The application of nanoparticles (NPs) has attracted considerable attention as targeted delivery systems. CaCO3 has become the focus due to its advantages including affordability, low toxicity, biocompatibility, cytocompatibility, pH sensitivity and sedate biodegradability and environment friendly materials. In this article, we will discuss the potential roles of CaCO3-NPs in three major therapeutic applications; as antimicrobial, for drug delivery, and as gene delivery nanocarrier.
Antimicrobial agent

Plants have been a major source of natural products for sustaining human health. The use of the different parts of the plant as infusions, decoctions, extracts, and powders are being employed in the treatment of different diseases in humans, plants, and animals. One property of great significance in terms of therapeutic treatments, especially with the emergence of multi-drug resistant microbes, is the antimicrobial activity. A new promising source of antimicrobials that demonstrate novel mechanisms of therapeutic strategies is low molecular weight peptides. In this study, the antimicrobial activities of Mimosa pudica crude and partially purified peptide extracts against Gram-negative Enterobacter cloacae ATCC 23355 and Enterobacter aerogenes ATCC 13048, and Gram-positive Staphylococcus epidermidis ATCC 12228 using resazurin colorimetric assay and tricine SDS-PAGE bioautography were reported. M. pudica crude and partially purified extracts exhibited antimicrobial activity against all the bacteria tested. Specifically, the peptide that was partially purified from M. pudica with a molecular weight of 5.14 kDa inhibited the growth of Enterobacter cloacae.
Antimicrobial Peptides

Background and Objectives: Antimicrobial resistance (AMR) is a global public health threat that results from misuse and overuse of antimicrobials. The Department of Health (DOH) institutionalized the Antimicrobial Stewardship (AMS) Program in hospitals, based on the core elements (1) Leadership, (2) Policies, Guidelines, and Pathways, (3) Surveillance Antimicrobial Use (AMU) & AMR, (4) Action, (5) Education, and (6) Performance Evaluation to ensure rational use of antimicrobials and improve patient outcomes. The program implementation will require the involvement of the AMS clinical pharmacist to positively influence the success of the program’s implementation. This study aims to identify the enablers and challenges as perceived by AMS clinical pharmacists in the implementation of an AMS program in a level 3 hospital in Manila. Methods: A quantitative descriptive study design was employed by administering an online 50-item survey questionnaire to AMS pharmacists, who have at least six (6) months of experience as an AMS pharmacist in the hospital. The survey questionnaire was validated by an expert consultant and underwent pre-testing (Cronbach α = 0.983) for acceptable internal consistency. Responses were collated, coded, and analyzed using median values and frequency distributions for each questionnaire item per Department of Health (DOH) Core Element. Items garnering a median of >3.50 up to 5 were considered as perceived enablers, while those ≤3.50 were identified as perceived challenges. Results: Some perceived enablers by the AMS pharmacists include presence of a leader and/or clinician in the AMS team, Information Technology (IT) resource availability, clear roles of AMS pharmacists, readily available hospital AMS guidelines, engagement in AMR and AMU surveillance activities, regular performance of AMS interventions (e.g., IV-to-PO conversion, dose optimization, de-escalation of broad spectrum), regular monitoring and evaluating of prescriptions and prescribing behavior, and continuous education on infection, prevention, and control (IPC) and hygiene. On the other hand, some perceived challenges include insufficient funding, inadequate knowledge in interpreting antibiograms, lack of adequate and specialized training sessions, lack of coordination with medical and nursing staff to ensure timely drug administration and automatic stop order, prescribing of non-Philippine National Formulary (PNF) antimicrobials, lack of time to perform AMS activities, lack of qualified personnel, and lack of hospital management and information technology (IT) support. Conclusion Empowering AMS clinical pharmacists is vital to addressing the perceived challenges and maximizing the perceived enablers to ensure the successful implementation of the AMS program in the hospital.
Antimicrobial Stewardship

Background: Streptococcus pneumonia (S.pneumoniae) is the main cause of acquired pneumonia in the community along with otitis media, sinusitis, septicemia and meningitis. Objectives: The study determined antimicrobial resistance and serotype distribution of Streptococcus pneumonia isolates from hospitalized children at Hai Phong Children's Hospital, Vietnam. Subjects and method: From June 2006 to September 2007, 80 pneumococccal isolates were tested for susceptibility to the 13 antibiotics and 84 pneumococcal isolates were serotyped. Results:Seventy-five percent of strains showed multi-drug resistance. Ninety percent of strains showed resistance to penicillin (48% intermediate and 42% fully resistant). In addition, 100% of isolates were resistant to cotrimoxazole, 74% of isolates were resistant to cephalexin; 71 % of isolates were resistant to erythroomycin and 58% were resistant to cefuroxxime. Almost all the isolates were susceptible to amoxicillin, cefotaxime, ceftriaxone, ceefepime, ofloxacin and 100% of isolates were susceptible to vancomycin. Among the 84 serotypes, 82% were included in the 23 valent pneumococcal polysaccharide vaccine including: 19F (30%), 23F (21 %), 14 (13%) and 6B (13%). Six other serotypes (13, 15C, 18, 11A, 15B and 6A) accounted for 12% of strains and 9 (11%) strains were untypeable. Conclusion: Pneumococcal antibiotics is spreading most rapidly among children in Vietnam, especially strains typs 19F and 23 F. Concerted efforts are necessary to prevent it spreading.\r\n", u'\r\n', u'
Antimicrobial resistance ; streptococcus pneumonia

Background: Based on the 2017-2020 annual report of the Department of Health-Antimicrobial Resistance Surveillance Program, significant resistance patterns have been observed for common disease-causing pathogens. In the hospital setting, antimicrobial stewardship programs have been implemented to optimize the use of antimicrobials. Drug utilization review studies provide essential feedback to improve prescribing and use of medications. Objectives: This study aimed to review drug utilization of monitored parenteral antimicrobials among patients admitted from January to December 2019. Methods: The study employed a retrospective, cross-sectional, descriptive research design. A retrospective chart review of drugs administered to patients was conducted. : Results. A total of 821 patients charts met the inclusion criteria. The patients’ ages ranged from 18 to 98 years old and 52% were females. General Internal Medicine practitioners (28%) were the top prescribers of monitored parenteral antimicrobials primarily for the management of moderate-risk community-acquired pneumonia (39%). They were mostly indicated for empirical treatment of infections (94%) and were given for an average of 5.73 days. Only 58% of the total cases had orders for culture and sensitivity testing. Of which, principally 47% had colony cultures. Blood (29%) and sputum (27%) were the most common specimens taken for culture and sensitivity testing. The microorganisms often isolated were Escherichia coli (19%), Klebsiella pneumoniae (18%), and Staphylococcus aureus (9%). In addition, extended-spectrum beta lactamase-producing gram-negative pathogens (4%) and methicillin-resistant S. aureus (1%) were also isolated. All the microorganisms isolated showed most resistance to ampicillin (81%) and most susceptibility to colistin (100%). There were drug therapy-related problems encountered. There was one case of an adverse drug reaction (0.1%) and two cases of contraindications (0.2%). Therapeutic duplication was also observed in 5% of the cases. Moreover, 39% had instances of drug-drug interactions.Piperacillin-tazobactam had the highest consumption (79.50 defined daily doses/1,000-patient days) among the monitored parenteral antimicrobials. Some prescriptions were deemed inappropriate upon evaluation. 12% of cases were inappropriate based on the justification indicator. As for the critical indicators, duration of therapy (78%) was the main reason. Only four components of the DUE criteria indicators have met or exceeded the established threshold level.The cost analysis indicated that the total actual cost of therapy with the monitored parenteral antimicrobials amounted to ₱17,645,601.73. Considering Department of Health National Antibiotic Guidelines recommenda-tions, ideal total cost of treatment was ₱14,917,214.29. Potential cumulative cost savings of ₱2,728,387.44 could have been achieved for patients admitted last 2019. Conclusion Consumption of piperacillin-tazobactam was relatively high as compared to the other monitored parenteral antimicrobials covered in this study. Physicians at the study site seldom prescribe monitored parenteral antimicrobials as recommended by the National Antibiotic Guidelines. This is evidenced in the incidence of inappropriate therapy regimens, with inapt duration of therapy as the leading explanation.From the patient’s perspective, the main economic implication was on the direct medical costs, particularly the increased cost of the actual antimicrobial therapy prescribed to manage various infections. Adherence of physicians to the established guidelines and selection of the most cost-effective therapy could have resulted in considerable cost savings.
Drug Utilization Review ; Antimicrobial Stewardship

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 ; Viperidae ; Health Personnel

Introduction: Surgical site infections (SSI) are common healthcare associated infections (HAI) that is associated with increased morbidity and cost. Antimicrobial prophylaxis is effective when used appropriately. This study assesses the prophylactic antimicrobial prescribing and practice in the orthopaedic wards based on the Scottish Intercollegiate Guidelines Network (SIGN) guideline on antibiotic prophylaxis in surgery. Materials and Methods: Patients admitted to the Orthopaedics wards over a four-week period were studied (n = 68). Criterions 1 to 4; appropriateness, choice of antimicrobial and route of administration (1- given when indicated, 2- not given when not indicated, 3- appropriate choice and 4- given intravenously), criterions 5 to 7; allergy status and documentation (5: documentation, 6- details and 7- definite or possible history reaction immediately after penicillin therapy should not receive prophylaxis with a beta-lactam antimicrobial), criterions 8 to 10; documentation of antimicrobial given (8- name, dose and route of administration, 9- documentation in the appropriate 'one-off' section of the drug chart and 10- documentation of time of administration and surgical incision) and criterion 11 to 14; time and doses required (11- prophylaxis should be given 30 minutes before surgery, 12- additional intra-operative dose not required, 13- post-operative doses of prophylaxis not given and 14- a 24 hours regimen of prophylactic antimicrobial is given for primary arthroplasty procedures). A simple scoring system was used to allocate level of appropriateness. The rate was considered 'very good' for above 85%, 'good' for 70%-85%, 'moderate' for 50%-69%, 'poor' for 30%-49% and 'very poor' for below 30%. Results: The overall conformation to criteria and standards was 66.4% (95% CI 61.7-70.7). The rates were rated as 'very good' for criterion 1, 3, 4, 5b, 6, 8 and 9, 'good' for criterion 5a and 'poor' for criterions 2 and 5c. The adherence rates were 'very poor' to criterion 10a, 10b, 13 and 14. Intravenous cefuroxime was used as the first choice for antimicrobial prophylaxis. Conclusions: The overall practice was moderate and the choice of drug was considered appropriate. However, certain areas such as documentation need improvement. A local guideline may be useful.
Antimicrobial ; Orthopaedic Surgery ; Surgical Site Infection

Background and Objectives: The increase in the number of invasive Aspergillus infections has been observed among immunocompromised and hospitalized patients. In the Philippines to date, no published data focused on the prevalence of Aspergillus species or any other thermotolerant fungal species in a hospital environment. This research served as a primary study to characterize the antifungal susceptibility of environmental strains of Aspergillus fumigatus from a hospital facility against three antifungal agents and to determine the virulence of these isolates on BALB/c mice using an animal survival assay.
Methodology: Ten environmental strains of A. fumigatus were isolated from three air-conditioned wards in a medical facility using Andersen Air Sampler. The antifungal susceptibility profile of the isolates was determined against Voriconazole, Amphotericin B and Caspofungin. The virulence of these isolates was also tested on BALB/c mice using an animal survival assay. Moreover, the lung tissues of infected BALB/c mice were subjected to histopathological analyses using Gomori Methenamine Silver stain (GMS) and Hematoxylin & Eosin (H&E) stains.
Results: Etest result for antifungal susceptibility testing showed that two of the ten isolates were resistant to Amphotericin B (AF2-A and AF-3A); one isolate resistant to Voriconazole (AF2-A) and an isolate that manifested non- susceptibility to Caspofungin m(AF2-A). Epidemiological cut-off values were determined for each antifungal following the M38-A2 CLSI guidelines. BALB/c mice median survival analysis revealed that the isolate with the highest Minimum Inhibitory Concentration (MIC= 4.89 ?g/ml) for Voriconazole resulted in the most number of mortality with the least number of observation days. GMS AND H&E histopathology slides showed fungal elements embedded on left lung lobe of mice.
Conclusion: This study showed that there were strains of Aspergillus fumigatus from a hospital indoor air which were considered as resistant strains to Voriconazole, Amphotericin B, and Caspofungin (AF2-A and AF3-A). Lung tissues of infected mice showed characteristics of bronchopneumonia.

Antimicrobial peptides (AMPs) are small molecule peptides that are widely found in living organisms with broad-spectrum antibacterial activity and immunomodulatory effect. Due to slower emergence of resistance, excellent clinical potential and wide range of application, AMP is a strong alternative to conventional antibiotics. AMP recognition is a significant direction in the field of AMP research. The high cost, low efficiency and long period shortcomings of the wet experiment methods prevent it from meeting the need for the large-scale AMP recognition. Therefore, computer-aided identification methods are important supplements to AMP recognition approaches, and one of the key issues is how to improve the accuracy. Protein sequences could be approximated as a language composed of amino acids. Consequently, rich features may be extracted using natural language processing (NLP) techniques. In this paper, we combine the pre-trained model BERT and the fine-tuned structure Text-CNN in the field of NLP to model protein languages, develop an open-source available antimicrobial peptide recognition tool and conduct a comparison with other five published tools. The experimental results show that the optimization of the two-phase training approach brings an overall improvement in accuracy, sensitivity, specificity, and Matthew correlation coefficient, offering a novel approach for further research on AMP recognition.
Anti-Bacterial Agents/chemistry* ; Amino Acid Sequence ; Antimicrobial Cationic Peptides/chemistry* ; Antimicrobial Peptides ; Natural Language Processing

Antimicrobial peptides (AMPs) are a class of peptides widely existing in nature with broad-spectrum antimicrobial activity. It is considered as a new alternative to traditional antibiotics because of its unique mechanism of antimicrobial activity. The development and application of natural AMPs are limited due to their drawbacks such as low antimicrobial activity and unstable metabolism. Therefore, the design and optimization of derived peptides based on natural antimicrobial peptides have become recent research hotspots. In this paper, we focus on ribosomal AMPs and summarize the design and optimization strategies of some related derived peptides, which include reasonable primary structure modification, cyclization strategy and computer-aided strategy. We expect to provide ideas for the design and optimization of antimicrobial peptides and the development of anti-infective drugs through analysis and summary in this paper.
Antimicrobial Cationic Peptides/chemistry* ; Antimicrobial Peptides ; Drug Design ; Anti-Infective Agents/pharmacology* ; Anti-Bacterial Agents