9HQGUDPLQ)6HWDO
$QWLELRWLFRWHUDSLDSUR¿OiWLFDHRXWHUDSrXWLFDHPSDFLHQWHVVXEPHWLGRVjFLUXUJLDSOiVWLFDHVWpWLFD
Franco T et al.
ARTIGO ORIGINAL
$QWLELRWLFRWHUDSLDSUR¿OiWLFDHRXWHUDSrXWLFDHP
SDFLHQWHVVXEPHWLGRVjFLUXUJLDSOiVWLFDHVWpWLFDXPD
QHFHVVLGDGH"
Prophylactic antibiotic therapy and/or therapeutic in patients undergoing plastic surgery: a necessity?
GONÇALVES APARECIDO DIAS1
RESUMO
Introdução:$DQWLELRWLFRWHUDSLDSUR¿OiWLFDHWHUDSrXWLFDpPXLWDVYH]HVXVDGDGHIRUPD
HTXLYRFDGDSHORFLUXUJLmRSDUDSUHYHQLUDLQIHFomRWUD]HQGRSUHMXt]RVDRSDFLHQWHHFRQ-­
WULEXLQGRSDUDDVHOHomRGHEDFWpULDVUHVLVWHQWHVDRVDQWLELyWLFRV(VWHWUDEDOKRWHYHSRU
REMHWLYRDYDOLDUVHKiQHFHVVLGDGHGHDQWLELRWLFRWHUDSLDHPFLUXUJLDSOiVWLFDHVWpWLFDMé-­
todo:)RUDPLQFOXtGRVQHVWHHVWXGRSDFLHQWHVVXEPHWLGRVjFLUXUJLDSOiVWLFDHVWpWLFD
HQWUHHGLYLGLGRVHPTXDWURJUXSRV*UXSRSDFLHQWHRSHUDGRHP
UHJLPHDPEXODWRULDOWHPSRFLU~UJLFRDWpKRUDVUHFHEHUDPDQWLELRWLFRWHUDSLDSUR¿OiWLFD
*UXSRSDFLHQWHVRSHUDGRVHPUHJLPHDPEXODWRULDOWHPSRFLU~UJLFRDWp
KRUDVQmRUHFHEHUDPDQWLELyWLFRV*UXSRSDFLHQWHVRSHUDGRVHPUHJLPH
KRVSLWDODUGXUDomRPDLVGHKRUDVUHFHEHUDPDQWLELRWLFRWHUDSLDSUR¿OiWLFDHWHUDSrXWL-­
FD*UXSRSDFLHQWHVRSHUDGRVHPUHJLPHKRVSLWDODUGXUDomRVXSHULRUD
KRUDVUHFHEHUDPDQWLELRWLFRWHUDSLDSUR¿OiWLFDResultados:1RV*UXSRVHQmRKRXYH
LQIHFomRQRJUXSRKRXYHXPFDVRGHLQIHFomRQRJUXSRTXDWURRXWUR
FDVRConclusão:$QWLELRWLFRWHUDSLDSUR¿OiWLFDQmRLQÀXHQFLRXQDRFRUUrQFLDGHLQIHFomR
HPFLUXUJLDVTXHGXUDUDPDWpGXDVKRUDV2XVRGHDQWLELRWLFRWHUDSLDWHUDSrXWLFDQmRLQ-­
WHUIHULXQDLQFLGrQFLDGHLQIHFomRHPFLUXUJLDVTXHWLYHUDPGXUDomRDFLPDGHWUrVKRUDV
Descritores:&LUXUJLDSOiVWLFD$JHQWHVDQWLEDFWHULDQRV&RQWUROHGHLQIHFo}HV
7UDEDOKRUHDOL]DGRQD6DQWD&DVD
GH0LVHULFyUGLDGH,WXYHUDYD
,WXYHUDYD63%UDVLO
$UWLJRVXEPHWLGRSHOR
6*36LVWHPDGH*HVWmRGH
3XEOLFDo}HVGD5%&3
$UWLJRUHFHELGR $UWLJRDFHLWR
SUMMARY
Introduction:$QWLELRWLFWKHUDS\DQGWKHUDS\LVRIWHQXVHGLQHUURUE\WKHVXUJHRQWRSUH-­
YHQWLQIHFWLRQFDXVLQJORVVHVWRWKHSDWLHQWDQGFRQWULEXWLQJWRWKHVHOHFWLRQRIUHVLVWDQW
EDFWHULDDQWLELRWLFV7KLVVWXG\HYDOXDWHVZKHWKHUWKHUHLVQHHGIRUDQWLELRWLFWKHUDS\LQ
DHVWKHWLFSODVWLFVXUJHU\Methods:7KLVVWXG\LQFOXGHGSDWLHQWVZKRXQGHUZHQWSODVWLF
VXUJHU\EHWZHHQDQGGLYLGHGLQWRIRXUJURXSV*URXSSDWLHQWRSHUDWHGLQ
RXWSDWLHQWVXUJLFDOWLPHXSWRKRXUVUHFHLYHSURSK\ODFWLFDQWLELRWLFWKHUDS\
*URXSSDWLHQWVRSHUDWHGRQLQRXWSDWLHQWVXUJLFDOWLPHXSWRKRXUVGLG
QRWUHFHLYHDQWLELRWLFV*URXSSDWLHQWVRSHUDWHGLQUHJLPHKRVSLWDOVWD\
PRUHWKDQKRXUVDQGUHFHLYHGSURSK\ODFWLFDQWLELRWLFWKHUDS\*URXSSDWLHQWVRSHUD-­
WHGRQLQKRVSLWDOV\VWHPGXUDWLRQPRUHWKDQKRXUVUHFHLYHGSURSK\ODFWLF
DQWLELRWLFVResults: ,Q*URXSVHWKHUHZDVQRLQIHFWLRQLQ*URXSZDVRQH
FDVHRILQIHFWLRQDQGLQ*URXSDQRWKHUFDVHConclusion:3URSK\ODFWLFDQWLELRWLF
WKHUDS\GLGQRWLQÀXHQFHWKHRFFXUUHQFHRILQIHFWLRQLQVXUJHU\WKDWODVWHGXSWRWZRKRXUV
7KHXVHRIDQWLELRWLFWKHUDS\GLGQRWDIIHFWWKHLQFLGHQFHRILQIHFWLRQLQVXUJHU\WKDWODVWHG
RYHUWKUHHKRXUV
Descriptors:6XUJHU\SODVWLF$QWLEDFWHULDODJHQWV,QIHFWLRQFRQWURO
(VSHFLDOL]DomRHP&LUXUJLD3OiVWLFDFLUXUJLmRSOiVWLFRHSUHVLGHQWHGD&RPLVVmRGH&RQWUROHGH,QIHFomR+RVSLWDODUGD6DQWD&DVDGH0LVHULFyUGLDGH
,WXYHUDYD,WXYHUDYD63%UDVLO
Rev. Bras. Cir. Plást. 2010;; 25(3): 423-­7
423
'LDV*$
INTRODUÇÃO
,QIHFomRHPSyVRSHUDWyULRGHFLUXUJLDSOiVWLFDpRFRU-­
UrQFLD LPSRUWDQWH R TXH OHYD R FLUXUJLmR D XVDU DQWLELRWL-­
FRWHUDSLD SUR¿OiWLFD H jV YH]HV WHUDSrXWLFD GH PDQHLUD
H[FHVVLYDYLVDQGRSUHYHQLUHVWDFRPSOLFDomReQHFHVViULR
TXHVHIDoDDUHYLVmRGHDOJXQVFRQFHLWRVSDUDHQWHQGHUH
SUHYHQLUGHIRUPDDGHTXDGDDVLQIHFo}HVGRVtWLRFLU~UJLFR
Flora transitória: p IRUPDGD SRU PLFURRUJDQLVPRV
DGTXLULGRV QR FRQWDWR FRP R DPELHQWH TXHU VHMD DQLPDGR
RX LQDQLPDGR SRGHQGR VHU GH RULJHP KRVSLWDODU H UHVLV-­
WHQWHDDQWLELRWLFRWHUDSLDXVXDO4XDOTXHUWLSRGHEDFWpULD
SRGHVHUHQFRQWUDGRWUDQVLWRULDPHQWHQDSHOHHPJHUDOHQDV
PmRVDSHVDUGHVHUPDLVFRPXPHQFRQWUDU*UDPQHJDWLYRV
Escherichia coliH3VHXGRPRQDVHFRFRV*UDPSRVLWLYRV
Staphylococos aureus, Streptococos WRGRV WrP XP FXUWR
WHPSR GH VREUHYLYrQFLD XP HOHYDGR SRWHQFLDO SDWRJrQLFR
H VmR IDFLOPHQWH WUDQVPLWLGRV SRU FRQWDWR IDFLOLGDGH HP
SURPRYHULQIHFomR$ODYDJHPGDVPmRVFRPVDEmRVLPSOHV
UHPRYHD FRP IDFLOLGDGH SRLV DV EDFWpULDV VH HQFRQWUDP
VXSHU¿FLDOPHQWHHSRXFRDGHULGDVjSHOH
Flora residente: $ÀRUDUHVLGHQWHH[LVWHQRUPDOPHQWHQD
HSLGHUPHRQGHVHPXOWLSOLFDWHQGRIXQo}HVLPSRUWDQWHVGH
SUHYHQomRGDFRORQL]DomRFRPDÀRUDWUDQVLWyULD(VWDÀRUD
pFRQVWLWXtGDSULQFLSDOPHQWHSRUStaphylococos epidermidis e Propionibacterium DFQH UDUDPHQWH FDXVD GRHQoD D QmR
VHU TXDQGR LQWURGX]LGD GH IRUPD WUDXPiWLFD QRV WHFLGRV
XOWUDSDVVDQGR EDUUHLUDV QDWXUDLV (VVHV PLFURRUJDQLVPRV
QmRVmRIDFLOPHQWHUHPRYLGRVSHODDomRPHFkQLFDGDODYDJHP
GDVPmRVVHQGRQHFHVViULRUHFRUUHUjDomRTXtPLFDGHXP
DQWLVVpSWLFRDVVRFLDGRRXQmRDRDJHQWHGHODYDJHPSRLVVH
ORFDOL]DPHPORFDLVGHGLItFLODFHVVRFRPRVXOFRVGDSHOH
IROtFXORVSLORVRVGXFWRVGHJOkQGXODVVHEiFHDV
Contaminação: SUHVHQoD WUDQVLWyULD GH PLFURRUJD-­
QLVPRV HP VXSHUItFLH VHP LQYDVmR WHFLGXDO RX UHODomR GH
SDUDVLWLVPR 3RGH RFRUUHU HP REMHWRV LQDQLPDGRV RX HP
KRVSHGHLURVFRPRSRUH[HPSORÀRUDWUDQVLWyULDGDVPmRV
Colonização: FUHVFLPHQWRHPXOWLSOLFDomRGHXPPLFUR
RUJDQLVPR HP VXSHUItFLHV HSLWHOLDLV GR KRVSHGHLUR VHP
H[SUHVVmRFOtQLFDRXLPXQROyJLFDFRPRSRUH[HPSORPLFUR-­
ELRWDKXPDQDQRUPDO6
Infecção: GDQR GHFRUUHQWH GD LQYDVmR PXOWLSOLFDomR H
DomRGHSURGXWRVWy[LFRVGHDJHQWHVLQIHFFLRVRVQRKRVSH-­
GHLURRFRUUHQGRLQWHUDomRLPXQROyJLFD
Infecção hospitalar: pDTXHODDGTXLULGDDSyVDDGPLVVmR
GRSDFLHQWHTXHVHPDQLIHVWDGXUDQWHDLQWHUQDomRRXDSyVD
DOWDHTXHSRGHVHUUHODFLRQDGDFRPDLQWHUQDomRRXSURFH-­
GLPHQWRVKRVSLWDODUHV6
Antissepsia: pXPSURFHVVRGHGHVWUXLomRGHPLFURRUJD-­
QLVPRVH[LVWHQWHVQDVFDPDGDVVXSHU¿FLDLVHSURIXQGDVGD
SHOHPHGLDQWHDDSOLFDomRGHXPJHUPLFLGDGHEDL[DFDXVWLFL-­
GDGHKLSRDOHUJrQLFRSDVVtYHOGHDSOLFDomRHPWHFLGRYLYR 424
Desinfecção: pDGHVWUXLomRGHPLFURRUJDQLVPRSDWRJr-­
QLFRHLQDWLYDomRGHYtUXVPDVQmRQHFHVVDULDPHQWHHVSRURV
SRUPHLRGDDSOLFDomRGHPHLRVItVLFRVRXDJHQWHVTXtPLFRV
Esterilização:pRSURFHVVRGHGHVWUXLomRLQDWLYDomRRX
UHPRomRGHWRGDVDVIRUPDVGHYLGDPLFURELDQDVEDFWpULDV
IXQJRV YtUXV H HVSRURV PHGLDQWH DSOLFDomR GH DJHQWHV
ItVLFRVRXTXtPLFRV
Limpeza: pDHOLPLQDomRGHWRGRPDWHULDOHVWUDQKRWHUUD
PDWHULDORUJkQLFRFRPDX[tOLRGHiJXDSHODDomRPHFkQLFD
HGHWHUJHQWH$OLPSH]DDQWHFHGHRVSURFHGLPHQWRVGHGHVLQ-­
IHFomRHHVWHULOL]DomR
2HVTXHPDTXHFODVVL¿FDRULVFRGHLQIHFomRGRVtWLRFLU~U-­
JLFRpEDVHDGRQRJUDXGHFRQWDPLQDomRGHQVLGDGHEDFWH-­
ULDQD GXUDQWH D FLUXUJLD H IRL GHVHQYROYLGR SHOD National Academy of SciencesHSHORNational Research CouncilQRV
(8$TXHFODVVL¿FRXRVSURFHGLPHQWRVFLU~UJLFRVHPOLPSR
SRWHQFLDOPHQWH FRQWDPLQDGRV FRQWDPLQDGRV H LQIHFWDGRV
$OJXPDV SXEOLFDo}HV VREUH R DVVXQWR WUD]HP LQIRUPDo}HV
UHODFLRQDGDVjWD[DGHLQIHFomRGRVtWLRFLU~UJLFRSDUDHVVDV
FODVVHVTXHYDULDPGHDSDUDFLUXUJLDVOLPSDVGH
DSDUDFLUXUJLDVSRWHQFLDOPHQWHFRQWDPLQDGDVH
GHDSDUDFLUXUJLDVFRQWDPLQDGDV'HVGHTXHDV
FLUXUJLDV OLPSDV WrP PHQRV SUREDELOLGDGH GH VH WRUQDUHP
LQIHFWDGDV LQIHFomR GR VtWLR FLU~UJLFR HP FLUXUJLDV OLPSDV
VmR XVXDOPHQWH DVVRFLDGDV DR SDFLHQWH DR SUp H DR LQWUD
RSHUDWyULR
$OJXPDV UHFRPHQGDo}HV GHYHP VHU VHJXLGDV SDUD
SUHYHQLULQIHFomRGRVtWLRFLU~UJLFR
Cuidados com o paciente D GHVQXWULomR SRGH HVWDU
SUHVHQWH HP SDFLHQWHV VXEPHWLGRV j FLUXUJLD EDULiWULFD
WRUQDQGRVH PDLV VXVFHWtYHLV j LQIHFomR H DSUHVHQWDQGR
GL¿FXOGDGHVQDFLFDWUL]DomRVHQGRLPSRUWDQWHID]HURGLDJ-­
QyVWLFRHFRUULJLUHVVDDOWHUDomRPDQWHUJOLFHPLDPHQRUTXH
PJGOGXUDQWHRDWRRSHUDWyULRHQDVSULPHLUDVKRUDV
D REHVLGDGH TXH HVWi UHODFLRQDGD j GLPLQXLomR GR DSRUWH
VDQJXtQHRDRWHFLGRJRUGXURVRGLPLQXLDFRQFHQWUDomRWHFL-­
GXDOGRDQWLELyWLFRSUR¿OiWLFRHIDYRUHFHDLQIHFomRVHQGR
DVVLPRLGHDOpQmRRSHUDUREHVRVHVHIRUH[WUHPDPHQWH
QHFHVViULRXVDUWpFQLFDFLU~UJLFDPHWLFXORVDVXVSHQVmRGR
IXPR SRU WULQWD GLDV DQWHV H DSyV R SURFHGLPHQWR WUDWDU
LQIHFo}HVjGLVWkQFLDLQWHUQDomRQRGLDGDFLUXUJLDSRUTXH
DOJXQVHVWXGRVGHPRQVWUDPTXHDSyVDOJXPDVKRUDVGHLQWHU-­
QDomRDSHOHMiHVWiFRORQL]DGDSRUEDFWpULDVGRDPELHQWH
KRVSLWDODU
Preparo da pele R EDQKR SUpRSHUDWyULR UHGX] D ÀRUD
EDFWHULDQDORFDOGLPLQXLQGRDFKDQFHGHLQIHFomRGHYHVH
OHPEUDU TXH D TXDQWLGDGH GH EDFWpULDV QHFHVViULDV SDUD
SURYRFDU LQIHFomR p GD RUGHP GH PO GH OtTXLGR
ELROyJLFRRXSRUPLOtPHWUR F~ELFRGHSHOHGHL[DQGRFODUDD
LPSRUWkQFLDHPUHGX]LURVPLFURRUJDQLVPRVORFDLVSRUWDQWR
pUHFRPHQGDGREDQKRFRPiJXDHVDEmRQDYpVSHUDHQRGLD
GDFLUXUJLDQmRKiHYLGrQFLDVFLHQWt¿FDVTXHFRPSURYHPTXH
Rev. Bras. Cir. Plást. 2010;; 25(3): 423-­7
$QWLELRWLFRWHUDSLDSUR¿OiWLFDHRXWHUDSrXWLFDHPSDFLHQWHVVXEPHWLGRVjFLUXUJLDSOiVWLFDHVWpWLFD
EDQKRFRPDQWLVVpSWLFRVVHMDPPDLVH¿FLHQWHVGRTXHREDQKR
FRP iJXD H VDEmR UHPRomR GH SHORV TXDQGR QHFHVViULD
GHYHVHUUHDOL]DGDLPHGLDWDPHQWHDQWHVGDFLUXUJLDXVDQGR
DSDUHOKR HOpWULFR RX FUHPH GHSLODWyULR H QmR OkPLQDV TXH
SRGHPSURYRFDUIHULPHQWRVQDSHOHVHUYLQGRFRPRSRUWDGH
HQWUDGDSDUDDJHQWHVSDWRJrQLFRVDDQWLVVHSVLDGDSHOHGHYH
VHU IHLWD HP VHQWLGR FHQWUtIXJR XVDQGR FORUH[LGLQD D RXDOFRyOLFRDFRPDYDQWDJHPGHQmRVHULQDWLYDGR
SHORVDQJXHHpLQFRORUSHUPLWLQGRERDYLVXDOL]DomRGDSHOH
HGDVXDYLWDOLGDGHWHPDLQGDERDDomRUHVLGXDOQDDXVrQFLD
GDFORUH[LGLQDSRGHVHXVDURLRGRSRYLGLQHGHJHUPDQWHRX
VROXomRDOFRyOLFDTXHQmRWrPERDDomRUHVLGXDOVmRLQDWL-­
YDGRVSRUVDQJXHHFRORUHPDSHOHGL¿FXOWDQGRDDYDOLDomR
GHVXDYLWDOLGDGH
Preparo da equipe cirúrgicaODYDJHPGDVXQKDVPmRVH
DQWHEUDoRDWpDFLPDGRFRWRYHORGXUDQWHSHORPHQRVPLQXWRV
WHPSRPtQLPRSDUDRFRUUHUDGHJHUPDomRORFDOPDQWHUDV
PmRVHRDQWHEUDoRÀHWLGRVFRPUHODomRDREUDoRSDUDTXHR
OtTXLGRHVFRUUDGRVGHGRVSDUDDVPmRVGRDQWHEUDoRSDUDR
FRWRYHORHHQ[XJDUFRPFRPSUHVVDHVWpULOHVHFDSDUDPHQ-­
WDomRGDHTXLSHFLU~UJLFDJRUURPiVFDUDFDSRWHOXYDQmRKi
FRPSURYDomRGHTXHRXVRGHSURSpVVREUHRVVDSDWRVGLPLQXL
RULVFRGHLQIHFomRGRVtWLRFLU~UJLFR
Ato cirúrgicoGHYHVHURPHQRVWUDXPiWLFRFRPPDQLSX-­
ODomRFXLGDGRVDGHWHFLGRVHYLWDUFDXWHUL]Do}HVH[DJHUDGDVR
WHPSRFLU~UJLFRGHYHVHURPDLVFXUWRSRVVtYHOVHPLQWHUIHULU
QDVHJXUDQoDGRSDFLHQWHHQDTXDOLGDGHGRDWRRSHUDWyULR
ID]HUDVtQWHVHGRVWHFLGRVGHPRGRDHYLWDUHVSDoRPRUWR
SUHYHQLU D IRUPDomR GH KHPDWRPDV H VHURPDV UHPRYHU
WHFLGRV GHVYLWDOL]DGRV H VH SRVVtYHO QmR XVDU GUHQR FDVR
VHMD QHFHVViULR FRORFDU GUHQR GH VXFomR IHFKDGR GLVWDQWH
GD LQFLVmR FLU~UJLFD YHUL¿FDU D TXDOLGDGH GR SURFHVVR GH
HVWHULOL]DomRSRUPHLRGDOHLWXUDGRVLQGLFDGRUHVELROyJLFRV
GHFDGDSDFRWHHFDL[DFLU~UJLFDRPDWHULDOFLU~UJLFRFDPSRV
HFDSRWHVGHYHPVHUDEHUWRVQRPRPHQWRGDFLUXUJLD Sala cirúrgicaGHYHHVWDUOLPSDFRPDVSRUWDVIHFKDGDV
PDQWHUSUHVVmRSRVLWLYDQRLQWHULRUGDVDODVRPHQWHFRP
DV SHVVRDV QHFHVViULDV DR DWR FLU~UJLFR WHPSHUDWXUD HQWUH
H JUDXV FHQWtJUDGRV 5HDOL]DU HVWHULOL]DomR UiSLGD
DSHQDV SDUD PDWHULDLV TXH VHUmR XWLOL]DGRV LPHGLDWDPHQWH
H TXH IRUDP LQDGYHUWLGDPHQWH FRQWDPLQDGRV 0DQXWHQomR
SUHYHQWLYD GR VLVWHPD GH YHQWLODomR TXDQGR GD SUHVHQoD
GH FRQWDPLQDomR YLVtYHO SRU VDQJXH RX ÀXLGRV FRUSyUHRV
HP VXSHUItFLHV RX HTXLSDPHQWRV GHYHVH OLPSDU DQWHV GD
SUy[LPDFLUXUJLDHUHDOL]DUOLPSH]DWHUPLQDODSyVD~OWLPD
FLUXUJLDGRSHUtRGR
CurativoSURWHJHUDIHULGDFLU~UJLFDFRPFXUDWLYRHVWpULO
QXPSHUtRGRGHDKRUDVHQDVWURFDVGHFXUDWLYRXVDU
WpFQLFD DVVpSWLFD H KLJLHQL]DomR GDV PmRV DQWHV H DSyV R
SURFHGLPHQWR
Vigilância epidemiológica SDUD EXVFD GH FDVRV GH
LQIHFomR XWLOL]DU D REVHUYDomR SURVSHFWLYD GLUHWD LQGLUHWD
Rev. Bras. Cir. Plást. 2010;; 25(3): 423-­7
RXXPDFRPELQDomRGDVGXDVGXUDQWHDLQWHUQDomRHXWLOL]DU
VLVWHPDGHYLJLOkQFLDSyVDOWDFRPSDWtYHOFRPRVUHFXUVRV
TXHDWHQGDPjQHFHVVLGDGHGHREWHQomRGRVGDGRV9
$QWLELRWLFRWHUDSLD SUR¿OiWLFD R XVR GH DQWLELyWLFRV
SDUDSUHYHQLULQIHFomRFLU~UJLFDIHULGDRSHUDWyULDWHPVXD
LQGLFDomRFRPEDVHQRULVFRGHLQIHFomRRXHPVXDJUDYL-­
GDGH'HYHPVHOHYDUHPFRQWDDOJXQVIDWRUHVGHULVFR
HQWUHRVTXDLVVHGHVWDFDPRVVHJXLQWHVSRWHQFLDOGHFRQWD-­
PLQDomRGDIHULGDFLU~UJLFDFRQGLo}HVFOtQLFDVGRSDFLHQWH
HWHPSRFLU~UJLFR'HDFRUGRFRPDFODVVL¿FDomRGHIHULGDV
SOiVWLFDV HVWpWLFDV VmR FRQVLGHUDGDV FLUXUJLDV OLPSDV RX
SRWHQFLDOPHQWHFRQWDPLQDGDVTXDQGRRULVFRGHLQIHFomRp
GHDWpQHVVHFDVRQmRQHFHVVLWDPGHDQWLELRWLFRWHUDSLD
SUR¿OiWLFDJHQHUDOL]DGDTXHVmRUHFRPHQGDGDVSDUDFLUXUJLDV
FRPGXUDomRDFLPDGHKRUDVHSDUDJUDQGHVGHVFRODPHQWRV
HFRORFDomRGHLPSODQWHVGHVVDIRUPDRXVRGHGUHQRVQmR
LPSOLFD HP DQWLELRWLFRSUR¿OD[LD SURORQJDGD 'H DFRUGR
FRPDOLWHUDWXUDPpGLFDRIiUPDFRGHYHVHUXVDGRSRUYLD
HQGRYHQRVD FODVVLFDPHQWH QR PRPHQWR GD LQGXomR FLU~U-­
JLFD SDUD DWLQJLU QtYHLV VpULFRV HOHYDGRV QR PRPHQWR HP
TXHRVWHFLGRVIRUHPLQFLVDGRVSRLVpDSDUWLUGHVVHPRPHQWR
TXHRFRUUHDFRQWDPLQDomRGDIHULGDFLU~UJLFDGHYHQGRVHU
UHSHWLGRGHDFRUGRFRPDPHLDYLGDGRIiUPDFRHRWHPSRGH
FLUXUJLDDWpTXHVHMDIHLWDDVtQWHVHGRVWHFLGRVHIHFKDPHQWR
GDSHOHTXHFRQVWLWXLXPDSURWHomRLPSRUWDQWHFRQWUDLQIHF-­
o}HV$SUR¿OD[LDFRPDQWLELyWLFRVSRUORQJRVSHUtRGRVDOpP
GRWHPSRFLU~UJLFRQmRSUHYLQHLQIHFomROHYDQGRjVHOHomR
GH FHSDV H FRQVHTXHQWH DXPHQWR GD UHVLVWrQFLD EDFWHULDQD
DRVDQWLELyWLFRV
Antibioticoterapia terapêutica p LQGLFDGD TXDQGR Ki
GLDJQyVWLFRLQHTXtYRFRGHLQIHFomRHVHSRVVtYHOGHDFRUGR
FRP FXOWXUD H DQWLELRJUDPD 1D LPSRVVLELOLGDGH GH SRGHU
HVSHUDUSHORVH[DPHVFROKHUPDWHULDOSDUDDQiOLVHHDVHJXLU
LQLFLDU DQWLELRWLFRWHUDSLD HPStULFD XVDQGR IiUPDFRV TXH
WHQKDPDomRVREUHDÀRUDEDFWHULDQDORFDODWpTXH¿TXHP
SURQWRV RV H[DPHV TXH LQGLFDUmR R DJHQWH FDXVDGRU GD
LQIHFomRHVXDVHQVLELOLGDGH$FROHWDGHPDWHULDOGHYHVHU
IHLWDSRUSXQomRHYLWDQGRVHFRQWDPLQDomRFRPDVXSHUItFLH
GDOHVmRTXHQRUPDOPHQWHpFRORQL]DGDSRUÀRUDPLFURELRWD
ORFDO (P FDVR GH FROHWD FRP FRWRQHWH GHYHVH DEULU D
IHULGDHFROHWDUPDWHULDOGRVHXLQWHULRUSRUTXHXPDFROHWD
LQDGHTXDGD OHYD D HUUR GH GLDJQyVWLFR 4XDQWR j GXUDomR
GDWHUDSrXWLFDDWHQGrQFLDDWXDOpGHUHGX]tODWHQGRFRPR
SDUkPHWURVRVDFKDGRVORFDLVHDFRQGLomRFOtQLFDGRSDFLHQWH
$SULQFLSDOIDOKDHPWHUDSrXWLFDFRPDQWLPLFURELDQRVpSRU
HUUR HP LGHQWL¿FDU H WUDWDU R IRFR GD LQIHFomR p SUHFLVR
FRPSUHHQGHUTXHDEVFHVVRGHYHVHUGUHQDGRHQmRUHFHEHU
DQWLELyWLFRV1HFURVHVGHYHPVHUWUDWDGDVFRPUHVVHFomRH
QmRFRPIiUPDFRV3RU¿PpLPSRUWDQWHOHPEUDUTXHWDQWR
DSUR¿OD[LDTXDQWRDWHUDSrXWLFDDQWLPLFURELDQDLQDGHTXDGDV
DOWHUDPDÀRUDPLFURELRWDQRUPDOFRPVHOHomRGHJHUPHV
UHVLVWHQWHV (P FLUXUJLD SOiVWLFD HVWpWLFD R ULVFR
425
'LDV*$
GH LQIHFomRp VXSHUHVWLPDGR OHYDQGR DR XVR H[FHVVLYR GH
DQWLELyWLFRV2LGHDOpTXHVHMDPVHJXLGDVDVRULHQWDo}HV
GD PHGLFLQD EDVHDGD HP HYLGrQFLDV FLHQWt¿FDV OHPEUDQGR
VHPSUHTXHRVDQWLELyWLFRVVmRDSHQDVXPDSDUWHGRQRVVR
DUVHQDOQDOXWDFRQWUDDVLQIHFo}HVPDVTXHH[LVWHPRXWURV
FXLGDGRV TXH VmR WmR RX PDLV LPSRUWDQWHV TXH R XVR GRV
DQWLELyWLFRV
2 WUDEDOKR WHYH SRU REMHWLYR DYDOLDU VH Ki QHFHVVLGDGH
GH XVDU DQWLELRWLFRWHUDSLD SUR¿OiWLFD H RX WHUDSrXWLFD QD
SUHYHQomRGDVLQIHFo}HVHPSDFLHQWHVVXEPHWLGRVjFLUXUJLD
SOiVWLFDHVWpWLFD
MÉTODO
,QFOXLXVHQHVVHHVWXGRRVSDFLHQWHVVXEPHWLGRVjFLUXUJLD
SOiVWLFDHVWpWLFDHQWUHRVDQRVGHHWRWDOL]DQGRGH
FLUXUJLDV7RGRVRVSDFLHQWHVIRUDPRSHUDGRVSHODPHVPD
HTXLSH FLU~UJLFD QR PHVPR KRVSLWDO PDQWHQGR D WpFQLFD
FLU~UJLFDGHDFRUGRFRPRSURFHGLPHQWRUHDOL]DGR$GURJD
XWLOL]DGDSDUDUHDOL]DUDSUR¿OD[LDIRLDFHID]ROLQDJUDPD
SRUYLDLQWUDYHQRVDPLQXWRVDQWHVGRLQtFLRGDFLUXUJLD
VHQGRUHSHWLGDDFDGDKRUDVGHDFRUGRFRPDGXUDomRGR
SURFHGLPHQWR1DVFLUXUJLDVFRPGXUDomRLQIHULRUDKRUDV
RSDFLHQWHUHFHEHXXPD~QLFDGRVHGRIiUPDFR$WHUDSrXWLFD
FRP DQWLPLFURELDQRV IRL LQLFLDGD DSyV D DOWD KRVSLWDODU R
DQWLELyWLFRGHHVFROKDIRLDFHIXUR[LPDPJGHHP
KRUDVYLDRUDOSRUVHWHGLDV
2V SDFLHQWHV IRUDP GLYLGLGRV HP TXDWUR JUXSRV GD
VHJXLQWHPDQHLUD
‡ Grupo 1 -­ 3DFLHQWHVVXEPHWLGRVjFLUXUJLDSOiVWLFDHVWp-­
WLFDHPUHJLPHDPEXODWRULDOFRPGXUDomRGHDWpKRUDV
)RUDPRSHUDGRVQRVDQRVGHHSDFLHQWHV
WRGRVUHFHEHUDPDQWLELRWLFRWHUDSLDSUR¿OiWLFD$VFLUXU-­
JLDVUHDOL]DGDVIRUDPEOHIDURSODVWLDVULQRSODVWLDV
HRWRSODVWLDV
‡ Grupo 2 -­ 3DFLHQWHVVXEPHWLGRVjFLUXUJLDSOiVWLFDHVWp-­
WLFDHPUHJLPHDPEXODWRULDOFRPGXUDomRGHDWpKRUDV
)RUDPRSHUDGRVQRVDQRVGHHSDFLHQWHV
TXHQmRUHFHEHUDPDQWLELyWLFRV$VFLUXUJLDVUHDOL]DGDV
IRUDPEOHIDURSODVWLDVULQRSODVWLDVHRWRSODVWLDV
‡ Grupo 3 -­ 3DFLHQWHV VXEPHWLGRV j FLUXUJLD SOiVWLFD
HVWpWLFD HP UHJLPH KRVSLWDODU FRP GXUDomR VXSHULRU D
KRUDV)RUDPRSHUDGRVQRVDQRVGHH
SDFLHQWHVTXHUHFHEHUDPDQWLELRWLFRWHUDSLDSUR¿OiWLFDH
WHUDSrXWLFD$VFLUXUJLDVUHDOL]DGDVIRUDPDEGRPLQR-­
SODVWLDVPDPRSODVWLDVUHGXWRUDVPDPRSODVWLDVGH
DXPHQWRHliftingIDFLDO
‡ Grupo 4 -­ 3DFLHQWHV VXEPHWLGRV j FLUXUJLD SOiVWLFD
HVWpWLFD HP UHJLPH KRVSLWDODU FRP GXUDomR VXSHULRU D
KRUDV)RUDPRSHUDGRVQRVDQRVGHH
SDFLHQWHV TXH UHFHEHUDP DQWLELRWLFRWHUDSLD SUR¿OiWLFD
$VFLUXUJLDVUHDOL]DGDVIRUDPDEGRPLQRSODVWLDV
426
PDPRSODVWLDVGHUHGXomRPDPRSODVWLDVGHDXPHQWR
e 22 lifting IDFLDO
$V DYDOLDo}HV FOtQLFDV IRUDP IHLWDV QR VpWLPR GpFLPR
TXDUWR YLJpVLPR SULPHLUR YLJpVLPR RLWDYR H WULJpVLPR
TXLQWRGLDSyVRSHUDWyULR$DQiOLVHHVWDWtVWLFDIRLIHLWDSRU
WHVWHGH)LVKHU
RESULTADOS
1RVJUXSRVXPHGRLVQmRKRXYHFDVRVGHLQIHFomR
1RJUXSRWUrVKRXYHXPFDVRGHLQIHFomRHP
FLUXUJLDGHPDPRSODVWLDGHDXPHQWRGLDJQRVWLFDGRDRQRQR
GLD GH SyVRSHUDWyULR TXDQGR KRXYH VDtGD GH VHFUHomR
DPDUHODGD SHOD LQFLVmR FLU~UJLFD$ SDFLHQWH DSUHVHQWDYD
ERPHVWDGRJHUDOVHPVLQDLVGHLQIHFomRVLVWrPLFDFROKLGR
PDWHULDOSDUDH[DPHVDWUDYpVGHSXQomRGDORMDDJXDUGRXVH
RUHVXOWDGRGDFXOWXUDHDQWLELRJUDPDIRLIHLWRWUDWDPHQWR
FOtQLFR VHP VXFHVVR H R FDVR HYROXLX SDUD UHWLUDGD GR
LPSODQWH
1RJUXSRTXDWURKRXYHXPFDVRGHLQIHFomRHP
DEGRPLQRSODVWLDIHEUHTXHGDGRHVWDGRJHUDOOHXFRFLWRVH
GLDJQRVWLFDGRQRTXLQWRGLDSyVRSHUDWyULRTXHHYROXLXFRP
DEVFHVVRORFDOL]DGRQRVXEFXWkQHRGDUHJLmRHSLJiVWULFD2
GLDJQyVWLFR IRL IHLWR SRU XOWUDVVRQRJUD¿D R SURFHGLPHQWR
GH GUHQDJHP IRL IHLWR FRP GUHQR GH VXFomR IHFKDGR QR
ORFDOLQLFLRXVHDQWLELRWLFRWHUDSLDKRVSLWDODUHPStULFDSRLV
DSDFLHQWHDSUHVHQWDYDVLQDLVGHLQIHFomRVLVWrPLFDHSRVWH-­
ULRUPHQWH GH DFRUGR FRP FXOWXUD H DQWLELRJUDPD R GUHQR
IRLUHWLUDGRORJRTXHKRXYHSDUDGDQDVDtGDGHVHFUHomR$
SDFLHQWH WHYH ERD HYROXomR FRP R WUDWDPHQWR LQVWLWXtGR H
UHFHEHXDOWDKRVSLWDODUDVVLQWRPiWLFD
DISCUSSÃO
$LQIHFomRHPFLUXUJLDSOiVWLFDSRGHVHUGHVDVWURVDSRLV
DOpPGHFRPSURPHWHURUHVXOWDGRGDFLUXUJLDFRORFDHPULVFR
DYLGDGRSDFLHQWHeFRPSOLFDomRSRXFRIUHTXHQWHSRUpP
EDVWDQWHWHPLGDHDSHVDUGHHVWXGRVJHUDLVLQGLFDUHPDIRUPD
FRUUHWDSDUDRXVRGHDQWLELyWLFRVHPFLUXUJLDSOiVWLFDVmR
SRXFRVRVWUDEDOKRVFLHQWt¿FRVTXHWUDWDPVREUHRWHPD
$ DQWLELRWLFRWHUDSLD SUR¿OiWLFD H WHUDSrXWLFD p WiWLFD
PXLWDVYH]HVXVDGDGHPRGRHTXLYRFDGRSHORFLUXUJLmRSOiV-­
WLFRFRPDLQWHQomRGHHYLWDURDSDUHFLPHQWRGHLQIHFomRQR
VtWLRFLU~UJLFR$WHUDSrXWLFDFRPDQWLPLFURELDQRVGHYHVHU
IHLWDDSHQDVTXDQGRKiGLDJQyVWLFRLQHTXtYRFRGHLQIHFomR
p QHFHVViULR WHUPRV FRQVFLrQFLD TXH R XVR LQGLVFULPLQDGR
GH DQWLELyWLFRV QmR SUHYLQH LQIHFomR PDV SRU RXWUR ODGR
VHOHFLRQD EDFWpULDV TXH HVWmR FDGD YH] PDLV UHVLVWHQWHV
j DQWLELRWLFRWHUDSLD Mi H[LVWHP UHODWRV GH Staphylococus aureus UHVLVWHQWHV j YDQFRPLFLQD RX VHMD SRGHUHPRV D
TXDOTXHUPRPHQWRQRVGHSDUDUFRPXPTXDGURLQIHFFLRVRGH
GLItFLOWUDWDPHQWRSRUFRQWDGHXPDEDFWpULDPXOWLUUHVLVWHQWH
Rev. Bras. Cir. Plást. 2010;; 25(3): 423-­7
$QWLELRWLFRWHUDSLDSUR¿OiWLFDHRXWHUDSrXWLFDHPSDFLHQWHVVXEPHWLGRVjFLUXUJLDSOiVWLFDHVWpWLFD
e LPSRUWDQWH WHU FLrQFLD TXH XP JUDQGH Q~PHUR GH
FXLGDGRV GHYH VHU WRPDGR SDUD SUHYHQLU LQIHFomR GR VtWLR
FLU~UJLFR H TXH D XWLOL]DomR LQDGHTXDGD GH DQWLELyWLFRV
WUD] FRPSURPHWLPHQWR SDUD WRGD D FRPXQLGDGH KRVSLWDODU
VHOHFLRQDQGRJHUPHVFRPSRXFDRXQHQKXPDVHQVLELOLGDGH
DRVDQWLPLFURELDQRV'HYHPRVVHJXLUDVRULHQWDo}HVGD
PHGLFLQDEDVHDGDHPHYLGrQFLDVFLHQWt¿FDVRIHUHFHQGRXP
WUDWDPHQWRVHJXURSDUDRVQRVVRVSDFLHQWHV
5HVWDDLQGDOHPEUDUTXHHPERUDDLQFLGrQFLDGHLQIHFomR
HP FLUXUJLD SOiVWLFD HVWpWLFD VHMD EDL[D p UHVSRQViYHO SRU
Do}HV MXGLFLDLV FRQWUD KRVSLWDLV FOtQLFDV H PpGLFRV
0XLWDVGHVWDVGHPDQGDVVmRUHVROYLGDVSRUSHUtFLDPpGLFD
RPpGLFRSHULWRSURGX]RODXGRSHULFLDOEDVHDQGRVHQDOLWH-­
UDWXUDPpGLFDHVSHFLDOL]DGDVHQGRLPSRUWDQWHTXHQHVWDV
VLWXDo}HVDQRVVDFRQGXWDHVWHMDEDVHDGDHPIXQGDPHQWRV
FLHQWt¿FRVDWXDOL]DGRV
1HVVHHVWXGRDDYDOLDomRFOtQLFDQmRGHPRQVWURXGLIH-­
UHQoDHVWDWtVWLFDHQWUHRV*UXSRVHTXHXVDUDPDQWLELR-­
WLFRWHUDSLD SUR¿OiWLFD RX QmR XVDUDP UHVSHFWLYDPHQWH RX
VHMDSDUDFLUXUJLDVFRPDWpKRUDVGHGXUDomRQmRKRXYH
LQIHFomRXVDQGRRXQmRDQWLELyWLFRV
2PHVPRVHREVHUYDTXDQGRFRPSDUDPRVR*UXSRTXH
XVRX DQWLELRWLFRWHUDSLD SUR¿OiWLFD H WHUDSrXWLFD H R JUXSR
TXDWUR QR TXDO IRL IHLWR DSHQDV SUR¿OD[LD FRP DQWLPLFUR-­
ELDQRVSRLVQHVVHVJUXSRVHPTXHDVFLUXUJLDVWLYHUDPXP
WHPSRFLU~UJLFRDFLPDGHKRUDVKRXYHXPFDVRGHLQIHFomR
SDUDFDGDJUXSRPRVWUDQGRTXHRXVRSURORQJDGRGHDQWLELy-­
WLFRV*UXSRQmRWHYHLQÀXrQFLDQDLQFLGrQFLDGHLQIHFomR
SDUDHVWHJUXSRRXPHOKRUXVDQGRRXQmRDQWLELRWLFRWHUDSLD
WHUDSrXWLFDDSRUFHQWDJHPGHLQIHFomRSDUDRVGRLVJUXSRV
QmRGHPRQVWURXGLIHUHQoDVHVWDWtVWLFDVVLJQL¿FDWLYDV*UXSR
H*UXSRRTXHYDLGHHQFRQWURDRVGDGRV
GDOLWHUDWXUDTXHDSUHVHQWDWD[DGHLQIHFomRGHDWpSDUD
FLUXUJLDVSOiVWLFDVHVWpWLFDV
CONCLUSÃO
$DQWLELRWLFRWHUDSLDSUR¿OiWLFDQmRLQÀXHQFLRXQDRFRU-­
UrQFLDGHLQIHFomRHPFLUXUJLDVTXHGXUDUDPDWpGXDVKRUDV
EOHIDURSODVWLDRWRSODVWLDHULQRSODVWLD
2XVRGHDQWLELRWLFRWHUDSLDWHUDSrXWLFDQmRLQWHUIHULXQD
LQFLGrQFLDGHLQIHFomRQRVSDFLHQWHVVXEPHWLGRVjFLUXUJLD
Correspondência para:
SOiVWLFDHVWpWLFDTXHWLYHUDPGXUDomRVXSHULRUDWUrVKRUDV
DEGRPLQRSODVWLDPDPRSODVWLDHlifting IDFLDO
REFERÊNCIAS
)UDQFR'/RSHV&DUGRVR)/)UDQFR78VRGHDQWLELyWLFRVHPFLUXUJLD
SOiVWLFD5HY6RF%UDV&LU3OiVW
)HUUD]$$%)HUUD](0$QWLELRWLFRSUR¿OD[LDHPFLUXUJLD3URJUDPD
GHDWXDOL]DomRHPXVRGHDQWLELyWLFRVHPFLUXUJLD&ROpJLR%UDVLOHLUR
GH &LUXUJL}HV 'LVSRQtYHO HP 85/ KWWSZZZFEFRUJEUXSORDG
HPFDWXDOL]DFDRDQWLELRWLFRVIUDPBDQWLELRWHSLDKWP
%XFDOHP*:HL7+$QWLVpSWLFRVQDODYDJHPGDVPmRVGRFLUXUJLmR
'LVSRQtYHO HP 85/ KWWSZZZLQVFULFDRRQOLQHFRPEUGRFVVEFM
LPJ9$DDSGI
6DQWRV$$0 +LJLHQL]DomR GDV PmRV QR FRQWUROH GDV LQIHFo}HV HP
VHUYLoRGHVD~GH$QYLVD'LVSRQtYHOHP85/KWWSZZZDQYLVDJRY
EUVHUYLFRVDXGHFRQWUROHKLJLHQL]DFDRBPDRSGI
*HLVV+.+HHJ3+DQGZDVKLQJDJHQWVDQGQRVRFRPLDOLQIHFWLRQV1
(QJO-0HG
$QGUDGH*03ULQFLSDLVFRQFHLWRVHPLQIHFomRKRVSLWDODU'LVSRQtYHO
HP85/KWWSYVLWHVXQEEULEFHOPLFURELRORJLDFLKFRQFSSW
%UDYR 1HWR *3$WXDOL]DomR HP DQWLELyWLFRV HP FLUXUJLD JHUDO 5HY
$05,*6
5LEHLUR - ,QIHFomR GH VtWLR FLU~UJLFR PHGLGDV GH SUHYHQomR H DQWL-­
ELRWLFRSUR¿OD[LD 1&,++%') 'LVSRQtYHO HP KWWSZZZ
DSXDEUDVLORUJEUDUTXLYRVDXODSGI
6mR3DXOR6HFUHWDULDGH(VWDGRGD6D~GH&HQWURGH9LJLOkQFLD(SL-­
GHPLROyJLFD'LYLVmRGH,QIHFomR+RVSLWDODU3URMHWRGHSUHYHQomRGH
LQIHFomRFLU~UJLFDSURYLWDH,QIHFomRHPVtWLRFLU~UJLFR'LVSRQtYHOHP
85/KWWSZZZFYHVDXGHVSJRYEUKWPLKSURYLWDHBLQIHFFDRKWP
)U\'(6XUJLFDOVLWHLQIHFWLRQSDWRJHQHVLVDQGSUHYHQWLRQ&OLQLFDO
XSGDWH'LVSRQtYHOHPPHGVFDSHKWWSZZZPHGVFDSHFRPYLHZSUR-­
JUDP
/DUVRQ(6NLQK\JLHQHDQGLQIHFWLRQSUHYHQWLRQPRUHRIWKHVDPHRU
GLIIHUHQWDSSURDFKHV"&OLQ,QIHFW'LV
&&,++8&))8)5-5HFRPHQGDomRSDUDRXVRGHDQWLELyWLFRSUR¿-­
OiWLFRHPFLUXUJLD'LVSRQtYHOHPKWWSZZZKXFIIXIUMEUQRYRBKX
HVSHFLDOLGDGHVFFLK3GISUR¿ODWLFRSGI
)DWLFD&$*RUGRQ60=LQV-(7KHUROHRISUHRSHUDWLYHDQWLELRWLFSUR-­
SK\OD[LVLQFRVPHWLFVXUJHU\3ODVW5HFRQVWU6XUJ
3HQWHDGR)LOKR65&RQWUROHGHDQWLPLFURELDQRVWHRULDHYLGrQFLDVH
SUDWLFD3UiWLFD+RVSLWDODU
5LEDV50*RQWLMR)LOKR33&H]iULR5&6LOYD3)3HQD/DQJRQL'5
'XTXH$6)DWRUHVGHULVFRSDUDFRORQL]DomRSRUEDFWpULDVKRVSLWDOD-­
UHVPXOWLUUHVLVWHQWHVHPSDFLHQWHVFUtWLFRVFLU~UJLFRVHFOtQLFRVHXP
KRVSLWDOEUDVLOHLUR5HY0HG0LQDV*HUDLV
&DUYDOKR -&0 5HVSRQVDELOLGDGH FLYLO PpGLFD  HG 5LR GH
-DQHLUR(GLWRUD'HVWDTXH
1LJUH$/)$ 2 DWXDU PpGLFR GLUHLWRV H REULJDo}HV 5LR GH -DQHLUR
(GLWRUD1RD
Gonçalves Aparecido Dias
Rua Anhanguera, 930 – Cidade Universitária – Ituverava, SP, Brasil – CEP 14500-000
E-mail: [email protected]
Rev. Bras. Cir. Plást. 2010;; 25(3): 423-­7
427