Vancomicina na prevenção de mediastinite
DOI:
https://doi.org/10.61695/rcs.v2i2.42Palabras clave:
Mediastinite, Cirurgia Cardiovascular, Infecção esternal, profilaxiaResumen
Introdução: A mediastinite e a deiscência esternal são complicações graves em pacientes submetidos à esternotomia, aumentando a morbimortalidade. A incidência varia (0,15 a 8%) e ocorre entre 10 e 20 dias de PO. A vancomicina tópica nas bordas do esterno parece reduzir a incidência de infecção esternal, mas pode favorecer o surgimento de resistência a antibióticos e nefrotoxicidade. Objetivo: Avaliar o uso tópico de vancomicina como profilaxia de infecção superficial ou profunda em pacientes submetidos a esternotomia mediana. Método: Trata-se estudo prospectivo e randomizado, onde 196 pacientes submetidos a esternotomia mediana foram divididos em dois grupos: grupo A (101 pacientes) não fizeram uso de vancomicina tópica e grupo B (95 pacientes) fizeram uso de vancomicina tópica, aplicada na medula do osso esterno após a esternotomia e antes da esternorrafia. Definimos como infecção superficial quando não atinge o osso esterno e profunda quando atinge fios de aço, esterno ou apresenta coleção retroesternal. Para comparar as proporções entre os grupos estudados, utilizamos o teste do qui-quadrado com correção de Yates, enquanto os meios foram comparados pelo teste t de Student. Consideramos o nível de significância em 5%. Resultados: As características cirúrgicas dos grupos não diferiram. No grupo B, não houve infecção superficial ou profunda. Sete pacientes do grupo A tiveram infecção esternal (7% - p <0,03), sendo seis casos de mediastinite (6% - p<0,05). Na série estudada, não houve mortalidade. Conclusão: Na série estudada, uso tópico de vancomicina demonstrou poder bacteriostático e bactericida, capaz de evitar a infecção esternal.
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Derechos de autor 2024 Helmgton Souza, Beatriz Estrella Souza, Isaac Azevedo Silva, Marcus Vinícius Santos, Glauco Kalil Pina, Ricardo Barros Corso
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
