Postmortem microbiology sampling following death in hospital: an ESGFOR task force consensus statement

Abstract

Postmortem microbiology (PMM) is a valuable tool in the identification of the cause of death and of factors contributory to death where death has been caused by infection. The value of PMM is dependent on careful autopsy planning, appropriate sampling, minimisation of postmortem bacterial translocation and avoidance of sample contamination. Interpretation of PMM results requires careful consideration in light of the clinical history, macroscopic findings and the histological appearances of the tissues. This consensus statement aims to highlight the importance of PMM in the hospital setting and to give microbiological and pathological advice on sampling in deaths occurring in hospital.

Postmortem Study of Cause of Death Among Children Hospitalized With Respiratory Illness in Kenya

“…Their detection may be a result of contamination, postmortem translocation from nonsterile sites, or molecular amplification of pathogens not directly responsible for the cause of death, reflecting past infection or “normal” microbiota. 19 , 30 Many of the cases had some degree of malnutrition and 5 were HIV positive, each of which might have played a role in weakening response to infections and might partially explain the presence of multiple pathogens. In our study, P. jirovecii was a common etiology of pneumonia, the only etiologic agent assigned to cause of death in 4 of the 7 cases in which it was identified.…”

How often is autopsy contributory in cases of sepsis?

“…The main limitations of this study are considered to lie in the acceptance of the clinical and autopsy diagnoses without verifying the criteria and confirming the validity of the conclusions. It was not determined if pathologists performed optimal microbiological investigations 5,14 in all cases. Nonetheless, as a first study of the contribution of medico-legal autopsy to the investigation of death following a clinical diagnosis of sepsis, useful information has been obtained.…”

“…The autopsy can provide useful microbiological information in cases of sepsis. 5 However, the medico-legal autopsy generally does not focus on issues of medical audit, education and research. Consequently, following a diagnosis of sepsis, it appears it would be beneficial for clinicians to request an autopsy through the hospital system, unless there are mandatory reporting issues surrounding a death that necessitate referral into the coronial or other medico-legal system.…”

“…4 This study aimed to determine how frequently a coronial autopsy provided contributory information when the clinical opinion was that death had resulted from sepsis. Due to difficulties surrounding post-mortem microbiology, 5 it was hypothesised that in the majority of cases an autopsy would not provide contributory information regarding the source of sepsis that was not known before death.…”

Microbiology in minimally invasive autopsy: best techniques to detect infection. ESGFOR (ESCMID study group of forensic and post-mortem microbiology) guidelines

“…If sepsis, bacteremia or other conditions are suspected, it is recommended to add samples from other tissues (Table 1). [19][20][21]. According to the method of MIA used, the aim would be to replicate these samples as much as possible.…”