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Postmortem bacteriology and pneumonia in a mentally retarded population
Abstract:
Postmortem pathologic and bacteriologic reports were analyzed for 237 deaths occurring at a large institution for the mentally retarded from 1958 to 1973. Bronchopneumonia, aspiration pneumonia, and lipid pneumonia were frequently reported at autopsy, and in a total of 146 cases (61.6%) at least one type of pneumonia was reported. Postmortem bacteriologic cultures in a smaller group revealed high recovery rates of staphylococci (coagulase-positive), hemolytic streptococci, and gram-negative bacilli in throat and lung cultures. Enteric aerobic gram-negative bacilli were particularly frequent along with yeast (Candida albicans). The institutionalized retarded appear similar to other hospitalized populations, in that a large proportion of hospital-acquired respiratory infections is related to aerobic gram-negative bacilli. The high frequency of aspiration and its sequelae in this population is unusual, however, and post-mortem bacteriologic findings appear consistent with those of antemortem studies of cases of aspiration pneumonia.
Insights
Pneumonia, particularly aspiration pneumonia, was common in institutionalized individuals with intellectual disabilities. Bacterial and yeast infections were frequently found, similar to other hospitalized patients, but aspiration was unusually high.
Area of Science:
- Medical Microbiology
- Pathology
- Infectious Diseases
Background:
- Institutions for individuals with intellectual disabilities have unique health challenges.
- Respiratory infections are a significant cause of morbidity and mortality in institutionalized populations.
Purpose of the Study:
- To analyze postmortem pathologic and bacteriologic findings in deaths among institutionalized individuals with intellectual disabilities.
- To identify common causes of death, focusing on pneumonia and associated microbial agents.
Main Methods:
- Retrospective analysis of 237 postmortem pathologic and bacteriologic reports from 1958-1973.
- Identification of pneumonia types (bronchopneumonia, aspiration pneumonia, lipid pneumonia) and microbial pathogens from throat and lung cultures.
Main Results:
- Pneumonia was reported in 61.6% of cases, with bronchopneumonia and aspiration pneumonia being frequent.
- High recovery rates of Staphylococcus (coagulase-positive), hemolytic streptococci, and gram-negative bacilli (especially enteric aerobic) were observed.
- Yeast (Candida albicans) was also frequently identified.
Conclusions:
- Institutionalized individuals with intellectual disabilities share similarities with general hospitalized populations regarding hospital-acquired respiratory infections linked to aerobic gram-negative bacilli.
- A high frequency of aspiration and its complications is a notable characteristic of this population.
- Postmortem bacteriologic findings support antemortem studies on aspiration pneumonia.