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

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

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 most frequent cause of mortality in neonates is infections which include sepsis, meningitis, pneumonia, diarrhea and tetanus. Approximately 1.6 million deaths due to neonatal infections occur annually in developing countries. The causes of sepsis vary from one geographic area to another. Thus, it is important to create a database for the Philippines regarding the etiologies of neonatal sepsis. Objectives: The study was undertaken to determine the most common bacterial pathogens of neonatal sepsis in the Philippines and the antibiotic sensitivity patterns of these pathogens. Methods: A multicenter surveillance and chart review was conducted in five hospital sites for a period of six months- from July to December 2006. All neonates less than or equal to 28 days who had positive cultures from a sterile site and or had fulfilled the SIRS criteria as defined by the International Pediatric Sepsis Consensus Conference in the presence of suspected or proven infection were included in the study. Results: A total of 289 neonates fulfilled the criteria of sepsis. More than 61% of the patients had early onset neonatal sepsis. The most common site of infection was the lungs, (57%), followed by sepsis without an obvious site of infection (35%). In 50% of patients, an organism was identified; gram-negative bacteria were the dominant bacteria found (Pseudomonas, Burkholderia, Klebsiella) which comprised 94% of the bacteria isolated. Resistance patterns varied among the different urban study centers. The Pseudomonas and Burkholderia isolates from the Philippine General Hospital (PGH) were sensitive to ceftazidime. All Klebsiella isolates from St. Louis University (SLU) were resistant to third generation cephalosporins. In contrast, Klebsiella isolates from PGH and Davao were sensitive to third generation cephalosporins but resistant to piperacillin-tazobactam. The overall mortality rate was 11%. Ampicillin and an aminoglycoside were the most common regimens used but were only successful in less than 50% of cases. Conclusion: Gram-negative organisms comprised the majority of the neonatal infections, with Pseudomonas and Burkholderia being the most prevalent. Resistance patterns differed among the different centers. Continuing surveillance of infections is still needed in order choose the most appropriate empiric therapy for each center.
Human ; Male ; Female ; Infant Newborn ; SEPSIS ; INFECTION

Background: Using plants as antimicrobials has long been a practice of traditional healers and validating these customs may lead to the discovery and development of useful herbal medicines. Objective: This study aimed to determine the antibacterial activity of guyabano, tsaang gubat, sambong, and ulasimang bato against common pathogens. Methods: Aqueous or alcoholic leaf extracts of the different medicinal plants were prepared. The solid agar dilution method was used to determine the MIC of guyabano, tsaang gubat, sambong, and ulasimang bato against common pathogens including Staphylococcus aureus, Echerichia coli, Streptococcus pneumoniae, Hemophilus influenzae, Pseudomonas aeruginosa, Salmonella typhi, and Shigella flexneri. Results: The alcoholic leaf extract of guyabano showed moderate activity against oxacillin-sensitive S. aureus with an MIC of 5-6.3 mg/mL. However, tsaang gubat did not exhibit any antibacterial activity for drug-resistant enteric organisms (S. typhi, S. flexneri, and E. coli) and S. aureus at a concentration of 25 mg/mL. Even at a concentration of 100mg/mL, ulasimang bato failed to show any antibacterial activity against drug-resistant S. aureus, S. pneumonia, H. influenzae, E. coli, and P. aeruginosa. Sambong alcoholic extract had some antibacterial activity against penicillin-resistant S. pneumoniae with an MIC of 12.5 mg/mL. Conclusions Guyabano alcoholic leaf extract showed moderate antibacterial activity against oxacillin-sensitive S. aureus. Sambong alcoholic extract likewise exhibited inhibitory activity against S. pneumoniae. However, tsaang gubat and ulasimang bato aqueous extracts failed to show significant antibacterial activity for the pathogens tested.
Anti-Bacterial Agents

Objective: Leptospirosis in children is one of the most common diagnostic dilemmas, hence this study was performed to determine the clinical profile, outcome and risk factors associated with mortality in patients seen at tertiary government hospitals from January 2008 to December 2012. Methods: A case-control retrospective study was done among admitted patients at UP-PGH, SLH, and RITM. Descriptive statistics and multiple logistic regressions were utilized. Results: Among the 404 leptospirosis cases included in the study, 94% were male, with 43% belonging to 16-18-year-old age group (age range 3 to 18 years old). A higher occurrence was noted during the rainy season and in Manila. Clinical findings include fever, abdominal pain, calf tenderness, vomiting and conjunctival suffusion. Significant correlation was noted in patients with jaundice (p-value 0.014; OR 6.293, CI 1.449-27.335), dyspnea (p-value 0.004; OR 7.880, CI 1.967-31.561) and cardiac abnormality (p-value 0.042; OR 15.343, CI 1.106-212.853). Abnormal laboratory findings include neutrophilia, azotemia, creatinemia, anemia, elevated bilirubin levels and thrombocytopenia. Prolonged prothrombin time was associated with poor outcome (p-value 0.004, OR 23, CI 2.79-189.67). Penicillin was the drug of choice given to 96.8%. 94.6% of cases who had oliguric renal failure were conservatively converted to non-oliguric type. 5.4% underwent peritoneal dialysis and survived. Inotropes were used in 93% of non-survivors. The case fatality rate was 3.5% with the cause of death mostly due to Weil’s disease. The average hospital stay among survivors was 6.8+3.3 days as compared with 1.8+1.9 days in non survivors. Shorter hospital stay (p-value 0.00; OR 3.514, CI 2.115-5.839), as well as inotropic support (p-value 0.035; OR 62.511, CI 1.33-2949.134), were associated with poorer outcome, but these findings can be attributed to late presentation of cases at the hospital for admission. Conclusion A5 year review of patients with leptospirosis showed that jaundice, dyspnea, cardiac abnormality and prolonged prothrombin time were predictive of mortality.
Leptospirosis

Background: Amoebiasis is a global health problem affecting poor regions in the world. Few drugs such as metronidazole are available to treat this disease; unfortunately, it is associated with several serious side effects. Tsaang gubat and ampalaya have been used by traditional healers from different cultures to treat dysentery. Objective: The aim of this research was to provide evidence to validate the use of tsaang gubat and ampalaya leaf extracts for dysentery by determining their anti-amoebic activity. Methods: The tsaang gubat and ampalaya leaves were sourced from the University of the Philippines at Los Baños and processed into a lyophilized aqueous extract. Anti-amoebic activity was determined in an in vitro assay using Entamoeba histolytica HK-9 strain against 10 dose levels (18-10,000 μg/mL). The amoeba and leaf extracts were incubated for 24, 48, and 72 hours. The trophozoites were stained with Trypan blue and dispensed into chambers of a Neubauer hemocytometer. The live trophozoites (unstained) were counted under a binocular microscope. The MIC and IC50 were determined. Metronidazole and DMSO served as positive and negative controls, respectively. Results: Tsaang gubat and ampalaya leaves failed to show anti-amoebic activity and even had increased growth of amoeba at all dose levels. The IC50 of tsaang gubat and ampalaya leaf extracts were >500 μg/mL at 24, 48, and 72 hours. Metronidazole was able to eradicate the amoeba parasite at 24 and 72 hours, while exposure to DMSO did not result in inhibition nor death of the parasite. Conclusion Tsaang gubat and ampalaya aqueous leaf extracts did not exhibit any anti-amoeba activity.
Momordica charantia ; Antiparasitic Agents

Background: Multidrug-resistant gram-negative (MDR GN) infections pose a significant threat to pediatric health. One of the treatment options in resource-limited settings is polymyxin-based combination therapy. However, evidence on the safety and clinical effectiveness of polymyxin B in children is scarce. Objectives: This study described the outcomes of mortality, bacteriologic cure and clinical response in pediatric patients with MDR GN infections treated with polymyxin-B-based combination therapy. Adverse drug events (ADE) are likewise described. Methodology: This is a retrospective descriptive study conducted at the Philippine General Hospital (PGH) among pediatric inpatients from December 2020 to June 2023 with MDR GN infections treated with polymyxin B (PmB), combined with at least one other antibiotic with gram-negative coverage for at least 48 hours. Frequency and rates of the outcomes were measured and analyzed, in relation to the bacterial groups (Enterobacterales, Acinetobacter spp., Pseudomonas aeruginosa) and combination antibiotic regimens used, i.e., meropenem- and fluoroquinolone-containing regimen (PmB+MEM vs PmB+FQ). Frequency of ADEs were measured. Results: A total of 172 cases in 136 patients were reviewed. The rates for 14-day mortality, failure in bacteriologic cure, and failure in clinical response were 26%, 15%, and 19%, respectively. In Enterobacterales infections, PmB+FQ demonstrated lower rates of mortality, failure in bacteriologic cure, and failure in clinical responses. On the other hand, in Acinetobacter infections, PmB+MEM numerically had lower rates for the same outcomes. The Pseudomonas group had conflicting data on which regimen is numerically more favorable overall. No statistically significant differences were found in the outcomes. ADEs noted were tubulopathy (5 cases), anaphylaxis (2 cases), and neurotoxicity (1 case). Conclusion Polymyxin-B-based combination therapy appears to be an acceptable treatment option for MDR GN infections in children, especially in settings where novel antibiotics are not accessible. Safety profiles indicate common but manageable adverse effects.
Polymyxin B ; Child