Iatrogenic Staphylococcus aureus septicaemia following intravenous and intramuscular injections: clinical course and pathomorphological findings

Abstract

The clinical course, autopsy and histological findings are presented from three (one 33-year-old female and two males aged 26 and 56) fatalities resulting from injection therapy which has produced Staphylococcus aureus septicaemia. The autopsies were performed within 2-4 days postmortem. No primary focus other than the insertion site of the peripheral venous catheters or the intramuscular injections, representing the initial entry site of Staphylococcus aureus, could be identified. Death was attributed directly to the staphylococcal infection as a result of iatrogenic injection therapy for the treatment of a non-severe underlying illness (premature labour pains, acute loss of hearing, lumbago). The forensic diagnosis of Staphylococcus aureus septicaemia following iatrogenic injections has to be critically evaluated and can be established routinely in cases with delayed autopsy only when no other cause of death is revealed by autopsy, no apparent source of infection other than the insertion site can be detected and careful attention is paid to histological and bacteriological findings. All doubtful cases of nosocomial bloodstream infections with fatal outcome should undergo an immediate autopsy. In cases of very early forensic involvement microbiological investigations, including phagotyping, molecular biological characterization and identification of bacterial toxins from micro-organisms out of appropriate specimens obtained postmortem, could be efforts of potential evidential value regarding the aetiological proof. To optimize aetiopathogenetic conclusions concerning a causal relationship between iatrogenic injections and septic complications, the medicolegal investigation should also include an interdisciplinary co-operation with consultants from other relevant fields (e.g. microbiology and hygienics).

Serum procalcitonin (PCT): a valuable biochemical parameter for the post-mortem diagnosis of sepsis

“…Apart from the immunohistochemical detection of an enhanced pulmonary expression of different cellular adhesion molecules, such as P-selectin [20], E-selectin [32], VLA-4 and ICAM-1 [31] in sepsis-induced lung injury, there are no defined post-mortem markers for death caused by sepsis. These immunohistochemical investigations are not routinely used in forensic casework and as a result, clinical data and morphological findings that are to a great extent unspecific remain the diagnostic criteria in the postmortem diagnosis of death due to sepsis [26,28,30,33]. In a variety of forensic studies, the post-mortem determination of biochemical parameters has been recognized as useful in establishing the post-mortem diagnosis of the underlying cause of death, e.g.…”

Serial monitoring of interleukin-1?, soluble interleukin-2 receptor and lipopolysaccharide binding protein levels after death

“…Special constellations of death due to sepsis are frequently encountered in forensic autopsy practice, e.g., septic conditions following iatrogenic interventions or infected pressure sores [24,25]. Since in a number of such cases information about the circumstances of death or data of the deceased's symptoms prior to death are often not available at the time of the autopsy, especially when fatalities occurred out of hospital, and in addition, gross pathology and histology is, apart from the detection of septicopyemic abscesses, usually unspecific in sepsisassociated fatalities [26], the postmortem diagnosis of fatal sepsis is occasionally more difficult in medico-legal casework than it is in clinical pathology.…”

Scratched pustule or gunshot wound? A medical odyssey

“…It is well known that problems can arise in the description and interpretation of wounds, injuries and mechanisms leading to death [1,2]. However, the failure to diagnose a gunshot wound is an extraordinary event [3,4,5].…”