Entre a Cirurgia e Antibióticos: Abordagem ao Tratamento das Infeções Ósseas e Articulares
DOI:
https://doi.org/10.65332/rpdi.v20.138Palavras-chave:
Infeção associada a prótese articular, Infeção associada a fratura, Algoritmo para abordagem da infeção ortopédicaResumo
Contexto: As infeções osteoarticulares estão frequentemente associadas a elevada morbilidade e impacto funcional. O tratamento de infeções associadas a implantes é particularmente complexo devido à resistência bacteriana mediada por biofilme.
Objetivo: Fornecer um algoritmo interdisciplinar para a abordagem das infeções osteoarticulares, incluindo orientações relativas à retenção ou remoção de implantes.
Contexto científico: Foi revista a evidência atual relativa à artrite séptica, osteomielite, infeções relacionadas com fraturas e infeções protésicas. Os princípios fundamentais do tratamento incluem desbridamento radical, colheita de amostras microbiológicas, estabilização, cobertura adequada dos tecidos moles e antibioterapia dirigida. As estratégias terapêuticas dependem da presença de implantes e da cronicidade da infeção, incluindo procedimentos de desbridamento, antibioterapia e retenção do implante (DAIR), revisão em um ou dois tempos, ou terapêutica antibiótica supressiva.
Contextos-chave: As infeções sem implante são tratadas com desbridamento extensivo e seis semanas de antibioterapia. As infeções agudas associadas a implantes podem ser tratadas com DAIR e antibióticos com atividade anti-biofilme, alcançando taxas de cura entre 60,0% e 90,0% em condições ideais. As infeções crónicas ou com biofilme maduro geralmente requerem a remoção do implante em etapas e a reconstrução subsequente. Embora a revisão em um único tempo seja viável em casos selecionados, os procedimentos em dois tempos continuam a constituir a abordagem preferencial no tratamento de infeções complexas. A duração da antibioterapia deve ser individualizada de acordo com a resposta clínica.
Conclusão: O sucesso do tratamento depende de uma abordagem multidisciplinar que integre estratégias cirúrgicas e médicas. A individualização da terapêutica, baseada no estado do implante, na presença de biofilme e em fatores específicos do doente, é essencial para maximizar a erradicação da infeção e a recuperação funcional.
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