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Burton JL, Saegeman V, Arribi A, Rello J, Andreoletti L, Cohen MC, Fernandez-Rodriguez A. Postmortem microbiology sampling following death in hospital: an ESGFOR task force consensus statement. J Clin Pathol 2019; 72:329-336. [PMID: 30661015 DOI: 10.1136/jclinpath-2018-205365] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 10/30/2018] [Accepted: 12/13/2018] [Indexed: 12/23/2022]
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.
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Affiliation(s)
- Julian L Burton
- Academic Unit of Medical Education, University of Sheffield Medical School, Sheffield, UK
| | | | - Ana Arribi
- Microbiology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Jordi Rello
- CIBERES and Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Laurent Andreoletti
- Molecular and Clinical Virology Department, University of Reims Champagne-Ardenne, Reims, France
| | - Marta C Cohen
- Histopathology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Amparo Fernandez-Rodriguez
- Microbiology Laboratory, Biology Department, Instituto Nacional de Toxicología y Ciencias Forenses, Las Rozas, Spain
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Ondruschka B, Woydt L, Bernhard M, Franke H, Kirsten H, Löffler S, Pohlers D, Hammer N, Dreßler J. Post-mortem in situ stability of serum markers of cerebral damage and acute phase response. Int J Legal Med 2018; 133:871-881. [PMID: 30167776 DOI: 10.1007/s00414-018-1925-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/23/2018] [Indexed: 01/04/2023]
Abstract
The aim of the given study was to test the in situ stability of biochemical markers of cerebral damage and acute phase response in the early post-mortem interval to assess their usability for forensic pathology. A monocentric, prospective study investigated post-mortem femoral venous blood samples at four time points obtained within 48 h post-mortem starting at the death of 20 deceased, using commercial immunoassays for the ten parameters: S100 calcium-binding protein B (S100B), glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), brain-derived neurotrophic factor (BDNF), interleukin-6 (IL-6), C-reactive protein (CRP), procalcitonin (PCT), ferritin, soluble tumor necrosis factor receptor type 1 (sTNFR1), and lactate dehydrogenase (LDH). Significant changes in serum levels were observed only later than 2 h after death for all markers. Inter-laboratory comparability was high, and intra-assay precision was sufficient for most markers. Most of the biomarker levels depended on the severity of hemolysis and lipemia but were robust against freeze-thaw cycles. Serum levels increased with longer post-mortem intervals for S100B, NSE, ferritin, sTNFR1, and LDH (for all p < 0.001) but decreased over this period for CRP (p = 0.089) and PCT (p < 0.001). Largely unchanged median values were found for GFAP (p = 0.139), BDNF (p = 0.106), and IL-6 (p = 0.094). Serum levels of CRP (p = 0.059) and LDH (p = 0.109) did not differ significantly between the final ante-mortem (resuscitation) and the first post-mortem sample (moment of death). Collecting the post-mortem blood sample as soon as possible will reduce the influence of post-mortem blood changes. Serum GFAP for detection of cerebral damage as well as serum IL-6 and CRP as proof of acute phase response seemed to be preferable due to their in situ stability in the first 2 days after death.
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Affiliation(s)
- Benjamin Ondruschka
- Medical Faculty, Institute of Legal Medicine, University of Leipzig, Johannisallee 28, 04103, Leipzig, Germany.
| | - Lina Woydt
- Medical Faculty, Institute of Legal Medicine, University of Leipzig, Johannisallee 28, 04103, Leipzig, Germany
| | - Michael Bernhard
- Emergency Department, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Heike Franke
- Rudolf Boehm Institute of Pharmacology and Toxicology, University of Leipzig, Leipzig, Germany
| | - Holger Kirsten
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany.,LIFE Center (Leipzig Interdisciplinary Research Cluster of Genetic Factors, Phenotypes and Environment), University of Leipzig, Leipzig, Germany
| | - Sabine Löffler
- Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | - Dirk Pohlers
- Center of Diagnostics GmbH, Klinikum Chemnitz, Chemnitz, Germany
| | - Niels Hammer
- Department of Anatomy, University of Otago, Dunedin, New Zealand.,Department of Orthopedic and Trauma Surgery, University Hospital of Leipzig, Leipzig, Germany.,Fraunhofer Institute for Machine Tools and Forming Technology, Dresden, Germany
| | - Jan Dreßler
- Medical Faculty, Institute of Legal Medicine, University of Leipzig, Johannisallee 28, 04103, Leipzig, Germany
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Maiese A, Del Nonno F, Dell'Aquila M, Moauro M, Baiocchini A, Mastracchio A, Bolino G. Postmortem diagnosis of sepsis: A preliminary immunohistochemical study with an anti-procalcitonin antibody. Leg Med (Tokyo) 2017; 28:1-5. [PMID: 28728072 DOI: 10.1016/j.legalmed.2017.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 06/05/2017] [Accepted: 07/10/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Aniello Maiese
- Department of Anatomy, Histology Forensic Medicine and Orthopaedics, Sapienza University of Rome, Viale Regina Elena 336, Rome 00185, Italy.
| | - Franca Del Nonno
- Infectious Diseases Department, National Institute for Infectious Diseases "L. Spallanzani", 00149 Rome, Italy
| | - Marco Dell'Aquila
- Department of Anatomy, Histology Forensic Medicine and Orthopaedics, Sapienza University of Rome, Viale Regina Elena 336, Rome 00185, Italy
| | - Mario Moauro
- Infectious Diseases Department, National Institute for Infectious Diseases "L. Spallanzani", 00149 Rome, Italy
| | - Andrea Baiocchini
- Infectious Diseases Department, National Institute for Infectious Diseases "L. Spallanzani", 00149 Rome, Italy
| | - Antonio Mastracchio
- Medical UOC Pathology Local Health Agency Rome/6, University of Rome "Tor Vergata", 00149 Rome, Italy
| | - Giorgio Bolino
- Department of Anatomy, Histology Forensic Medicine and Orthopaedics, Sapienza University of Rome, Viale Regina Elena 336, Rome 00185, Italy
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