The introduction of antibiotics has revolutionized the control of infections that remarkably reduced morbidity and mortality worldwide. Antibiotics have been the mainstay of treatment for many bacterial infections since their introduction in the 1940s. Through the years, the number and variety of antibiotics have increased due to the emergence of different bacterial infections. The challenge of antibiotic resistance is global. Many studies have been published showing the gravity of this problem both in the hospital and community setting. An important aspect of antimicrobial resistance (AMR) greatly affecting the medical community are the extended-spectrum beta-lactamase- producing organisms (ESBL).

OBJECTIVE: The study aims to determine the prevalence, antibiogram, and genotypic characteristics of the different isolates of ESBL in the Philippines.

METHODS: Available literature on ESBL in the Philippines from PUBMED and Herdin was collected, and additional microbiological data was gathered from the Philippine General Hospital (PGH). Ten studies and three annual ARSP reports of the 22 sentinel sites were included. The bacterial isolates and sensitivity to extended-spectrum antibiotics were collated and compared with each other.

RESULTS: There is increasing prevalence of ESBL from 1999-2013. The proportion of ESBL K. pneumoniae and E.coli ranged from 10 - 43.24% and 4 - 20.9%, respectively. There was varying antimicrobial activity against antibiotics. Limited data on the genotypic characteristics of ESBL was reported.

CONCLUSION: The continued rise in ESBL resistance needs immediate action. Information on ESBLs is limited, particularly in the country. More studies need to be conducted to expand our knowledge of ESBLs.

.escherichia Coli ; Anti-bacterial Agents ; Prevalence ; Hospitals, General ; Philippines ; Anti-infective Agents ; Drug Resistance, Bacterial ; Klebsiella Pneumoniae ; Microbial Sensitivity Tests ; Bacterial Infections ; Beta-lactamases ; Pubmed ; Gravitation

COVID-19 has disrupted daily living globally due to increased deaths and lockdowns that heavily affected 156 million learners as of July 2021. Over 28 million Filipino students had their classes cancelled for more than 41 weeks; hence, educational institutions have endeavored to continue teaching via alternative learning modes with remote learning as the most feasible. However, literature has mixed views of online education, citing positive and negative factors affecting learning. Thus, the objective of the article is to synthesize existing literature on the potential factors influencing student learning during the COVID-19 pandemic. Curricular design should take note of both physical and human factors. Physical factors include internet access and EdTech, while human factors include instructor's characteristics, curricular design, and student characteristics, attitudes, and psychosocial needs. Various steps such as ensuring internet access, training teachers, and characterizing students, alongside continuous feedback and timely preparation, are recommended to properly execute remote learning in emergencies.
Learning ; COVID-19

Background: In the time of the COVID-19 pandemic, the use of personal protective equipment (PPE) as an infection control measure is recommended for healthcare settings to prevent the spread of the virus. However, given the increased demand for PPEs worldwide and the limited resources available in the country, supply shortages are experienced by many healthcare facilities and workers. Furthermore, most PPEs should be discarded after use and may only be reused under emergency situations. Thus, the study sought to determine how to maximize PPE usage. Objective: The study aimed to compare the effect of Ultraviolet Germicidal Irradiation (UVGI) against Bacillus subtilis between 30 and 40-minute periods. Specifically, the study targetted to establish if there is a difference in the mean percent reduction in CFUs of B. subtilis between that of the 40-minute and 30-minute treatment group of N95 FFRs and coverall suits. Methodology: The study is a secondary research which builds upon the experimental results of the commissioned study conducted by the Department of Medical Microbiology (DMM), College of Public Health, University of the Philippines Manila researchers to conduct data analysis. Furthermore, the PPE evaluated were coverall suits and N95 filtering facepiece respirators. They inoculated a total of 30 samples with B. subtilis for each type of PPE and subjected them to UVGI treatment in 30 and 40-minute periods. This study then employed inferential statistics, particularly a two-sample independent t-test, to further analyze the data from DMM and assess the difference between the two UVGI exposure durations on PPE decontamination. Results: After calculating and analyzing the data using OpenEpi, the mean percent reduction was statistically greater (p-value = <0.0000001, α = 0.05) in the 40-minute exposure than the 30-minute exposure. The mean percent reductions of the N95 respirators were 98.68% and 99.41% for the 30 and 40-minute exposures, respectively. On the other hand, the mean percent reductions of the coverall suits were 80.40% and 99.71% for the 30 and 40-minute exposures. Conclusion Based on the significant difference in bacterial reduction between the two time exposures, the longer UVGI time exposure was more effective as a disinfectant. The results of the study contributed to knowledge on infection control using UVGI and its possibility as a method of decontaminating PPEs.
N95 Respirators

Background: Salmonellosis is one of the most reported bacterial foodborne illnesses worldwide. Salmonella outbreaks are also prevalent in the Philippines, with egg-containing food and feces of chicken as implicated sources. The presence of Salmonella in eggshells and in egg content poses a significant threat to public health. Hence, this study aimed to determine the presence of S. enterica from different parts of chicken eggs sold in a public market in the City of Manila. Methodology: A descriptive study design was employed to detect the presence of Salmonella spp. in different parts of retail chicken eggs. A total of 72 egg samples from 24 stalls were included. The methodology for isolation and identification of Salmonella followed the guidelines set by the US Food and Drug Administration as seen in the Bacteriological Analytical Manual with some additions and modifications. Results: Contaminated eggs were found in 21 (87%) of the 24 stalls. A total of 29 (40%) out of 72 eggs were identified as the source of putative Salmonella isolates. Nineteen (66%) eggs had putative Salmonella isolates from the eggshell, while 7 (24%) had putative Salmonella isolates from the egg content. There were three (10%) eggs with both eggshell and egg content possibly contaminated with Salmonella. Conclusion The presence of putative Salmonella and Enterobacteriaceae highlight the need to strengthen food safety at the production and distribution levels of retail chicken eggs. There is also a need to establish a national surveillance system along with strengthened diagnostic capacity for S. enterica in the Philippines.
Salmonella

Background: Coronavirus disease 2019 (COVID-19) is a respiratory disease that causes remarkable morbidities and mortalities worldwide. Public health measures have been implemented to control the spread of the disease. Knowledge, attitudes, and practices (KAP) of the community have to be optimum for the successful implementation of the prevention and control measures. Objective: Cognizant that children may possibly contribute to community transmission and that primary caregivers are the main educators of their children and implementers of preventive measures at the household level, the study aimed to determine the KAP of primary caregivers towards COVID-19 in a private tertiary hospital in Metro Manila, Philippines. Methodology: The study utilized a descriptive, cross-sectional design employing a web-based self-administered survey to determine the KAP of primary caregivers towards COVID-19 in a tertiary hospital. Results: There were a total of 149 respondents. Participants had a generally high knowledge of COVID-19, its symptomatology, and its prevention. Most of the respondents agreed that vaccination, quarantine, and community quarantine are necessary to prevent transmission. Primary caregivers responded that they protected their children by avoiding exposure and observing good hygiene measures. Despite the ongoing pandemic, most respondents would still bring their children to the doctor for routine vaccinations and consultations at the hospital when sick. Conclusion The findings of the study revealed a generally good KAP among the primary caregivers of pediatric patients which can help ensure the prevention and control of COVID-19. A strong health education campaign is needed to provide accurate information that will help sustain and/or increase compliance with COVID-19 prevention and control measures.
COVID-19 ; Knowledge ; Attitude

Background and Objective: Antimicrobial resistance (AMR) is a leading global public health concern as it resulted in more difficult-to-treat infections and fatalities. In the Philippines, drug-resistant E. coli, including multidrug-resistant (MDR), extended-spectrum beta-lactamase (ESBL)-producing, carbapenemase-producing carbapenem-resistant (CP-CR) E. coli, have been isolated from common food animals, increasing the risk of cross-contamination between humans, animals, and the environment. However, there is a lack of data on the distribution of E. coli in chicken meat in public wet markets. This study aims to describe the AMR profile of E. coli in raw chicken meat from retail stalls in a selected wet market in Manila City. Methods: This quantitative descriptive study characterized the AMR profile of E. coli isolated from 25 raw chicken meat samples from a wet market in Manila City. Antimicrobial susceptibility was determined through disk diffusion method against 23 antimicrobial agents in 16 antimicrobial classes. MDR E. coli were identified based on the resistance patterns. ESBL- and carbapenemase-producing capacities of the bacteria were tested through double disk synergy test and modified carbapenem inactivation method, respectively. Results: Twenty-four out of 25 (96%) chicken samples contained E. coli isolates. Of these, 23 (96%) were classified as MDR. High resistance rates were observed against ampicillin (92%), tetracycline (88%), trimethoprim-sulfamethoxazole (83%), chloramphenicol (79%), ampicillin-sulbactam (75%), amoxicillin-clavulanic acid (67%), fosfomycin (67%), and streptomycin (54%). The majority of the E. coli isolates were still susceptible to a wide range of selected antimicrobial agents, including carbapenems (100%), ceftriaxone (100%), cefepime (100%), cefuroxime (96%), cefotaxime (96%), ceftazidime (96%), piperacillin-tazobactam (96%), aztreonam (96%), cefoxitin (92%), and nitrofurantoin (83%), among others. Meanwhile, none of the 24 isolated E. coli samples were classified as ESBL- and CP-CR E. coli. Conclusion Among the 25 chicken samples, 24 E. coli colonies were isolated that exhibited 0% to 92% resistance rates against selected antimicrobial agents. Most isolates were classified as MDR, but none were considered ESBLand CP-CR E. coli. This study suggests that chickens in wet markets can potentially serve as reservoir hosts for drugresistance genes, which could transfer to other bacteria and contaminate humans, animals, and the environment within the food production and supply chain. These findings emphasize the need for AMR surveillance and strategies to combat AMR in the Philippines through the One Health approach.
drug resistance ; multi-drug resistance ; drug resistance, multiple ; carbapenemase ; Escherichia coli

BACKGROUND AND OBJECTIVE

Nontuberculous mycobacteria (NTM) lung disease appears like tuberculosis infection but is resistant to primary anti-tuberculosis drugs. Hence, patients whose sputum sample tests positive for acid-fast bacilli (AFB) and bacterial culture for several times should be assessed for colonization or infection with NTM in a damaged lung secondary to TB. In such cases, though drug-resistant TB may be adequately treated, treatment may need to be directed towards the NTM as well. In NTM therapy, the duration and choice of treatment agent is based upon the specific organism and disease extent. This study used one-step multiplex PCR (mPCR) assay for rapid differentiation of solid cultures in Ogawa medium as Mycobacterium tuberculosis (MTB) and/or NTM.

METHODS

A total of 80 stocked isolates obtained from the Lung Center of the Philippines from January to December 2018 were screened for NTM in terms of growth in Ogawa medium, acid fastness, and MPT64 TB antigen test result. These were from sputum specimens of multidrug-resistant tuberculosis (MDR-TB) patients. DNA was extracted from cultures (n=55) grown in Ogawa medium and one-step mPCR was performed to identify NTM to the species level.

RESULTS

Out of 80 samples screened, a total of 55 isolates were identified as NTM. One-step mPCR identified 12.73% (7/55) as M. abscessus, 34.55% (19/55) as M. massiliense, 1.82% (1/55) as M. kansasii, and 50.91% (28/55) were identified only up to genus Mycobacteria spp. Neither M. avium complex nor M. intracellulare was identified among the samples tested.

CONCLUSION

One-step mPCR was able to identify isolates as MTB or NTM coinciding with the initial screening using MPT64 TB antigen test. Multiplex PCR has given a more specific identificati on to the species level. The use of mPCR in identifying MTB and clinically significant NTM’s is suitable for the adequate treatment of mycobacterial infection.

Human ; Bacteria ; Multiplex Pcr ; Multiplex Polymerase Chain Reaction ; Mycobacteria ; Mycobacterium ; Tuberculosis, Multidrug-resistant

BACKGROUND AND OBJECTIVE

The human nasal passages host major human pathogens. Recent research suggests that the microbial communities inhabiting the epithelial surfaces of the nasal passages play a key factor in maintaining a healthy microenvironment by affecting both resistance to pathogens and immunological responses. Colonization of the nasal cavity by different pathogens such as Staphylococcus aureus and Klebsiella aerogenes, is associated with a higher postoperative infection morbidity. Povidone-iodine (PVP-I) as an antiseptic has been proven to display high antibacterial, antiviral, and antifungal properties even at low concentrations, and was shown to be effective in the control of infections to limit their impact and spread. It can be used as a topical antiseptic for skin decontamination and wound management, as a nasal spray, or as a gargle. There are different methods in testing the efficacy of potential antimicrobial suspensions. This study aimed to determine the concentration of PVP-I that is most effective in nasal decolonization using microsuspension test and colorimetric minimum inhibitory concentration (MIC) determination assays, resazurin microtiter assay (REMA), and Dey-Engley (D/E) neutralizer assay. The findings of this study will contribute to knowledge regarding the intended use of PVP-I in microbial control, particularly in bacterial infections.

METHODS

Several dilutions (2.0%, 1.0%, 0.5%, 0.25%, 0.1% and 0.09%) of commercially bought 10% (10 mg per 100 ml) povidone-iodine were prepared and tested against a standardized inoculum (1x105) of Staphylococcus aureus and Klebsiella aerogenes at different contacttimes (5 seconds, 10 seconds, 30 seconds, 1 minute, and 5 minutes). Microdilution suspension test was performed to determine the log reduction per variable, while REMA and D/E neutralizer assay were used to determine the MIC. A value of greater than or equal to 5 log reduction was considered effective for microdilution suspension test. Estimates of agreement statistics were used to interpret the results of the assay in which the overall percent agreement (OPA), positive percent agreement (PPA), negative percent agreement (NPA), and Cohen’s kappa statistics were calculated.

RESULTS

Povidone-iodine concentration of 0.25% exhibited ?5 log reduction against K. aerogenes at the minimum contact time of 5 seconds. On the other hand,  a slightly higher PVP-I concentration was required to achieve ?5 log reduction for S. aureus at 0.5% concentration and a minimum contact time of 1 minute. There was an observed concordance of the results of REMA and D/E neutralizer as MIC colorimetric indicators, which yielded an overall test percent agreement of 90.30% (95% CI: 84.73–94.36), and a strong level of agreement (? = 0.8, pCONCLUSION

Low povidone-iodine concentrations (i.e., 0.5% against S. aureus and 0.25% against K. aerogenes) were observed to have bactericidal activity of at least 5 log reduction as rapid as the minimum contact time of 5 seconds. Furthermore, D/E and REMA, as colorimetric indicators, had comparable performance (OPA = 90.30%; ? = 0.8, p
Human ; Bacteria ; Povidone-iodine ; Microbial Sensitivity Tests ; Anti-infective Agents, Local ; Enterobacter Aerogenes ; Staphylococcus Aureus

BACKGROUND

Pneumococcal vaccination has been widely used for the prevention of pneumococcal disease, with two types of vaccines available since 2009. With the World Health Organization (WHO) recommendation of incorporating pneumococcal conjugate vaccines (PCVs) in National Immunization Programs (NIPs) worldwide, a ten-valent PCV (PHiD-CV) was initially introduced in the Philippines in 2012. This, however, transitioned to the use of the 13-valent PCV (Prevnar) subsequent to the recommendation of the Formulary Executive Council in 2014.

OBJECTIVE

This review aimed to present evidence on pneumococcal disease and vaccine inclusion in the Philippine NIP from 2005 - 2021.

METHODS

This narrative review compiled articles on Pneumococcus from January 2005 to October 2021, sourcing literature from databases such as BIOSIS Preview, CAB Direct, Embase, Google Scholar, and others.

RESULTS

In the Philippines, there was a shift in prevalent serotypes of Streptococcus pneumoniae among children under five following the introduction of PCV13 in the National Immunization Program in 2014, with serotype 14 becoming the most common by 2018, and a significant reduction in isolates reported in 2020, where only serotypes 5, 19A, and 23F were identified among invasive strains. The immunogenicity results of a potential vaccine candidate should be factored into the overall evidence when conducting a reassessment of PCV.

CONCLUSION

As part of the decision making about the inclusion of the PCVs in the NIP of the Philippines, various factors such as local epidemiology, vaccine supply, cost, and programmatic characteristics must be careful weighed. Enhancing laboratory and surveillance capacity are essential to provide evidencebased decision-making in terms of existing serotype distribution and antimicrobial resistance (AMR) profile in the country. With the introduction of a new affordable formulation of a 10-valent PCV offering a comparable serotype coverage, the reassessment of choice of PCV with the consideration of all three formulations, namely PCV13, PHiD-CV, and SIIPL-PCV, may be warranted.

Bacteria ; 10-valent Pneumococcal Conjugate Vaccine ; 13-valent Pneumococcal Vaccine ; Pneumococcal Vaccines ; Philippines

Higher Education Institutions (HEIs) are acknowledged as key drivers in realizing health-related Sustainable Development Goals (SDGs). The University of the Philippines Manila, College of Public Health (UP CPH) together with the Asia-Pacific Academic Consortium for Public Health (APACPH), hosted the 53rd APACPH International Conference last 21-23 September 2022. The conference discussed current issues relating to the attainment of SDGs and promoted collaboration of leading academic institutions and other stakeholders in addressing various public health challenges. The conference revolved around the challenges and opportunities in attaining health-related SDGs, and the good practices and roles of HEIs in addressing health disparities. The lack of certificati on framework of public health tertiary programs, pedagogy and infrastructure, and ambiguous roles and network of public health professionals were discussed. The conference served as a platform for discussing potential resolutions and ways forward in addressing these challenges. Opportunities for improvement such as updating of policies and curricula, strengthening of internship and community engagement programs, establishment of capacity-building partnerships and programs, and developing multidisciplinary-competent faculty and students were identified. This paper providesthe highlights of the conference focusing on the good practices and roles of HEIs in addressing health disparities, the impact of COVID-19 pandemic, and other issues and challenges in attaining SDGs.

Human ; Sustainable Development ; Sustainable Development Goals ; Public Health