Human ; Male ; Female ; Young Adult ; Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; ANTI-BACTERIAL AGENTS

Herbal Medicine

Background: Environmental surfaces harbor pathogens that transmit them and there is a need for environmental cleaning and disinfection to prevent the spread of infection. Objective: This study aimed to determine if the use of fluorescent marking (FM) technique in high touch areas can be used as an index of cleanliness and disinfection as determined by aerobic colony count. Methods: This was an experimental study done at the University of the Philippines Philippine General Hospital Neonatal Intensive Care Unit (NICU). A total of 40 surfaces were swabbed for cultures with aerobic colony count (ACC) then adjacent areas are marked with fluorescent gel. After cleaning and disinfection, checking for residual fluorescent markings with congruent environmental culture with an aerobic colony count of the same surface was done. The rate of removal and colony count were then compared to assess the specificity and sensitivity of the fluorescent marking technique as a gauge of cleanliness of high touch surface areas. Any residual fluorescence of the marked areas was considered unclean and an aerobic colony count of < 2.5 – 5CFU/ml 2 were considered an acceptable level of cleanliness. Result: A total of 40 high contact surfaces were sampled from 5 areas were collected. Prior to cleaning, 60% (24) of the surfaces (60%) did not contain microorganisms. After cleaning, the (FM) had 38% and in the ACC 83% were assessed to be clean. The sensitivity of FM is 85.71% and specificity of 42.42%. The positive predictive value (PPV) is 24% with the positive likelihood ratio (positive LR) of 1.49 and the negative predictive value (NPP) is 93.33%. Conclusion The use of Fluorescent Marking technique in high touch areas as an index of cleanliness and disinfection is a good marker for cleanliness and disinfection. Furthermore, it is a simple, rapid, inexpensive and has potential to increase awareness of the environment that can be utilized as an objective parameter to assess cleanliness and disinfection.
Cross Infection

The Philippine General Hospital (PGH) has the most number of high-risk infant admissions locally. Neonatal bacteremia and sepsis are the perennial problems encountered. Previous researches may not be reflective of the current situation in the Neonatal Intensive Care Unit (NICU) of PGH, thus an updated study on neonatal bacteremia becomes important. Objectives: This study was performed to describe the clinical profile of neonates born with positive blood cultures together with the new criteria for sepsis as defined by the 2001 International Pediatric Consensus Conference at PGH from July to December 2006. Methods: A prospective chart review of all neonates born with positive blood cultures at UP-PGH from July 1 to December 31, 2006 was performed. Demographic, clinical, and laboratory data were then analyzed. Results: Out of 3,870 live births, 103 (2.6%) patients with positive blood cultures fulfilled the criteria of sepsis. Mothers were around 20 to 25 years of age comprising 35 (34%), less than half had prenatal check-ups and more than 2/3 had not maternal immunizations. Fifty-eight (56%) of the neonates were males, 68 were premature (66%), 76 were appropriate for gestational age (74%), and 37 were of low birth weight (36%). Most patients (62 or 60%) developed sepsis within the first 3 days of admission, while 65 (63%) patients had pneumonia. The most common organisms isolated were Pseudomonas putida (50 or 49%), Burkholderia mallei (15 or 15%) and Burkholderia cepacia (8 or 8%). The organisms were sensitive Ceftazidime, Cefepime and Piperacillin-Tazobactam. Of 103 subjects, 58 or 56% fulfilled the criteria for systemic inflammatory response syndrome (SIRS) for sepsis. Multivariate analysis showed that those with SIRS were 4.89 times more likely to die than those without SIRS. Conclusion: Sepsis usually develops among neonates in less than 72 hours after their delivery at PGH. The neonates who were prone to develop sepsis were those who are male, premature, appropriate for gestational age, and of low birth weight. The organisms that predominate in PGH are usually gram-negative pathogens. The number of hospital-acquired infection is significant. SIRS could be an important prognostic factor in affecting outcome and may aid significantly in the proper diagnosis of sepsis in newborns.
Human ; Male ; Female ; Infant Newborn ; BACTEREMIA ; SEPSIS

Background: Surgical site infection (SSI) poses a serious threat in Neurosurgery. The mere presence of SSI would warrant a prompt medical and/ or surgical intervention for the outcome is very poor. This study aims to establish whether a pre-operative hospital stay of >7 days & other risk factors predisposes to surgical site infections. Methods: Retrospective, cross-sectional study of all pediatric patients who underwent clean neurosurgical procedures for the first time from January 1, 2011- June 30, 2014, in the Philippine General Hospital. The primary outcome was the development of a surgical site infection within 30 days from spine surgery or 90 days from intracranial surgery. Univariate and multivariate logistic regression analyses were performed to show the association of demographic and clinical factors with the development of SSI. Results: 279 medical charts were available for review. Median age was 1 year(5 days to 18 years old). The overall prevalence rate of SSI was 11.26%. Patients with >7 days pre-operative hospital stay had an incidence rate for SSI of 76.47% compared to 23.53% in patients with <7 days pre-operative hospital stay (OR 1.61, CI 0.68-3.84, p=0.280). Conclusions The incidence of SSI is high compared to other centers. There was no association of preoperative hospital stay with SSI. The association was significant only for the history of nosocomial infection. Early pre-operative clearance and surgery are recommended. Further prospective studies and surveillance are warranted
Surgical Wound Infection ; Cross Infection

Infections caused by invasive fungal species continue to rise due to various contributing factors including the changes in the environmental and weather conditions, lifestyle, the occurrence of natural disasters, and the weakened human immune system. Even though synthetic drugs effectively cure fungal diseases, their unwanted side effects, as well as the rapid rise in resistance, have compelled researchers to develop new antifungal agents. Several medicinal plants are folklorically known to have antifungal activities. Among the traditionally used antifungal herbal plants is Senna alata, commonly known as akapulko and ringworm bush. In the current review, phytochemical analysis and numerous non-clinical studies on akapulko have been performed and confirmed its activity against several fungi pathogenic to humans. Anthraquinone compounds seemed to be the major phytochemicals responsible for its antifungal activity. In the Philippines, clinical trials have also confirmed its utility as a topical agent in treating cutaneous fungal infections. Research gaps that need to be addressed include the determination of the exact molecular mechanisms of their fungal killing action.
Phytochemicals

The current strategy in treating multi-drug resistant gram-negative bacterial (MDR-GNB) infections is salvage therapy by using polymyxins. However, the beginning emergence of polymyxin resistance should enforce strict antimicrobial stewardship programs to preserve polymyxin efficacy. Knowledge of structural characteristics, pharmacodynamic, and pharmacokinetic profiles of polymyxins, as well as consideration of efficacy, safety, suitability, and cost, will help in the choice of the appropriate polymyxin for therapy. Polymyxin B is the recommended polymyxin for systemic use, while colistin is recommended for lower urinary tract infections, intraventricular, and intrathecal use. Either polymyxin can be used for hospital-acquired and ventilator-associated pneumonia. Combination therapy over monotherapy remains to be advantageous due to synergism and decreased resistance development. The choice of the second drug to be used should be based on full susceptibility, or if unavailable, a drug with the least minimum inhibitory concentration relative to the breakpoint set by the Clinical and Laboratory Standards Institute. Using the mnemonic ESCAPE can also guide physicians in their polymyxin prescription process: (1) Checking if the pathogen is Extensively resistant or multi-drug resistant; (2) checking the patient’s clinical status if compatible with Significant infection; (3) using Combination therapy; (4) ensuring Adequate dosing; (5) Proper preparation and administration of drug; and (6) keeping an Eye for response and adverse effects.
Polymyxin B ; Colistin ; Polymyxins