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.

Background and Objectives: The hospital as health care facility has also become a source of infection that provides a place for different microbiological agents such as fungi. Exposure to these organisms is specifically detrimental to highly immunocompromised in-house patients. This study aimed to 1) detect the presence of fungi in a public tertiary hospital in Metro Manila; 2) determine the dominating fungal organism; and 3) describe the environmental conditions and physical factors affecting the proliferation of fungal organisms. Methodology: Eight sampling sites were selected for this study. The hospital main lobby was the comparison site for the three non-air-conditioned surgery wards (NACWs) while the fourth level nurse station is the comparison site for the air-conditioned wards (ACWs). Meteorologic conditions such as environmental temperature and relative humidity were also determined. Andersen air sampler was utilized to conduct the environmental indoor air sampling. A total of 98 malt extract agar supplemented with chloramphenicol (0.01%) plates were utilized for the duplicate sampling in eight sites. After three to five days of incubation at 37° C, the isolated fungal organisms were culturally and morphologically characterized. Results: Seven fungal organisms were isolated from the indoor air sampling conducted namely: Aspergillus fumigatus, Aspergillus flavus, Aspergillus niger, Curvularia sp., Penicillium sp., Alternaria sp. and Rhizopus sp.). The most dominant fungal species among the NACWs was A. niger. On the other hand, A. fumigatus was the most observed isolate among the ACWs. The air-conditioned wards showed a higher number of fungal isolates. In particular, A. fumigatus and A. flavus colonies in the ACWs were evidently higher than in the NACWs. Conclusion The ubiquitous nature of the Aspergillus species and slow settling rate due to small spore size make it the most dominant fungal organism retrieved in the air sampling conducted. No strict numerical guidelines were available for the spore counts of Aspergillus species to assess contamination rate. However, according to the Health Protection Surveillance Centre, 2018, the values of CFU/m³ of most of the isolates not only by Aspergillus species showed non-compliance with the threshold level documented.
Temperature

Objective: Data are scarce on the prevailing Streptococcus pneumoniae serotypes in the Philippines, including the relative antimicrobial resistance (AMR) of these bacteria. This study is designed to fill that gap by describing the serotype distribution and AMR of S. pneumoniae in the Philippines from 2012 to 2018. Methodology: S. pneumoniae isolates from clinical specimens were collected through the Philippine Department of Health Antimicrobial Resistance Surveillance Program from 1 January 2012 to 31 December 2018. Identification and antimicrobial susceptibility testing (AST) were performed using conventional and automated methods (Vitek2 Compact Automated Machine). AST for penicillin, erythromycin, co-trimoxazole, ceftriaxone and levofloxacin was done following the Clinical and Laboratory Standard Institute recommendations. Serotyping was done through slide agglutination following the Denka Seiken slide agglutination method. Results: From a total of 307 isolates of S. pneumoniae, 32 serotypes were identified; the most frequently occurring were serotypes 1, 3, 5, 4, 18, 19A, 6B, 15 and 14. Many (n=113, 36.53%) of the isolates were from those aged <5 years. Pneumococcal conjugate vaccine (PCV) coverage was as follows: PCV7 (32.69%), PCV10 (54.16%) and PCV13 (69.23%). The overall AMR of invasive S. pneumoniae isolates was low. Penicillin-resistant serotypes were 14, 19, 24, 4, 5, 1, 15, 6 and 32. Discussion: With the inclusion of PCV13 in the National Immunization Program, continued monitoring of the prevailing serotypes of S. pneumoniae isolates in the Philippines is needed to guide disease and AMR control measures.

Problem: Operation of the Philippine Antimicrobial Resistance Surveillance Program (ARSP) has been affected by the coronavirus disease 2019 (COVID-19) pandemic, during which time difficulties in maintaining laboratory functions, staffing levels and participation were reported. Context: The COVID-19 pandemic has increased pressure on most health systems and programmes in the Philippines, including ARSP. As ARSP is the source of national data on antimicrobial resistance (AMR) trends, there are concerns that the negative effects of the pandemic may have impacted the quality of data produced. Action: We describe disruptions to laboratory operations, personnel availability and participation in ARSP surveillance, and their impact on reported data for 2020. Outcome: Surveillance operations were challenged by reallocation of human, infrastructure and financial resources for pandemic response among both the sentinel sites and the coordinating laboratory, the Antimicrobial Resistance Surveillance Reference Laboratory. There was a decrease in the amount of data submitted to the surveillance system, as well as in the number of isolates sent to the reference laboratory for confirmation of bacterial identification and antimicrobial susceptibility testing. Nevertheless, overall performance scores of the sentinel sites for most parameters were comparable to 2019, the year prior to the pandemic. Discussion The impact of operational changes to ARSP due to the pandemic needs to be considered when analysing AMR surveillance data from 2020. Automation of data submission, good working relationships between the coordinating laboratory and sentinel sites, and supply chain system strengthening were identified as key to maintaining AMR surveillance during the COVID-19 pandemic.

Objective: The epidemiology of invasive non-typhoidal Salmonella (iNTS) in the Philippines is not well elaborated. The present study describes the serotype distribution and antimicrobial susceptibility patterns of iNTS in the Philippines from 2014 to 2018. Methods: Invasive NTS isolates were collected through the Department of Health’s Antimicrobial Resistance Surveillance Program (ARSP). The identification of the isolates was confirmed using automated (Vitek®, bioMérieux, Marcy l’Étoile, France) and conventional methods. The isolates were serotyped using the slide agglutination method, and susceptibility testing was performed using Clinical and Laboratory Standards Institute guidelines. Demographic data were collected from the ARSP database. Results: There were 138 isolates collected from human invasive specimens with 97.8% from blood samples. The most common serotypes were Salmonella Enteritidis (n = 84, 60.9%) and Salmonella Typhimurium (n = 18, 13.0%). Most of the isolates were from males (n = 88, 63.8%) and from the 0–5-year age group (n = 61, 44.2%). The proportions of iNTS isolates resistant to first-line antibiotics were as follows: ampicillin (23.2%), chloramphenicol (9.6%), ciprofloxacin (8.7%), ceftriaxone (2.2%) and trimethoprim-sulfamethoxazole (8.8%). The proportion of isolates with multi-drug resistance was 13.0% (18/138) with the most common resistance profile being resistance to ampicillin-chloramphenicol-ciprofloxacin from Salmonella Enteritidis isolates (n = 5). Discussion: Resistance to first-line antibiotics limits the therapeutic choices for Salmonella infection. Relevant local antimicrobial resistance data on iNTS may support appropriate empiric therapy among vulnerable populations.