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"
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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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√"Cqu"ektwtikùgu"Ft0"Ycipgt"Vcocmk"g"Ftc0"Gnk|cdgvj"Etgxgnctk."rgnqu"
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qrqtvwpkfcfg" fg" eqorctvknjct" itcpfgu" oqogpvqu" pc" xkfc" rtqhkuukqpcn" g"
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crtgugpvcèùgu"kpvgtpcekqpcku"fqu"tguwnvcfqu"fguug"vtcdcnjq0"
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Kpuvkvwvq"fq"Eqtcèçq"fg"Uçq"Rcwnq."Etkuvkpc."Fcpkgnc."Lgcpg."Pgkfg"g"Rcwnc."
rgnc" fgfkecèçq" pq" ceqorcpjcogpvq" cqu" rcekgpvgu" fguug" vtcdcnjq" g" rgnc"
cngitkc"fkurgpucfc"pc"eqpxkxípekc"fkâtkc0"
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crqkq"fwtcpvg"q"rgtîqfq"fg"gncdqtcèçq"fguuc"vgug0"
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itcpfg"crqkq"pc"gzgewèçq"fguug"vtcdcnjq0"
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Nqwtgpèq." Ft0" Pguvqt"Tqftkiwgu" fg" Qnkxgktc" Pgvq." Ft0"Ectnqu" Engdgt" Ucpvqu"
Ogpg|gu."Ft0"Lquê"Ectnqu"Vcxctgu"fc"Equvc."Ft0"Kxcp"Cnhqpuq"Twk|"Rgtgktc."
Ft0" Lquê" Octkq" Dciikq" Lûpkqt." Ft0" Iwuvcxq" Iqogu" Vqttgu" ." Ft0" Rcdnq"
Octcpjçq" Cndwswgtswg." Ft0" Cdgnctfq" Iqpècnxgu" Guectkçq." Ft" Tqftkiq"
Vcxctgu"Uknxc."Ft0"Ectnqu"Gfwctfq"Dcvkuvc"NKoc."Ft0"Fcpkgnc"Ictekc"Oqtgpq"
Ecdtcn" Ocejcfq." Ftc0" E{pvkc" Kdtcjko" Iwktcq." Ftc0" Ucxkc" Ejtkuvkpc" Rgtgktc"
Dwgpq."Ft0"Gtkem"Uguuc"Ogtèqp."Ft0"Octeq"Cngzcpftg"Xcnxgtfg"Cmcokpg."Ft0"
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SUMÁRIO
Nkuvcu"fg"cdtgxkcvwtcu."uîodqnqu"g"ukincu"
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Uwooct{"
30"KPVTQFWÑ’Q00000000000000000000000000000000000000000000000000000000000000000000000000000000000000
303"Kphgeèçq"g"Ektwtikc000000000000000000000000000000000000000000000000000000000000000000000000000000
304"Fkcipôuvkeq"fc"kphgeèçq"ektûtikec00000000000000000000000000000000000000000000000000000000
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4030303"Rguuqcn000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000
4030304"Codkgpvg000000000000000000000000000000000000000000000000000000000000000000000000000000000000000
4030305"Ct000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000
404"Hcvqtgu"fg"tkueq"rctc"q"fgugpxqnxkogpvq"fg"kphgeèçq"ektûtikec000000000"
40403"Vgorq"fg"kpvgtpcèçq"rtê/qrgtcvôtkc000000000000000000000000000000000000000000000000
40404"Cpvkuugrukc"fq"uîvkq"ektûtikeq000000000000000000000000000000000000000000000000000000000000
40405"Fwtcèçq"fq"rtqegfkogpvq"ektûtikeq00000000000000000000000000000000000000000000000000
40406"Vêepkec"ektûtikec000000000000000000000000000000000000000000000000000000000000000000000000000000
40407"Rtgugpèc"fg"kphgeèùgu"fg"uîvkqu"tgoqvqu00000000000000000000000000000000000000000
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405"Rtgxgpèçq"fc"kphgeèçq"ektûtikec000000000000000000000000000000000000000000000000000000000
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4050703"Eqpukfgtcèùgu"jkuvôtkecu00000000000000000000000000000000000000000000000000000000000000
4050704"Rtkpeîrkqu"fc"rtqhknczkc"cpvkoketqdkcpc000000000000000000000000000000000000000000
4050705"Rtqhknczkc"cpvkoketqdkcpc"dcugcfc"go"gxkfípekc00000000000000000000000000
50"QDLGVKXQU000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000
503"Qdlgvkxq"rtkoâtkq000000000000000000000000000000000000000000000000000000000000000000000000000000000
504"Qdlgvkxq"ugewpfâtkq00000000000000000000000000000000000000000000000000000000000000000000000000000
60"ECUW¯UVKEC"G"OÖVQFQU000000000000000000000000000000000000000000000000000000000000000000
603"Fkpãokec"fq"guvwfq00000000000000000000000000000000000000000000000000000000000000000000000000000
60303"Rtqegfkogpvqu"ektûtikequ00000000000000000000000000000000000000000000000000000000000000000
60304"Ugiwkogpvq"enîpkeq000000000000000000000000000000000000000000000000000000000000000000000000000
6030403"Fghkpkèçq"fg"kphgeèçq"pc"nqlc"fg"octecrcuuq0000000000000000000000000000000
6030404" Fghkpkèçq" fg" gpfqectfkvg" tgncekqpcfc" c" ecdqu/
gngvtqfqu000000000000000000000000"
6030405"Vgtcríwvkec"fg"kphgeèçq0000000000000000000000000000000000000000000000000000000000000000
6030406"Etkvêtkqu"rctc"gzrncpvg"fg"ukuvgoc000000000000000000000000000000000000000000000000
6030407"Cxcnkcèçq""enîpkec000000000000000000000000000000000000000000000000000000000000000000000000000
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6030408"Cxcnkcèçq"gngvtõpkec0000000000000000000000000000000000000000000000000000000000000000000000
6030409"Geqectfkqitcoc"vtcpuguqhâikeq0000000000000000000000000000000000000000000000000000
603040:"Kuqncogpvq"fq"cigpvg"kphgeekquq000000000000000000000000000000000000000000000000000
60305"Eqokví"fg"ugiwtcpèc00000000000000000000000000000000000000000000000000000000000000000000000
604"Xctkâxgku"uwdogvkfcu"ä"cpânkug"guvcvîuvkec000000000000000000000000000000000000000000
605"Cpânkug"guvcvîuvkec00000000000000000000000000000000000000000000000000000000000000000000000000000000
70"TGUWNVCFQU00000000000000000000000000000000000000000000000000000000000000000000000000000000000000
703"Xctkâxgku"cpcnkucfcu0000000000000000000000000000000000000000000000000000000000000000000000000000
70303"Ugzq0000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000
70304"Kfcfg0000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000
70305"Ectfkqrcvkc"fg"dcug0000000000000000000000000000000000000000000000000000000000000000000000000
70306"Encuug"hwpekqpcn"fg"kpuwhkekípekc"ectfîcec000000000000000000000000000000000000000
70307"Htcèçq"fg"glgèçq"fq"xgpvtîewnq"guswgtfq0000000000000000000000000000000000000000
70308"Fkcdgvgu"ognnkvwu000000000000000000000000000000000000000000000000000000000000000000000000000000
70309"Jkrqvktgqkfkuoq000000000000000000000000000000000000000000000000000000000000000000000000000000000
7030:"Fqgpèc"rwnoqpct"qduvtwvkxc"etõpkec000000000000000000000000000000000000000000000000
7030;"Jkrgtvgpuçq"ctvgtkcn"ukuvíokec0000000000000000000000000000000000000000000000000000000000
703032"Kpuwhkekípekc"tgpcn"etõpkec00000000000000000000000000000000000000000000000000000000000000
703033"Wuq"fg"eqtvkequvgtôkfgu000000000000000000000000000000000000000000000000000000000000000000
703034"Wuq"fg"cpvkeqciwncpvg00000000000000000000000000000000000000000000000000000000000000000000
703035"Wuq"fg"octecrcuuq"vgorqtâtkq00000000000000000000000000000000000000000000000000000
703036"Vkrq"fg"rtqegfkogpvq000000000000000000000000000000000000000000000000000000000000000000000
703037"Eqorngzkfcfg"fqu"rtqegfkogpvqu0000000000000000000000000000000000000000000000000
703038"Fwtcèçq"fq"rtqegfkogpvq00000000000000000000000000000000000000000000000000000000000000
703039"Jgocvqoc"fg"nqlc00000000000000000000000000000000000000000000000000000000000000000000000000
704"Cpânkug"ownvkxctkcfc0000000000000000000000000000000000000000000000000000000000000000000000000000
705"Cpânkug"fguetkvkxc"fqu"ecuqu"fg"kphgeèçq00000000000000000000000000000000000000000000
706"Gxqnwèçq"enîpkec"fqu"ecuqu"fg"kphgeèçq0000000000000000000000000000000000000000000000
707"Cpânkug"fg"ôdkvqu000000000000000000000000000000000000000000000000000000000000000000000000000000000
708"Rgtfc"fg"ugiwkogpvq"enîpkeq000000000000000000000000000000000000000000000000000000000000000
80"FKUEWUU’Q00000000000000000000000000000000000000000000000000000000000000000000000000000000000000000
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LISTA DEABREVIATURAS
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oêfkc"ocku"qw"ogpqu"fguxkq"rcftçq"
htcèçq"fg"glgèçq"fq"xgpvtîewnq"guswgtfq"cq"geqectfkqitcoc"
kpvgtxcnq"fg"eqphkcpèc"
octecrcuuq"
vgtcrkc"fg"tguukpetqpk|cèçq"ectfîcec"
ectfkqxgtuqt/fguhkdtkncfqt"korncpvâxgn"
cvtkqxgpvtkewnct"
vtqec"fg"igtcfqt"
okpwvqu"
rôuvgtq/cpvgtkqt"
dcvkogpvqu"rqt"okpwvq"
kpewtuùgu"tgurktcvôtkcu"rqt"okpwvq"
eênwncu"
geqectfkqitcoc"vtcpuvqtâekeq"
geqectfkqitcoc"vtcpuguqhâikeq"
encuug"hwpekqpcn"
Oketqguhgtcu"fg"Cndwokpc"Jwocpc"
fqgpèc"rwnoqpct"qduvtwvkxc"etõpkec"
kpuwhkekípekc"tgpcn"etõpkec"
Kpvgtpcvkqpcn"Pqtocnk|gf"Tcvkq"
octecrcuuq"vgorqtâtkq"
pûogtq"
pçq"ukipkhkecpvg"
LISTA DE SÍMBOLOS
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ogpqt"swg""
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ogpqt"qw"kiwcn"
ockqt"qw"kiwcn""
oknîogvtqu"eûdkequ"
kiwcn"
swknqitcocu"
wpkfcfgu"
jqtcu"
Itcwu"Egnukwu"
rqt"egpvq"
LISTA DE SIGLAS
"
"
P[JC""
EFE""
PPKU"""
CUC"" "
"
Pgy"[qtm"Jgcv"Cuuqekcvkqp"
Egpvgt"hqt"Fkugcug"Eqpvtqn"cpf"Rtgxgpvkqp"
""""Pcvkqpcn"Pquqeqokcn"Kphgevkqp"Uwtxgknncpeg"
""""Cogtkecp"Uqekgv{"qh"Cpguvjgukqnqikuvu"
RESUMO
KPVTQFWÑ’Q< Kphgeèçq" go" ukuvgocu" fg" guvkowncèçq" ectfîcec" ctvkhkekcn"
rgtukuvg"eqoq"wo"itcxg"rtqdngoc."fgxkfq"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" rncegdq" *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" oqpvju" 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" hgcvwtgu" 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" eqowogpvg"
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"xkfc30"
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" Wpkfqu4.5.60" 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"wtkpâtkq70"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"Wpkfqu80"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/jqurkvcnctgu9.:.;.320" Q" ewuvq"
rqt" rcekgpvg" rqfg" ugt" ockqt" swg" &52222" rctc" rcekgpvgu" uwdogvkfqu" ä"
ektwtikc"ectfîcec"qw"qtvqrêfkec33.340"
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), respectivamente350" 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"4226360"
Q"tkueq"fg"fgugpxqnxkogpvq"fg"kphgeèçq"fq"uîvkq"ektûtikeq"ê"chgvcfq"
rgnq" itcw" fg" eqpvcokpcèçq" oketqdkcpc0" Wo" ukuvgoc" corncogpvg" cegkvâxgn"
fg" encuukhkecèçq" fg" eqpvcokpcèçq" fq" uîvkq" ektûtikeq" hqk" fgugpxqnxkfq" rgnc"
Pcvkqpcn" Tgugctej" Eqwpekn370" 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"Hqqtf38"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'" tgurgevkxcogpvg0" 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" uwlcu370" 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"9.3'390""
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"
cn03:" 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" Ewujkpi3;" 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"encuukhkecèçq"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"rtqhknczkc"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"
Ektûtikeq370" 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/cdfqokpcn42.430"""
Q"tkueq"fg"kphgeèçq"fq"uîvkq"ektûtikeq"rqfg"ugt"eqpegkvwcfq"fg"ceqtfq"
eqo"c"ugiwkpvg"tgncèçq44.45<"
"
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" @327" oketqqticpkuoqu" rqt" itcoc" fg" vgekfq." q" tkueq" fg"
kphgeèçq" ektûtikec" ê" octecfcogpvg" cwogpvcfq460" 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+47.48.490"
"
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"cpq4:0"
Kphgeèçq"fq"uîvkq"ektûtikeq"ê"woc"eqornkecèçq"htgs°gpvg"go"ektwtikc"
ectfîcec4;0" Rctvkewnctogpvg" c" kphgeèçq" guvgtpcn" rtqhwpfc" g" ogfkcuvkpkvg." cu"
swcku"qeqttgo"go"2.47"c"4'"fqu"rcekgpvgu"uwdogvkfqu"ä"ektwtikc"ectfîcec520"
Guucu" eqornkecèùgu" uçq" cuuqekcfcu" eqo" vczc" fg" oqtvcnkfcfg" ockqt" swg"
52'53" g" q" vtcvcogpvq" htgs°gpvgogpvg" tgswgt" tgkpvgtxgpèçq" ektûtikec." dgo"
eqoq" woc" vgtcríwvkec" cpvkdkôvkec" rtqnqpicfc." cnêo" fg" ugtgo" cuuqekcfcu"
eqo" wo" uwduvcpekcn" cwogpvq" pq" rgtîqfq" fg" rgtocpípekc" jqurkvcnct54.55" g"
ewuvq"fqu"ewkfcfqu33/560"
Q"wuq"fg"rtqhknczkc"cpvkdkôvkec"crtqrtkcfc"vgo"oquvtcfq"woc"tgfwèçq"
pc" kpekfípekc" fg" kphgeèçq" fq" uîvkq" ektûtikeq" crôu" ektwtikc" ectfîcec57.58.590" 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" cigpvgu5:0" Qu"
tguwnvcfqu" hqtco" kpeqtrqtcfqu" g" cu" tgeqogpfcèùgu" dgo" cegkvcu" rctc"
rtqhknczkc"cpvkoketqdkcpc"go"ektwtikc"ectfîcec."cu"swcku"ceqpugnjco"q"wuq"fg"
woc"eghcnqurqtkpc"fg"rtkogktc"qw"ugiwpfc"igtcèçq5;0""
Wo" etguegpvg" 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"
tgeqogpfcèùgu620" 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."
tgurgevkxcogpvg63.64.65.66.67.680" 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|gu68.69.6:0"
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"cn06;"
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"fg"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"korncpvâxgku720"
Q" fkcipôuvkeq" fg" kphgeèçq" cuuqekcfc" c" rtôvgugu" fgxg" ugt" hgkvq" eqo"
owkvc" ecwvgnc0" Cniwocu." ocu" pgo" vqfcu" cu" kphgeèùgu" fg" hgtkfcu" ektûtikecu."
chgvco"c"rtôvgug730"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"rtôvgugu730"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"rcekgpvg730"
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." go" 3;7574." rctc" q" vtcvcogpvq" fg" kpuwhkekípekc" côtvkec."
qwvtcu"rtôvgugu"ectfîcecu"rgtocpgpvgu."kpenwkpfq"octecrcuuqu75."crctgnjqu"
rctc" cuukuvípekc" xgpvtkewnct" guswgtfc76" g" ectfkqxgtuqtgu/fguhkdtkncfqtgu"
korncpvâxgku77" 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" vtcvcogpvq"
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" ektûtikeq790" " 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°gpvgogpvg790" Gjtgpmtcp|" g" Rhchh7:." 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" cn7;." 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" ektûtikeq" uçq" tgurqpuâxgku" rgnc" ockqtkc" fcu" kphgeèùgu"
ektûtikecu820""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‚gtk83" 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"fkuvcpvgu72.840""
2.1.1.1."Pessoal
Cu" oçqu" fc" gswkrg" ektûtikec" cdtkico" oketqqticpkuoqu" swg" rqfgo"
eqpvcokpct" q" uîvkq" ektûtikeq" rgnc" kpqewncèçq" fktgvc" fwtcpvg" q"
rtqegfkogpvq85.86.870" 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"
qw"ocku38.870"Gpvtgvcpvq."eqo"jkikgpg"rtê/qrgtcvôtkc"crtqrtkcfc"rctc"tgfw|kt"
c" swcpvkfcfg" fg" oketqqticpkuoqu" pcu" oçqu" fq" ektwtikçq." pçq" gzkuvg"
gxkfípekc"swg"vcn"rgthwtcèçq"fc"nwxc"vgpjc"ukipkhkecfq"enîpkeq0"Fqffu"gv"cn088"
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."
kpenwkpfq" S. aureus" g" dcevêtkcu" itco" pgicvkxcu890" Jâ‚gk" g" Ykng{8:"
fgoqpuvtctco"swg"c"ecdgèc"g"q"rgueqèq"rqfgo"vgqtkecogpvg"ug"hqpvgu"fg"
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"ektûtikec89.8;0"""
Q"pctk|"g"c"qtqhctkpig"fqu"ogodtqu"fc"gswkrg"ektûtikec"vcodêo"uçq"
eqnqpk|cfqu" eqo" oketqqticpkuoqu" swg" rqfgo" eqpvcokpct" q" uîvkq" ektûtikeq0"
Hqtf" gv" cn092" 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"
rtgxgpkfqu" rqt" cfgukxqu" swg" cu" eqdtkco" pcu" dqtfcu0" Ukoknctogpvg." Ngvvu" g"
Fqgtogt93" 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" kphgeèùgu940" Okeqdcevêtkc" cvîrkec" uçq" wdîswcu." rqfgo" ugt"
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" ocoqrncuvkc95.96.97." 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" ektwtikcu98." 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|cfqu990""
16
Pqu"tctqu"ecuqu"go"swg"hqpvgu"kpcpkocfcu"fc"ucnc"fg"ektwtikc"hqtco"
kpetkokpcfcu."c"hqpvg"gtc."pc"xgtfcfg."uqnwèùgu"eqpvcokpcfcu."cpvkuuêrvkequ."
qw" xguvkogpvcu0" Tqwrcu" gnâuvkecu" eqpvcokpcfcu" vgo" ukfq" kornkecfcu" eqoq"
ecwuc" fg" kphgeèçq" ektûtikec" ecwucfc" rqt" Rhizopus9:.9;.:2" g" C. perfringens:30"
Uqnwèùgu" eqpvcokpcfcu" uçq" c" hqpvg" fg" kphgeèùgu" ektûtikecu" ecwucfcu" rqt"
Pseudomonas aeruginosa, P. multivorans g Serratia marcescens:4.:5.:60"
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"ektûtikec93.940"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" ektûtikeq83.8:.930" C" fgurgkvq" fguuc" rquukdknkfcfg." gzkuvg"
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:7.:8.:9.::.:;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" fq"
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"ukipkhkecpvgogpvg"ogpqu"rquukdknkfcfg"fg"eqornkect"
eqo" kphgeèçq" swcpfq" hqtco"tgcnk|cfcu" go" ucncu" knwokpcfcu" eqo" kttcfkcèçq"
wnvtc/xkqngvc."eqorctcfcu"eqo"ektwtikcu"tgcnk|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;30"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" Ewndgtvuqp45" 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"vío"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;20"Etwug"g"Hqqtf38"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"eqphwuçq3;.;4.;5.;60""
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" cnvgtct" 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" kphgeèçq"
crôu" tgoqèçq" fqu" rgnqu" eqo" 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" ocku" swg" 46" jqtcu" cpvgu" fc" ektwtikc0" Pq"
guvwfq"fg"Etwug"g"Hqqtf38."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" kpenwîfqu" 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;70"
"
Jcoknvqp"g"Nqpg322"wuctco"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"
Hqqtf38" 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"
cpcnkucfqu80""
C" hqtoc" gzcvc" fg" eqoq" c" fwtcèçq" fq" rtqegfkogpvq" ektûtikeq"
cwogpvc" q" tkueq" fg" kphgeèçq" fq" uîvkq" ektûtikeq" rgtocpgeg" gurgewncvkxc0"
Etwug" g" Hqqtf38" 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" Ewujkpi3;" 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"cn0323"uwigtktco"swg"q"cwogpvq"pc"
22
kpekfípekc"fg"kphgeèçq"crôu"jkuvgtgevqokcu"rtqnqpicfcu"rqfg"ugt"q"tguwnvcfq"
fg" fkokpwkèçq" fq" ghgkvq" fc" rtqhknczkc" cpvkdkôvkec" 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" cn0324" 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" cecttgvc" ockqt" gzrgtkípekc" g" ektwtikùgu" ocku"
23
gzrgtkgpvgu." igtcnogpvg." cfswktgo" ognjqtgu" vêepkecu0" Oknngt" gv" cn0325"
cxcnkctco"c"tgncèçq"gpvtg"q"pîxgn"fg"vtgkpcogpvq"fq"ektwtikçq"g"c"kpekfípekc"
fg"gpfqogvtkvg"crôu"ugeèçq"rctc"eguctkcpc0"Gpvtg"37"xctkâxgku"gzcokpcfcu"
rqt" cpânkug" fg" tgitguuçq" nqiîuvkec." uqogpvg" c" rtgugpèc" fg" wo" tgukfgpvg"
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" Gfyctfu84" 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" Ewujkpi3;." 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" ektûtikec38." ;2.;6.;;.326.3270""
Ictkdcnfk"g"Ewujkpi3;"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" hqk" wo" ognjqt" rtgfkvqt"
fg"uwuegrvkdknkfcfg"fq"rcekgpvg"swg"c"kfcfg"kuqncfc0"
Etwug" g" Hqqtf38" 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" Nkfitgp328" g" Okujtkmk" gv" cn0;6." go"
eqpvtcuvg." pçq" gpeqpvtctco" fkhgtgpèc" ukipkhkecpvg" pc" vczc" fg" kphgeèçq"
ektûtikec"gpvtg"fkcdêvkequ"g"pçq"fkcdêvkequ0"C"cuuqekcèçq"gpvtg"qdgukfcfg"g"
vczc" fg" kphgeèçq" rctgeg" ugt" ognjqt" guvcdgngekfc0" Q" Pcvkqpcn" Tgugctej"
Eqwpekn;2." Pcicejkpvc" gv" cn0;5." Nknkgphgnf" gv" cn0329" g" P{uvtqo" gv" cn032:"
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" cxcnkcfqu38.;2.;6.32;/3340" 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"crnkecfc"cpvgu"qw"fwtcpvg"
c" ektwtikc." ocu" cniwocu" uçq" crnkecfcu" crôu" c" qrgtcèçq" qw" oguoq" crôu" q"
rcekgpvg"tgegdgt"cnvc"jqurkvcnct380"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"qrgtcèçq38.";20""
"
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" ugt" cnvgtcfc0"
Qdgukfcfg."fkcdgvgu"g"fgupwvtkèçq"vío"ukfq"kornkecfcu"eqoq"cwogpvcpfq"q"
tkueq" rctc" kphgeèçq" ektûtikec328." 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" Hqqtf38"
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"Ykjndqti335" g"Jc{gm"gv"cn0336"rctgego"eqphktoct"cu"qdugtxcèùgu"
fg"Etwug"g"Hqqtf380"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" cn0337" pçq"
gpeqpvtctco" fkhgtgpèc" ukipkhkecpvg" pc" vczc" fg" kphgeèçq" gpvtg" rcekgpvgu"
ektûtikequ" swg" hqtco" uwdogvkfqu" c" dcpjq" eqo" enqtgzgfkpg" g" cswgngu" swg"
vqoctco" dcpjq" eqo" rqxkfqpg/kqfkpg" qw" ucdçq0" Go" wo" rtqurgevkxq."
tcpfqok|cfq." fwrnq" egiq" guvwfq." gpxqnxgpfq" 30622" rcekgpvgu" swg" hqtco"
uwdogvkfqu"c"dcpjq"rtê/qrgtcvôtkq"eqo"qw"ugo"enqtgzgfkpg."Tqvvgt"gv"cn0338"
vcodêo"gpeqpvtctco"woc"ukipkhkecpvg"fkhgtgpèc"pc"vczc"fg"kphgeèçq0"
"
2.3.4. Remoção dos pelos
Qu"ektwtikùgu"rtghgtgo"tgoqxgt"qu"rgnqu"fq"ecorq"qrgtcvôtkq"rctc"
gxkvct" eqpvcokpcèçq" fq" uîvkq" qrgtcvôtkq" fwtcpvg" c" ektwtikc0" Ugtqrkcp" g"
Tg{pqnfu;7" g" qwvtqu" guvwfqu38.322" oquvtctco" swg" tgoqèçq" fqu" rgnqu" eqo"
nãokpc" rqfg" ecwuct" kplûtkcu" pc" rgng" g" cwogpvct" q" tkueq" fg" kphgeèçq0" Woc"
ogpqt"vczc"fg"kphgeèçq"ektûtikec"vgo"ukfq"cuuqekcfc"eqo"q"eqtvg"fqu"rgnqu"
qw" fgrkncèçq" eqo" wo" cigpvg" fgrkncvôtkq." rqtvcpvq" guugu" oêvqfqu" uçq"
rtghgtkfqu0"Ug"c"tgoqèçq"fqu"rgnqu"ug"hc|"pgeguuâtkc."guvwfqu"uwigtgo"swg"
guvc"fgxg"ugt"hgkvc"kogfkcvcogpvg"cpvgu"fc"qrgtcèçq;7.";;0"
"
2.3.5. Profilaxia Antimicrobiana
2.3.5.1. Considerações históricas
Owkvqu" fgdcvgu" g" eqphwuùgu" cdqtfcpfq" c" ghkeâekc" fc" rtqhknczkc"
cpvkoketqdkcpc" go" ektwtikc" qeqttgtco" crôu" c" rwdnkecèçq" fqu" tguwnvcfqu" fg"
wo"itcpfg"guvwfq"enîpkeq"pc"fêecfc"fg"720"Gttqu"pc"ogvqfqnqikc"fq"guvwfq"
28
kpenwktco" pçq/tcpfqok|cèçq." guvwfq" pçq" egiq." kpcfgswcfq" vgorq" fc"
cfokpkuvtcèçq"kpkekcn"qw"wuq"rtqnqpicfq"fq"cpvkdkôvkeq"g"gueqnjc"kpeqttgvc"fq"
cigpvg"cpvkoketqdkcpq0""
Guvwfqu" gzrgtkogpvcku" rwdnkecfqu" fwtcpvg" q" kpîekq" fc" fêecfc"
ugiwkpvg." clwfctco" c" guenctgegt" owkvqu" fguugu" rtqdngocu" g" tguwnvctco" go"
gxkfípekcu" ekgpvîhkecu" ocku" enctcu" uqdtg" c" rtqhknczkc" cpvkdkôvkec0" C" ocku"
ukipkhkecpvg"hqk"tgrqtvcfc"rqt"Dwtmg339"swg"fgoqpuvtqw"c"tgncèçq"etwekcn"gpvtg"
q"vgorq"fg"cfokpkuvtcèçq"fq"cpvkdkôvkeq"g"uwc"ghkeâekc"rtqhknâvkec0"Ugw"guvwfq"
gzrgtkogpvcn" oquvtqw" swg" rctc" woc" ukipkhkecpvg" tgfwèçq" gzrgtkogpvcn" fc"
kphgeèçq" fc" rgng" rtqfw|kfc" rqt" S. aureus" rgpkeknkpq/ugpuîxgn." c" rgpkeknkpc"
fgxg" guvct" pc" rgng" cpvgu" qw" cq" oguoq" vgorq" fc" kpqewncèçq" dcevgtkcpc0"
Tgvctfqu"pc"cfokpkuvtcèçq"fq"cpvkdkôvkeq."crôu"c"kpqewncèçq"fc"dcevêtkc."fg"
5"c"6"j"tguwnvqw"go"nguùgu"kphgevcfcu"swg"hqtco"kpfkuvkpiwîxgku"go"vcocpjq"
g" crctípekc" jkuvqnôikec" fcswgncu" fg" cpkocku" swg" pçq" vkpjco" tgegdkfq"
rtqhknczkc0" Guvg" guvwfq" g" qwvtqu" swg" ugiwktco" clwfctco" c" fgugpxqnxgt"
cvkvwfgu" swg" rtgxkpgo" kphgeèùgu" uwdugs°gpvgu." rqtvcpvq" q" cigpvg"
cpvkoketqdkcpq" fgxg" guvct" pq" vgekfq" cpvgu" qw" cq" oguoq" vgorq" fc"
eqpvcokpcèçq" dcevgtkcpc0" Guvc" korqtvcpvg" owfcpèc" fg" guvtcvêikc" gxkvqw" q"
gttq" eqowo" fg" cfokpkuvtct" c" fqug" fq" cpvkoketqdkcpq" rtqhknâvkeq" pc" ucnc" fg"
tgewrgtcèçq."crôu"c"ektwtikc"vgt"ukfq"eqpenwîfc0"
Go" 3;86." Dgtpctf" gv" cn033:" hqtco" qu" rtkogktqu" c" tgrqtvctgo" q"
uweguuq" fq" wuq" fg" rtqhknczkc" cpvkoketqdkcpc" go" wo" guvwfq" enîpkeq"
tcpfqok|cfq." rtqurgevkxq." g" rncegdq/eqpvtqncfq" fg" ektwtikcu" fq" vtcvq"
icuvtqkpvguvkpcn0"Guug"guvwfq"wuqw"vtíu"fqugu"kpvtcowuewnctgu"fg"cpvkdkôvkequ"
cfokpkuvtcfqu" kogfkcvcogpvg" cpvgu." fwtcpvg" g" kogfkcvcogpvg" crôu" c"
29
ektwtikc0"Uguugpvc"g"ugku"rcekgpvgu"swg"tgegdgtco"q"cpvkdkôvkeq"vkxgtco"woc"
tgfwèçq" ukipkhkecvkxc" fc" htgs°ípekc" fc" kphgeèçq" rôu/qrgtcvôtkc" rctc" :'."
eqorctcfc"eqo"49'"fg"kphgeèçq"qdugtxcfc"go"9;"rcekgpvgu"vtcvcfqu"eqo"
rncegdq0"Q"uweguuq"fc"rtqhknczkc"cpvoketqdkcpc"pqvcfq"pguvg"rtkogktq"guvwfq"
hqk"enctcogpvg"rquuîxgn"fgxkfq"ä"crtqrtkcfc"ugngèçq"fqu"rcekgpvgu"g"gueqnjc"
fg" cfgswcfqu" cigpvgu" cpvkoketqdkcpqu" g" vgorq" fg" uwc" cfokpkuvtcèçq0"
Cxcpèqu" cfkekqpcku" pq" gpvgpfkogpvq" fc" rtqhknczkc" cpvkdkôvkec" go" ektwtikc"
cdfqokpcn" qeqttgtco" pc" fêecfc" fg" 92." swcpfq" c" swcnkvcvkxc" g" swcpvkvcvkxc"
pcvwtg|c" fc" hnqtc" icuvtqkpvguvkpcn" gpfôigpc" go" rguuqcu" ucwfâxgku" g"
fqgpvgu"hqtco"fghkpkfcu33;0"
"
2.3.5.2 Princípios da profilaxia antimicrobiana
Rtqhknczkc"cpvkoketqdkcpc"ektûtikec"tghgtg/ug"c"wo"ewtuq"owkvq"dtgxg"
fg" wo" cigpvg" cpvkoketqdkcpq" kpkekcfq" kogfkcvcogpvg" cpvgu" fq" kpîekq" fq"
rtqegfkogpvq" ektûtikeq3420" Rtqhknczkc" cpvkoketqdkcpc" pçq" ê" kpfkecfc" rctc"
guvgtknk|cèçq"fg"vgekfqu."ocu"eqoq"wo"cflwpvq"wucfq"rctc"tgfw|kt"q"pûogtq"
fg" oketqqticpkuoqu" go" eqpvcokpcèçq" kpvtc/qrgtcvôtkc" rctc" wo" pîxgn"
kpecrc|"fg"uwrgtct"c"fghguc"fq"jqurgfgktq0"C"rtqhknczkc"pçq"vgo"c"hkpcnkfcfg"
fg" rtgxgpkt" c" kphgeèçq" ektûtikec" ecwucfc" rqt" eqpvcokpcèçq" rôu/
qrgtcvôtkc3430" Kphwuçq" kpvtcxgpquc" fg" cpvkoketqdkcpq" ê" q" oqfq" ocku"
htgs°gpvg" fg" rtqhknczkc" wucfc" pc" rtâvkec" ektûtikec" oqfgtpc344.345.3460"
Guugpekcnogpvg." vqfcu" cu" kpfkecèùgu" fg" rtqhknczkc" cpvkoketqdkcpc" kpenwgo"
qrgtcèùgu" gngvkxcu." pcu" swcku" c" kpekuçq" fc" rgng" ê" hgejcfc" pc" ucnc" fg"
ektwtikc0"Qu"qdlgvkxqu"fc"rtqhknczkc"kpenwgo<""
30"
Rtgxgpkt"kphgeèçq"rôu/qrgtcvôtkc"fq"uîvkq"ektûtikeq="
30
40"
Rtgxgpkt"oqtdkfcfg"g"oqtvcnkfcfg"kphgeekquc"rôu/qrgtcvôtkc="
50"
Tgfw|kt"c"fwtcèçq"g"q"ewuvq"fqu"ugtxkèqu"jqurkvcnctgu"*swcpfq"
q" ewuvq" cuuqekcfq" eqo" q" ocpwugkq" fc" kphgeèçq" rôu/qrgtcvôtkc" ê"
eqpukfgtcfq."q"ewuvq/ghgvkxkfcfg"fc"rtqhknczkc"ug"vqtpc"gxkfgpvg+"347.348="
60"
Pçq"rtqfw|kt"ghgkvqu"cfxgtuqu."g"
70"
Pçq" vgt" eqpugs°ípekcu" cfxgtucu" rctc" c" hnqtc" oketqdkcpc" fq"
rcekgpvg"qw"jqurkvcn3490"
Swcvtq" *26+" rtkpeîrkqu" fgxgo" ugt" ugiwkfqu" rctc" oczkok|ct" q"
dgpghîekq"fc"rtqhknczkc"cpvkoketqdkcpc<"
30"
Wuct" wo" cigpvg" cpvkoketqdkcpq" rctc" vqfcu" cu" qrgtcèùgu" qw"
encuugu"fg"qrgtcèùgu."pcu"swcku"guvg"vgo"ghgkvq"go"tgfw|kt"c"kpekfípekc"fg"
kphgeèçq" fq" uîvkq" ektûtikeq." dcugcfq" go" gxkfípekc" fg" gpuckqu" enîpkequ." qw"
rctc" cswgncu" qrgtcèùgu" pcu" swcku" kphgeèçq" ektûtikec" kpekukqpcn" qw" fg"
ôtiçq1gurcèq"rqfgo"tgrtgugpvct"woc"ecvâuvtqhg34:/352="
40"
Wuq" fg" wo" cigpvg" cpvkoketqdkcpq" ugiwtq." dctcvq" g" eqo"
gurgevtq" fg" cvkxkfcfg" dcevgtkekfc" swg" kpenwk" q" ocku" rtqxâxgn" igtog"
eqpvcokpcpvg"kpvtc/qrgtcvôtkq"rctc"c"ektwtikc"go"swguvçq="
50"
Cfokpkuvtcèçq" fc" fqug" kpkekcn" fq" cigpvg" cpvkoketqdkcpq" pq"
vgorq" cfgswcfq." fg" hqtoc" swg" cu" eqpegpvtcèùgu" uêtkec" g" vgekfwcn"
dcevgtkekfc" fc" ftqic" guvglco" guvcdgngekfcu" pq" oqogpvq" fc" kpekuçq" pc"
rgng353="
60"
Ocpwvgpèçq"fqu"pîxgku"vgtcríwvkequ"uêtkeq"g"vgekfwcn"fq"cigpvg"
cpvkoketqdkcpq"fwtcpvg"q"rtqegfkogpvq"ektûtikeq."cvê"cniwocu"jqtcu"crôu"q"
hgejcogpvq" fc" kpekuçq" pc" ucnc" fg" ektwtikc34:/352.3540" Fgxkfq" ä" rtgugpèc" fg"
31
eqâiwnq"go"vqfcu"cu"hgtkfcu"ektûtikecu."q"pîxgn"uêtkeq"fq"cpvkoketqdkcpq"ê"vçq"
korqtvcpvg"eqoq"q"pîxgn"vgtcríwvkeq"vgekfwcn0"
Rtqhknczkc" cpvkoketqdkcpc" ê" kpfkecfc" vcodêo" rctc" qrgtcèùgu" ewlcu"
kpekuùgu"uçq"hgkvcu"go"vgekfqu"pqtocku."pcu"swcku"pgpjwoc"xîuegtc"ê"cdgtvc."
g" ugo" pgpjwo" rtqeguuq" kphncocvôtkq" qw" kphgeekquq0" Fwcu" kpfkecèùgu" dgo"
eqpjgekfcu"fg"rtqhknczkc"cpvkoketqdkcpc"go"ektwtikcu"nkorcu"uçq<"*3+"swcpfq"
swcnswgt"ocvgtkcn"rtqvêvkeq"kpvtcxcuewnct"qw"woc"rtôvgug"ctvkewnct"hqt"kpugtkfq"
g"*4+"rctc"swcnswgt"qrgtcèçq"pc"swcn"woc"kphgeèçq"ektûtikec"kpekukqpcn"qw"fg"
ôtiçq1gurcèq" rqfg" ecwuct" tkueq" ecvcuvtôhkeq0" Gzgornqu" uçq" vqfcu" cu"
ektwtikcu"ectfîcecu."korncpvg"fg"rtôvgugu"rctc"tgxcuewnctk|cèçq"go"swcnswgt"
uîvkq" g" c" ockqtkc" fcu" ektwtikcu" pgwtqnôikecu0" Cniwpu" cwvqtgu" vío"
tgeqogpfcfq" q" wuq" fg" rtqhknczkc" go" vqfcu" cu" ektwtikcu" vqtâekecu346." 355." 3560"
Rqt" fghkpkèçq" rtqhknczkc" cpvkoketqdkcpc" pçq" ê" kpfkecfc" rctc" woc" qrgtcèçq"
encuukhkecfc" eqoq" eqpvcokpcfc" qw" uwlc0" Go" vcku" qrgtcèùgu." qu" rcekgpvgu"
guvçq"htgs°gpvgogpvg"tgegdgpfq"cigpvgu"cpvkoketqdkcpqu"vgtcríwvkequ"rctc"
kphgeèùgu"guvcdgngekfcu"pq"rtê/qrgtcvôtkq0"
Eghcnqurqtkpcu" uçq" qu" ocku" guvwfcfqu" cigpvgu" cpvkoketqdkcpqu"
rtqhknâvkequ3570" Uçq" ftqicu" ghgvkxcu" eqpvtc" owkvqu" oketqqticpkuoqu" itco/
rqukvkxqu" g" itco/pgicvkxqu0" Crtgugpvco" eqoq" xcpvcigpu<" ugiwtcpèc"
eqortqxcfc." hctoceqekpêvkec" cegkvâxgn" g" wo" dckzq" ewuvq" rqt" fqug3460" C"
eghc|qnkpc."go"rctvkewnct."ê"corncogpvg"wucfc"g"igtcnogpvg"cegkvc"eqoq"q"
cigpvg"fg"rtkogktc"gueqnjc"rctc"ektwtikcu"nkorcu34;0"Ug"q"rcekgpvg"pçq"rqfg"
tgegdgt"eghc|qnkpc"rqt"crtgugpvct"cngtikc"c"rgpkeknkpcu."woc"cnvgtpcvkxc"rctc"
eqdtkt"dcevêtkcu"itco/rqukvkxcu"ê"c"enkpfcokekpc"qw"c"xcpeqokekpc0"
"
32
2.3.5.3. Profilaxia antimicrobiana baseada em evidência
Fgufg"3;86."swcpfq"Dgtpctf"gv"cn033:"tgrqtvctco"rgnc"rtkogktc"xg|"q"
uweguuq"fq"wuq"fg"rtqhknczkc"cpvkdkôvkec"go"wo"guvwfq"enîpkeq"tcpfqok|cfq."
rtqurgevkxq." g" rncegdq/eqpvtqncfq" fg" ektwtikcu" fq" vtcvq" icuvtqkpvguvkpcn."
xâtkcu" eqpvtqxgtucu" uwtiktco" eqo" tgncèçq" cq" gortgiq" fguuc" vêepkec" rctc"
rtgxgpèçq"fg"kphgeèçq"go"rtqegfkogpvqu"ektûtikequ0"
Cvwcnogpvg." rctgeg" jcxgt" wo" enctq" eqpugpuq" swg" rtqhknczkc"
cpvkdkôvkec" ê" pgeguuâtkc" rctc" rtgxgpkt" eqornkecèùgu" kphgeekqucu" go"
rtqegfkogpvqu" ektûtikequ" nkorqu/eqpvcokpcfqu" swg" gpxqnxgo" ogodtcpc"
owequc"g"oketqhnqtc"gpfôigpc."rqtêo"rgtocpgeg"c"fkuewuuçq"eqo"tgncèçq"
cq"dgpghîekq"fguvc"go"ektwtikcu"nkorcu"swg"gpxqnxgo"q"korncpvg"fg"rtôvgugu0"
Gpvtg" 3;92" g" 3;:2." xâtkqu" guvwfqu" uwigtktco" swg" rtqhknczkc" cpvkdkôvkec"
tgfw|kc" c" htgs°ípekc" fg" kphgeèçq" ektûtikec" crôu" rtqegfkogpvqu" fg" korncpvg"
fg" rtôvgugu" ctvkewnctgu3580" Jknn" gv" cn0359" uwigtktco" swg" rtqhknczkc" cpvkdkôvkec"
eqo"eghc|qnkpc"tgfw|kc"ukipkhkecvkxcogpvg"c"kpekfípekc"fg" kphgeèçq"ektûtikec"
eqorctcfc"eqo"rncegdq."gpvtgvcpvq."swcpfq"qu"tguwnvcfqu"hqtco"cpcnkucfqu"
fg"ceqtfq"eqo"q"vkrq"fg"codkgpvg"ektûtikeq"wvknk|cfq."fkhgtgpècu"ukipkhkecpvgu"
hqtco" gpeqpvtcfcu" gpvtg" rcekgpvgu" go" swg" c" ektwtikc" hqk" tgcnk|cfc" go"
codkgpvgu" eqpxgpekqpcku0" Swcpfq" woc" ucnc" ›uwrgt" guvêtknfi" hqk" wucfc." qw"
uglc." woc" ucnc" eqo" ewkfcfqu" gurgekcku" fg" guvgtknk|cèçq." kpenwkpfq" ukuvgocu"
fg" xgpvkncèçq" g" knwokpcèçq" fkhgtgpekcfqu." c" htgs°ípekc" fg" kphgeèçq" hqk" c"
oguoc"rctc"q"itwrq"swg"tgegdgw"eghc|qnkpc"qw"rncegdq0"Nkfygnn"gv"cn035:.35;"
eqpfw|ktco" cniwpu" guvwfqu" ownvkeípvtkequ." kpenwkpfq" egtec" fg" :0222"
rcekgpvgu."eqo"q"qdlgvkxq"ockqt"fg"qdugtxct"q"ghgkvq"fc"ucnc"ektûtikec"›uwrgt"
guvêtknfi" pc" htgs°ípekc" fg" kphgeèçq0" Guvc" kpxguvkicèçq" oquvtqw" woc" enctc"
33
tgfwèçq" pc" htgs°ípekc" fg" kphgeèçq" tgncekqpcfc" cq" rtqegfkogpvq" ektûtikeq."
swcpfq"qu"rtqegfkogpvqu"gtco"tgcnk|cfqu"go"codkgpvgu"›uwrgt"guvêtgkufi0"Q"
guvwfq"pçq"hqk"fgugpjcfq"rctc"cxcnkct"q" ghgkvq"fc"rtqhknczkc"cpvkoketqdkcpc."
gpvtgvcpvq." guvc" hqk" cuuqekcfc" c" woc" ogpqt" kpekfípekc" fg" kphgeèçq0" Qu"
cwvqtgu" uwigtktco" swg" ucncu" ›uwrgt" guvêtgkufi" g" rtqhknczkc" cpvkdkôvkec" vío"
kpfgrgpfgpvgu" g" ewowncvkxqu" ghgkvqu362" go" rtgxgpkt" kphgeèçq" fq" uîvkq"
ektûtikeq."rqtêo"chktoctco"swg"qu"fcfqu"fqu"guvwfqu"pçq"vkpjco"gxkfípekc"
uwhkekgpvg"rctc"eqphktoct"vcn"jkrôvgug0""
Owgtu"gv"cn0363"eqpfw|ktco"q"rtkogktq"guvwfq"rtqurgevkxq"swg"cxcnkqw"
q"rcrgn"fc"rtqhknczkc"cpvkoketqdkcpc"pc"rtgxgpèçq"fg"kphgeèçq"tgncekqpcfc"c"
rtqegfkogpvqu" ektûtikequ" gpxqnxgpfq" octecrcuuq" fghkpkvkxq" vtcpuxgpquq0"
Hqtco" tcpfqok|cfqu" 653" rcekgpvgu." ugpfq" 456" cnqecfqu" pq" itwrq"
vtcvcogpvq."tgegdgpfq"hnwenqzceknkpc"3i"lwpvcogpvg"eqo"dgp|knrgpkeknkpc"822"
oi"xkc"kpvtcowuewnct."woc"jqtc"cpvgu"fq"rtqegfkogpvq"g"3"g"8"j"crôu."g"3;9"
rcekgpvgu"cnqecfqu"pq"itwrq"ugo"rtqhknczkc0"Qeqttgtco";"ecuqu"fg"kphgeèçq"
fg" nqlc" fg" octecrcuuq" *4.3'+" ugo" gxkfípekc" fg" fgkueípekc" fc" hgtkfc" qw"
gtquçq"fc"rgng"uqdtg"c"nqlc0"Ugvg"kphgeèùgu"uwtiktco"crôu"korncpvgu"*4.7'+"
g" 4" crôu" vtqec" fg" igtcfqt" *3.6'=" [email protected]" rgnq" vguvg" gzcvq" fg" Hkujgt+0" Ugku"
kphgeèùgu"qeqttgtco"rtgeqegogpvg"*cvê"4"ogugu"crôu"q"rtqegfkogpvq+"g"5"
ecuqu" ocku" vctfkcogpvg0" Fqku" fqu" rcekgpvgu" swg" gxqnwîtco" eqo" kphgeèçq"
jcxkco" tgegdkfq" cpvkdkôvkeq" g" 9" pçq" vkpjco0" Tgrtgugpvcpfq" woc" fkhgtgpèc"
ukipkhkecvkxc" pc" kpekfípekc" fg" kphgeèçq" gpvtg" qu" 4" itwrqu" *41454" xu0" 913;2."
r?2.26"vguvg"gzcvq"/"wpkecwfcn+0""
Tcoufcng" gv" cn0364" tgcnk|ctco" wo" gpuckq" enîpkeq" swg" kpenwkw" 722"
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." kpkekcpfq" 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"
Dnwjo365" 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'."vtqecu"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"gphcvk|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" cn0366" 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" eqo" 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"cn0367" 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" guvkowncèçq"
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" kpekfípekc" 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
ƒ"
Cxcnkct" c" ghkeâekc" fc" rtqhknczkc" cpvkoketqdkcpc" rctc" rtgxgpkt"
eqornkecèùgu" kphgeekqucu" go" rtqegfkogpvqu" ektûtikequ" fg" guvkowncèçq"
ectfîcec"ctvkhkekcn0"
"
3.2. Objetivo secundário
ƒ"
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<""
ƒ"
Itwrq" K" /" Korncpvg" qw" vtqec" fg" octecrcuuq." ectkqxgtuqt/
fguhkdtkncfqt."tguukpetqpk|cfqt"g1qw"ecdqu/gngvtqfqu"eqo"rtqhknczkc"cpvkdkôvkec"
*Eghc|qnkpc"3i+"⁄"itwrq"vtcvcfq0"
ƒ"
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<"
ƒ"
Wuq"fg"cpvkkoketqdkcpq"rqt"swcnswgt"qwvtq"oqvkxq=
ƒ"
Rcekgpvgu" fg" nqecnkfcfgu" fkuvcpvgu." swg" fkhkewnvctkc" q"
ceqorcpjcogpvq"rôu/qrgtcvôtkq=
ƒ"
Kfcfg"ogpqt"swg"3:"cpqu=
ƒ"
Rcekgpvgu"uwdogvkfqu"ä"vqtceqvqokc"rctc"korncpvg"fg"gngvtqfq"
go"xgpvtîewnq"guswgtfq=
41
ƒ"
Ektwtikc"rtêxkc"tgegpvg"*ûnvkoqu"52"fkcu+=
ƒ"
Kphgeèçq"vtcvcfc"tgegpvg"*ûnvkoqu"52"fkcu+=
ƒ"
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"
Itwrq"KK"
*Eghc|qnkpc+
*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
70.5±34.8
67.5±26.8
73.3±40.8
0.094
Duração Procedimento –
min (M±DP)
"
42
Eqphqtog"fgoqpuvtcfq"pc"Vcdgnc"3."qu"itwrqu"hqtco"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"cneqônkec"
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" j0"
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" hqtco" 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"
/" Jgoqewnvwtc" *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"Fwmg368<"
Endocardite Definida
‰"Etkvêtkqu"Rcvqnôikequ<"
Oketqqticpkuoqu<"fgoqpuvtcfqu"rqt"ewnvwtc"qw"gzcog"jkuvqnôikeq"fg"
xgigvcèçq." go" woc" xgigvcèçq" 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"rcvqnôikec"
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"Fwmg368="
•"
Rquuîxgn"Gpfqectfkvg"rqt"etkvêtkqu"oqfkhkecfqu"fg"Fwmg368."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
GII - Placebo (SF 0,9%)
GI – Cefazolina 1g
Cirurgia
Seguimento Ambulatorial
(10 e 30 dias, 3 e 6 meses)
Infecção superficial
Cultura Secreção/Antibióticoterapia
Seguimento
Ambulatorial
"
"
Infecção loja
Infecção sistêmica
Cultura Secreção/Hemocultura/ECO
Internação
Antibióticoterapia
Explante do Sistema de Estimulação
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" cxcnkcèçq" 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<"
ƒ"
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="
ƒ"
Kphgeèçq" fg" nqlc< Kphgeèçq" nkokvcfc" ä" nqlc." ugo" gxkfípekc" fg"
ocpkhguvcèùgu"ukuvíokecu="
ƒ"
Kphgeèçq"ukuvíokec<"Kphgeèçq"fg"nqlc"cuuqekcfc"ä"gxkfípekcu"fg"
ocpkhguvcèùgu"ukuvíokecu="
ƒ"
Gpfqectfkvg<"Wvknk|coqu"qu"etkvêtkqu"oqfkhkecfqu"fg"Fwmg368."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"kpekfípekc"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" crtgugpvctco" ukipkhkeãpekc" guvcvîuvkec" pc"
cpânkug" wpkxctkcfc" hqtco" wvknk|cfcu" pq" clwuvg" fq" oqfgnq" fg" tgitguuçq"
nqiîuvkec" oûnvkrnc" *›uvgrykugfi+0" Qu" xcnqtgu" fg" r>2.27" hqtco" eqpukfgtcfqu"
guvcvkuvkecogpvg"ukipkhkecpvg3690""
"
"
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"
"
porcentagem de pacientes
infectados (%)
Gráfico 1. Incidência de infecção por grupo
3,5
3
2,5
p=0,016
2
1,5
1
0,5
0
3,28
0,64
Cefazolina
Placebo
5.1. Variáveis Analisadas
Qu"tguwnvcfqu"fcu"xctkâxgku"cpcnkucfcu"hqtco"qu"ugiwkpvgu<"
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" cuuqekcèçq" ukipkhkecpvg" fguuc" xctkâxgn"
*r?2.76:+."eqphqtog"fgoqpuvtcfq"pq"Itâhkeq"40"
"
Gráfico 2. Incidência de infecção por sexo
"
"
"
"
"
"
2,5
porcentagem de pacientes
infectados (%)
"
2
1,5
p=0,54
1,65
2,31
1
0,5
0
"
Masculino
Feminino
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"
56
ukipkhkecvkxc" pc" kpekfípekc" fg" kphgeèçq" eqo" tgncèçq" ä" kfcfg" rgnq" vguvg" v" fg"
Uvwfgpv"*r?2.47+."eqphqtog"fgoqpuvtcfq"pq"Itâhkeq"50"
Gráfico 3. Incidência de infecção por duração do
procedimento
100
tempo (min)
80
60
p=0,25
70,1
89,6
40
20
0
Não Infectado
Infectado
"
"
"
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"
"
57
10
8
infectados (%)
porcentagem de pacientes
Grafico 4. In cid ên cia d e in fecção p o r card io p atia
d e b ase
p=0,16
6
4
2
0
C h ag ásica
Isq u êm ica
H ip erten siva
D ilatad a 0
H ip ertró fica
Ou tras
"
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"
58
Gráfico 5. In cid ên cia d e in fecção p o r classe
fu n cio n al d e in su ficiên cia card íaca (N YH A)
infectados(%)
porcentagem de pacientes
10
8
p=0,68
6
4
2
0
I
II
III
IV
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"
"
"
"
"
"
59
"
"
porcentagem de pacientes
infectados(%)
Gráfico 6. Incidência de infecção por função
ventricular esquerda - FEVE (% )
58
56
57,3
p=0,10
54
52
50
50,2
48
46
Não Infectado
Infectado
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"
60
Gráfico 7 Incidência de infecção em relação a
presença de diabetes mellitus
porcentagem de pacientes
infectados (%)
4
3,96
3
p=0,12
2
1
1,64
0
Não diabéticos
Diabéticos
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"
61
"
Gráfico 8. Incidência de infecção em relação a
presença de hipotireoidismo
"
"
"
"
"
"
porcentagem de pacientes
infectados (%)
"
7
6,89
6
p=0,11
5
4
3
2
1
1,77
0
"
Sem Hipotireoidismo
Com Hipotireoidismo
"
"
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"
"
"
62
Gráfico 9. Incidência de infecção em relação a
presença de DPOC
porcentagem de pacientes
infectados (%)
10
10
8
p=0,18
6
4
2
1,88
0
Sem DPOC
Com DPOC
"
"
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"
"
"
63
"
Gráfico 10. Incidência de infecção em relação à
presença de HAS
"
"
"
porcentagem de pacientes
infectados (%)
2
"
"
"
"
"
2
2
1,5
p=1,0
1
0,5
"
0
"
"
Sem HAS
Com HAS
"
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"
"
"
64
Gráfico 11. Incidência de infecção em relação a
presença de IRC
porcentagem de pacientes
infectados (%)
2,5
2
p=1,0
2,03
1,5
1
0,5
0
0
Sem IRC
Com IRC
"
"
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"
"
"
"
"
"
65
"
Gráfico 12. Incidência de infecção em relação ao
uso de corticosteróides
porcentagem de pacientes
infectados (%)
2,5
"
"
"
2
2,02
"
p=1,0
1,5
1
0,5
0
0
Sem Corticosteróides
Com Costicosteróides
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"
"
66
"
"
Gráfico 13. Incidência de infecção em relação ao
uso de anticoagulantes
"
"
"
"
"
"
6
porcentagem de pacientes
infectados (%)
"
p=0,07
5
5,88
4
3
2
1
0
0,17
Sem Anticoagulante
Com Anticoagulante
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"
"
67
"
"
Gráfico 14. Incidência de infecção em relação ao
uso de marcapasso temporário
"
"
"
"
"
"
3,5
porcentagem de pacientes
infectados (%)
"
3,41
3
p=0,40
2,5
2
1,5
1,78
1
0,5
0
"
Sem MPT
Com MPT
"
"
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"rcekgpvgu"uwdogvkfqu"äu"vtqecu"fq"
igtcfqtgu"*5"ecuqu+"*r?2.24+."eqphqtog"fgoqpuvtcfq"pq"Itâhkeq"370"
"
68
porcentagem de pacientes
infectados (%)
Gráfico 15. Incidência de infecção por tipo de
procedimento
3,5
3
2,5
p=0,027
2
3,3
1,5
1
0,5
0,87
0
Troca
Implante
"
"
"
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" vguvg" 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"
"
69
"
"
Gráfico 16. Incidência de infecção em relação à
complexidade dos procedimentos
"
"
"
"
"
"
2,5
porcentagem de pacientes
infectados (%)
"
2
p=0,90
2,05
1,5
1
1
0,5
0
0
Marcapasso
Ressincronizador
CDI
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"
70
qeqttípekc"
fg"
kphgeèçq."
eqphqtog"
fgoqpuvtcfq"
pq"
Itâhkeq"
390"
Gráfico 17. Incidência de infecção por duração do
procedimento
100
tempo (min)
80
60
p=0,009
70,1
89,6
40
20
0
Não Infectado
Infectado
"
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" hqk" wo" octecfqt" fg" ockqt" qeqttípekc" fg" kphgeèçq" go"
cpânkug" wpkxctkcfc." rgnq" vguvg" gzcvq" fg" Hkujgt" *r?2.25:+." eqphqtog"
fgoqpuvtcfq"pq"Itâhkeq"3:0""
71
"
"
Gráfico 18. Incidência de infecção por ocorrência
de hematoma de loja
"
"
porcentagem de pacientes
infectados (%)
"
"
"
"
"
"
"
"
"
"
"
"
"
"
"
14
12
10
p=0,038
8
6
12,5
4
2
0
1,74
Sem hematoma
Com hematoma
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"
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"fg"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/sistêmica
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"
S. coagulase
8"
55/F"
TG MP AV/90"
30"
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"
OR"CX"?"Vtqec"fg"igtcfqt"fg"octecrcuuq"Cvtkqxgpvtkewnct"
igtcfqt"fg"Ectfkqfguhkdtkncfqt"Cvtkqxgpvtkewnct"
/VI"
/VI" EFK" CX" ?" Vtqec" fg"
"
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"Fwmg368"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" kphgeekquq0" 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" kphgeekquq." 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
"
"
Figura 2. Evolução dos Pacientes infectados
n (%)
"
"
Tipo de
Infecção
Superficial 5 (38,4)
Loja 4 (30,7)
Loja/sistêmica 4 (30,7)
1*
"
Cultura
Secreção
"
(+) 4 (100)
(+) 5 (100)
(+) 4 (100)
"
Hemocultura
(-) 4 (80)
(+) 1 (20)
(+) 2 (50)
(-) 2 (50)
"
"
Ecocardiograma
Transesofágicoco
(+) 1¤ (20)
(-) 4 (80)
1 (100)
3 (75)¥
(-) 4 (100)
"
"
"
Explante do
Sistema
Cultura do Eletrodo
(+)4 (100)
4 (100)
(+)3 (75)
(-)1 (25)
"
"
* infecção superficial que evoluiu para infecção de loja
"¥ 1 paciente recusou explante do sistema
¤ não preencheu critérios para endocardite
"(-) negativo
(+) positivo
"
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"
76
qu"fqku"itwrqu"rgnq"vguvg"swk/swcftcfq"*r?2.73+."eqphqtog"fgoqpuvtcfq"pq"
itâhkeq"3;0"
"
"
Gráfico 19. Incidência de óbitos por grupo
"
"
"
"
"
porcentagem de óbitos (%)
"
0,3
0,25
0,27
0,2
0,15
p=0,51
0,19
0,1
0,05
0
"
"
Cefazolina
Placebo
"
"
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""
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."eqphqtog"lâ"fgoqpuvtcfq"rqt"Fctqwkejg"gv"
cn072" 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" cn03530" Q" cigpvg" cpvkoketqdkcpq" wvknk|cfq" hqk" woc" eghcnqurqtkpc."
swg" ê" q" cigpvg" cpvkoketqdkcpq" rtqhknâvkeq" ocku" guvwfcfq3570" Go" rctvkewnct" c"
eghc|qnkpc"swg"ê"corncogpvg"wucfc"g"igtcnogpvg"cegkvc"eqoq"q"cigpvg"fg"
rtkogktc"gueqnc"rctc"rtqhknczkc"go"ektwtikcu"nkorcu34;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"cn0367"
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"cn036:" 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" fc"
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" ocuewnkpq." 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"
guugu" rtqegfkogpvqu0" Crôu" 48.7" ogugu" fg" tcpfqok|cèçq." eqo" woc"
ecuwîuvkec" fg" 86;" rcekgpvgu" fkuvtkdwîfqu" gpvtgu" codqu" qu" itwrqu." q" guvwfq"
hqk" kpvgttqorkfq" rgnq" eqokví" fg" ugiwtcpèc." eqo" woc" fghkpkèçq" rtgekuc" fc"
pgeguukfcfg" fq" wuq" fg" rtqhknczkc" cpvkoketqdkcpc" rctc" rtqegfkogpvqu"
ektûtikequ" go" guvkowncèçq" ectfîcec" ctvkhkekcn." kpfgrgpfgpvg" fc" kphnwípekc" fg"
swcnswgt" qwvtq" hcvqt0" Guvcdgngegw" ckpfc" swg" c" qeqttípekc" fg" jgocvqoc" fg"
nqlc."pq"rgtîqfq"rôu/qrgtcvôtkq."fgvgtokpc."vcodêo"fg"hqtoc"kpfgrgpfgpvg."
woc"ockqt"kpekfípekc"fg"kphgeèçq0""
Pguug" guvwfq" pçq" wvknk|coqu" rtqhknczkc" cpvkoketqdkcpc" vôrkec."
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rtâvkec"eqowo"fwtcpvg"qu"rtqegfkogpvqu"gpxqnxgpfq"octecrcuuqu"g"EFKu0"
Dcekvtcekpc." cokpqinkequîfgqu." eghcnqurqtkpcu." xcpeqokekpc" g" rqxgfkpg/
kqfcfq"uçq"qu"cpvkoketqdkcpqu"ocku"wvknk|cfqu"rctc"kttkicèçq"fc"nqlc"fwtcpvg"
guugu" rtqegfkogpvqu0" Go" tgegpvg" guvwfq" tgvtqurgevkxq." Ncmmktgff{" gv" cn036;"
cxcnkctco"c"kphnwípekc"fc"kttkicèçq"fc"nqlc"eqo"uqnwèçq"fg"rqxgfkpg/kqfcfq"
pc"kpekfípekc"fg"kphgeèçq"go"korncpvgu"fg"ukuvgocu"fg"guvkowncèçq"ectfîcec"
ctvkhkekcn0"Guvwfctco"wo"vqvcn"fg"40786"rcekgpvgu"eqpugewvkxqu."uwdogvkfqu"c"
korncpvgu"fg"octecrcuuqu"qw"EFKu"gpvtg"3;;6"g"42240"Rqxgfkpg/kqfcfq"hqk"
wvknk|cfq" rctc" kttkicèçq" fc" nqlc" go" 75'" fqu" rcekgpvgu" g" uqnwèçq" ucnkpc" go"
69'0"Wo"vqvcn"fg"3:"rcekgpvgu"*2.9'+"fgugpxqnxgtco"kphgeèçq"fg"nqlc"eqo"
2.9'"*3213057;+"pq"itwrq"rqxgfkpg/kqfcfq"g"2.8'"*:130427+"pq"itwrq"ucnkpc"
*r?pu+0"Qu"cwvqtgu"eqpenwîtco"swg"c"kttkicèçq"fc"nqlc"eqo"rqxgfkpg/kqfcfq"
81
pçq"cnvgtqw"c"htgs°ípekc"fg"kphgeèçq"crôu"korncpvg"fg"octecrcuuq"qw"EFK0""
Rqtvcpvq." q" rcrgn" fc" rtqhknczkc" cpvkoketqdkcpc" vôrkec" go" rtqegfkogpvqu" fg"
guvkowncèçq"ectfîcec"rgtocpgeg"eqpvtqxgtuq0""""""""""
Qu"rtqegfkogpvqu"ektûtikequ"rctc"guvkowncèçq"ectfîcec"ctvkhkekcn"vío"
cwogpvcfq"go"pûogtq"g"eqorngzkfcfg"cq"nqpiq"fcu"ûnvkocu"fêecfcu0""Eqo"
c" gxkfípekc" fq" dgpghîekq" fq" korncpvg" fg" EFK" pq" rtqnqpicogpvq" fc"
uqdtgxkfc372." q" pûogtq" fg" korncpvgu" fguvgu" crctgnjqu" vgo" cwogpvcfq"
uwduvcpekcnogpvg0"Pqu"Guvcfqu"Wpkfqu"fc"Coêtkec."q"pûogtq"fg"korncpvgu"
fg"EFK"cwogpvqw"egtec"fg"32"xg|gu"gpvtg"qu"dgpghkekâtkqu"fq"Ogfkectg."pq"
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fg" kphgeèçq" cuuqekcfc" cq" octecrcuuq" xctkc" fg" 2.35" c" 3;.;'377.378.37937:0"
Guuc" kpekfípekc." go" rqrwncèùgu" fg" cnvq" tkueq." vcn" eqoq" rguuqcu" eqo"
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tgoqèçq" eqorngvc" fq" ukuvgoc" fg" guvkowncèçq" ectfîcec382." ewkfcfqu"
kpvgpukxqu"*kpenwkpfq"cpvkdkôvkeq"kpvtcxgpquq+."g"tgkorncpvg"fq"ukuvgoc0""
Rqtvcpvq."rctcngncogpvg"cq"cwogpvq"pq"pûogtq"g"eqorngzkfcfg"fqu"
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82
cwogpvq"rtqrqtekqpcn"pc"qeqttípekc"fg"eqornkecèùgu"kphgeekqucu."tguwnvcpfq"
pwo"cnvq"ewuvq."ockqt"oqtdkfcfg"g"oqtvcnkfcfg0""
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rqt" kphgeèçq" gpxqnxgpfq" ukuvgocu" fg" guvkowncèçq" ectfîcec." pc" gphgtoctkc"
fq"ugtxkèq"fg"Guvkowncèçq"Ectfîcec"Ctvkhkekcn"fq"Kpuvkvwvq"fq"Eqtcèçq"fg"Uçq"
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rgtîqfq0" Guug" pûogtq" fg" rcekgpvgu" swg" crtgugpvctco" kphgeèùgu"
tgncekqpcfcu"cqu"ukuvgocu"fg"guvkowncèçq"ectfîcec"ctvkhkekcn"igtqw"woc"vczc"
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vczc" vqvcn" fg" qewrcèçq" fg" 34.:'0" Q" ewuvq" jqurkvcnct" oêfkq" rqt" rcekgpvg"
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cu"kphgeèùgu"qeqttgtco"vqfcu"cvê"q"55£"fkc"crôu"q"rtqegfkogpvq"gpxqnxgpfq"
q"ukuvgoc"fg"guvkowncèçq"ectfîcec0""
Pguug" gpuckq" enîpkeq." eqpugiwkoqu" kfgpvkhkect" fqku" hcvqtgu" eqoq"
rtgfkvqtgu" kpfgrgpfgpvgu" fg" kphgeèçq" pq" rôu/qrgtcvôtkq" fg" guvkowncèçq"
ectfîcec" ctvkhkekcn." go" cpânkug" ownvkxctkcfc." q" pçq" wuq" fc" rtqhknczkc"
cpvkoketqdkcpc" g" c" rtgugpèc" fg" jgocvqoc" fg" nqlc0" Xâtkqu" qwvtqu" guvwfqu"
vgpvctco" guvcdgngegt" hcvqtgu" fg" rtgfkurqukèçq" c" eqornkecèùgu" kphgeekqucu"
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jgocvqoc" rôu/qrgtcvôtkq." wuq" fg" octecrcuuq" vgorqtâtkq" g" fkcdgvgu"
ognnkvwu"eqoq"octecfqtgu"fg"kphgeèçq"go"cpânkug"wpkxctkcfc0"Guugu"hcvqtgu"
83
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Pq" guvwfq" fg" Oqwpug{" gv" cn0366" qu" rcekgpvgu" eqo" wo" qw" ocku" fqu"
eqpukfgtcfqu" rquuîxgku" hcvqtgu" fg" tkueq" rctc" eqornkecèùgu" kphgeekqucu."
eqoq"ektwtikc"rtêxkc"tgegpvg."wuq"fg"eqtvkequvgtôkfgu."rqtvcfqtgu"fg"fkcdgvgu"
ognnkvwu" g" pgqrncukcu" ocnkipcu." pçq" crtgugpvctco" ockqt" kpekfípekc" fg"
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guvwfq." rqtêo." q" cwvqt" gpeqpvtqw" wo" pûogtq" ukipkhkecvkxcogpvg" ockqt" fg"
kphgeèçq" pqu" rcekgpvgu" qrgtcfqu" rqt" rtqhkuukqpcku" eqo" ogpqt" gzrgtkípekc"
pguug"vkrq"fg"rtqegfkogpvq."qw"uglc."ektwtikùgu"swg"jcxkco"tgcnk|cfq"ogpqu"
swg" 322" rtqegfkogpvqu" gpxqnxgpfq" guvkowncèçq" ectfîcec" ctvkhkekcn0" Pçq"
qeqttgpfq" swcnswgt" ecuq" fg" kphgeèçq" gpvtg" qu" rcekgpvgu" qrgtcfqu" rqt"
rtqhkuukqpcku" swg" jcxkco" tgcnk|cfq" ocku" fg" 722" qrgtcèùgu" fguug" vkrq0"
Ugognjcpvg" cq" pquuq" guvwfq." qu" rcekgpvgu" kphgevcfqu" crtgugpvctco" ockqt"
fwtcèçq"fq"rtqegfkogpvq"ektûtikeq"*98"okpwvqu+."gpswcpvq"qu"rcekgpvgu"pçq"
kphgevcfqu" vkxgtco" rtqegfkogpvqu" eqo" fwtcèçq" oêfkc" fg" 76" okpwvqu" *r" ?"
2.225+0" Fgpvtg" qu" rcekgpvgu" kphgevcfqu." 52.:'" vkpjco" ukfq" uwdogvkfqu" c"
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pq" itwrq" pçq" kphgevcfq" *r" ?" 2.223+0" " Kfcfg." ugzq" g" octecrcuuq" fwrnc"
eãoctc" pçq" ug" eqttgncekqpctco" eqo" ockqt" kpekfípekc" fg" kphgeèçq0" Cpânkug"
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kphgeèçq"vcodêo"pçq"hqk"tgcnk|cfc"pguug"guvwfq0""
Owgtu"gv"cn0363"cxcnkctco"c"eqttgncèçq"gpvtg"c"rtgugpèc"fg"fkcdgvgu"
ognnkvwu." pgqrncukc" ocnkipc." wuq" fg" eqtvkequvgtôkfgu" qw" vgtcrkc"
84
cpvkeqciwncpvg"g"c"kpekfípekc"fg"kphgeèçq0"Guugu"hcvqtgu"hqtco"gpeqpvtcfqu"
go" 69" fqu" rcekgpvgu" kphgevcfqu0" C" kpekfípekc" hqk" fg" 6.4'." eqorctcfq" eqo"
9156:" *3.:'+" gpvtg" rcekgpvgu" ugo" guugu" hcvqtgu." pçq" gpeqpvtcpfq" woc"
eqttgncèçq" ukipkhkecvkxc" gpvtg" guugu" hcvqtgu" g" c" qeqttípekc" fg" eqornkecèçq"
kphgeekquc"*[email protected]="vguvg"gzcvq"fg"Hkujgt+0"
Go" wo" guvwfq" ocku" tgegpvg." Dgtvcinkc" gv" cn036:" gpeqpvtctco" go"
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kphgeèçq0""
Eqphqtog" rqfgoqu" eqpuvcvct." cvtcxêu" fg" tgxkuçq" fc" nkvgtcvwtc."
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eqornkecèùgu"
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go"
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ctvkhkekcn0""
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kpekfípekc" fg" kphgeèçq." kpfgrgpfgpvgogpvg" fq" wuq" fg" rtqhknczkc"
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pq" swg" ug" tghgtg" cq" wuq" fg" cpvkeqciwncpvg" qtcn." rqtêo" q" wuq" fguvc"
ogfkecèçq" pçq" hqk" octecfqt" fg" kphgeèçq" go" cpânkug" wpkxctkcfc." uwigtkpfq"
swg"c"cpvkeqciwncèçq"qtcn"pçq"kphnwgpekqw"c"qeqttípekc"fg"jgocvqoc"fg"nqlc0"
85
Qdugtxcoqu" swg" qu" korncpvgu" hqtco" octecfqtgu" fg" kphgeèçq"
swcpfq" eqorctcfqu" eqo" cu" vtqecu" fg" igtcfqtgu." rtqxcxgnogpvg" guug"
cejcfq" guvglc" eqttgncekqpcfq" c" ockqt" fwtcèçq" fqu" rtqegfkogpvqu" fg"
korncpvgu." eqo" ockqt" gzrqukèçq" ä" eqpvcokpcèçq0" Cetgfkvcoqu" swg" guuc"
kphqtocèçq"fkhgtg"fc"wuwcnogpvg"tgncvcfc"pc"nkvgtcvwtc36:.384"rqt"fkhgtgpèc"pc"
vêepkec" ektûtikec0" Go" pquuq" ugtxkèq." fwtcpvg" q" rtqegfkogpvq" fg" vtqec" fg"
igtcfqt" tgcnk|coqu" ugortg" woc" cornkcèçq" fc" nqlc" fq" octecrcuuq."
hceknkvcpfq" c" cfcrvcèçq" fq" pqxq" igtcfqt." g" rquukxgnogpvg" fkokpwkpfq" cu"
eqornkecèùgu"kphgeekqucu"qecukqpcfcu"rqt"kuswgokc."pgetqug"g"cvê"gzvtwuçq"
fq"igtcfqt"ecwucfc"rgnc"oâ"cfcrvcèçq"fq"oguoq"ä"pqxc"nqlc0"" "
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kphgeèçq" tgncekqpcfc" cq" ukuvgoc" fg" guvkowncèçq" ectfîcec" guvçq" ugpfq"
fgugpxqnxkfqu"pcu"ûnvkocu"4"fêecfcu0"Q"geqectfkqitcoc"dkfkogpukqpcn"vgo"
ukfq" wucfq." eqo" tguwnvcfqu" ucvkuhcvôtkqu" rctc" fgvgeèçq" fg" xgigvcèùgu" g"
uwcu" eqornkecèùgu" cuuqekcfcu." go" rcekgpvgu" eqo" gpfqectfkvg0" Guvwfqu"
rqrwncekqpcku"vío"fgoqpuvtcfq"swg"q"Geqectfkqitcoc"Vtcpuvqtâekeq"*GVV+."
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ugpukdknkfcfg" swg" xctkc" fg" 62" c" :2'" rctc" fgvgeèçq" fg" xgigvcèùgu385.3860"
Eqo" q" Geqectfkqitcoc" Vtcpuguqhâikeq" *GVG+" c" swcnkfcfg" fc" kocigo" ê"
ognjqt." rgnq" wuq" fg" vtcpufwvqt" fg" cnvc" htgs°ípekc" g" rqtswg" pçq" jâ"
kpvgtrqukèçq"fq"vgekfq"rwnoqpct0"Rqtvcpvq."xâtkqu"guvwfqu"vío"oquvtcfq"uwc"
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eqornkecèùgu387.388.3890"
Mnwi" gv" cn038:" tgcnk|ctco" GVV" g" GVG" go" 74" rcekgpvgu" eqpugewvkxqu"
cfokvkfqu" eqo" uwurgkvc" fg" gpfqectfkvg" tgncekqpcfc" cq" gngvtqfq" fg"
86
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korncpvg" g" etõpkec" go" 5:" rcekgpvgu0" Pq" itwrq" eqo" crtgugpvcèçq" ciwfc" q"
GVV" fgoqpuvtqw" cpqtocnkfcfgu" tgncekqpcfcu" cqu" ecdqu/gngvtqfqu" uqogpvg"
go" 3" rcekgpvg" *9.3'+." woc" itcpfg" xgigvcèçq" hqk" xkuwcnk|cfc" pq" ecdq/
gngvtqfq"xgpvtkewnct"fktgkvq0"Q"GVG"hqk"tgcnk|cfq"go"qwvtqu"34"rcekgpvgu"eqo"
ocpkhguvcèçq" ciwfc" g" gpeqpvtqw" cpqtocnkfcfgu" tgncekqpcfcu" cqu" ecdqu/
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*;6.9'+0" Rqtvcpvq." q" GVG" oquvtqw/ug" uwrgtkqt" cq" GVV" vcpvq" go" rcekgpvgu"
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Rqtvcpvq." fgxkfq" ä" uwrgtkqtkfcfg" fq" GVG" go" tgncèçq" cq" GVV" pq"
fkcipôuvkeq" fg" kphgeèçq" tgncekqpcfc" c" ukuvgocu" fg" guvkowncèçq" ectfîcec."
qrvcoqu"rqt"tgcnk|â/nq"go"vqfqu"qu"rcekgpvgu"eqo"kphgeèçq"fg"nqlc"qw"hgdtg"
c"guenctgegt0"
Kphgeèçq" fg" nqlc." htgs°gpvgogpvg." ê" tguwnvcfq" fg" eqpvcokpcèçq" fq"
uîvkq" ektûtikeq" rqt" igtogu" fc" hnqtc" fc" rgng" fwtcpvg" q" rtqegfkogpvq38;.392."
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" dcevgtgokcu378.3930" Ecowu" gv"
cn0378." 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" cn0394" 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" rcekgpvgu." 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" cn0366." swg" gpeqpvtqw" 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/gngvtqfqu3770" Qu" rcvôigpqu" ocku" eqowogpvg"
gpeqpvtcfqu" uçq" qu" rgtvgpegpvgu" ä" hnqtc" fc" rgng." gurgekhkecogpvg."
Staphylococcus
aureus,
staphylococcus
eqciwncug/pgicvkxq." kpenwkpfq"
Staphylococcus epidermidis"g"dceknqu"itco/pgicvkxqu382.393.3940"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" jwocpc3970" Ö" cfswktkfq" rtkoctkcogpvg" fg" cpkocku"
fqoêuvkequ" g" ugwu" rtqfwvqu3970" 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"
ugrug398.399.39:.39;.3:20" Wo" ecuq" fg" quvgqokgnkvg" g" ugrug." swg" qeqttgw"
kogfkcvcogpvg"crôu"tgfwèçq"cdgtvc"g"hkzcèçq"kpvgtpc"fg"woc"htcvwtc"hgejcfc"
fg" vqtpq|gnq3:3" g" wo" ecuq" fg" quvgqokgnkvg" rûdkec" eqo" dcevgtgokc39:" 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" vêepkec" 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" rgtukuvgpvg." ockqt" tgurquvc" kphncocvôtkc."
89
ockqt"
xktwnípekc"
swcpfq"
eqorctcfq"
eqo"
qwvtqu"
eqciwncug/
pgicvkxqu3:4.3:5.3:60" " Cfkekqpcnogpvg." S. simulans" rtqfw|" eqpukfgtâxgn"
ecocfc" oweôkfg." c" swcn" hceknkvc" uwc" cfgtípekc" c" eqtrqu" guvtcpjqu." eqoq"
rtôvgugu3:70"
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"fg
swgkocfwtcu0"
"
Infecção Incisional Profunda
Kphgeèçq"qeqttg"cvê"52"fkcu"crôu"c"ektwtikc"ug"pgpjwoc"rtôvgugφ"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"rtôvgugφ"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"cn32"
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:
ƒ"
Oketqqticpkuoqu"vîrkequ"fg"gpfqectfkvg"kphgeekquc."kuqncfqu"go"24""
coquvtcu"kuqncfcu"fg"jgoqewnvwtc"/"Uvtgrvqeqeewu"xktkfcpu."Uvtgrvqeqeewu"dqxku.""
itwrq"JCEGM."qw"
ƒ"
Uvcrj{nqeqeewu"cwtgwu"qw"gpvgtqeqeewu"cfswktkfqu"pc"eqowpkfcfg."pc"cwuípekc""
fg"wo"hqeq"rtkoâtkq."qw"
ƒ"
Jgoqewnvwtc"rgtukuvgpvgogpvg"rqukvkxc"rctc"oketqqticpkuoq"eqpukuvgpvg"eqo""
gpfqectfkvg"kphgeekquc."go"coquvtcu"eqnjkfcu"eqo"kpvgtxcnqu"@"34"jqtcu."qw"
ƒ"
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
ƒ"
Geqectfkqitcoc"rqukvkxq"rctc"gpfqectfkvg"kphgeekquc"
ƒ"
Ocuuc"quekncpvg"kpvtcectfîcec."go"ecdqu/gngvtqfqu"qw"go"guvtwvwtc"gpfqeâtfkec"g
go"eqpvcvq"eqo"ecdqu/gngvtqfqu"
ƒ"
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"eqtqpct{"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" Kphgevkqpu" 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" Kphgevkqwu"
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"
5tf"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" yqwpf" 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" kphgevkqp" tcvgu" kp" engcp" uwtigt{<" c" rqvgpvkcnn{" okungcfkpi" tkum"
encuukhkecvkqp0"Infect Control Hosp Epidemiol"3;;4=35<679/840"
520"Pcvkqpcn" Pquqeqokcn" Kphgevkqpu" 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"5tf."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."7vj"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" tgrncegogpvu" 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"xgtuwu"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" 4pf" gf0" Dcnvkoqtg<"
Yknnkcou"("Yknmkpu0"3;;5=r0836/8860"
3550"
Ngg" LV0" Uwtikecn" yqwpf" kphgevkqpu<" uwtxgknncpeg" hqt" swcnkv{"
kortqxgogpv0" Kp<" Ht{" FG." gf0" Uwtikecn" 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" Tcpfqok|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." 6vj" 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<" Kpekfgpeg" 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"qh"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" Kphgevkqp" 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" cpf"
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" CN." 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" Enkpkecn" 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{" kp" 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" vtcpuguqrjcigcn" 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." Dcffqwt" 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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