title: Difficulties in interpretation of post-mortem microbiology results in unexpected infant death: evidence from a multidisciplinary survey.
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.
  
  
  OBJECTIVE
  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.
authors.affiliation: UCL Institute of Child Health, London, UK.
authors.forename: Jeremy W
authors.initials: JW
authors.lastname: Pryce
authors.forename: Martin A
authors.initials: MA
authors.lastname: Weber
authors.forename: John C
authors.initials: JC
authors.lastname: Hartley
authors.forename: Michael T
authors.initials: MT
authors.lastname: Ashworth
authors.forename: Marian
authors.initials: M
authors.lastname: Malone
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Sebire
mesh_terms: D001291:Attitude of Health Personnel; D001344:Autopsy; D001424:Bacterial Infections / Q000473:pathology*; D002423:Cause of Death; D003253:Consultants; D006801:Humans; D007223:Infant; D010338:Pathology, Clinical / Q000379:methods / Q000592:standards*; D011364:Professional Practice; D013398:Sudden Infant Death / Q000473:pathology*; D011795:Surveys and Questionnaires