LITERATURE REVIEW

Postmortem bacteriology: a re-evaluation

J A Morris¹, L M Harrison¹, S M Partridge²

¹ Department of Pathology, Royal Lancaster Infirmary, Lancaster, LA1 4RP, UK
² Department of Pathology, Furness General Hospital, Barrow in Furness, LA14 4LF, UK

Correspondence to:
Correspondence to:
Professor J A Morris
Department of Pathology, Royal Lancaster Infirmary, Lancaster, LA1 4RP, UK; Jim.A.Morris{at}rli.mbht.nhs.uk

Aim: To assess the value of postmortem bacteriology in necropsy practice, with specific emphasis on bacterial invasion of blood and cerebrospinal fluid (CSF).

Methods: A review of published articles on postmortem bacteriology. Studies were selected to cover the full range of necropsy practice including adults, the perinatal period, and infancy. The review covers over 5000 necropsies, mainly in adults, but including 1108 perinatal cases and 468 cases of sudden unexpected death in infancy. Data are available on 4992 blood cultures, 1168 specimens of CSF, and 743 cultures of spleen.

Results: Studies in which careful precautions have been taken to reduce contamination show that approximately two thirds of blood cultures are negative, two in nine yield a single isolate, and one in nine have a mixed growth. The postmortem interval has only a small effect on the isolation rate. A pure growth of a known pathogen has a more than 50% likelihood of being found in association with genuine infection in adults and in the perinatal period.

Conclusions: The main postmortem artefact is contamination, but this can be considerably reduced by careful technique. Agonal spread is less common than is often assumed. Postmortem translocation is not a problem if the body is appropriately stored. A pure growth of a pathogen in blood or CSF should be regarded as a possible contributing factor to death at all ages.

Abbreviations: CI, confidence interval; CSF, cerebrospinal fluid; NPV, negative predictive value; OR, odds ratio; PPV, positive predictive value; SUDI, sudden unexpected death in infancy

Keywords: postmortem bacteriology; agonal spread; postmortem translocation; contamination; sudden unexpected death in infancy

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Goldwater, P N (2009). Sterile site infection at autopsy in sudden unexpected deaths in infancy. Arch. Dis. Child. 94: 303-307 [Abstract] [Full Text]  
• Whary, M. T., Danon, S. J., Feng, Y., Ge, Z., Sundina, N., Ng, V., Taylor, N. S., Rogers, A. B., Fox, J. G. (2006). Rapid Onset of Ulcerative Typhlocolitis in B6.129P2-IL10tm1Cgn (IL-10-/-) Mice Infected with Helicobacter trogontum Is Associated with Decreased Colonization by Altered Schaedler's Flora. Infect. Immun. 74: 6615-6623 [Abstract] [Full Text]