DIAGNOSTIC UTILITY OF POSTMORTEM FINE-NEEDLE ASPIRATION CULTURES

Background.-Microbiological cultures at autopsy have not proved to be very useful. In life, transthoracic and fine-needle aspirations of oth er tissues have provided better results. The aim of this prospective s tudy was to assess the diagnostic utility of postmortem cultures obtai ned by fine-needle aspiration puncture (FNAP) of several tissues when punctures were performed in the immediate postmortem period. Methods.- Comparative analysis was performed between FNAP cultures and those obt ained in life and by conventional autopsy. All adult autopsied patient s who died at a general teaching hospital in a 3-year period were incl uded. Clinical data, microbiological cultures before death, and pathol ogic data from autopsies of all patients were recorded, as were result s of FNAP performed after death from the heart, right tower lung, live r, spleen, and other areas suspicious for infection. Cultures from the same sites were made at autopsy. Microorganisms were isolated and def ined as infectious agents, colonizers, or contaminants according to st andard criteria. Results.-Ninety-two patients (59 men, 33 women) were included in the study; patients had a mean age of 67.7 years. There we re five main diagnostic groups: neoplastic (n = 25), digestive (n = 15 ), respiratory (n = 14), circulatory (n = 10), and infectious diseases (n = 10). Infection was suspected in 47 patients (51.3%). Autopsy was performed 12 hours after death or later in 61% of patients. No signif icant differences were found in terms of contamination or colonization in relation to time between death and FNAP, time between death and au topsy, or microorganisms isolated. The sensitivity of FNAP and autopsy with respect to the isolation of infective microorganisms was similar (80.9% vs 87%), but FNAP was more specific (66.7% vs 44.4%). Age, sex , time between death and FNAP, clinical diagnosis, cause of death, and antimicrobial therapy did not influence the results significantly. Bl ood cultures, as compared with cultures from other tissues, gave the b est relative sensitivity for FNAP (42%). Conclusions.-Fine-needle aspi ration puncture performed in the immediate postmortem period adds rele vant microbiological information to the clinicopathologic picture and provides higher specificity than autopsy cultures. Blood cultures are especially useful. When difficulties are associated with autopsy exami nation or in cases of selected clinical conditions, FNAP can be an eff ective tool for the postmortem diagnosis of infection.