Postmortem Bacteriology in Forensic Autopsies—A Single Center Retrospective Study in Romania

Diac, Iuliana; Keresztesi, Arthur-Atilla; Cerghizan, Anda-Mihaela; Negrea, Mihai Octavian; Dogaroiu, Catalin

doi:10.3390/diagnostics12082024

Cited by 3 publications

(2 citation statements)

References 26 publications

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“…Empiric broad-spectrum antibiotics are given initially, but the course is modified based on the result of blood culture, which may take several hours. To identify causative organisms during a postmortem examination in the absence of perimortem blood cultures, postmortem blood cultures can be performed at time of autopsy, however, the results of which can be limited given the higher likelihood of contamination and postmortem bacterial transmigration ( 16 - 18 ). In the case of the decedent described above, perimortem blood cultures were not performed, given the acuity of the decedent’s presentation.…”

Section: Discussionmentioning

confidence: 99%

Infective Endocarditis in an Intravenous Drug User Leading to Myocardial Rupture and Hemopericardium

Cao,

Herath

2023

Academic Forensic Pathology

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Introduction: Infective endocarditis (IE) is an infectious disorder of the innermost lining of the heart that can be fatal if left untreated. Infective endocarditis can spread beyond the endocardium into the myocardium and cause arrhythmias and myocardial wall rupture. Individuals with a history of intravenous drug use are at increased risk of developing IE and are at higher risk of dying, given their limited access to health care and adherence to treatment. Methods: A medicolegal autopsy was performed on a 30-year-old woman with a history of intravenous drug use and recent assault after a hospital admission during which she did not survive resuscitation. Results: The cause of death was found to be myocardial rupture in the setting of transmural IE. Postmortem imaging showed hemopericardium which was identified grossly with valvular vegetations in the heart. A ventricular wall defect along with transmural abscess formation was identified. Perimortem toxicology was positive for fentanyl, methamphetamine, and benzoylecgonine, a metabolite of cocaine. Postmortem blood cultures were positive for coagulase-negative Staphylococci, Staphylococcus aureus, Candida tropicalis, and Viridians group Streptococci. Postmortem tissue cultures taken from the heart was positive for Candida glabrata and Streptococcus mitis. Discussion: The decedent had significant risk factors for IE, such as intravenous drug use and a prior admission to hospital for IE. The organisms identified on culture are in-keeping with the gross findings of IE and the terminal event of myocardial rupture was likely the result of tissue damage resulting from IE.

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Section: Discussionmentioning

confidence: 99%

Infective Endocarditis in an Intravenous Drug User Leading to Myocardial Rupture and Hemopericardium

Cao,

Herath

2023

Academic Forensic Pathology

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“…Post-mortem bacteriology is rarely requested during medico-legal autopsies at The Mina Minovici National Institute of Legal Medicine where the present study was performed ( 26 ) due to its costly and time-consuming nature. However, rapid diagnostic tests are emerging, some with applications in forensic medicine ( 12-15 , 23 ).…”

Section: Discussionmentioning

confidence: 99%

Assessing O.K.N.V.I. RESIST‑5 performance for post‑mortem biological samples: A prospective pilot study

Diac,

Neculai‑Cândea,

Horumbă

et al. 2023

Exp Ther Med

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In recent years, the emergence of carbapenem-resistant strains has been increasing worldwide, including in Romania. Rapid tests for post-mortem examinations have been researched and currently have several applications. In the present study, we aimed to test the performance of O.K.N.V.I. RESIST-5 tests on impure post-mortem biological samples compared with a standard of pure cultures. When a death occurs during hospitalization and the issue of malpractice arises, the medico-legal practice would benefit from rapid tests applicable to post-mortem samples. Thus, detection and differentiation of the five targeted carbapenemases, namely oxacilinase-48, Klebsiella pneumoniae carbapenemase, New Delhi metallo-β-lactamase, Verona integron-encoded metallo-β-lactamase and imipenemase, could be useful in guiding sampling for third-party microbiological assessment and could also be an asset from an epidemiological standpoint. The present prospective and observational pilot study included medico-legal autopsy cases performed at Mina Minovici National Institute of Legal Medicine (Romania) between June and July 2022. A total of two sets of O.K.N.V.I. RESIST-5 tests were performed: Test I, which was performed on-site from biological samples obtained during autopsy; and Test II, which was performed on pure cultures after sample inoculation and incubation. Total of 39 O.K.N.V.I. RESIST-5 rapid tests were performed on 19 biological samples, at least one sample per case. The O.K.N.V.I. RESIST-5 tests performed on-site showed an overall sensitivity of 92.3% with a 100% specificity. The results obtained through rapid tests using post-mortem impure samples were comparable to the results obtained from sample cultures with good sensitivity and specificity. Through post-mortem screening for carbapenem resistance, it would be possible to narrow down the number of cases that require further bacteriological assessment.

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Specifics of Organizational and Design Solutions for Buildings of the Bureau of Forensic Medical Examination

Milushkina,

Timerzyanov,

Vasiliev

2023

PH&LE

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Introduction: Nowadays, biosafety of medical personnel and visitors of the Bureau of Forensic Medical Examination (BFME) is of special importance. One of the most significant issues in terms of infection prevention and control is the design solution for premises of the BFME and departments of anatomic pathology. Up-to-date forensic medical examination institutions shall combine functionality, good technical equipment, and engineering design, all ensuring human comfort and safety. Objective: To evaluate sanitary and hygienic measures, especially organizational and design solutions for BFME buildings ensuring occupational safety and health of the personnel and proper infection control, based on the analysis of scientific publications and valid regulatory documents. Materials and methods: We have reviewed recent Russian and English-language scientific papers on current approaches to infection prevention and control in bureaus of forensic medical examination published in 2018–2022. They were selected using a logical search on such platforms as eLIBRARY.ru, PubMed, CyberLeninka, and Google Scholar. The criteria for inclusion of publications in the review were a non-zero Hirsch index (h-index) or the Russian Science Citation Index (RSCI) and the presence of the following phrases in the title, abstract, and/or keywords: autopsy biosafety, infection of medical staff, infection prevention and control, design of forensic medical examination premises, and occupational safety in forensic medical services. Of 143 sources selected, 47 articles contained a proven risk assessment of biosafety of medical personnel and description of preventive measures and were thus found eligible for inclusion in the review. Results: We established problems in the design of construction or reconstruction of BFME premises in terms of creating a safe working environment. We have noted that the workflow, functionality of the premises, and the level of sanitary measures aimed at prevention of infection in staff and visitors is often disregarded. The procedure of instrument sterilization is not regulated by documents of the Russian Federation. Organization of forensic activities in areas remote from large cities and in towns of 25,000 residents or less remains challenging. It is essential to revise and supplement current regulations to ensure biosafety of forensic medical services. Conclusion: The article describes the shortcomings of design solutions that must be taken into account in construction and/or reconstruction of BFME premises. The design of such buildings in terms of infection control shall be specified in regulatory documents.

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Postmortem Bacteriology in Forensic Autopsies—A Single Center Retrospective Study in Romania

Cited by 3 publications

References 26 publications

Infective Endocarditis in an Intravenous Drug User Leading to Myocardial Rupture and Hemopericardium

Infective Endocarditis in an Intravenous Drug User Leading to Myocardial Rupture and Hemopericardium

Assessing O.K.N.V.I. RESIST‑5 performance for post‑mortem biological samples: A prospective pilot study

Specifics of Organizational and Design Solutions for Buildings of the Bureau of Forensic Medical Examination

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