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Difficulties in interpretation of post-mortem microbiology results in unexpected infant death: evidence from a multidisciplinary survey
  1. Jeremy W Pryce1,
  2. Martin A Weber2,
  3. John C Hartley3,
  4. Michael T Ashworth2,
  5. Marian Malone2,
  6. Neil J Sebire1,2
  1. 1UCL Institute of Child Health, London, UK
  2. 2Department of Paediatric Pathology, Great Ormond Street Hospital for Children, London, UK
  3. 3Department of Microbiology, Great Ormond Street Hospital for Children, London, UK
  1. Correspondence to Professor Neil J Sebire, Great Ormond Street Hospital for Children and UCL Institute of Child Health, London, UK; sebirn{at}gosh.nhs.uk

Abstract

Background Post-mortem (PM) microbiological investigations are recommended in cases of sudden unexpected death in infancy (SUDI), and infection is a recognised cause of such deaths, but no current evidence-based guidelines exist for the appropriate interpretation of results.

Aim To assess interpretive difficulties using a targeted cross-specialty questionnaire.

Methods 109 consultant specialists involved in infant death management were given a questionnaire providing information on five hypothetical standardised SUDI cases, which differed only in their PM microbiology findings. Participants classified each case into categories: definite bacterial infection, probable bacterial infection, bacterial growth of uncertain significance and PM contamination.

Results 63 (57%) specialists responded. There was no clinical scenario in which complete concordance in interpretation of PM microbiology results was established among participants. In cases with pure growth of Group 2 pathogens such as Group B β-haemolytic Streptococcus, 96% of respondents agreed upon probable or definite bacterial infection. With mixed growth of Group 2 pathogens, 83% reported probable or definite bacterial infection. Growth of organisms such as Staphylococcus aureus caused the most difficulty, with almost equal numbers of participants interpreting the finding as significant or non-significant. There were no consistent differences in interpretation between different specialist groups.

Conclusions While there is general agreement in interpretation of PM microbiology findings in some SUDI scenarios, no consensus was achieved for any clinical setting, and variation in the presumed significance between specialists was apparent. In the absence of appropriate evidence-based guidelines, this has practical implications for the management of such deaths in a multidisciplinary setting.

  • Questionnaire
  • infection
  • blood cultures
  • infant death
  • autopsy

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Footnotes

  • Funding JWP is funded by a grant awarded by SPARKS charity. SPARKS had no involvement in the collection, analysis or interpretation of data, in the writing of this paper, or in the decision to submit the paper for publication.

  • Competing interests None.

  • Provenence and peer review Not commissioned; externally peer reviewed.

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