INTRODUCTION: Healthcare associated infections (HAIs) continue to be a major public health concern throughout the world particularly in developing countries wherein prevalence rates range from 5.7%-19.1%.

OBJECTIVES: The aims of this study were to determine the prevalence of HAIs among pediatric patients admitted at Philippine General Hospital and to describe the trends of annual prevalence of HAIs in relation to infection control programs implemented.

METHODOLOGY: A retrospective study was conducted at the 145-bed capacity wards and intensive care units of the Department of Pediatrics, Philippine General Hospital (PGH) from January 2011 to December 2014 wherein HAI records from the database of the Section of Infectious and Tropical Disease in Pediatrics (INTROP) were reviewed. The following data were collected and encoded: (1) number of patients admitted in the different areas: Pediatric wards (Ward 9 and Ward 11), PICU and NICU; (2) number of patients who developed HAIs; and (3) microbial isolates, sites and antibiotic susceptibility results. Trends of yearly prevalence of HAIs in relation to infection programs implemented were determined, and the microbial isolates and their antibiotic sensitivity patterns were described.

RESULTS: Among 30,032 pediatric patients at risk for HAIs and admitted from January 2011 to December 2014, the prevalence of HAI was 11.37%. There was a decreasing trend in the yearly HAI rates from 2011 to 2014 which coincided with implementation of infection control programs and hiring of a part-time infection control nurse in 2012. The prevalence of HAIs was highest at the PICU (15.17%- 27.81%) followed by the two Pediatric wards, ward 9 (9.03%-19.87%) and ward 11(8.75%-14.76%) and lowest at the NICU (7.52%-9.44%). Top isolates were Pseudomonas putida, Pseudomonas aeruginosa, and Klebsiella pneumonia. Pseudomonas organisms were still sensitive to Ceftazidime, and Klebsiella to Meropenem.

CONCLUSION: The overall HAI prevalence during the 4-year study period was 11.37% (9.14% - 13.65%) comparable to those seen in developing countries. There was a decreasing trend of prevalence annually that coincided with the implementation of various infection control programs and the hiring of a part-time infection control nurse. The microbial isolates obtained vary per area but overall the same organisms were isolated during the study periods which were susceptible to the empiric treatment given.

Human ; Male ; Female ; Cross Infection ; Ceftazidime ; Pseudomonas Aeruginosa ; Meropenem ; Anti-bacterial Agents ; Pseudomonas Putida ; Klebsiella ; Intensive Care Units, Neonatal ; Infection Control ; Thienamycins

OBJECTIVE: The aim of this research was to describe the epidemiologic, clinical laboratory and microbiologic characteristics, complications and outcome of pertussis among pediatric patients at the Philippine General Hospital.
METHODS: A retrospective chart review was performed which included pediatric patients with final diagnosis of pertussis, both clinical and laboratory -confirmed admitted from December 2012 to August 2013 at the Philippine General Hospital.
RESULTS: This chart review included 28 pertussis patients highest in those aged 1-3 months (86%), females (57%) and from region 4A (57%). 26 (93%) had exposure to household members with respiratory symptoms and unknown pertussis vaccination status. Of those patients who were eligible for vaccination, only 24% received age-appropriate DPT vaccination.
Onset of illness varied from 3-56 days; majority 9/L, range: 14.7-111.5x109/L;), lymphocytic predominance (mean lymphocyte 0.47, range: 0.20-0.72;) and thrombocytosis (mean platelet count: 567x109/L, range: 269-823x109/L;). 28% were culture positive for B. pertussis, while 86% tested positive for PCR.
The most common complications  were pneumonia requiring mechanical ventilation (64%), ARDS (28%), seizures (21%), nosocomial pneumonia (11%) and myocarditis (11%). The average length of hospital stay was 7.4 days with 13 deaths or 46% case fatality rate. Deaths were attributed to respiratory failure due to progressive pneumonia and ARDS. Other contributing causes were arrhythmia, MODS, and  septic shock.
CONCLUSION: Susceptible young infants acquire pertussis from household contacts with respiratory symptoms. Paroxysmal cough and cyanosis are common clinical features, with leukocytosis, lymphocytosis and thrombocytosis. High case fatality rate for pertussis was noted among these patients.

Human ; Male ; Female ; Infant ; Infant Newborn ; Whooping Cough ; Leukocytosis ; Lymphocytosis ; Cross Infection ; Bordetella Pertussis ; Thrombocytosis ; Respiratory Insufficiency ; Arrhythmias, Cardiac

Measles continues to be a major childhood illness in Baguio City considering that the Philippines is elimination phase due to continuous transmission among susceptible population. Despite a high percentage of anti-measles vaccination coverage, outbreaks have been reported.

OBJECTIVE: The goal of this study is to describe the epidemiology of measles cases during 2010-2012 and relate it to the outbreak response immunization (ORI) and supplemental immunization activities (SIA) of Health Services Office.

METHODS: It is a cross sectional design utilizing data from Philippine Integrated Disease Surveillance and Response (PIDSR) of the City Epidemiology and Surveillance Unit and reports from the Expanded Program on Immunization of the Field Health Service Information System of Baguio City. Simple descriptive statistical analysis utilizing frequency and percentage distribution was used to characterize the measles cases according to age, sex, case final classification and vaccination status.

RESULTS: During the 3-year, period, there were 457 total suspected measles cases with history of fever, generalized rash, and either cough, coryza or conjunctivitis. Outbreak started in February 2010 and reached 97 suspected cases and eventually decreased after the ORI by March to April 2010. The mean age of the cases is 11.18±10.64 years old, 10.28 are aged from 0-8 months. Of this total, 105 (22.98%) were clinically confirmed, 66 (14.44%) were laboratory confirmed positive for anti-measles IgM antibodies, 27, (5.91%) were epidemiologically linked to confirmed cases and 295, (56.67%) discarded non-measles cases. Among 171 laboratory and clinically confirmed cases, 33 (19.30%) did not received measles vaccination, 40 (23.40%) received 1 dose and 54.40% has unknown immunization status.

CONCLUSION: There were observed cased of measles that are out of age targer of the immunization program which necessitates public health action. There is a need to revisit immunization programs and policies to address out of target cases.

Human ; Male ; Female ; Infant ; Cough ; Public Health ; Measles ; Immunization Programs ; Vaccination ; Disease Outbreaks ; Exanthema ; Conjunctivitis ; Immunoglobulin M

B.S. was born live, full-term male, appropriate for gestational age, to a 40 year-old G2P2 (2002) mother via emergency repeat cesarean section CS). His APGAR score was 8 and 9 at 1 and 5 minutes. His mother had an unremarkable course of pregnancy with regular pre-natal checkups. She had no history of hypertension, diabetes, asthma, thyroid disease, and no exposure to smoke, alcohol or x-ray. However, one day prior to delivery, his mother developed intermittent low to moderate grade fever (T: 37.6-38C) with accompanying maculopapular rashes over the trunk and abdominal area. There were no joint pains or body malaise. This progressed and persisted until a day adterm hence, emergency CS was done. Mother was discharged 48 hours after delivery afebrile but still with maculopapular rashes on the trunk and abdominal area. Due to maternal fever, B.S. was admitted and worked up for possible early-onset neonatal sepsis. On his first hour of life, blood culture and sensitivity were done and he was started on Ampicillin and Cefotaximine. His CBC revealed Leukocytosis of 25.36 with predominance of neutrophils (67) and platelet count of 246 (Table 1). He remained to have stable vital signs, thermoregulated, active and with good suck.
Human ; Male ; Female ; Adult ; Infant Newborn ; Mothers ; Exanthema ; Fever ; Emotions

Storage of human breast milk is unavoidable especially among working mothers who need to report back to work soon after delivery. The aim of this study was to describe the effects of storage process on the bacterial growth-inhibiting activity of expressed human breast milk on common neonatal pathogens. Methods: This was an experimental study performed at the Ospital ng Makati on the breast milk of mothers who were without infection prior to delivery, did not take any medications, and spontaneously delivered their babies full term. Fifteen mothers expressed breast milk within the first seven days up to one month, postpartum. Each milk sample was stored and tested with the following time series: immediately after expression; thawed after being frozen for 24; and thawed after being frozen for 72 hours. Each of the broth medium containing Staphylococcus aureus, Escherichia coli or Klebsiella pneumonia was added to 1 ml of expressed breast milk. Tenfold dilutions were made. Each dilution was plated at zero and four hours and colony-forming units (CFU) were counted after 24 hours incubation. Same procedure was performed on a negative control. Results: The number of CFU for the three tested organisms (had lower nominal counts with the breast milk solution when compared to control solutions both at zero-hour and four-hour test samples. Breast milk exhibited bacteriostatic properties against most pathogens except for Escherichia coli after being frozen for 24 hours. For the breast milk that was frozen for 72 hours, most tests did not show significant lower counts when compared to control solutions, except still for Staphylococcus aureus and Escherichia coli both at 0 hour. Conclusion: Breast milk has bacterial inhibiting property against common neonatal pathogens. Bacteriostatic property of breast milk started to diminish after being frozen for 72 hours, but still exerted its inhibiting property.
Human ; Animal ; Female ; Adult ; Young Adult ; MILK, HUMAN ; STAPHYLOCOCCUS AUREUS ; ESCHERICHIA COLI ; KLEBSIELLA PNEUMONIAE

Introduction: The influenza virus is a single stranded RNA virus which has the potential to cause periodic global pandemics. The first major Influenza A global pandemic devastated the 20th century with the Spanish flu in 1918; it had more than 2.5% case fatality rate. In the 21st century, the Influenza A pandemic was first detected in Mexico in March 2009 and from then, there had been a rapid increase in the number of reported cases and deaths reported which created panic. Objectives: This study aims to determine the profile of pediatric patients with confirmed Novel Influenza AH1N1 at a Local Tertiary Hospital from June 2009 to December 2009. Methods: This study is retrospective chart review of patients aged 0-19 years old, confirmed to have influenza A H1N1 and were admitted at Baguio General Hospital. Their demographic profile, signs and symptoms, laboratory examinations, treatment and outcome were recorded in a uniform case repot form. Results: Of the 235 pediatric cases of influenza-like illness seen, 31(13%) were admitted. Fifteen (48.3%) of the admitted patients were positive for the novel influenza AH1N1. Majority of the cases were from the five-to-nine age group (34%), while three (20%) were from the age group, two years old and below. The presenting signs or symptoms were fever (100%), cough (80%), colds (47%) and sore throat (34%). Most common underlying conditions noted were bronchial asthma in six (40%) of the cases. Complete blood count revealed anemia in 40%, leukopenia in 26.67%, and lymphocytosis in 26.67% cases. Using chest radiograph, pneumonia was seen in 40% (6/15) of patients. Two (13.3%) revealed no growth in their blood cultures while one had Klebsiella pneumonia and another one grew Candida non-albicans. All received Oseltamivir upon admission and was completed for five days. Antibiotics were given to those with bacterial co-infection. The mean duration of hospital stay was eight days: 13 (86%) patients were discharged in improved condition; while, two (13.3%) died due to respiratory failure. Conclusion: There was an equal distribution of both sexes in the study. Incidence was highest among five years old and below. The pediatric influenza AH1N1 infection presented with mild acute respiratory tract infection. Most cases were uncomplicated although majority of them had underlying medical conditions putting them at risk for complications. Oseltamivir was the mainstay of treatment in conjunction with antimicrobials for those who had bacterial co-infections. Most of the patients improved with a case fatality rate of 13.3%.
Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; INFLUENZA, HUMAN ; RESPIRATORY TRACT INFECTIONS

In the Cordillera Administrative Region, pneumonia has been the second most common cause of morbidity. In Baguio General Hospital and Medical Center (BGHMC) pneumonia has been the number one cause of morbidity and one of the top three causes of mortality among pediatric patients since 2002; these were all treated as bacterial pneumonia. However, the epidemiology of viral pneumonia has not yet been studied. OBJECTIVES: The goal of this study was to determine the prevalence of viral pneumonia among pediatric patients admitted from May 2009 to April 2010. METHODS: A chart review was performed to provide data on (1) all patients' ages 0 to 18 years old admitted in the institution for pneumonia; (2) those enrolled in the SARI epidemiological surveillance from May 2009 to April 2010; (3) only patients admitted on Sundays or Wednesdays; and (4) those swabbed within 24 hours of admission (This is the schedule agreed upon by the involved groups on the oropharyngeal and nasopharyngeal swabbing at the institution for the SARI surveillance which is done during Mondays and Thursdays); (5) those who recently have not taken any antiviral medications; and (6) those who were not subjected to oropharyngeal or nasopharyngeal swabs prior to admission. the prevalence of viral pneumonia among pediatric patients admitted from May 2009 to April 2010 (indicate aseline characteristics such as age, sex, clinical symptoms, and co-morbid diseases, course and length of hospital stay; and outcome data was gathered. RESULTS: A total of 982 pediatric patients were admitted for pneumonia. Of the three-hundred-seventy-seven patients tested for viral isolates, 28.1% were positive and most of the cases with viral isolates were in October. In all ages, Respiratory Syncytial Virus (RSV) was the most prevalent (87.74%). Subjects who were less than one year old showed a higher detection rate of virus. There were more patients from the viral isolate negative group who presented with signs of respiratory distress. Most of the patients of both groups were discharged after one-to-three hospital days. CONCLUSION: RSV was the most common virus isolated. Children less than one year old had the highest detection rate of a virus.
Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; PNEUMONIA, VIRAL ; RESPIRATORY TRACT INFECTIONS ; PREVALENCE

Parapneumonic effusions frequently occur as complications of pneumonia. Data from developing countries is limited. The purpose of this paper is to review the epidemiological and clinical profile of parapneumonic effusions among children admitted in a tertiary government hospital. Methodology: Medical records of 72 children diagnosed with parapneumonic effusions from 2005-to-2009 were obtained. Demography, clinical presentations, diagnostics, treatment modalities, outcomes, etiology and antibiotic susceptibilities were analyzed using descriptive statistics. Comparison of purulent effusion and empyema was done using parametric or non-parametric statistics, accordingly. Results: There were 106 children discharged with a diagnosis of parapneumonic effusion. Of the 96 medical records available, 72 patients fulfilled the criteria for parapneumonic effusions. Only 53 patients submitted pleural fluid for analysis: 29 cases were empyema, while 24 cases were purulent effusion; mean age was 9.66 years. Fever (90.28%), cough (69.44%), and dyspnea (66.67%) were the most common clinical presentations. Forty-four patients underwent thoracentesis while 37 children had closed-tube thoracostomy. Methicillin-resistant Staphylococcus aureus(MRSA) was the most commonly isolated organism from the pleural fluid cultures (9.26%) and blood cultures (6.25%). Patients with purulent effusion were treated with a combination of antibiotics and anti-TB meds (75%).Majority of patients with empyema were treated with antibiotics alone (79.31%). Earlier improvement and shorter hospital stay were observed among patients with purulent effusion. Conclusion: Parapneumonic effusions occurred in 6.80% of hospitalized children with pneumonia; 54.72% of which were empyema and 45.28% were purulent effusion. MRSA was the most commonly isolated organism. Chest imaging, pleural fluid analysis and cultures, and blood cultures were important diagnostic procedures. The mainstays of treatment were medical, surgical or both, depending on the severity of effusion. Prompt diagnosis and management could account for favorable clinical outcomes.
Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; PNEUMONIA ; EMPYEMA ; PLEURAL EFFUSION

Background: Zinc supplementation has been shown to lower mortality and morbidity due to diarrhea and pneumonia. Because of the positive effect of zinc in the prevention of pneumonia, several studies have been conducted to investigate its effect as an adjunct therapy for pneumonia. For this reason, a systematic, quantitative review of available studies is needed to determine the overall effect of zinc as an adjunct in the treatment of pneumonia in children less than five years old. Objectives: To assess from literature the effect of zinc, when given with antibiotics, in reducing mortality, treatment failure, length of hospital stay, and duration of symptoms of pneumonia in children less than five years old. Design: Meta-analysis of randomized, placebo-controlled intervention trials. Methods: Studies for inclusion were identified by PubMed search, journal handsearch, and other methods. The authors independently assessed study quality and extracted data. Statistical Analysis: Revman Version 4.2 was used to analyze the data gathered. The summary relative risks (RRs) and 95% CI for each outcome variable were estimated using a fixed-effects model. Chi-square and I2 were computed to assess for heterogeneity of results. Results: A total of three acceptable studies were included in the meta-analysis. The summary RRs showed that zinc had no overall treatment effect on mortality from pneumonia (RR 0.69, CI 0.08, 5.70) and treatment failure (RR 1.05, CI 0.74, 1.49). These results were statistically insignificant with p-values of 0.73 and 0.77, respectively. Chi2 and I2 tests showed significant heterogeneity of results for treatment failure (Chi2 = 5.06, I2 = 60.5%). The same tests did not show significant heterogeneity of results for mortality (Chi2 = 0.43, I2 = 0%). In one study, the use of zinc reduced the duration of severe pneumonia with mean difference of four (4.2-4.9) versus five (4.5-5.5) days leading to shorter hospitalization [5 (4.8-5.5) versus six (5.1-6.1) days]. In another study, the zinc group's recovery rate from very ill status was 2.6 times (p = 0.004) more, and the resolution of fever was 3.1 times (p = 0.003) more than those in the placebo group. However, these results could not be combined due to lack of data on standard deviation. Conclusion: There is not enough evidence to conclude that zinc is effective in reducing mortality, treatment failure and duration of symptoms of pneumonia. A large population, multi-center, randomized, placebo-controlled trial should be conducted to obtain statistically significant evidence.
Human ; ZINC ; PNEUMONIA

Introduction: Urinary tract infection (UTI) is a common reason for outpatient consults. It is almost always in the Top Ten consults at the sick-child clinic of a tertiary hospital. However, a study concerning the incidence and clinical and laboratory profiles of UTI in the Philippines has yet to be documented. Objectives: To determine the incidence rate and clinical and laboratory profiles of UTI among patients who consulted at the pediatric outpatient clinic of a tertiary hospital. Methods: All patients 0 to 12 years, who were UTI suspects and consulted at the Sick-Child Clinic of a tertiary hospital from January to December 2006 were included in the study. Patients who had recurrent UTI or history of previous UTI and those with co-morbidities such as anatomic and/or functional problems involving the urinary tract were excluded. Chart review was done and the following were noted: demographics and clinical and laboratory characteristics. Results: Four hundred twenty three patients were included in the study. The incidence rate was 30 per 1000 persons (95% CI). 54% percent were female. The majority of the patients were between 7 to 12 years of age. The most common presenting symptoms were fever, abdominal pain, vomiting, and dysuria. Only 25 patients had urine culture done and only 8 had positive results, mostly with E. coli. The most common antibiotics used were Cotrimoxazole, Cefuroxime, and Amoxicillin. Conclusion: The incidence rate is higher compared to other studies done in general practice. The presenting signs and symptoms were however similar. Important to note is the high incidence of patients who did not follow up. It is also noted that the gold standard for the diagnosis of UTI, which is the urine culture is very seldom requested. This may lead to the over- or maybe under-diagnosis of UTI and its eventual mismanagement. Therefore, it is recommended that the approach to the diagnosis and management of UTI in children should be reviewed.
Human ; Male ; Female ; Child ; Child Preschool ; Infant ; Infant Newborn ; URINARY TRACT INFECTIONS ; INCIDENCE ; DIAGNOSIS