Antimicrobiano parenteral exclusivo ou associado com a via oral na prevenção de infecção após cirurgia colorretal

Prevention of the post-operative infection using parenteral antimicrobial agents alone or combined with oral administration

ARTIGOS ORIGINAIS

Antimicrobiano parenteral exclusivo ou associado com a via oral na prevenção de infecção após cirurgia colorretal

Prevention of the post-operative infection using parenteral antimicrobial agents alone or combined with oral administration

Martin Zavadinack Netto^I; Eduardo Crema, TCBC-SP^II; Erwin Rossetto Vani^III; Fábio Schmidt Goffi, TCBC-SP^IV; Antônio Claudio de Godoy^V

^IMestre em Medicina (Área de Gastroenterologia Cirúrgica) -IAMSPE-HSPE

^IIProfessor de Gastroenterologia Cirúrgica da Faculdade de Medicina da Universidade Federal do Triângulo Mineiro. Vice-Coordenador de Pós Graduação em Gastroenterologia Cirúrgica - IAMSPE.HSPE

^IIIEx-Residente do Serviço de Gastroenterologia Cirúrgica do HSPE

^IVPró-Reitor de Pós-Graduação. Diretor da Divisão de Ensino e Pesquisa IAMSPE.HSPE

VDiretor do Serviço de Gastroenterologia Cirúrgica do HSPE

^{Endereço para correspondência}

RESUMO

Estudo prospectivo da incidência de complicações infecciosas, após operações para câncer colorretal. Sessenta e nove pacientes foram divididos em dois grupos, tendo o primeiro grupo recebido neomicina e metronidazol, por via oral, associados a gentamicina e metronizadol por via parenteral e o segundo grupo somente gentamicina e metronidazol por via parenteral. Foi estabelecido como objetivo principal a avaliação da influência do antimicrobiano administrado no preparo intestinal sobre a incidência de complicações infecciosas pós-operatórias. Os pacientes que receberam antimicrobianos por via oral no preparo intestinal apresentaram menor porcentagem de complicações infecciosas (14,29%) em relação aos pacientes que receberam apenas antimicrobiano por via parenteral (38,24%), sendo esta diferença estatisticamente significante, em nível de 5%. Esses dados apóiam a sugestão de associar antimicrobianos por via oral aos antimicrobianos por via parenteral na tentativa de reduzir as complicações infecciosas na cirurgia colorretal.

Unitermos: Cirurgia colorretal; Preparo intestinal; Flora bacteriana; Antimicrobianos.

ABSTRACT

According to literature data there is a fifty percent chance of infectious complication after colorectal surgery when antimicrobial agents are not used. Those drugs were first employed orally with fair results. A few years latter the parenteral route was introduced either alone or associated to administrations per os. This work presents a prospective study on infectious complications after coloretal cancer operations in 69 patients divided into two groups. The first group received oral neomycin and metronidazole in addition to parenteral gentamycin and metronidazole; the second group received only parenteral gentamycin and metronidazole. Every patient had a previous bowel cleansing by oral administration of a 1.500ml solution of 10% manitol. The main objective was to evaluate the influence of administering antimicrobials for intestinal preparation on the incidence of postsurgical infectious complications. The abdominal wall soiling, intra-abdominal sepsis and/or fistula were considered as infectious complication. In those cases a bacterial culture was performed. Patients receiving oral antimicrobials during bowel preparation presented lower percentage of infectious complications (14,2%) compared to those receiving only parenteral antimicrobials (38,24%); this difference being statistically significant at the level of 5%. Oral antimicrobials for bowel preparation were efficient in reducing the incidence of infectious complications after surgery for colorectal cancel: These data confirm the recommendation for the association of oral and parenteral antimicrobials for best prevention of infectious complications.

Key words: Colorectal surgery; Intestinal sterilization; Bacterial flora; Antimicrobial prophilaxis.

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Recebido em 5/10/98

Aceito para publicação em 20/5/99

Trabalho realizado no Serviço de Gastroenterologia Cirúrgica do IAMSPE-HSPE, São Paulo. Condensado de Dissertação de Martin Zavadinack Netto para obtenção do título de Mestre no Curso de Pós-Graduação em Medicina (Gastroenterologia Cirúrgica) do IAMSPE.SP.

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Endereço para correspondência:

Dr. Martin Zavadinack Netto

Secretaria de Estado da Saúde

IAMSPE-SP - Área Gastroenterologia

Av. Ibirapuera, 981

04029-000 - São Paulo-SP

Datas de Publicação

• Publicação nesta coleção
  26 Jan 2010
• Data do Fascículo
  Jun 1999

Histórico

• Recebido
  05 Out 1998
• Aceito
  20 Maio 1999