1.Antimicrobial stewardship: Attitudes, perceptions, and practices of healthcare workers in a pediatric tertiary hospital
Angelina C. Bernardo ; Jay Ron O. Padua
The Philippine Children’s Medical Center Journal 2024;20(1):1-21
Objectives:
This study aims to determine the healthcare workers’ (HCWs) attitudes,
perceptions, and practices regarding Antimicrobial Stewardship (AMS) at the Philippine Children's
Medical Center (PCMC).
Materials and Methods:
This cross-sectional study employed a validated online survey.
Results:
The study included 288 healthcare workers, predominantly female (77.35% ) and
aged 31-40 years (47.74%), with physicians being the largest professional group (57.14%). HCWs
had positive attitudes toward AMS. They perceived moderate to high antimicrobial resistance
(AMR) levels in different contexts but believed the hospital had lower AMR levels than the
country. HCWs agreed that AMR impacts antimicrobial choices, patient outcomes, and safety.
Contributors to AMR were prescribing inappropriate antimicrobials, unnecessary prescriptions,
poor patient adherence, and inadequate infection control measures. HCWs, except medical
technologists, were aware of the Antimicrobial Stewardship Program (ASP) and its interventions.
Only nurses and pharmacists were aware of the hospital policies against AMR. Barriers to AMS
implementation include inadequate training in antimicrobial use, lack of infectious disease/
microbiology services, lack of electronic medication management services, and personnel shortages.
HCWs had high self-reported AMS practices, but a practice gap in single-dose surgical antibiotic
prophylaxis was identified, with low physician adherence (50.6%).
Conclusion
This study revealed positive attitudes and high self-reported AMS practices
among HCWs. They also perceived moderate to high AMR in different contexts but believed that
the hospital has lower AMR levels than the country. Addressing the identified barriers to
implementation and practice gaps is crucial for achieving antimicrobial stewardship goals.
Antimicrobial Stewardship
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Viperidae
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Health Personnel
2.SARS-CoV-2 RT-PCR cycle threshold value and its association with disease severity and mortality among hospitalized pediatric COVID-19 patients
Aubrey O. Artienda ; Jay Ron O. Padua
Pediatric Infectious Disease Society of the Philippines Journal 2023;24(2):52-63
Objective:
This study determined the association of SARS-CoV-2 RT-PCR cycle threshold (Ct) value with disease severity and mortality among hospitalized pediatric COVID-19 patients.
Methodology:
This is a retrospective cohort study of patients aged 0-18 years with SARS-CoV-2 RT-PCR-confirmed COVID-19 from 1-September-2020 to 31-August-2022. The cohort was divided into those with high (>30), medium (> 20) and low (= 20) Ct values. Association between Ct values and disease severity was determined using Chi-square test and association between Ct values and mortality was determined using logistic regression.
Results:
There were 236 patients included with male predominance. Median age was 7 years. Most belonged to the 0-5 years age group. Most were severe to critical COVID-19 cases. Median day of illness on swab collection was 4 days. Majority presented with symptoms such as fever (54%), cough (22%) and dyspnea (22%). Eighty-four percent had co-morbidities, of which majority were cancer and neurologic diseases. Median Ct value was 30.81. Fifty-four percent had high Ct values. The median age of patients with a high Ct value was significantly lower than other cohorts. The median day of illness of patients with low Ct value was significantly shorter than other cohorts. There was no significant difference across the terciles in terms of presence of co-morbidities. Majority of patients for each cohort had high Ct values. There was no significant association between Ct value and COVID-19 disease severity on admission. Nearly fifty percent had critical disease and the all-cause mortality rate was 21.61%. There was no significant association between Ct value and mortality.
Conclusions
Ct value was not associated with disease severity and all-cause mortality after controlling for confounders. A look into medical interventions, emergence of variants, and other factors that may affect the clinical presentation, disease course, severity and outcome are recommended in future studies.
COVID-19
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Mortality
3.Interim guidelines on the screening, assessment and clinical management of pediatric patients with suspected or confirmed Coronavirus Disease 2019 (COVID-19) version 2, 12 April 2020
Maria Carmen B. Nievera ; Anna Lisa T. Ong-Lim ; John Andrew T. Camposano ; Ma. Liza Antoinette M. Gonzales ; Francesca Mae T. Pantig ; Paul Sherwin O. Tarnate ; Cecilia C. Maramba-Lazarte ; Lesley Anne C. Dela Cruz ; Jay Ron O. Padua ; Abigail C. Rivera
Pediatric Infectious Disease Society of the Philippines Journal 2020;21(1):69-113
4.2021 clinical practice guidelines in the evaluation and management of pediatric community-acquired pneumonia
Ma. Victoria S. Jalandoni-Cabahug, M.D. ; Maria Rosario Z. Capeding, M.D. ; Kristine Alvarado-Dela Cruz, M.D. ; Mark Joseph S. Castellano, M.D. ; Maria Nerissa A. De Leon, M.D. ; Jay Ron O. Padua, M.D. ; et al.
Pediatric Infectious Disease Society of the Philippines Journal 2023;24(1):121-175
Preface
The Clinical Practice Guidelines (CPG) for the Diagnosis and Management of Pediatric Community-Acquired Pneumonia (PCAP) was
initiated by the Philippine Academy of Pediatric Pulmonologists, Inc. (PAPP) and the Pediatric Infectious Disease Society of the
Philippines (PIDSP), in cooperation with Philippine Pediatric Society, Inc. (PPS) way back in 2004. Several CPG updates were then
undertaken by the PAPP PCAP CPG Task Force from 2008 to 2016. Clinically-relevant research questions were answered with recent
and current recommendations based on evidence from local and international data.
The 2021 PCAP CPG initiative was envisioned in March 2018 upon the recommendations of the 2018 PAPP Board for the purpose of
updating the evidence in the PCAP CPG 2016 clinical questions. This led to the collaboration of PAPP and PIDSP to develop this CPG.
Individual members were identified from each society as content experts to form the Steering Committee along with a clinical
epidemiologist and technical writer as review experts. The committee identified the scope and target end user of the CPG as well as
additional clinical questions to be included in the 2021 update aside from the questions on the previous CPGs. Selected members from
the two societies formed the Technical Working Group (TWG) who did the literature search, appraisal of evidences, and formulation
of recommendations. These recommendations were then presented to the stakeholders who became part of the consensus panel.
There was no identified conflict of interest among the CPG developers, TWG members and stakeholders. A survey to determine
potential competing interests were conducted during the development of this CPG. This initiative was fully funded by the PAPP and
PIDSP societies.
The 2021 PCAP CPG significantly differs from the previous CPGs in several aspects. First, the current guideline is a consensus between
two pediatric societies. Second, much of the literature review has been centered on meta-analyses or systematic reviews instead of
individual studies. Finally, appraisal of published literature was based on Grading of Recommendations, Assessment, Development
and Evaluation (GRADE) criteria. Such methodological differences may provide difficulties in defining evolution of care through the
years.
As identified in the previous CPG updates, there is lack of local data hence most of the evidences gathered came from international
studies. The applicability of such data to the local setting needs to be critically assessed for its value and relevance. Corollary to this,
several gaps in knowledge are identified and these may serve as a guide for future research.
5.Interim guidelines on the screening, assessment and clinical management of pediatric patients with suspected or confirmed Coronavirus disease 2019 (COVID-19)
Maria Carmen B. Nievera ; Cecilia C. Maramba-Lazarte ; Anna Lisa T. Ong-Lim ; John Andrew T. Camposano ; Ma. Liza Antoinette M. Gonzales ; Francesca Mae T. Pantig ; Paul Sherwin O. Tarnate ; Lesley Anne C. Dela Cruz ; Imelda A. Luna ; Jay Ron O. Padua ; Abigail C. Rivera ; Ma. Kristina Ulob-Torio
Pediatric Infectious Disease Society of the Philippines Journal 2020;21(2):71-109
6.Interim guidelines on the screening, assessment and clinical management of pediatric patients with suspected or confirmed Coronavirus Disease 2019 (COVID-19)
John Andrew T. Camposano ; Anna Lisa T. Ong-Lim ; Francesca Mae T. Pantig ; Paul Sherwin O. Tarnate ; Cecilia C. Maramba-Lazarte ; Lesley Anne C. Dela Cruz ; Imelda A. Luna ; Jay Ron O. Padua ; Abigail C. Rivera ; Ma. Kristina Ulob-Torio ; Ma. Liza Antoinette M. Gonzales
Pediatric Infectious Disease Society of the Philippines Journal 2021;22(1):103-160
7.SARS-CoV-2 Infection in Filipino Children: An interim report from the SALVACION registry
Abigail C. Rivera ; Francesca Mae T. Pantig ; Cecilia C. Maramba-Lazarte ; Arlene S. Dy-Co ; Venus Oliva C. Rosales ; Raymond Francis R. Sarmiento ; Allyne M. Aguelo ; Mary Crist A. Delos Santos-Jamora ; Imelda A. Luna ; Jay Ron O. Padua ; Cleo Anna Marie D. Pasco ; Anna Soleil Cheshia V. Tan-Figueras ; Pia Catrina T. Torres
Pediatric Infectious Disease Society of the Philippines Journal 2022;23(2):31-42
Background:
The COVID-19 pandemic continues to afflict nations worldwide. The Philippines is no exception which has recorded more than 3 million cases as of December 2021 with children comprising 12% of total cases. Since the start of the pandemic, the Pediatric Infectious Disease Society of the Philippines (PIDSP) has been collecting data nationwide, through an online pediatric COVID-19 registry (SALVACION registry), to provide a better understanding of COVID-19 in children in the local setting.
Methods:
This was an ambispective cohort study of pediatric COVID-19 cases in the Philippines reported from March 2020 to December 2021. Data on clinical features, laboratory findings, disease severity, and treatment outcomes were voluntarily reported by physicians across the country. This study was approved by the Department of Health Single Joint Research Ethics Board.
Results:
As of December 30, 2021, there were 2,127 cases reported in the registry, with a median age of 5 years (interquartile range: 1-13 years) and mostly mild (41.9%) or moderate (24.5%) in severity. The top symptoms reported were fever (57.9%), cough (42.7%), coryza/colds (29.4%), anorexia (25.2%), and difficulty of breathing (23.1%). The most common comorbidities were hematologic-oncologic diseases (7.4%), neurologic diseases (7.0%) and surgical conditions (4.4%), while the most common coinfections were sepsis (6.3%), dengue fever (4.8%) and healthcare-associated pneumonia (2.1%). Significantly higher median CRP, procalcitonin, D-dimer, ferritin, transaminases and lactate dehydrogenase were seen among severe/critical cases compared to non-severe cases. There was a high frequency of antibiotic use (58%). Most cases recovered, although 172 deaths were reported with an 8.6% case fatality rate. The most common comorbidities in those who died were neurologic (15.7%), cardiac (12.8%) and hematologic (11.6%) diseases.
Conclusion
Children across all age groups are susceptible to COVID-19 and most cases are mild or moderate in severity. Among severe and critical cases, the most common comorbidities were neurologic, hematologic-oncologic and cardiac diseases. Most patients recovered with supportive management.
COVID-19
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SARS-CoV-2
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Child
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Registries
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Philippines