Estudo prospectivo e randomizado de profilaxia...

JÚLIO CÉSAR DE OLIVEIRA

Estudo prospectivo e randomizado de profilaxia antimicrobiana para procedimentos cirúrgicos

em estimulação cardíaca artificial

Tese apresentada à Faculdade de Medicina da Universidade de São Paulo para obtenção do título de Doutor em Ciências

Área de concentração: Cardiologia Orientador: Prof. Dr. Martino Martinelli Filho

São Paulo 2007

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Dados Internacionais de Catalogação na Publicação (CIP)

Preparada pela Biblioteca da Faculdade de Medicina da Universidade de São Paulo

©reprodução autorizada pelo autor""

Oliveira, Júlio César de Estudo prospectivo e randomizado de profilaxia antimicrobiana para procedimentos cirúrgicos em estimulação cardíaca artificial / Júlio César de Oliveira. -- São Paulo, 2007.

Tese(doutorado)--Faculdade de Medicina da Universidade de São Paulo. Departamento de Cardio-Pneumologia.

Área de concentração: Cardiologia. Orientador: Martino Martinelli Filho.

Descritores: 1.Antibioticoprofilaxia 2.Marca-passo artificial 3.Infecção/prevenção &controle 4.Endocardite bacteriana 5.Estimulação cardíaca artificial 6.Desfibriladores implantáveis 7.Estudos prospectivos

USP/FM/SBD-225/07

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SUMÁRIO

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LISTA DEABREVIATURAS

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LISTA DE SIGLAS

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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

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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"

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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<"

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6

Fqug"fg"eqpvcokpcèçq"dcevgtkcpc"Z"xktwnípekc"?"Tkueq"fg"kphgeèçq"ektûtikec"

""""""""""""""""Tgukuvípekc"fq"rcekgpvg""

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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"

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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'=" r@2.7" 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

" Cxcnkct" c" ghkeâekc" fc" rtqhknczkc" cpvkoketqdkcpc" rctc" rtgxgpkt"

eqornkecèùgu" kphgeekqucu" go" rtqegfkogpvqu" ektûtikequ" fg" guvkowncèçq"

ectfîcec"ctvkhkekcn0"

"

3.2. Objetivo secundário

" Guvcdgngegt"eqttgncèùgu"rtgfkvkxcu"fg"eqornkecèùgu"kphgeekqucu"

pguvgu"vkrqu"fg"rtqegfkogpvqu0"

"

40

4. CASUÍSTICA E MÉTODOS

Hqtco"kpenwîfqu"pq"guvwfq."rtqurgevkxcogpvg."fg"oqfq"eqpugewvkxq"

g" tcpfqok|cfq" qu" rcekgpvgu" uwdogvkfqu" c" rtqegfkogpvqu" ektûtikequ" go"

ukuvgocu"fg"guvkowncèçq"ectfîcec"ctvkhkekcn"pq"Kpuvkvwvq"fq"Eqtcèçq"c"rctvkt"fg"

23"fg"lwnjq"fg"42250""Q"pûogtq"fg"rcekgpvgu"c"ugtgo"kpenwîfqu"pq"guvwfq"hqk"

ecnewncfq" dcugcfq" pc" kpekfípekc" ogfkc" fg" kphgeèçq" pguvg" vkrq" fg"

rtqegfkogpvqu"gpeqpvtcfc"pc"nkvgtcvwtc."eqpukfgtcpfq"woc"rtqdcdknkfcfg"fg"

kphgeèçq"fg"4'."eqo"gttq" α = 5% e poder estatîuvkeq"fg";2'0"Ejgicpfq"c"

wo" p" ecnewncfq" fg" 3222" rcekgpvgu" swg" ugtkco" tcpfqok|cfqu" go" fqku"

itwrqu<""

" Itwrq" K" /" Korncpvg" qw" vtqec" fg" octecrcuuq." ectkqxgtuqt/

fguhkdtkncfqt."tguukpetqpk|cfqt"g1qw"ecdqu/gngvtqfqu"eqo"rtqhknczkc"cpvkdkôvkec"

*Eghc|qnkpc"3i+"⁄"itwrq"vtcvcfq0"

" Itwrq" KK" /" Korncpvg" qw" vtqec" fg" octecrcuuq." ectfkqxgtuqt/

fguhkdtkncfqt."tguukpetqpk|cfqt"g1qw"ecdqu/gngvtqfqu"ugo"rtqhknczkc"cpvkdkôvkec"

*Uqnwèçq"ucnkpc"2.;'+"⁄"itwrq"eqpvtqng0"

Hqtco"fghkpkfqu"qu"ugiwkpvgu"etkvêtkqu"fg"gzenwuçq<"

" Wuq"fg"cpvkkoketqdkcpq"rqt"swcnswgt"qwvtq"oqvkxq=

" Rcekgpvgu" fg" nqecnkfcfgu" fkuvcpvgu." swg" fkhkewnvctkc" q"

ceqorcpjcogpvq"rôu/qrgtcvôtkq=

" Kfcfg"ogpqt"swg"3:"cpqu=

" Rcekgpvgu"uwdogvkfqu"ä"vqtceqvqokc"rctc"korncpvg"fg"gngvtqfq"

go"xgpvtîewnq"guswgtfq=

41

" Ektwtikc"rtêxkc"tgegpvg"*ûnvkoqu"52"fkcu+=

" Kphgeèçq"vtcvcfc"tgegpvg"*ûnvkoqu"52"fkcu+=

" Qwvtc"kpfkecèçq"rctc"rtqhknczkc"cpvkdkôvkec"*gz0"rtôvgug"xcnxct+0

Q"guvwfq" hqk" kpvgttqorkfq"rtgeqegogpvg"rgnq"eqokví"fg"ugiwtcpèc."

eqo"48.7"ogugu"fg"tcpfqok|cèçq."vgpfq"kpenwîfq"86;"rcekgpvgu."ugpfq"536"

pq" itwrq" eghc|qnkpc" g" 557" pq" itwrq" rncegdq." ewlcu" ectcevgtîuvkecu" enîpkeq/

grkfgokqnôikecu"dcucku"guvçq"fgoqpuvtcfcu"pc"Vcdgnc"30"

Tabela 1. Características Clínico-Epidemiológicas Basais

xctkâxgku" Total" Itwrq"K"

*Eghc|qnkpc+

Itwrq"KK"

*Rncegdq+""

" n=649" n=314" n=335" r"

Idade (M±DP)" 64.2±15.3" 64.1±15.9" 64.3±14.8" 0.831

Sexo M (n/%)" 303/46.7" 140/44.6" 163/48.6" 0.290

Classe NYHA (I/II/III/IV)" 292/247/43/1 157/112/16/0 135/135/27/1" 0.052

FEVE (% - M±SD)" 57.2±26.3" 57.4±15.2" 56.8±33.4" 0.826

Diabetes (n/%) 101/15.5 44/14.0" 57/17.0" 0.292

Hipotireoidismo 29/4.4 13/4.1 16/4.8 0.695

Doença Pulmonar Crônica (n/%) 10/1.5 5/1.6 5/1.5 0.53

Terapia com Corticóide (n/%) 6/0.9 3/0.9 3/0.9 1.000

Terapia Anticoagulante (n/%) 51/7.8 15/4.7 36/10.7 0.005

MP temporário (n/%) 88/13.5 38/12.1 50/14.9 0.294

Implante/Troca(n) 303/346 140/174 163/172 0.299

MP/TRC/CDI/Outros(n) 585/8/50/6 283/2/25/4 302/6/25/2 0.439

Duração Procedimento – min (M±DP)

70.5±34.8 67.5±26.8 73.3±40.8 0.094

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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"

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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

Cirurgia

Seguimento Ambulatorial (10 e 30 dias, 3 e 6 meses)

Infecção superficial

Cultura Secreção/Hemocultura/ECO

GI – Cefazolina 1g GII - Placebo (SF 0,9%)

Infecção loja Infecção sistêmica

Seguimento Ambulatorial

Internação Antibióticoterapia

Explante do Sistema de Estimulação

Cultura Secreção/Antibióticoterapia

49

4.1.2.5. Avaliação clínica

Qu"rcekgpvgu" hqtco"cxcnkcfqu"codwncvqtkcnogpvg."fg"ceqtfq"eqo"c"

tqvkpc" fq" codwncvôtkq" fg"octecrcuuq" fc" kpuvkvwkèçq0" Cnêo" fc" cpcopgug" g"

cxcnkcèçq" ectfkqxcuewnct" igtcn." hqtco" uwdogvkfqu" ä" 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<"

" Kphgeèçq" uwrgthkekcn<" Kphgeèçq" fc" hgtkfc" qrgtcvôtkc." eqo"

rtgugpèc"fg"ukpcku" kphncocvôtkqu" nqecku"ocku"ugetgèçq"rwtwngpvc"pc" kpekuçq."

ugo"gxkfípekc"fg"ceqogvkogpvq"fc"nqlc"qw"ocpkhguvcèùgu"ukuvíokecu="

" Kphgeèçq" fg" nqlc< Kphgeèçq" nkokvcfc" ä" nqlc." ugo" gxkfípekc" fg"

ocpkhguvcèùgu"ukuvíokecu="

" Kphgeèçq"ukuvíokec<"Kphgeèçq"fg"nqlc"cuuqekcfc"ä"gxkfípekcu"fg"

ocpkhguvcèùgu"ukuvíokecu="

" Gpfqectfkvg<"Wvknk|coqu"qu"etkvêtkqu"oqfkhkecfqu"fg"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"

"

5.1. Variáveis Analisadas

Qu"tguwnvcfqu"fcu"xctkâxgku"cpcnkucfcu"hqtco"qu"ugiwkpvgu<"

0,64

3,28

00,5

11,5

22,5

33,5

porc

enta

gem

de

paci

ente

s in

fect

ados

(%)

Gráfico 1. Incidência de infecção por grupo

Cefazolina Placebo

p=0,016

55

5.1.1. Sexo

Hqtco"kpenwîfqu"568"rcekgpvgu"fq"ugzq"hgokpkpq"*75.53'+"g"525"fq"

ugzq" ocuewnkpq." ugpfq" 396" rcekgpvgu" fq" ugzq" hgokpkpq" pq" itwrq" swg"

tgegdgw" eghc|qnkpc" g" 394" pq" itwrq" swg" tgegdgw" rncegdq0" Pçq" qeqttgw"

fkhgtgpèc" guvcvîuvkec" go" tgncèçq" cq" ugzq" gpvtg" qu" 24" itwrqu0" Fq" oguoq"

oqfq." c" cpânkug" fc" kphnwípekc" fq" ugzq" pc" kpekfípekc" fg" kphgeèçq." rgnq"

oêvqfq" swk/swcftcfq." pçq" oquvtqw" cuuqekcèçq" ukipkhkecpvg" fguuc" xctkâxgn"

*r?2.76:+."eqphqtog"fgoqpuvtcfq"pq"Itâhkeq"40"

"

"

"

"

"

"

"

"

"

5.1.2. Idade

C"kfcfg"xctkqw"fg"3;"c";8"cpqu"*O"?"86.4"∑"37.5+."oêfkc"86.3∑"

37.;" pq" itwrq" eghc|qnkpc" g" 86.5" ∑" 36.:" pq" itwrq" rncegdq." pçq" jcxgpfq"

fkhgtgpèc"guvcvîuvkec"gpvtg"qu"itwrqu0"Fq"oguoq"oqfq"pçq"jqwxg"fkhgtgpèc"

1,65 2,31

0

0,5

1

1,5

2

2,5

porc

enta

gem

de

paci

ente

s in

fect

ados

(%)

Gráfico 2. Incidência de infecção por sexo

Masculino Feminino

p=0,54

56

ukipkhkecvkxc" pc" kpekfípekc" fg" kphgeèçq" eqo" tgncèçq" ä" kfcfg" rgnq" vguvg" v" fg"

Uvwfgpv"*r?2.47+."eqphqtog"fgoqpuvtcfq"pq"Itâhkeq"50"

"

"

"

5.1.3. Cardiopatia de base

Cu" ectfkqrcvkcu" ocku" htgs°gpvgu" hqtco<" ejciâukec" *3:.3:'+."

kuswíokec" *:.54'+." jkrgtvgpukxc" *5.2:'+" fkncvcfc" *6.84'+" g" jkrgtvtôhkec"

*3.76'+0"Pçq"qeqttgw"fkhgtgpèc"ukipkhkecvkxc"pc"kpekfípekc"fg"ectfkqrcvkc"gpvtg"

qu" fqku" itwrqu0" Pçq" jqwxg" kphnwípekc" guvcvkuvkecogpvg" ukipkhkecvkxc" fc"

ectfkqrcvkc"fg"dcug"pc"kpekfípekc"fg"kphgeèçq"*r?2.38+."eqphqtog"Itâhkeq"260"

"

70,189,6

0

20

40

60

80

100

tem

po (m

in)

Gráfico 3. Incidência de infecção por duração do procedimento

Não Infectado Infectado

p=0,25

57

"

5.1.4. Classe funcional de insuficiência cardíaca " Pq"oqogpvq" fg" kpenwuçq" pq" guvwfq" 4;4" rcekgpvgu" *66.;;'+" guvcxco""

go"EH"K"*P[JC+."469"*5:.27'+""go"EH"KK."65"*8.84'+"go"EH"KKK"g"crgpcu"23"

rcekgpvg"*2.37'+"guvcxc""go"EH"KX0"Pçq"jqwxg"fkhgtgpèc"ukipkhkecvkxc"gpvtg"qu"

itwrqu" eghc|qnkpc" g" rncegdq" swcpvq" ä" encuug" hwpekqpcn" fg" kpuwhkekípekc"

ectfîcec0"C"encuug"hwpekqpcn"fg"kpuwhkekípekc"ectfîcec"pçq"eqttgncekqpqw"eqo"c"

kpekfípekc" fg" kphgeèçq" rgnq" vguvg" swk/swcftcfq" *r?2.8:+." fgoqpuvtcfq" pq"

Itâhkeq"70"

0

0

2

4

6

8

10

porc

enta

gem

de

paci

ente

s in

fect

ados

(%

)

Grafico 4. Incidência de infecção por cardiopatia de base

Chagásica Isquêmica H ipertensivaD ilatada Hipertrófica Outras

p=0,16

58

5.1.5. Fração de ejeção do ventrículo esquerdo

C"htcèçq"fg"glgèçq"fq"xgpvtîewnq"guswgtfq"oêfkc"*HGXG+"hqk"fg"79.4"∑"

45." ugpfq"79.6"∑" 37.4"pq"itwrq" eghc|qnkpc"g"78.:"∑" 55.6"pq"itwrq"rncegdq0"

Pçq" jqwxg" fkhgtgpèc" guvcvkuvkecogpvg" ukipkhkecvkxc" gpvtg" qu" fqku" itwrqu0" C"

htcèçq" fg" glgèçq" pçq" kphnwgpekqw" pc" kpekfípekc" fg" kphgeèçq" rgnq" vguvg" v" fg"

Uvwfgpv"*r?2.32+."fgoqpuvtcfq"pq"Itâhkeq"80"

"

"

"

"

"

0

2

4

6

8

10

porc

enta

gem

de

paci

ente

s in

fect

ados

(%)

Gráfico 5. Incidência de infecção por classe funcional de insuficiência cardíaca (N YH A)

I II III IV

p=0,68

59

"

"

5.1.6. Diabetes mellitus

Pq" oqogpvq" fc" tcpfqok|cèçq" 323" rcekgpvgu" *37.78'+" vkpjco" q"

fkcipôuvkeq" fg" fkcdgvgu" ognnkvwu0" C" rtgxcnípekc" fg" rcekgpvgu" fkcdêvkequ" hqk"

36.23'" pq" itwrq" eghc|qnkpc" g" 39.23'" pq" itwrq" rncegdq." pçq" jcxgpfq"

fkhgtgpèc" guvcvkuvkecogpvg" ukipkhkecvkxc0" C" rtgugpèc" fg" fkcdgvgu" pçq"

eqttgncekqpqw" eqo" ockqt" kpekfípekc" fg" kphgeèçq" rgnq" vguvg" gzcvq" fg" Hkujgt"

*r?2.34+."eqphqtog"Itâhkeq"90"

57,3

50,2

46

48

50

52

54

56

58

porc

enta

gem

de

paci

ente

s in

fect

ados

(%)

Gráfico 6. Incidência de infecção por função ventricular esquerda - FEVE (%)

Não Infectado Infectado

p=0,10

60

5.1.7. Hipotireoidismo

Jkrqvktgqkfkuoq" guvgxg" rtgugpvg" go" 4;" rcekgpvgu" *6.68'+." 35"

rcekgpvgu" *6.36'+"pq"itwrq" eghc|qnkpc" g" 38" *6.99'+"pq"itwrq"rncegdq0"Pçq"

jqwxg"fkhgtgpèc"ukipkhkecvkxc"pc"rtgxcnípekc"fg"jkrqvktgqkfkuoq"gpvtgu"qu"fqku"

itwrqu0" Pq" Itâhkeq" :." guvâ" fgoqpuvtcfc" c" cwuípekc" fg" eqttgncèçq" gpvtg"

jkrqvktgqkfkuoq"g"c"kpekfípekc"fg"kphgeèçq"rgnq"vguvg"gzcvq"fg"Hkujgt"*r?2.33+0"

1,64

3,96

0

1

2

3

4po

rcen

tage

m d

e pa

cien

tes

infe

ctad

os (%

)

Gráfico 7 Incidência de infecção em relação a presença de diabetes mellitus

Não diabéticos Diabéticos

p=0,12

61

"

"

"

"

"

"

"

"

"

"

"

5.1.8. Doença pulmonar obstrutiva crônica

Hqtco" kpenwîfqu" pq" guvwfq" 32" rcekgpvgu" *3.76'+" eqo" fqgpèc"

rwnoqpct" qduvtwvkxc" etõpkec." ugpfq" 28" *3.;3'+" pq" itwrq" eghc|qnkpc" g" 26"

*3.3;'+"pq"itwrq"rncegdq0"Pçq"jqwxg"fkhgtgpèc"guvcvkuvkecogpvg"ukipkhkecvkxc"

gpvtgu" qu" fqku" itwrqu" swcpvq" ä" qeqttípekc" fg" fqgpèc" rwnoqpct" qduvtwvkxc"

etõpkec0"C"cpânkug"fc"eqttgncèçq"gpvtg"kphgeèçq"g"fqgpèc"rwnoqpct"qduvtwvkxc"

etõpkec" pçq" hqk" guvcvkuvkecogpvg" ukipkhkecvkxc." rgnq" vguvg" gzcvq" fg" Hkujgt"

*r?2.3:+0"Fgoqpuvtcfc"pq"Itâhkeq";0"

"

"

1,77

6,89

01234567

porc

enta

gem

de

paci

ente

s in

fect

ados

(%)

Gráfico 8. Incidência de infecção em relação a presença de hipotireoidismo

Sem Hipotireoidismo Com Hipotireoidismo

p=0,11

62

"

"

5.1.9. Hipertensão arterial sistêmica

Jkrgtvgpuçq" ctvgtkcn" ukuvíokec" *JCU+" guvcxc" rtgugpvg" go" 622"

rcekgpvgu" *83.85'+." ugpfq"3;;" *85.59'+"pq"itwrq"eghc|qnkpc"g"423" *82.2'+"

pq" itwrq" rncegdq0" C" htgs°ípekc" fg" jkrgtvgpuçq" ctvgtkcn" ukuvíokec" hqk"

guvcvkuvkecogpvg" ugognjcpvg" gpvtg" qu" fqku" itwrqu0"Eqoq" rqfgoqu" qdugtxct"

pq"Itâhkeq" 32." pçq" jqwxg" eqttgncèçq" gpvtg" rtgugpèc" fg" jkrgtvgpuçq" ctvgtkcn"

ukuvíokec"g"kpekfípekc"fg"kphgeèçq"rgnq"vguvg"gzcvq"fg"Hkujgt"*r?3.2+0"

"

"

1,88

10

0

2

4

6

8

10

porc

enta

gem

de

paci

ente

s in

fect

ados

(%)

Gráfico 9. Incidência de infecção em relação a presença de DPOC

Sem DPOC Com DPOC

p=0,18

63

"

"

"

"

"

"

"

"

"

"

"

"

"

5.1.10. Insuficiência renal crônica

Pqxg" rcekgpvgu" *3.5:'+" vkpjco" fkcipôuvkeq" fg" kpuwhkekípekc" tgpcn"

etõpkec" pq"oqogpvq"fg" kpenwuçq"pq" guvwfq." ugpfq"26"rcekgpvgu" *3.49'+"pq"

itwrq" eghc|qnkpc" g" 27" *3.6;'+" pq" itwrq" rncegdq0" Pçq" jqwxg" fkhgtgpèc"

guvcvîuvkec"gpvtg"qu"itwrqu0"C"cpânkug"rgnq"vguvg"gzcvq"fg"Hkujgt"pçq"oquvtqw"

eqttgncèçq" gpvtg" kpuwhkekípekc" tgpcn" etõpkec" g" kphgeèçq" *r?3.2+." fgoqpuvtcfc"

pc"Itâhkeq"330"

"

"

2 2

0

0,5

1

1,5

2po

rcen

tage

m d

e pa

cien

tes

infe

ctad

os (%

)

Gráfico 10. Incidência de infecção em relação à presença de HAS

Sem HAS Com HAS

p=1,0

64

"

"

5.1.11. Uso de corticosteróides

Ugku"rcekgpvgu"*2.;4'+"fqu"rcekgpvgu"kpenwîfqu"pq"guvwfq"hc|kco"wuq"

fg"eqtvkequvgtôkfgu"etqpkecogpvg."ugpfq"25"*2.;7'+"pq"itwrq"eghc|qnkpc"g"26"

*2.:;'+" pq" itwrq" rncegdq0" Pçq" jcxgpfq" fkhgtgpèc" guvcvkuvkecogpvg"

ukipkhkecvkxc"gpvtg"qu"fqku"itwrqu0"Q"wuq"fg"eqtvkequvgtôkfg"pçq"kphnwgpekqw"pc"

kpekfípekc" fg" kphgeèçq." eqphqtog"cpânkug" rgnq" vguvg" gzcvq" fg"Hkujgt" *r?3.2+."

fgoqpuvtcfq"pq"Itâhkeq"340"

"

"

"

"

"

2,03

00

0,5

1

1,5

2

2,5

porc

enta

gem

de

paci

ente

s in

fect

ados

(%)

Gráfico 11. Incidência de infecção em relação a presença de IRC

Sem IRC Com IRC

p=1,0

65

"

"

"

"

"

5.1.12. Uso de anticoagulante

Hqtco"kpenwîfqu"73"rcekgpvgu"*9.:8'+"go"wuq"fg"cpvkeqciwncpvg"qtcn0""

Q" wuq" fg" cpvkeqciwncpvg" qtcn" hqk" guvcvkuvkecogpvg" ocku" htgs°gpvg" pq" itwrq"

rncegdq." 58" rcekgpvgu" *32.96'+" swg" pq" itwrq" eghc|qnkpc." 37" rcekgpvgu"

*6.99'+." rgnq" vguvg" swk/swcftcfq" *r?2.227+0" Gpvtgvcpvq." q" wuq" fg"

cpvkeqciwncpvg" pçq" eqttgncekqpqw" eqo" c" kpekfípekc" fg" kphgeèçq" rgnq" vguvg"

gzcvq"fg"Hkujgt"*r?2.29+."eqphqtog"fgoqpuvtcfq"pq"Itâhkeq"350"

"

2,02

00

0,5

1

1,5

2

2,5

porc

enta

gem

de

paci

ente

s in

fect

ados

(%)

Gráfico 12. Incidência de infecção em relação ao uso de corticosteróides

Sem Corticosteróides Com Costicosteróides

p=1,0

66

"

"

"

"

"

"

"

"

"

5.1.13. Uso de marcapasso temporário

Pq"oqogpvq" fc" kpenwuçq" pq" guvwfq" ::" rcekgpvgu" *35.78'+" guvcxco"

go" wuq" fg" octecrcuuq" vgorqtâtkq" jâ" rgnq" ogpqu" 46" j0" Q" pûogtq" fg"

rcekgpvgu"go"wuq"fg"octecrcuuq"vgorqtâtkq"hqk"guvcvkuvkecogpvg"ugognjcpvg."

5:" rcekgpvgu" *34.3'+" pq" itwrq" eghc|qnkpc" g" 72" *36.;4'+" pq" itwrq" rncegdq0"

Eqphqtog"qdugtxcfq"pq"Itâhkeq"36."q"wuq"fg"octecrcuuq"vgorqtâtkq"pçq"ug"

eqttgncekqpqw" eqo" c" kpekfípekc" fg" kphgeèçq" rgnq" vguvg" gzcvq" fg" Hkujgt" *r?"

2.62+0"

"

0,17

5,88

0

1

2

3

4

5

6po

rcen

tage

m d

e pa

cien

tes

infe

ctad

os (%

)

Gráfico 13. Incidência de infecção em relação ao uso de anticoagulantes

Sem Anticoagulante Com Anticoagulante

p=0,07

67

"

"

"

"

"

"

"

"

"

"

"

"

5.1.14. Tipo de procedimento

Fwtcpvg" q" rgtîqfq" fg" kpenwuçq" fq" guvwfq" hqtco" tgcnk|cfqu" 525"

korncpvgu"*68.8:'+"g"568"vtqecu"fg"igtcfqtgu"*75.53'+0"Q"pûogtq"fg"vtqecu"

pq" itwrq" eghc|qnkpc" hqk" 396" *77.63'+" g" pq" itwrq" rncegdq" hqk" 394" *73.56'+."

pçq" jcxgpfq" fkhgtgpèc" guvcvkuvkecogpvg" ukipkhkecvkxc0" Go" cpânkug" wpkxctkcfc."

rgnq" vguvg" swk/swcftcfq." jqwxg" ockqt" kpekfípekc" fg" kphgeèçq" pqu" rcekgpvgu"

uwdogvkfqu"c"korncpvg"*32"ecuqu+"swg"pqu"rcekgpvgu"uwdogvkfqu"äu"vtqecu"fq"

igtcfqtgu"*5"ecuqu+"*r?2.24+."eqphqtog"fgoqpuvtcfq"pq"Itâhkeq"370"

"

1,78

3,41

00,5

11,5

22,5

33,5

porc

enta

gem

de

paci

ente

s in

fect

ados

(%)

Gráfico 14. Incidência de infecção em relação ao uso de marcapasso temporário

Sem MPT Com MPT

p=0,40

68

""

"

5.1.15. Complexidade dos procedimentos

Hqtco"tgcnk|cfqu"7:7"rtqegfkogpvqu"go"octecrcuuqu"eqpxgpekqpcku"

*;2.36'+." 72" go" ectfkqxgtuqtgu" fguhkdtkncfqtgu" korncpvâxgku" *9.92'+." :" go"

tguukpetqpk|cfqtgu"ectfîcequ"*3.45'+"g"28"qwvtqu"vkrqu"fg"rtqegfkogpvqu"swg"

gpxqnxkco" uqogpvg" vtqec" qw" tgrqukekqpcogpvq" fg" ecdqu/gngvtqfqu" *2.;4'+0"

Pçq" jqwxg" fkhgtgpèc" guvcvkuvkecogpvg" ukipkhkecvkxc" gpvtg" qu" itwrqu" swcpvq" ä"

eqorngzkfcfg" fqu" rtqegfkogpvqu0" Eqoq" rqfgoqu" pqvct" pq" Itâhkeq" 38." c"

eqorngzkfcfg" fqu" rtqegfkogpvqu" pçq" eqttgncekqpqw" eqo" c" kpekfípekc" fg"

kphgeèçq" rgnq" 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"

"

0,87

3,3

00,5

11,5

22,5

33,5

porc

enta

gem

de

paci

ente

s in

fect

ados

(%

)

Gráfico 15. Incidência de infecção por tipo de procedimento

Troca Implante

p=0,027

69

"

"

"

"

"

"

"

"

"

5.1.16. Duração do procedimento C" fwtcèçq" oêfkc" fqu" rtqegfkogpvqu" hqk" fg" 92.7" ∑" 56.:" okpwvqu."

ugpfq"89.7"∑"48.:"okpwvqu"pq"itwrq"eghc|qnkpc"g"95.5"∑"62.:"okpwvqu"pq"itwrq"

rncegdq0"C"fwtcèçq"hqk"guvcvkuvkecogpvg"ugognjcpvg"gpvtg"qu"fqku"itwrqu0"Qu"

rtqegfkogpvqu" eqo" fwtcèçq" ocku" rtqnqpicfc" crtgugpvctco" kpekfípekc" fg"

kphgeèçq" guvcvkuvkecogpvg"ocku" gngxcfc" go"cpânkug" wpkxctkcfc." rgnq" vguvg" fc"

uqoc" fg" rquvqu" fg" Ykneqzqp" *r?2.22;+." ugpfq." rqtvcpvq." wo" octecfqt" fg"

2,05

0

1

0

0,5

1

1,5

2

2,5po

rcen

tage

m d

e pa

cien

tes

infe

ctad

os (%

)

Gráfico 16. Incidência de infecção em relação à complexidade dos procedimentos

Marcapasso Ressincronizador CDI

p=0,90

70

qeqttípekc" fg" kphgeèçq." eqphqtog" fgoqpuvtcfq" pq" Itâhkeq" 390"

"

5.1.17. Hematoma de loja Jgocvqocu" fg" nqlcu" pq" rôu/qrgtcvôtkq" qeqttgtco" go" 38" rcekgpvgu"

*4.68'+."ugpfq"7"*2.38'+"pqu"rcekgpvgu"fq"itwrq"eghc|qnkpc"g"33"*5.4:'+"pqu"

rcekgpvgu" fq" itwrq" rncegdq0" Pçq" jqwxg" fkhgtgpèc" guvcvkuvkecogpvg"

ukipkhkecvkxc" pc" qeqttípekc" fg" jgocvqoc" gpvtg" qu" itwrqu0" C" rtgugpèc" fg"

jgocvqoc" fg" nqlc" 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""

70,189,6

0

20

40

60

80

100

tem

po (m

in)

Gráfico 17. Incidência de infecção por duração do procedimento

Não Infectado Infectado

p=0,009

71

"

"""

"""""""""""""""

5.2. Análise multivariada C" cpânkug" ownvkxctkcfc." cvtcxêu" fg" tgitguuçq" nqiîuvkec"

*›uvgrykugfi+." hqk" tgcnk|cfc" eqpukfgtcpfq" vqfcu" xctkâxgku" fghkpkfcu" eqoq"

octecfqtgu"fg" kphgeèçq"rgnc"cpânkug"wpkxctkcfc<"wuq"fg"rtqhknczkc"cpvkdkôvkec."

fwtcèçq" fq" rtqegfkogpvq." vkrq" fg" rtqegfkogpvq" *korncpvg" qw" vtqec+" g"

rtgugpèc"fg"jgocvqoc"fg"nqlc0"Q"tguwnvcfq"guvâ"fgoqpuvtcfq"pc"Vcdgnc"40"

1,74

12,5

02468

101214

porc

enta

gem

de

paci

ente

s in

fect

ados

(%)

Gráfico 18. Incidência de infecção por ocorrência de hematoma de loja

Sem hematoma Com hematoma

p=0,038

72

Tabela 2. Análise multivariada

Variáveis Razão de Chance IC (95%) p

Profilaxia Antibióticaa

(não/sim) 60;7" 302:" 4408:" 0.0391

Hematoma (sim/não) 8094" 3054" 56026" 0.0214

Q" pçq" wuq" fg" rtqhknczkc" cpvkoketqdkcpc" g" c" rtgugpèc" fg"

jgocvqoc" fg" nqlc" hqtco" fghkpkfqu" eqoq" rtgfkvqtgu" kpfgrgpfgpvgu" fg"

kphgeèçq0" Q" pçq" wuq" fg" rtqhknczkc" cpvkoketqdkcpc" cwogpvc" go" 6.;7" xg|gu" c"

ejcpeg"fg"qeqttípekc"fg"kphgeèçq"go"rtqegfkogpvqu"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"

8" 55/F" TG MP AV/90" 30"

S. coagulase

negativo" superficial" Placebo"

9" 74/F" Impl MP V/120" 21" S. epidermidis*" loja" Placebo"

10" 65/F" Impl MP AV/75" 12" S. simulans*" superficial" Placebo"

11" 75/M" TG CDI AV/90" 12" S. aureus" loja/sistêmica" Placebo"

12" 66/M" Impl MP AV/160" 20" S. aureus" loja/sistêmica" Placebo"

13" 66/M" Impl MP AV/55" 11" S. epidermidis*" loja/sistêmica" Placebo"

","qzceknkpq"tgukuvgpvgu" "/"Korn"OR"CX"?"Korncpvg"fg"octecrcuuq"Cvtkqxgpvtkewnct" /VI"OR"CX"?"Vtqec"fg"igtcfqt"fg"octecrcuuq"Cvtkqxgpvtkewnct" /VI" EFK" CX" ?" Vtqec" fg"igtcfqt"fg"Ectfkqfguhkdtkncfqt"Cvtkqxgpvtkewnct""

5.4. Evolução clínica dos casos de infecção

C" gxqnwèçq" enîpkec" fqu" ecuqu" fg" kphgeèçq" guvâ" fgoqpuvtcfc" pq"

fkcitcoc"fc"Hkiwtc"40"Qeqttgtco"7"ecuqu"fg"kphgeèçq"uwrgthkekcn."6"fg"nqlc"g"

6" ukuvíokec." rqtêo" wo" rcekgpvg" eqo" kphgeèçq" uwrgthkekcn" gxqnwkw" rctc"

kphgeèçq" fg" nqlc." c" fgurgkvq" fq" vtcvcogpvq" enîpkeq." ugpfq" pgeguuâtkq" c"

74

kpvgtpcèçq." tgoqèçq" ektûtikec" g" tg/korncpvg" fq" ukuvgoc" fg" guvkowncèçq"

ectfîcec0" C" ewnvwtc" fg" ugetgèçq" hqk" rqukvkxc" go" vqfqu" qu" rcekgpvgu0" Q"

geqectfkqitcoc" vtcpuguqhâikeq" tgxgnqw" kocigo" hkncogpvct" cfgtkfc" cq"

gngvtqfq"xgpvtkewnct"go"uqogpvg"wo"ecuq."rqtêo"pçq"rtggpejgw"qu"etkvêtkqu"

fg"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

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5.5. Análise de óbitos

Qeqttgtco"37"ôdkvqu"*4.53'+"fwtcpvg"q"ugiwkogpvq."vqfqu"fg"ecwuc"

pçq"kphgeekquc"g"pçq"tgncekqpcfqu"cq"rtqegfkogpvq"ektûtikeq"go"guvkowncèçq"

ectfîcec"ctvkhkekcn0"Hqtco"8"ôdkvqu"pq"itwrq"eghc|qnkpc"*2.3;'+"g";"pq"itwrq"

rncegdq"*2.49'+0"Pçq"jcxgpfq"fkhgtgpèc"guvcvkuvkecogpvg"ukipkhkecvkxc"gpvtg"

Superficial 5 (38,4) Loja 4 (30,7)

(+) 4 (100) (+) 5 (100) (+) 4 (100)

Figura 2. Evolução dos Pacientes infectados

(-) 4 (80) (+) 2 (50)(+) 1 (20) (-) 2 (50)

(-) 4 (100)(+) 1¤ (20) (-) 4 (80)

4 (100)1 (100) 3 (75)¥

Loja/sistêmica 4 (30,7)

Hemocultura

Ecocardiograma Transesofágicoco

Explante do Sistema

Cultura do Eletrodo (+)4 (100) (+)3 (75) (-)1 (25)

1*

* infecção superficial que evoluiu para infecção de loja ¥ 1 paciente recusou explante do sistema ¤ não preencheu critérios para endocardite (-) negativo (+) positivo

n (%)

Tipo de Infecção

Cultura Secreção

76

qu"fqku"itwrqu"rgnq"vguvg"swk/swcftcfq"*r?2.73+."eqphqtog"fgoqpuvtcfq"pq"

itâhkeq"3;0"

"

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5.6. Perda de seguimento clínico

Fwtcpvg" q" guvwfq" jqwxg" rgtfc" fg" ugiwkogpvq" fg" 33" rcekgpvgu"

*3.9'+" cpvgu" fg" eqorngvct" qu" 8"ogugu"fg"cxcnkcèçq"rtê/qrgtcvôtkc0"Guugu"

rcekgpvgu"pçq"crtgugpvcxco"ukpcku"qw"ukpvqocu"fg" kphgeèçq"cvê"uwc"ûnvkoc"

cxcnkcèçq0""

0,19

0,27

0

0,05

0,1

0,15

0,2

0,25

0,3

porc

enta

gem

de

óbito

s (%

)

Gráfico 19. Incidência de óbitos por grupo

Cefazolina Placebo

p=0,51

6. DISCUSSÃO

Guug"guvwfq"rtqurgevkxq"hqk"rtqlgvcfq"go"4225."rctc"fghkpkt"q"rcrgn"

fc"rtqhknczkc"cpvkoketqdkcpc"pc"kpekfípekc"fg"kphgeèçq"go"rtqegfkogpvqu"fg"

guvkowncèçq" ectfîcec" ctvkhkekcn." swg" ug" eqpuvkvwk" pwo" itcxg" rtqdngoc." eqo"

itcpfg"korcevq"uôekq"geqpõokeq."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."

eqpukfgtcpfq" swg" guug" rtqegfkogpvq" ugtkc" wo" xkêu." woc" xg|" swg" ugw"

dgpghîekq" vcodêo" ckpfc" pçq" hqk" eqortqxcfq0" Gpvtgvcpvq." ugw" wuq" ê" woc"

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"

rgtîqfq"fg"3;:9"c"3;;7."dgo"eqoq"q"pûogtq"fg"jqurkvcku"swg" tgcnk|co"q"

rtqegfkogpvq" g" q" xqnwog" fg" korncpvgu" rqt" jqurkvcn3730" C" kpekfípekc" fg"

kphgeèçq" go" rtqegfkogpvqu" gpxqnxgpfq" EFK" pçq" guvâ" ckpfc" dgo"

fgvgtokpcfc." ocu" xctkc" fg" 2.:" c" 3.5'" pqu" korncpvgu" vtcpuxgpququ0""

Gxkfípekcu" vío" fgoqpuvtcfq" swg" tguukpetqpk|cfqtgu" ectfîcequ" vcodêo"

ognjqtco"c"swcnkfcfg"fg"xkfc."tgfw|go"c"htgs°ípekc"fcu"jqurkvcnk|cèùgu"g"

c"oqtvcnkfcfg"go"rcekgpvgu"eqo"kpuwhkekípekc"ectfîcec374.375.3760"C"kpekfípekc"

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"

dcevgtgokc" rqt"S aureus, rqfg" ejgict" c" 67'37;0" Q" ewuvq" cuuqekcfq" eqo"

guucu" kphgeèùgu" ê" uwduvcpekcn." rqtswg" q" vtcvcogpvq" igtcnogpvg" gpxqnxg" c"

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"

rtqegfkogpvqu" go" guvkowncèçq" ectfîcec" ctvkhkekcn." xgo" qeqttgpfq" wo"

82

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pwo"cnvq"ewuvq."ockqt"oqtdkfcfg"g"oqtvcnkfcfg0""

Pq"rgtîqfq"fg"lcpgktq"fg"4225"c"lwnjq"fg"4227."tgikuvtcoqu"fg"hqtoc"

rtqurgevkxc"cdgtvc."eqpugewvkxc"g"pçq"tcpfqok|cfc"64"ecuqu"fg"kpvgtpcèùgu"

rqt" kphgeèçq" gpxqnxgpfq" ukuvgocu" fg" guvkowncèçq" ectfîcec." pc" gphgtoctkc"

fq"ugtxkèq"fg"Guvkowncèçq"Ectfîcec"Ctvkhkekcn"fq"Kpuvkvwvq"fq"Eqtcèçq"fg"Uçq"

Rcwnq." rgthc|gpfq" 3.5'" fq" vqvcn" fg" 503:4" kpvgtpcèùgu" tgcnk|cfcu" pguug"

rgtîqfq0" Guug" pûogtq" fg" rcekgpvgu" swg" crtgugpvctco" kphgeèùgu"

tgncekqpcfcu"cqu"ukuvgocu"fg"guvkowncèçq"ectfîcec"ctvkhkekcn"igtqw"woc"vczc"

fg" qewrcèçq" jqurkvcnct" fg" 3.37" rcekgpvgu" rqt" fkc" g" woc" rqtegpvcigo" fc"

vczc" vqvcn" fg" qewrcèçq" fg" 34.:'0" Q" ewuvq" jqurkvcnct" oêfkq" rqt" rcekgpvg"

kphgevcfq"hqk"fg"T&"4;0885.82"∑"380228.640"Guug"tgikuvtq"oquvtqw."rqtvcpvq."q"

cnvq"ewuvq"fguuc"eqornkecèçq"rctc"q"ukuvgoc"rûdnkeq"fg"ucûfg3830"Q"vgorq"

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fkcipôuvkeq"fg"kphgeèçq"hqk"fg"4:"fkcu."ugognjcpvg"cq"pquuq"guvwfq."pq"swcn"

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"

pguug" vkrq" fg" rtqegfkogpvq0" Dnwjo" gv" cn0365" gpeqpvtctco" rtgugpèc" fg"

jgocvqoc" rôu/qrgtcvôtkq." wuq" fg" octecrcuuq" vgorqtâtkq" g" fkcdgvgu"

ognnkvwu"eqoq"octecfqtgu"fg"kphgeèçq"go"cpânkug"wpkxctkcfc0"Guugu"hcvqtgu"

83

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rcekgpvgu" ugo" kphgeèçq" *r?2.26+." rqtêo" pçq" hqk" tgcnk|cfc" c" cpânkug"

ownvkxctkcfc"rctc"kfgpvkhkect"rtgfkvqtgu"kpfgrgpfgpvgu"fg"kphgeèçq0""

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"

kphgeèçq" tgncekqpcfc" cq" ukuvgoc" fg" guvkowncèçq" ectfîcec" ctvkhkekcn0" Pguug"

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"

woc"pqxc"qrgtcèçq"rqt"eqornkecèùgu"pçq"kphgeekqucu."eqpvtc"crgpcu"5.9'"

pq" itwrq" pçq" kphgevcfq" *r" ?" 2.223+0" " Kfcfg." ugzq" g" octecrcuuq" fwrnc"

eãoctc"pçq" ug" eqttgncekqpctco" eqo"ockqt" kpekfípekc" fg" kphgeèçq0"Cpânkug"

ownvkxctkcfc" rctc" kfgpvkhkecèçq" fg" hcvqtgu" rtgfkvqtgu" kpfgrgpfgpvgu" fg"

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"*r@2.6="vguvg"gzcvq"fg"Hkujgt+0"

Go" wo" guvwfq" ocku" tgegpvg." Dgtvcinkc" gv" cn036:" gpeqpvtctco" go"

cpânkug" wpkxctkcfc." q" ugzq" ocuewnkpq." ogpqt" fwtcèçq" fq" rtqegfkogpvq" g"

ektwtikc"fg"vtqec"fg"igtcfqt"fg"octecrcuuq"eqoq"octecfqtgu"fg"kphgeèçq0"

C" rtgugpèc" fg" jgocvqoc" fg" nqlc" pçq" crtgugpvqw" eqttgncèçq" ukipkhkecvkxc"

eqo" c" qeqttípekc" fg" kphgeèçq0" Go" cpânkug" ownvkxctkcfc." pgpjwoc" fguucu"

xctkâxgku" hqk" guvcdgngekfc" eqoq" hcvqtgu" fg" rtgfkurqukèçq" kpfgrgpfgpvg" fg"

kphgeèçq0""

Eqphqtog" rqfgoqu" eqpuvcvct." cvtcxêu" fg" tgxkuçq" fc" nkvgtcvwtc."

pgpjwo" guvwfq" jcxkc" eqpugiwkfq" guvcdgngegt" swcnswgt" hcvqt" fg"

rtgfkurqukèçq" kpfgrgpfgpvg" rctc" eqornkecèùgu" kphgeekqucu" go"

rtqegfkogpvqu" ektûtikequ" gpxqnxgpfq" ukuvgocu" fg" guvkowncèçq" ectfîcec"

ctvkhkekcn0""

C" rtgugpèc" fg" jgocvqoc" fg" nqlc" cwogpvqw" go" swcug" 9" xg|gu" c"

kpekfípekc" fg" kphgeèçq." kpfgrgpfgpvgogpvg" fq" wuq" fg" rtqhknczkc"

cpvkoketqdkcpc" *r?2.2436=" Tc|çq" fg" Ejcpeg<8.94=" ;7'" KE<" 3.54" c" 56.26+0"

Gpeqpvtcoqu."c"fgurgkvq"fc" tcpfqok|cèçq."woc"fkhgtgpèc"gpvtg"qu"itwrqu"

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"" "

Oqfgtpqu"gswkrcogpvqu"g" vêepkecu"swg"cwzknkco"pq"fkcipôuvkeq"fg"

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+."

swg" vgo"ukfq"wucfq"pc"rtâvkec" enîpkec"jâ"ocku"fg"47"cpqu"crtgugpvc"woc"

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"

uwrgtkqtkfcfg" go" tgncèçq" cq" GVV" rctc" fgvgeèçq" fg" xgigvcèùgu" g" uwcu"

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

octecrcuuq0" C" crtgugpvcèçq" hqk" ciwfc" go" 36" rcekgpvgu." eqo" kpîekq" fqu"

ukpvqocu"pcu"rtkogktcu"8"ugocpcu"crôu"q"ûnvkoq"rtqegfkogpvq"pq"uîvkq"fq"

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/

gngvtqfqu"fg"octecrcuuq"go";3.9'"fqu"rcekgpvgu0"Pq"itwrq"etõpkeq."GVV"

hqk" tgcnk|cfq" go" 55" rcekgpvgu." fgoqpuvtcpfq" xgigvcèçq" go" gngvtqfq" fg"

octecrcuuq"go"32"*52.5'+"rcekgpvgu0""Q" GVG." tgcnk|cfq" go" 5:" rcekgpvgu"

eqo" ocpkhguvcèçq" etõpkec." hqk" pqtocn" uqogpvg" go" 4" g" cpqtocn" go" 58"

*;6.9'+0" Rqtvcpvq." q" GVG"oquvtqw/ug" uwrgtkqt" cq" GVV" vcpvq" go" rcekgpvgu"

eqo"ocpkhguvcèùgu"ciwfcu"eqoq"etõpkecu0""

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

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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"

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"

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

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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"fgswgkocfwtcu0""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"rtqhwpfq040" 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"ôtiçq1gurcèq050" 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:

" Oketqqticpkuoqu"vîrkequ"fg"gpfqectfkvg"kphgeekquc."kuqncfqu"go"24""

coquvtcu"kuqncfcu"fg"jgoqewnvwtc"/"Uvtgrvqeqeewu"xktkfcpu."Uvtgrvqeqeewu"dqxku.""

itwrq"JCEGM."qw"

" Uvcrj{nqeqeewu"cwtgwu"qw"gpvgtqeqeewu"cfswktkfqu"pc"eqowpkfcfg."pc"cwuípekc""

fg"wo"hqeq"rtkoâtkq."qw"

" Jgoqewnvwtc"rgtukuvgpvgogpvg"rqukvkxc"rctc"oketqqticpkuoq"eqpukuvgpvg"eqo""

gpfqectfkvg"kphgeekquc."go"coquvtcu"eqnjkfcu"eqo"kpvgtxcnqu"@"34"jqtcu."qw"

" Vqfcu"cu"vtíu"qw"c"ockqtkc"fg"swcvtq"qw"ocku"coquvtcu"kuqncfcu"fg"jgoqewnvwtc"rqukvkxcu.

"eqo"kpvgtxcnq"oîpkoq"gpvtg"c"eqngvc"fc"rtkogktc"g"c"ûnvkoc"coquvtc"fg"3"jqtc"

" Evidência de envolvimento endocárdico

" Geqectfkqitcoc"rqukvkxq"rctc"gpfqectfkvg"kphgeekquc"

" Ocuuc"quekncpvg"kpvtcectfîcec."go"ecdqu/gngvtqfqu"qw"go"guvtwvwtc"gpfqeâtfkec"g

go"eqpvcvq"eqo"ecdqu/gngvtqfqu"

" Cdueguuq"go"eqpvcvq"eqo"ecdqu/gngvtqfqu"

Critérios Menores

" Febre ≥ 38°C

" Fenômenos vasculares: embolia arterial, infarto pulmonar séptico, aneurisma micótico, hemorragia intracraniana, lesões de Janeway

" Fenômenos imunológicos: glomerulonefrite, nódulos de Osler, manchas de Roth

" Ecocardiograma: consistente com endocardite infecciosa, mas não definido como critério maior, como descrito previamente

" Evidência microbiológica: hemocultura positiva, mas não definida como critério maior, como descrito previamente

"

"

9. REFERÊNCIAS BIBLIOGRÁFICAS

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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"

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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

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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."

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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"

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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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