ABSTRACT

Post-mortem sepsis (PMS) represents a crucial yet underexplored dimension of infectious disease diagnostics, particularly in cases where infections are undiagnosed antemortem. This paper explores the concept of post-mortem diagnostic antimicrobial stewardship (D-AMS), emphasising the value of post-mortem microbiology (PMM) in guiding evidence-based assessments of infection-related deaths. By analysing tissue and fluid samples after death, PMM can uncover occult pathogens, clarify clinical ambiguities, and refine the understanding of antimicrobial resistance trends. Despite its potential, PMS is challenged by diagnostic variability, resource limitations, and the difficulty of distinguishing true pathogens from contaminants. The absence of standardised protocols further hampers the clinical utility of PMM. We highlight instances where post-mortem findings provided critical insights into unsuspected infections in diagnosis and treatment. We put forward integration of PMM into broader antimicrobial stewardship frameworks to bridge the gap between clinical and post-mortem. As diagnostic technologies advance, particularly with the inclusion of rapid molecular tools and artificial intelligence, PMM stands poised to enhance precision medicine and public health surveillance. The incorporation of PMM findings into clinical feedback loops can ultimately influence empirical therapy guidelines, detect lapses in diagnostic protocols, and contribute to more rational use of antimicrobials. This paper advocates for greater recognition of PMS and structured implementation of D-AMS as essential components of future health systems, combining forensic insight with clinical impact.