European Journal of Clinical Microbiology & Infectious Diseases vol:34 issue:5 pages:1045-1057
Post-mortem microbiology (PMM) is an important tool in forensic pathology, helping to
determine the cause and manner of death, especially in difficult scenarios such as
sudden unexpected death (SD). Currently, there is a lack of standardization of PMM
sampling throughout Europe. We present recommendations elaborated by a panel of
European experts aimed to standardize microbiological sampling in the most frequent
forensic and clinical post-mortem situations.
Methods: A network of forensic microbiologists, pathologists and physicians from
Spain, England, Belgium, Italy and Turkey shaped a flexible protocol providing minimal
requirements for PMM sampling at four practical scenarios: SD, bioterrorism, tissue
and cell transplantation (TCT) and paleomicrobiology. Biosafety recommendations
were also included.
Results: SD was categorized in 4 subgroups according to the age of the deceased and
circumstances at autopsy: (1) included SD in infancy and childhood (0-16 years); (2)
corresponded to SD in the young (17-35 years); (3) comprised SD at any age with
clinical symptoms; and (4) included traumatic/iatrogenic SD. For each subgroup, a
minimum set of samples and general recommendations for microbiological analyses
were established. Sampling recommendations for main bioterrorism scenarios were
provided. In the TCT setting, the Belgian sampling protocol was presented as an
example. Finally, regarding paleomicrobiology, the sampling selection for different
types of human remains was reviewed.
Conclusions: This proposal for standardization in the sampling constitutes the first step towards a consensus in PMM procedures. In addition, the protocol flexibility to adapt
the sampling to the clinical scenario and specific forensic findings adds a cost-benefit