UCL Institute of Child Health, London, UK.
J Clin Pathol. 2011 Aug;64(8):706-10. doi: 10.1136/jclinpath-2011-200056. Epub 2011 May 10.
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.
To assess interpretive difficulties using a targeted cross-specialty questionnaire.
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.
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.
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.
尸检（PM）微生物学调查被推荐用于婴儿猝死（SUDI）病例，感染是此类死亡的公认原因，但目前没有基于证据的指南来解释这些结果。
使用针对性的跨专业问卷评估解释上的困难。
109 名参与婴儿死亡管理的顾问专家收到了一份问卷，问卷提供了五个假设的标准化 SUDI 病例的信息，这些病例仅在 PM 微生物学发现上有所不同。参与者将每个病例归入以下类别：明确的细菌感染、可能的细菌感染、细菌生长意义不明和 PM 污染。
63 名（57%）专家作出了回应。在这些 PM 微生物学结果的解释方面，没有一种临床情况能够在参与者之间建立完全一致的共识。在仅出现 2 类病原体（如 B 群β溶血性链球菌）纯生长的情况下，96%的受访者认为可能或明确存在细菌感染。在 2 类病原体混合生长的情况下，83%的人报告可能或明确存在细菌感染。金黄色葡萄球菌等生物体的生长导致了最大的困难，几乎有同等数量的参与者认为该发现具有重要意义或无意义。不同专业组之间的解释没有一致的差异。
虽然在某些 SUDI 情况下对 PM 微生物学发现的解释有普遍共识，但在任何临床情况下都没有达成共识，而且专家之间对假定意义的差异是明显的。在缺乏适当的循证指南的情况下，这对多学科环境下处理此类死亡具有实际意义。
