Table of contents :
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total |
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clean |
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clean-contaminated |
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contaminated |
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dirty |
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clean surgery (prostheses and other) | Staphylococcus
aureus![]() ![]() ![]() |
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head and neck surgery
(clean-contaminated/contaminated).
Antibiotic prophylaxis is not recommended
in:
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anaerobic bacteria of oral cavity, aerobic
gram-negative bacteria (Enterobacteriaceae![]() |
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eye surgery : local policy makers may identify exceptions in cataract surgery | Staphylococcus
aureus![]() ![]() |
topical drops (parenteral antibiotics do not
penetrate the aqueous
or vitreous humour adequately) + cefazoline![]() |
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neurosurgery : | |||
election cholecystectomy (videolaparoscopy) | Enterobacteriaceae![]() ![]() ![]() ![]() ![]() Enterococcus spp. ![]() Clostridium spp. ![]() Bacterioides fragilis ![]() |
ureidopenicillins :
amoxicillin/clavulanate
(clavamox)![]() first-generation cephalosporins : second-generation cephalosporins : |
i.v. (bolus or small infusion) |
election cholecystectomy (abdominal route) | Enterobacteriaceae![]() ![]() ![]() ![]() ![]() Enterococcus spp. ![]() Clostridium spp. ![]() Bacterioides fragilis ![]() |
ureidopenicillins :
amoxicillin/clavulanate
(clavamox)![]() first-generation cephalosporins : second-generation cephalosporins : |
i.v. (bolus or small infusion) |
complicated cholecystectomy (pregressed cholecystitis/empyema) | Enterobacteriaceae![]() ![]() ![]() ![]() ![]() Enterococcus spp. ![]() Clostridium spp. ![]() Bacterioides fragilis ![]() |
ureidopenicillins :
amoxicillin/clavulanate
(clavamox)![]() first-generation cephalosporins : second-generation cephalosporins : |
i.v. (bolus or small infusion) |
choledocholithiasis![]() |
Enterobacteriaceae![]() ![]() ![]() ![]() ![]() Enterococcus spp. ![]() Clostridium spp. ![]() Bacterioides fragilis ![]() |
ureidopenicillins :
amoxicillin/clavulanate
(clavamox)![]() first-generation cephalosporins : second-generation cephalosporins : |
i.v. (bolus or small infusion) |
obstruction
jaundice![]() |
Enterobacteriaceae![]() ![]() ![]() ![]() ![]() Enterococcus spp. ![]() Clostridium spp. ![]() Bacterioides fragilis ![]() |
ureidopenicillins :
amoxicillin/clavulanate
(clavamox)![]() first-generation cephalosporins : second-generation cephalosporins : |
i.v. (bolus or small infusion) |
external biliary drainage | Enterobacteriaceae![]() ![]() ![]() ![]() ![]() Enterococcus spp. ![]() Clostridium spp. ![]() Bacterioides fragilis ![]() |
ureidopenicillins :
amoxicillin/clavulanate
(clavamox)![]() first-generation cephalosporins : second-generation cephalosporins : |
i.v. (bolus or small infusion) |
election operations on stomach, duodenum and small bowel | Staphylococcus
spp.![]() Streptococcus spp. ![]() Enterococcus spp. ![]() Escherichia coli ![]() Proteus spp. ![]() gram-positive and gram-negative anaerobes (Peptostreptococcus spp. ![]() Bacteroides spp. ![]() |
ureidopenicillins :
amoxicillin/clavulanate
(clavamox)![]() first-generation cephalosporins : second-generation cephalosporins : |
i.v. (bolus or small infusion) |
operations on colon (total colectomy, hemicolectomy, transversectomy, segmentary resection, etc.) | Bacteroides
spp.![]() Escherichia coli ![]() Enterobacteriaceae ![]() ![]() ![]() ![]() ![]() |
ureidopenicillins :
amoxicillin/clavulanate
(clavamox)![]() second-generation cephalosporins : clindamycin ![]() ![]() |
i.v. (bolus or small infusion) |
ano-rectal surgery | Staphylococcus
spp.![]() Streptococcus spp. ![]() Enterobacteriaceae ![]() ![]() ![]() ![]() ![]() anaerobes |
amoxicillin/clavulanate
(clavamox)![]() first-generation cephalosporins : vancomycin ![]() ![]() ![]() |
i.v. (bolus or small infusion) |
election appendicectomy | i.v. (bolus or small infusion) | ||
diverticulosis![]() |
i.v. (bolus or small infusion) | ||
obstetric-gynecological
surgery : antibiotic
prophylaxis is recommended but local policy makers
may identify exceptions
in:
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Enterobacteriaceae![]() ![]() ![]() ![]() |
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urology :
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vascular surgery
: antibiotic prophylaxis
is recommended in:
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general surgery
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orthopaedic
surgery
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Staphylococcus
aureus![]() ![]() Less commonly enteric Gram- negative bacilli and Clostridium |
cephazolin 1g iv or
cefamandole 2g iv or cefuroxime 1.5g iv or vancomycin 1g iv (where MRSA infections are common or patient is allergic to ß-lactam antibiotics) |
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major lacerations, > 4 hours and untreated | S. aureus
Streptococci Gram-negative bacilli |
Amoxycillin/clavulanic acid 1.2g iv
then 500mg orally q6-8h or cefoxitin 1g iv q6-8h |
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extensive soft tissue injury, penetrating wounds or crush injuries | anaerobes | cefotetan 1g iv q12h | |
animal or human bites | as above plus :
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as above | |
ruptured, perforated or gangrenous viscus | as for colorectal surgery | as for colorectal surgery but treat for at least 3 days |
Indications |
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investigation of unexplained microcytic
anemia![]() |
only if myelodysplastic
syndrome![]() |
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investigation of unexplained megaloblastic
anemia![]() |
only if myelodysplastic
syndrome![]() |
deoxyuridine suppression test may be useful but is mainly a research technique |
investigation of unexplained anaemia![]() |
usually | cytogenetic analysis if MDS is suspected; ultrastructural examination if congenital dyserythropoietic anaemia is suspected |
investigation of unexplained thrombocytopenia![]() |
only if myelodysplastic
syndrome![]() |
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investigation of pancytopenia![]() |
yes | cytogenetic analysis if MDS is suspected; appropriate culture if mycobacterial infection or leishmaniasis is suspected; bone marrow is a useful source of DNA if investigation for Pearson's syndrome is required; cytogenetic analysis if a haemophagocytic syndrome is suspected (because EBV-related haemophagocytic syndrome may be associated with a clonal proliferation of neoplastic T cells) |
investigation of a leucoerythroblastic blood film and suspected bone marrow infiltration | yes | cytogenetic analysis if a haematological neoplasm is suspected; if an abnormal infiltrate is found, immunophenotyping and cytogenetic analysis may be useful; cytogenetic analysis is indicated if a small cell tumour of childhood is suspected because the demonstration of certain specific cytogenetic abnormalities can confirm the diagnosis |
investigation of suspected acute leukaemia : although it is often possible to establish a diagnosis of acute leukaemia from peripheral blood examination, bone marrow aspiration should nevertheless be carried out. This is both because the likelihood of successful cytogenetic analysis is higher if bone marrow cells are used and because a baseline is needed for comparison with bone marrow aspirates performed during treatment. In addition, bone marrow aspiration permits the assessment of trilineage dysplasia, which may be of prognostic relevance. | no (unless there is difficulty obtaining a good aspirate) | cytogenetic and possibly molecular genetic analysis; immunophenotypic analysis unless cells are clearly myeloid |
assessment of remission status after treatment of acute leukaemia | no (unless there is difficulty obtaining a good aspirate) | follow up cytogenetic analysis is only occasionally useful; molecular genetic analysis may be indicated for assessment of minimal residual disease |
investigation of suspected myelodysplastic
syndromes![]() ![]() |
yes | cytogenetic analysis; investigation of colony forming units if juvenile myelomonocytic leukaemia is suspected |
investigation of suspected chronic
myeloid
leukaemia![]() |
no (unless there is difficulty obtaining a good aspirate or if the accelerated phase of the disease or blast transformation is suspected) | cytogenetic analysis; molecular genetic analysis is not indicated because it can be performed, when necessary, on peripheral blood cells |
follow up of chronic
myeloid
leukaemia![]() |
no | cytogenetic analysis |
investigation of suspected myeloproliferative
disorders![]() |
yes | cytogenetic analysis; investigation of colony forming units (erythropoietin independent burst forming units) may be useful but in most centres is not a routine diagnostic test |
investigation of chronic
lymphocytic
leukaemia![]() |
yes because the bone marrow aspirate gives very little information beyond that already available from examination of the blood, while BMTB permits an accurate assessment of the extent of infiltration and gives information of prognostic importance. During follow up of intensive treatment of CLL there is little point in performing a bone marrow aspirate alone because there may be residual disease detectable only by trephine biopsy. | immunophenotyping is not indicated because it can be performed easily on the peripheral blood |
investigation of suspected non-Hodgkin's
lymphoma![]() |
yes | if an abnormal infiltrate is present, immunophenotyping, molecular analysis and cytogenetic analysis may be needed |
diagnosis and follow up of hairy
cell
leukaemia![]() |
yes | immunophenotyping, unless there are sufficient circulating cells for it to be performed on peripheral blood cells; tartrate resistant acid phosphatase stain if detailed immunophenotyping is not available |
staging of low grade non-Hodgkin's
lymphoma![]() |
yes. A bone marrow biopsy performed in patients with low grade lymphoma sometimes shows unexpected high grade transformation, which necessitates a different therapeutic approach. | immunophenotyping, unless there are sufficient circulating cells for this to be done on blood cells; cytogenetic and molecular genetic analyses are sometimes useful if the specific type of NHL has not already been determined |
staging of high grade non-Hodgkin's
lymphoma![]() |
yes | |
investigation of
![]() ![]() A crush preparation of bone marrow fragments is useful |
generally indicated. Because infiltration is often focal, it is sometimes essential for a diagnosis. In other patients it provides a baseline for comparison with follow up biopsies | cytogenetic analysis may be useful because demonstration of poor prognosis abnormalities may influence management; immunophenotyping is only needed if cytology of the aspirate is not diagnostic and if it is not certain whether or not a monoclonal plasma cell population is present |
investigations of suspected storage
disease![]() |
not essential | |
investigation of fever
of
unknown origin (FUO)![]() |
yes | cultures for mycobacteria and also, if there is a possibility of previous exposure, for Leishmania and Histoplasma |
in suspected chromosomal disorders in neonates when rapid confirmation is required | no | cytogenetic analysis (may produce results in 1 day cf. several days if cultured peripheral blood lymphocytes are used) |
confirmation of normal bone marrow if bone
marrow is being aspirated
for allogeneic
HSCT![]() |
no | |
autoimmune
thrombocytopenic
purpura (AITP)![]() ![]() |
CD3, CD1a, CD5, CD8 | detection of T cells and T cell subsets (note: CD5 is also expressed on some B cells and B cell neoplasms and CD1a on Langherhan's cells) |
CD20, CD79a, CD10, CD23 | detection of B cells and B cell subsets |
terminal deoxynucleotidyl transferase (TdT) | detection of immature cells in most acute
lymphoblastic leukemias![]() ![]() |
CD34 | detection of immature cells in acute and chronic
leukaemias and some
cases of myelodysplastic
syndrome![]() |
myeloperoxidase, neutrophil elastase, CD68 | detection of granulocytic and monocytic differentiation |
glycophorin | detection of erythroid cells |
CD61 or von Willebrand's factor | detection of megakaryocytes |
light chains (k or l) | detection of isotype restriction (and therefore
probably monoclonality)
in multiple
myeloma![]() ![]() ![]() ![]() |
CD15 | confirmation of Reed-Sternberg and mononuclear Hodgkin's cells |
CD30 | detection of infiltration by anaplastic large cell lymphoma and Reed-Sternberg and mononuclear Hodgkin's cells |
CD31 | endothelial cells (macrophages, monocytes, megakaryocytes, and plasma cells are also positive) |
cyclin D1 | detection of mantle cell
lymphoma![]() |
ALK1 | detection of anaplastic
large
cell lymphoma![]() |
epithelial membrane antigen | detection of infiltration by carcinoma cells or anaplastic large cell lymphoma |
cytokeratin, prostate specific antigen, prostatic acid phosphatase | diagnosis of infiltration by carcinoma cells |
CD1a | diagnosis of Langherhan's
cell
histiocytosis![]() |
mast cell tryptase | detection of mast cells and diagnosis of systemic
mastocytosis![]() |
HMB45 and melan A (S100 less specific) | melanoma |
vimentin, desmin, actin, myoglobin, chromogranin A, protein gene product 9.5, neuron-specific enolase (NSE) | differential diagnosis of small cell tumours of childhood |
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