Uso de clindamicina e cefazolina na profilaxia de fratura exposta de fêmur e tíbia
Tipo
TCC
Data de publicação
2024-06-06
Periódico
Citações (Scopus)
Autores
Flores, Maria Clara Dornelles
Orientador
Zini, Cassio
Título da Revista
ISSN da Revista
Título de Volume
Membros da banca
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Resumo
Introdução: O trauma tem alta incidência e é a principal causa de morte na população jovem. As fraturas expostas (FE) quando presentes são a principal causa de morbimortalidade devido ao risco de infecção. O progresso clínico cirúrgico da abordagem da FE tem diminuído seu impacto danoso, e muito se deve a abordagem da antibiótico profilaxia, contudo a escolha do antibiótico ideal ainda permanece em discussão. Objetivo: Comparar a eficácia do manejo profilático antibióticos distintos, Clindamicina e Cefazolina, no manejo de FE de MI. Métodos: O estudo foi retrospectivo, observacional, transversal e individuado, realizado a partir de análise de 101 prontuários de pacientes do Hospital Universitário Evangélico Mackenzie (HUEM). Foram coletados, através de prontuários médicos, dados sobre o antibiótico administrado, os graus de exposição das fraturas, o mecanismo do trauma, o tempo de antibiótico e a evidência de infecção. Posteriormente, realizou-se testes estatísticos para avaliar as variáveis qualitativas e comparar a efetividade dos antibióticos em prevenir infecção. Resultados: não houve diferença significativa na eficiência entre os dois regimes de antibióticos manejados, nem diferença dentro do manejo profilático para cada grau de exposição. A taxa de infecção apresentou-se similar nos dois grupos. Conclusão: Como a taxa de infecção se mostrou similar entre os dois antibióticos comparados, a monoterapia com clindamicina verificou-se segura e uma opção viável na profilaxia de infecção no manejo das FE. Ratifica-se a necessidade do manejo assertivo para os diferentes graus de exposição, com a necessidade de manejo combinado com antibiótico de amplo espectro nas fraturas de grau mais avançado GA III.
Introduction: Trauma has a high incidence and is the main cause of death in young people. When open fracture (OF) are present, they are the main cause of morbidity and mortality due to the risk of infection. Clinical and surgical progress in the approach to OFs has reduced their harmful impact, and much of this is due to the use of antibiotic prophylaxis, and the choice of the ideal antibiotic is still under discussion. Objective: To compare the efficacy of different prophylactic antibiotics, Clindamycin and Cefazolin, in the management of low limb’s open fracture. Methods: The study was retrospective, observational, cross-sectional and individualized, based on an analysis of 101 patient records from the Mackenzie Evangelical University Hospital (HUEM). Medical records were used to collect data on the antibiotic administered, the degree of exposure of the fractures, the mechanism of trauma, the length of antibiotic therapy and evidence of infection. Statistical tests were then carried out to evaluate the qualitative variables and compare the effectiveness of the antibiotics in preventing infection. Results: There was no significant difference in efficacy between the two antibiotic regimens managed, nor was there any difference within prophylactic management for each degree of exposure. The infection rate was similar in both groups. Conclusion: As the infection rate was similar between the two antibiotics compared, monotherapy with clindamycin proved to be safe and a viable option for infection prophylaxis in the management of OF. The need for assertive management for the different degrees of exposure is confirmed, with the need for combined management with broad-spectrum antibiotics in more advanced GA III fractures.
Introduction: Trauma has a high incidence and is the main cause of death in young people. When open fracture (OF) are present, they are the main cause of morbidity and mortality due to the risk of infection. Clinical and surgical progress in the approach to OFs has reduced their harmful impact, and much of this is due to the use of antibiotic prophylaxis, and the choice of the ideal antibiotic is still under discussion. Objective: To compare the efficacy of different prophylactic antibiotics, Clindamycin and Cefazolin, in the management of low limb’s open fracture. Methods: The study was retrospective, observational, cross-sectional and individualized, based on an analysis of 101 patient records from the Mackenzie Evangelical University Hospital (HUEM). Medical records were used to collect data on the antibiotic administered, the degree of exposure of the fractures, the mechanism of trauma, the length of antibiotic therapy and evidence of infection. Statistical tests were then carried out to evaluate the qualitative variables and compare the effectiveness of the antibiotics in preventing infection. Results: There was no significant difference in efficacy between the two antibiotic regimens managed, nor was there any difference within prophylactic management for each degree of exposure. The infection rate was similar in both groups. Conclusion: As the infection rate was similar between the two antibiotics compared, monotherapy with clindamycin proved to be safe and a viable option for infection prophylaxis in the management of OF. The need for assertive management for the different degrees of exposure is confirmed, with the need for combined management with broad-spectrum antibiotics in more advanced GA III fractures.
Descrição
Palavras-chave
fraturas ósseas , fraturas da tíbia , fraturas do fêmur , infecção da ferida , bone fracture , tibia fracture , femur fracture , wound infection