." Ecdgnn" EJ0" Uvcrj{nqeqeewu" cwtgwu"
dcevgtgokc" kp" rcvkgpvu" ykvj" rgtocpgpv" rcegocmgtu" qt" korncpvcdng"
ectfkqxgtvgt/fghkdtknncvqtu0"Circulation"4223=326<324;/550"
3820"Ejwc" LF." Yknmqhh" DN." Ngg" K." Lwtcvnk" P." Nqpiyqtvj" FN." Iqtfqp" UO0"
Fkcipquku" cpf" ocpcigogpv" qh" kphgevkqpu" kpxqnxkpi" korncpvcdng"
gngevtqrj{ukqnqike"ectfkce"fgxkegu0"Ann Intern Med"4222=355<826/:0"
3830"Octvkpgnnk"O."Dwgpq"U."Qnkxgktc"LE."Xctglçq"V."Pkujkqmc"UCF."Rgftquc"
CCC." Ogtèqp" GU." Oq||cswcvtq" V." Equvc" T." Uquc" GC." Tcoktgu" LCH0"
Kphgevkqp" kp" u{uvgo" qh" ctvkhkekcn" ectfkce" uvkowncvkqp<" enkpkecn" korqtvcpeg"
cpf"geqpqoke"korcev0"Europace"4228=:*Uwrrn"3+<7:R15;0"
3840"Jcteqodg" CC." Pgygnn" UC." Nwfocp" RH." Ykuvqy" VG." Ujctrngu" NF."
Uejqhkgnf" RO." Uqpg" FN." Ujcrktq" NO." Eqng" V." Rgvej" OE0" Ncvg"
eqornkecvkqpu" hqnnqykpi" rgtocpgpv" rcegocmgt" korncpvcvkqp" qt" gngevkxg"
wpkv"tgrncegogpv0"Heart 3;;:=:2<462/4660"
3850"Octvkp" TR." Ognv|gt" TU." Ejkc" DN0" Enkpkec n" wvknkv{" qh" vyq/fkogpukqpcn"
gejqectfkqitcrj{"kp"kphgevkxg" gpfqectfkvku0" Am J Cardiol"3;:2=68<59;/
5:70"
113
3860"Okpv|" IU." Mqvjgt" PO." Ugicn" DN0" Eqorctkuqp" qh" vyq/fkogpukqpcn"
cpf" O/oqfg" gejqectfkqitcrj{" kp" vjg" gxcnwcvkqp" qh" rcvkgpvu" ykvj"
kphgevkxg"gpfqectfkvku0"Am J Cardiol"3;9;=65<95:/9660"
3870"Gtdgn" T." Tqjocpp" U." Ftgzngt" O." Oqjt/Mcjcn{" U0" Kortqxgf"
fkcipquvke" xcnwg" qh" gejqectfkqitcrj{" k p" rcvkgpvu" ykvj" kphgevkxg"
gpfqectkvkgu" d{" vtcpuguqrjcigcn" crrtqcej<" c" rtqurgevkxg" uvwf{0" Eur
Heart J"3;::=;<65/750"
3880"Ftgzngt" O." Gtdgn" T." Tqjocpp" U0" Fkcipquvke" xcnwg" qh" vyq/
fkogpukqpcn" vtcpuguqrjcigc n" xgtuwu" vtcpuvjqtceke" gejqectfkqitcrj{"
kp" rcvkgpvu" ykvj" kphgevkxg" gpfqectfkvku0" Eur Heart J" 3;:9=:*uwrrn"
L+<525/5280"
3890"Fcpkgn" YI." Ujtqgfgt" G." Pqppcuv/Fcpkgn" D0" Eqpxgpvkqpcn" cpf"
vtcpuguqrjcigcn" gejqectfkqitcrj{" kp" vjg" fkcipquku" qh" kphgevkxg"
gpfqectfkvku0"Eur Heart J"3;:9=:*uwrrn"L+<4:9/4;40"
38:0"Mnwi" F." Ncetqkz" F." Ucxq{g" E0" U{uvgoke" Kphgevkqp" Tgncvgf" vq"
Gpfqectfkvku" qp" Rcegocmgt" Ngcfu0" Enkpkecn" Rtgugpvcvkqp" cpf"
Ocpcigogpv0"Circulation 3;;9=;7<42;:/43290"
38;0"Fc" Equvc" C." Ngnkgxtg" J." Mktmqtkcp" I." Egnctf" O." Ejgxcnkgt" R."
Xcpfgpguej"H."Gvkgppg" L."Vqwdqwn"R0" Tqng"qh"vjg" rtgczknnct{"hnqtc"kp"
rcegocmgt"kphgevkqpu<"c"rtqurgevkxg"uvwf{0"Circulation0"3;;:=;9<39;3⁄"
39;70"
3920"Oqmcffgo" C." Dcejtcqwk" M." Ufktk" Y." Mcejdqwtc" U." Dqwlpcj" OT0" 0"
Rcegocmgt"kphgevkqpu0"Tunis Med0"4224=:2<72;"⁄7360"
114
3930"Mctejogt"CY0"Kphgevkqp"qh"rtquvjgvke"xcnxgu"cpf"kpvtcxcuewnct"fgxkegu0"
Kp<" Ocpfgnn" IN." Dgppgvv" LG." Fqnkp" T." gfu0" Principles and Practice of
Infectious Diseases0"Rjkncfgnrjkc<"Ejwtejknn"Nkxkpiuvqpg="4222<;25⁄;390""
3940"Ejcoku" NC." Rgvgtuqp" IG." Ecdgnn" EJ." I0" Eqtg{" T." Uqttgpvkpq" TC."
Itggphkgnf" TC." T{cp" V." Tgnngt" ND." Hqyngt" Lt" XI0" Staphylococcus
aureus dcevgtgokc" kp" rcvkgpvu" ykvj" rgtocpgpv" rcegocmgtu" qt"
korncpvcdng" ectfkqxgtvgt" ⁄" fghkdtknncvqtu0" Circulation0" 4223=326<324;" ⁄
32550"
3950"Ctdgt" P." Rtcu" G." Eqrrgtocp" [." Uejcrktq" LO." Ogkpgt" X." Nquuqu" KU."
Oknkvkcpw" C." Jcuukp" F." Rtcu" G." Ujck" C." gv" cn0" Rcegocmgt" gpfqectfkvku<"
tgrqtv"qh"66"ecugu"cpf"tgxkgy"qh"vjg"nkvgtcvwtg0"Medicine0"3;;6=95<4;;"⁄
5270"
3960"Uqjckn"OT."Wuncp"F\."Mjcp"CJ."Htkgfocp"RC."Jc{gu"FN."Yknuqp"YT."
Uvgemgndgti"LO." Uvqpgt"U."Dcff qwt" NO0"Ocpcigogpv"cpf"qwveqog"qh"
Rgtocpgpv" Rcegocmgt" cpf" Korncvcdng" Ectfkqxgtvgt/Fghkdtknncvqt"
Kphgevkqpu0"J Am Coll Cardiol "4229=6;<3:73/;0"
3970"Mnqqu"YG."Dcppgtocp"VN0" "Staphylococcus and Micrococcus."Kp<"
Owttc{"RT."Dctqp"GL."Rhcnngt"OC."Vgpqxgt"HE."[qnmgp" TJ."gfu0"Manual
of Clinical Microbiology." 9vj" gf0" Ycujkpivqp." FE<" CUO" Rtguu="
3;;;<486/4:40"
3980"Lcpugp" D." Uejwocejgt" ⁄" Rgftgcw" H." Rgvgtu" I." Tgkpjqnf" I."
Uejqpgocpp"L0"Pcvkxg" xcnxg" gpfqectfkvku" ecwugf" d{" Staphylococcus
simulans"]ngvvgt_0"Eur J Clin Microbiol Infect Dis."3;;4=33<48:/48;0"
115
3990"OeEctvj{"LU."Uvcpng{"RC."Oc{cnn"D0" "C" ecug" qh" Staphylococcus
simulans" gpfqectfkvku" chhgevkpi" c" pcvkxg" jgctv" xcnxg" ]ngvvgt_0"J
Infect."3;;3=44<433/4340"
39:0"Uvwtiguu"K."Octvkp"HE."G{m{p"U0" "Rwdke" quvgqo{gnkvku" ecwugf" d{"
Staphylococcus simulans."Postgrad Med J."3;;5=8;<;49/;4;0"
39;0""Hwtwvc"G."[cuwfc"O."[qujkqmc"M."Kuc{coc"V."Pqdwpcic"O0"
"U{pftqog"qh"kpcrrtqrtkcvg"ugetgvkqp"qh"cpvkfkwtgvke"jqtoqpg"kp"gnfgtn{"
rcvkgpvu" ykvj" tjgwocvqkf" ctvjtkvku" cuuqekcvgf" ykvj" kphgevkqpu<" tgrqtv" qh"
vyq"ecugu0"Intern Med."3;;8=57<69:/6:30"
3:20"Q|vwtmgtk"J."Mqecdg{qinw"Q."[gtiqm"[\."Mqucp"G."[gpgp"QU."Mgumkp"
M0"Fkuvtkdwvkqp"qh"eqciwncug/pgicvkxg"uvcrj{nqeqeek."kpenwfkpi"vjg"pgyn{"
fguetkdgf" urgekgu" Staphylococcus schleiferi." kp" pquqeqokcn" cpf"
eqoowpkv{"ceswktgf"wtkpct{"vtcev" kphgevkqpu0"Eur J Clin Microbiol Infect
Dis."3;;6=35<3298/329;0"
3:30"Ocngu"DO."Dctvjqnqogy"YT."Couvgtfco"F0" "Staphylococcus
simulans" ugrvkegokc" kp" c" rcvkgpv" ykvj" ejtqpke" quvgqo{gnkvku" cpf"
r{ctvjtquku0"J Clin Microbiol."3;:7=43<477/4790"
3:40"O{nn{u"X0" "Uvcrj{nqeqeek" kp" jgkhgt" ocuvkvku" dghqtg" cpf" chvgt"
rctvwtkvkqp0"J Dairy Res."3;;7=84<73/820"
3:50"Dktigtuuqp"C."Lqpuuqp"R."Jqnodgti"Q0" "Urgekgu" kfgpvkhkecvkqp" cpf"
uqog"ejctcevgtkuvkeu"qh"eqciwncug/pgicvkxg"uvcrj{nqeqeek"kuqncvgf"htqo"
dqxkpg"wffgtu0"Vet Microbiol."3;;4=53<3:3/3:;0"
3:60"Cctguvtwr"HO."Lgpugp"PG0" "Rtgxcngpeg" cpf" fwtcvkqp" qh" kpvtc/
ocooct{" kphgevkqp" kp" Fcpkuj" jgkhgtu" fwtkpi" vjg" rgtkrctvwo" rgtkqf0"J
Dairy Sci."3;;9=:2<529/5340"
116
3:70" Pcvkqpcn" Eqookvvgg" hqt" Enkpkecn" Ncdqtcvqt{"
Uvcpfctfu0"Performance Standards for Antimicrobial Susceptibility
Testing: Eleventh Informational Supplement."Yc{pg."Rc<"PEENU="42230"
PEENU"O322/U33."Xqn"43."Pq0"30" "
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