Weber M A, Klein N J, Hartley J C, Lock P E, Malone M, Sebire N J
Department of Paediatric Pathology, Great Ormond Street Hospital for Children and the Institute of Child Health, University College London, London, UK.
Lancet. 2008 May 31;371(9627):1848-53. doi: 10.1016/S0140-6736(08)60798-9.
The cause and mechanism of most cases of sudden unexpected death in infancy (SUDI) remain unknown, despite specialist autopsy examination. We reviewed autopsy results to determine whether infection was a cause of SUDI.
We did a systematic retrospective case review of autopsies, done at one specialist centre between 1996 and 2005, of 546 infants (aged 7-365 days) who died suddenly and unexpectedly. Cases of SUDI were categorised as unexplained, explained with histological evidence of bacterial infection, or explained by non-infective causes. Microbial isolates gathered at autopsy were classified as non-pathogens, group 1 pathogens (organisms usually associated with an identifiable focus of infection), or group 2 pathogens (organisms known to cause septicaemia without an obvious focus of infection).
Of 546 SUDI cases, 39 autopsies were excluded because of viral or pneumocystis infection or secondary bacterial infection after initial collapse and resuscitation. Bacteriological sampling was done in 470 (93%) of the remaining 507 autopsies. 2079 bacteriological samples were taken, of which 571 (27%) were sterile. Positive cultures yielded 2871 separate isolates, 484 (32%) of which showed pure growth and 1024 (68%) mixed growth. Significantly more isolates from infants whose deaths were explained by bacterial infection (78/322, 24%) and from those whose death was unexplained (440/2306, 19%) contained group 2 pathogens than did those from infants whose death was explained by a non-infective cause (27/243, 11%; difference 13.1%, 95% CI 6.9-19.2, p<0.0001 vs bacterial infection; and 8.0%, 3.2-11.8, p=0.001 vs unexplained). Significantly more cultures from infants whose deaths were unexplained contained Staphylococcus aureus (262/1628, 16%) or Escherichia coli (93/1628; 6%) than did those from infants whose deaths were of non-infective cause (S aureus: 19/211, 9%; difference 7.1%, 95% CI 2.2-10.8, p=0.005; E coli: 3/211, 1%, difference 4.3%, 1.5-5.9, p=0.003).
Although many post-mortem bacteriological cultures in SUDI yield organisms, most seem to be unrelated to the cause of death. The high rate of detection of group 2 pathogens, particularly S aureus and E coli, in otherwise unexplained cases of SUDI suggests that these bacteria could be associated with this condition.
尽管进行了专业尸检，但大多数婴儿猝死综合征（SUDI）病例的病因和机制仍不清楚。我们回顾了尸检结果，以确定感染是否为SUDI的病因。
我们对1996年至2005年间在一个专业中心对546名（年龄7至365天）突然意外死亡的婴儿进行的尸检进行了系统的回顾性病例分析。SUDI病例分为无法解释的、有细菌感染组织学证据可解释的或由非感染性原因解释的。尸检时采集的微生物分离株分为非病原体、1组病原体（通常与可识别的感染灶相关的微生物）或2组病原体（已知可导致败血症且无明显感染灶的微生物）。
在546例SUDI病例中，39例尸检因病毒或肺孢子菌感染或初始心脏骤停及复苏后的继发性细菌感染而被排除。在其余507例尸检中的470例（93%）进行了细菌学采样。共采集了2079份细菌学样本，其中571份（27%）无菌。阳性培养物产生了2871个单独的分离株，其中484个（32%）显示为纯培养生长，1024个（68%）为混合生长。与死亡由非感染性原因解释的婴儿相比，死亡由细菌感染解释的婴儿（78/322，24%）和死亡原因不明的婴儿（440/2306，19%）中含有2组病原体的分离株明显更多（与细菌感染相比，差异为13.1%，95%CI 6.9 - 19.2，p<0.0001；与原因不明相比，差异为8.0%，3.2 - 11.8，p = 0.001）。死亡原因不明的婴儿的培养物中金黄色葡萄球菌（262/1628，16%）或大肠杆菌（93/1628；6%）的检出率明显高于死亡由非感染性原因导致的婴儿（金黄色葡萄球菌：19/211，9%；差异为7.1%，95%CI 2.2 - 10.8，p = 0.005；大肠杆菌：3/211，1%，差异为4.3%，1.5 - 5.9，p = 0.003）。
尽管SUDI的许多尸检细菌学培养产生了微生物，但大多数似乎与死亡原因无关。在其他原因不明的SUDI病例中2组病原体，特别是金黄色葡萄球菌和大肠杆菌的高检出率表明这些细菌可能与这种情况有关。
