Post-Mortem Diagnosis of Sepsis

Sampling Protocol for Post-Mortem Sepsis Diagnosis

The post-mortem diagnosis of sepsis requires a comprehensive sampling protocol including blood cultures, tissue specimens, and specific biochemical markers, with samples collected within 2 hours if stored at room temperature or 48 hours if refrigerated, as recommended by the Clinical Microbiology and Infection guidelines 1
Blood cultures should be collected from the femoral vein for both aerobic and anaerobic cultures 1
Cerebrospinal fluid should be collected for bacterial culture and molecular analyses 1
Respiratory specimens, including nasopharyngeal swabs and lung tissue samples, should be collected 1
Tissue specimens, including spleen, heart, liver, kidney, and any tissues with macroscopic findings suggesting infection, should be collected 1, 2
Swabs from any identifiable lesions, particularly important for surgical site infections or other focal infections, should be collected 1, 3

The European Society of Intensive Care Medicine recommends examining for evidence of infection foci during external and internal examination, including surgical wounds, vascular access sites, pressure areas, or injection sites for evidence of infection 4
A macroscopic examination should look for mottled or ashen appearance, non-blanching petechial or purpuric rash, or cyanosis of skin, lips, or tongue, as suggested by the BMJ guidelines 5
Direct bacterial culture of collected specimens with antibiotic resistance studies should be performed 1
Molecular analyses for viral pathogens from appropriate specimens should be considered 1
Anaerobic cultures, particularly with abscesses, abdominal pathology, or peritonitis, should be considered 1

The Intensive Care Medicine guidelines suggest that C-reactive protein (CRP) levels ≥50 mg/L have high sensitivity (98.5%) for sepsis 4
Procalcitonin (PCT) levels ≥1.5 ng/ml have high sensitivity (100%) for sepsis, as recommended by the Intensive Care Medicine guidelines 4

The Intensive Care Medicine guidelines recommend distinguishing between superficial, deep, and organ/space surgical site infections 3
Deep surgical site infections and intra-abdominal sepsis are frequently associated with bacteremia, as suggested by the Intensive Care Medicine guidelines 3
Polymicrobial infections are common, particularly involving anaerobes, in surgical site infections, as recommended by the Intensive Care Medicine guidelines 3
For cases with suspected respiratory source, collect endotracheal aspirates or perform bronchoscopy sampling, as suggested by the Intensive Care Medicine guidelines 6
Gram staining is essential for evaluating respiratory specimens, as recommended by the Intensive Care Medicine guidelines 6
Presence of squamous cells (>10 per high power field) and absence of leukocytes (<25 per high power field) suggests contamination, as suggested by the Intensive Care Medicine guidelines 6

Post-mortem bacterial translocation can complicate interpretation of culture results, as noted by the Clinical Microbiology and Infection guidelines 1