2012 Journal

Journal 2012 Vol 13 Supplement 1
PIDSP reaches out to Families in Montalban
Timmy Gimenez,Cecilia Maramba-Lazarte, M.D., MScID
Abstract:
December 6, 2011 was our version of WE CARE DAY. Members of PIDSP (Drs. Betty Quiambao, Chette Gonzales, Joanne de Castro, Maean Banez, Timmy Gimenez, Nanette Madrid, Jing Pagkatipunan, and Cecile M. Lazarte) woke up early to travel to the HE CARES Foundation in Montalban, Rizal . The day was perfect , complimented and punctuated with amusing updates from the resident comedian, Joan. He Cares Foundation is a Christian non-profit organization that helps extremely poor families by providing basic needs like food, clothing, education and medical assistance, as well as spiritual support. It was founded by full-time lay missionaries, Joe Dean Sola & his wife, Ardis in 1996. Bro Joe Dean was on hand to introduce the families who benefit from services of the foundation. We had the opportunity to deliver free medical check-up services to around 120 patients aside from vaccinating 100 adults and children from the community. Despite the heat , we went home happy and determined to duplicate the endeavor. Our special thanks to Sanofi Aventis for donating the Influenza vaccines, Dr Betty for facilitating vaccine donation, Cecile for initiating and coordinating the mission and to Nanette who unselfishly celebrated her fortieth birthday with the group.
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Prevalence of Viral Pathogens Among Pediatric Patients Admitted for Pneumonia In a Local Tertiary Hospital
Charlene Mae B. Perez, M.D., Baguio General Hospital
Keywords: viral pneumonia, RSV, viral isolates, respiratory tract infection
Abstract:
In the Cordillera Administrative Region, pneumonia has been the second most common cause of morbidity. In Baguio General Hospital and Medical Center (BGHMC) pneumonia has been the number one cause of morbidity and one of the top three causes of mortality among pediatric patients since 2002; these were all treated as bacterial pneumonia. However, the epidemiology of viral pneumonia has not yet been studied.
Objectives: The goal of this study was to determine the prevalence of viral pneumonia among pediatric patients admitted from May 2009 to April 2010. METHODS: A chart review was performed to provide data on (1) all patients’ ages 0 to 18 years old admitted in the institution for pneumonia; (2) those enrolled in the SARI epidemiological surveillance from May 2009 to April 2010; (3) only patients admitted on Sundays or Wednesdays; and (4) those swabbed within 24 hours of admission (This is the schedule agreed upon by the involved groups on the oropharyngeal and nasopharyngeal swabbing at the institution for the SARI surveillance which is done during Mondays and Thursdays); (5) those who recently have not taken any antiviral medications; and (6) those who were not subjected to oropharyngeal or nasopharyngeal swabs prior to admission. the prevalence of viral pneumonia among pediatric patients admitted from May 2009 to April 2010 (indicate Baseline characteristics such as age, sex, clinical symptoms, and co-morbid diseases, course and length of hospital stay; and outcome data was gathered.
Results: A total of 982 pediatric patients were admitted for pneumonia. Of the three-hundred-seventy seven patients tested for viral isolates, 28.1% were positive and most of the cases with viral isolates were in October. In all ages, Respiratory Syncytial Virus (RSV) was the most prevalent (87.74%). Subjects who were less than one year old showed a higher detection rate of virus. There were more patients from the viral isolate negative group who presented with signs of respiratory distress. Most of the patients of both groups were discharged after one-to-three hospital days.
Conclusion: RSV was the most common virus isolated. Children less than one year old had the highest detection rate of a virus. .
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Effects Of Storage Process On The Bacterial Growth-Inhibiting Activity Of Expressed Human Breast Milk On Common Neonatal Pathogens, Staphylococcus aureus, Escherichia coli And Klebsiella pneumoniae
Jennifer Lou L. Lorico, M.D., Ma. Lucila Perez, M.D., Ospital ng Makati
Keywords: Breast milk, breast milk storage, Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae
Abstract:
Storage of human breast milk is unavoidable especially among working mothers who need to report back to work soon after delivery. The aim of this study was to describe the effects of storage process on the bacterial growth-inhibiting activity of expressed human breast milk on common neonatal pathogens.
Methods: This was an experimental study performed at the Ospital ng Makati on the breast milk of mothers who were without infection prior to delivery, did not take any medications, and spontaneously delivered their babies full term. Fifteen mothers expressed breast milk within the first seven days up to one month, postpartum. Each milk sample was stored and tested with the following time series: immediately after expression; thawed after being frozen for 24; and thawed after being frozen for 72 hours. Each of the broth medium containing Staphylococcus aureus, Escherichia coli or Klebsiella pneumonia was added to 1 ml of expressed breast milk. Tenfold dilutions were made. Each dilution was plated at zero and four hours and colony-forming units (CFU) were counted after 24 hours incubation. Same procedure was performed on a negative control.
Results: The number of CFU for the three tested organisms (had lower nominal counts with the breast milk solution when compared to control solutions both at zero-hour and four-hour test samples. Breast milk exhibited bacteriostatic properties against most pathogens except for Escherichia coli after being frozen for 24 hours. For the breast milk that was frozen for 72 hours, most tests did not show significant lower counts when compared to control solutions, except still for Staphylococcus aureus and Escherichia coli both at 0 hour.
Conclusion: Breast milk has bacterial inhibiting property against common neonatal pathogens. Bacteriostatic property of breast milk started to diminish after being frozen for 72 hours, but still exerted its inhibiting property.
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Clinical Profile and Outcome of Children with Parapneumonic Effusion
Grace Devota Gomez-Go, M.D., Ma. Liza Gonzales,M.D.**, Anna Ong-Lim,M.D.** **UPCM-Philippine General Hospital
Keywords: Parapneumonic effusion, community acquired pneumonia, empyema, pleural effusion
Abstract:
Parapneumonic effusions frequently occur as complications of pneumonia. Data from developing countries is limited. The purpose of this paper is to review the epidemiological and clinical profile of parapneumonic effusions among children admitted in a tertiary government hospital.
Methodology: Medical records of 72 children diagnosed with parapneumonic effusions from 2005-to-2009 were obtained. Demography, clinical presentations, diagnostics, treatment modalities, outcomes, etiology and antibiotic susceptibilities were analyzed using descriptive statistics. Comparison of purulent effusion and empyema was done using parametric or non-parametric statistics, accordingly.
Results: There were 106 children discharged with a diagnosis of parapneumonic effusion. Of the 96 medical records available, 72 patients fulfilled the criteria for parapneumonic effusions. Only 53 patients submitted pleural fluid for analysis: 29 cases were empyema, while 24 cases were purulent effusion; mean age was 9.66 years. Fever (90.28%), cough (69.44%), and dyspnea (66.67%) were the most common clinical presentations. Forty-four patients underwent thoracentesis while 37 children had closed-tube thoracostomy. Methicillin-resistant Staphylococcus aureus(MRSA) was the most commonly isolated organism from the pleural fluid cultures (9.26%) and blood cultures (6.25%). Patients with purulent effusion were treated with a combination of antibiotics and anti-TB meds (75%).Majority of patients with empyema were treated with antibiotics alone (79.31%). Earlier improvement and shorter hospital stay were observed among patients with purulent effusion.
Conclusion: Parapneumonic effusions occurred in 6.80% of hospitalized children with pneumonia; 54.72% of which were empyema and 45.28% were purulent effusion. MRSA was the most commonly isolated organism. Chest imaging, pleural fluid analysis and cultures, and blood cultures were important diagnostic procedures. The mainstays of treatment were medical, surgical or both, depending on the severity of effusion. Prompt diagnosis and management could account for favorable clinical outcomes.
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Novel Influenza AH1N1 Infection Among Pediatric Patients Admitted In A Local Tertiary Hospital
Sharon B. Gawigawen, M.D., Baguio General Hospital
Keywords: Influenza A H1N1, viral respiratory infections, influenza
Abstract:
Introduction: The influenza virus is a single stranded RNA virus which has the potential to cause periodic global pandemics. The first major Influenza A global pandemic devastated the 20th century with the Spanish flu in 1918; it had more than 2.5% case fatality rate. In the 21st century, the Influenza A pandemic was first detected in Mexico in March 2009 and from then, there had been a rapid increase in the number of reported cases and deaths reported which created panic.
Objectives: This study aims to determine the profile of pediatric patients with confirmed Novel Influenza AH1N1 at a Local Tertiary Hospital from June 2009 to December 2009.
Methods: This study is retrospective chart review of patients aged 0-19 years old, confirmed to have influenza A H1N1 and were admitted at Baguio General Hospital. Their demographic profile, signs and symptoms, laboratory examinations, treatment and outcome were recorded in a uniform case repot form.
Results: Of the 235 pediatric cases of influenza-like illness seen, 31(13%) were admitted. Fifteen (48.3%) of the admitted patients were positive for the novel influenza AH1N1. Majority of the cases were from the five-to-nine age group (34%), while three (20%) were from the age group, two years old and below. The presenting signs or symptoms were fever (100%), cough (80%), colds (47%) and sore throat (34%). Most common underlying conditions noted were bronchial asthma in six (40%) of the cases. Complete blood count revealed anemia in 40%, leukopenia in 26.67%, and lymphocytosis in 26.67% cases. Using chest radiograph, pneumonia was seen in 40% (6/15) of patients. Two (13.3%) revealed no growth in their blood cultures while one had Klebsiella pneumonia and another one grew Candida non-albicans. All received Oseltamivir upon admission and was completed for five days. Antibiotics were given to those with bacterial co-infection. The mean duration of hospital stay was eight days: 13 (86%) patients were discharged in improved condition; while, two (13.3%) died due to respiratory failure.
Conclusion: There was an equal distribution of both sexes in the study. Incidence was highest among five years old and below. The pediatric influenza AH1N1 infection presented with mild acute respiratory tract infection. Most cases were uncomplicated although majority of them had underlying medical conditions putting them at risk for complications. Oseltamivir was the mainstay of treatment in conjunction with antimicrobials for those who had bacterial co-infections. Most of the patients improved with a case fatality rate of 13.3%
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Pathogens Causing Urinary Tract Infection and Their Resistance Patterns among Pediatric Patients in Chong Hua Hospital (January 2003 to June 2005)
Arlene Rodriguez-Encarnacion, M.D,Chong Hua Hospital, Cebu
Keywords: UTI, urinary tract infection, etiology of UTI, E. coli
Abstract:
The management of urinary tract infection (UTI) is fraught with challenges, especially, in an era of increasing antimicrobial resistance. Antibiograms that make use of local and population-based data aid clinicians in their treatment strategies. Objectives: This study aims to determine the common organisms isolated in the urine culture and the organism’s sensitivity pattern to antibiotics among inpatients and outpatients aged 0-18 years old at Chong Hua Hospital from January 1, 2003 to June 30, 2005. Methods: Data from inpatients and outpatients aged 18 years old and below with a urine culture of ³ 100,000 CFU of a single pathogen were collected from the Chong Hua Hospital Microbiology Laboratory within a 30-month period. The organisms cultured were identified and the resistance pattern of the 5 most common isolates was determined. The medical charts of inpatients were reviewed to determine the initial antibiotics started. Results: 140 patients were included in the study. UTI was most common in the >28 days to 1 year age group. UTI was more frequent in males aged >28 days to 1 year and in females aged 1 to 5 years. The common isolates were: Escherichia coli (75%), Proteus mirabilis (6%), Pseudomonas aeruginosa (6%), Enterobacter sp (5%), and Klebsiella pneumoniae (4%). Antibiotic susceptibility testing revealed that there was resistance to ampicillin (76%) and cotrimoxazole (64.15%). Less than 10% resistance was found with ceftriaxone, imipenem, gentamicin, ciprofloxacin, netilmicin, amikacin and cefepime. Cefuroxime was the most common antibiotic started in hospitalized patients. Conclusion: The most common etiologic agents of UTI were E. coli, P. mirabilis, P. aeruginosa, Enterobacter sp. and K. pneumoniae. There was high resistance to the recommended first-line antibiotics cotrimoxazole and ampicillin.
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Nasal Carriage of Staphylococcus aureus among Pediatric Health Care Workers in a Pediatric Intensive Care Unit
Pablito M. Planta Jr., M.D.*, Armi Grace G. Laiño, M.D.*, Ma. Noreen B. Alqueza, M.D.* Ma. Liza M. Gonzales, M.D.* *Philippine General Hospital
Keywords: Staphylococcus, Staphylococcus aureus, MRSA, nasal carriage
Abstract
Background/Objective: An outbreak of nosocomial infections through nasal carriage of organisms by health care workers may also occur. The health care workers (who are in close contact with the patients are possible sources of hospital-acquired infections. Staphylococci are a leading cause of bacteremia, surgical wound infections and nosocomial infection in many areas around the globe. The objective of this study was to determine the nasal carriage rate of Staphylococcus aureus among health care workers in a pediatric intensive care unit.
Methods: Twenty six healthcare workers in a pediatric intensive care unit of a tertiary hospital were included. Cultures from the anterior nares were obtained using a sterile cotton tip swab, which was moistened with sterile normal saline solution. Samples were then analyzed using standard microbiological methods. The susceptibilities of the isolates to antibiotics were then determined by the Kirby Bauer disk diffusion method. Nasal carriage rate of Staphylococcus aureus was determined.
Results: The mean age of the subjects was 35 years (range 22-56) old. There were 20 nurses (76.9%), 4 (15.4%) nurse assistants, and 2(7.7%) utility workers; 3 (11. 5%) were males and 23 (88.5%) were females. Two subjects (7.7%) grew Staphylococcus aureus. Both reported 100% sensitivity to all tested antibiotics except for Penicillin G which showed 100% resistance. Twenty four of the subjects (92.3%) grew Staphylococcus epidermidis, 5 (20.83%) were methicillin resistant. All showed 100% sensitivity to Gatifloxacin, Levofloxacin, Oxacillin, and Vancomycin. There was high resistance (62.5%) to Penicillin G.
Conclusion: The nasal carriage rate (7.7%) of Staphylococcus aureus in this study is lower compared to earlier reports. The results of this study showed higher nasal carriage of Staphylococcus epidermidis (92.3%).
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Antibiotic Prescribing Patterns of Pediatric Residents: Do the Results of Blood Cultures Make a Difference?
Bernadette R. Regalario, M.D.*, Ma. Cecilia D. Alinea, M.D.*, *UPCM-Philippine General Hospital
Keywords: bacteremia, blood culture, antibiotics
Abstract:
The diagnosis of bacteremia relies on the isolation and identification of the bacteria from blood cultures, whether they are community-acquired or nosocomial in origin. However, studies have shown that, in the Philippines alone, physicians have been found to underutilize these laboratory examinations.
Objectives: The goal of this study was to determine the influence of positive blood cultures and sensitivity test results on the antibiotic choices of pediatrics residents at the University of the Philippines – Philippine General Hospital (UP-PGH).
Methods: A chart review of patients with positive blood cultures, who were 18 years old and below, and admitted initially at the UP-PGH Pediatric Emergency Room (UP-PGH PER) from August 1, 2004 to July 31, 2005 was performed. Excluded were patients who died before the release of the blood culture reports or discharged per request or against medical advice, post-operative patients, patients with presumed polymicrobial sepsis, and patients with contaminated blood cultures. Results: One hundred twenty two (122) patients with positive blood cultures were included: 87 or 71.3% of the isolates were community-acquired, the most common pathogens of which were gram-positive bacteria, Staphylococcus epidermidis (18.3%), followed by gram-negative Salmonella (11.5%). Among the patients diagnosed with bacteremia at the UP-PGH PER, Staph. epidermidis was also the most common pathogen; with 34% of all isolates acquired nosocomially. Other significant isolates included Pseudomonas putida, Pseudomonas aeruginosa, and Klebsiella sp. Prior to the release of the blood culture and sensitivity results, 45 of the 122 patients were already discharged. Therapy at the time of discharge was of questionable efficacy, accounting to 73.3%. Of the 77 patients discharged after the release of blood culture and sensitivity (CS) results, only 21(27%) of the antibiotic therapies were modified, and 56 (73%) were not modified at all. It is imperative to know, however, that 50% of the antibiotic therapies were modified a day after the corresponding blood culture and sensitivity (CS) results came out for patients who presented with nosocomial infection.
Conclusion: In general, blood culture and sensitivity test results have a limited effect on the antibiotic choices of pediatric residents at the UP-PGH (University of the Philippines – Philippine General Hospital).
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Demographic Profile And Outcomes Of Potentially Septic Patients At Baguio General Hospital (July 2004-June 2006)
Renelyn P. Ignacio, M.D., Concesa Padilla, M.D., Xenia Cathrine Fabay, M.D. Baguio General Hospital
Keywords: neonatal sepsis, potentially septic neonates, Enterobacter
Abstract:
Sepsis is a common cause of morbidity and mortality among high risk neonates with intrauterine maternal history of infection. Objectives: The main objective of this study is to describe all potentially septic newborns in the neonatal care unit of the Baguio General Hospital and Medical Center (BGH) including identification of the maternal risk factors and clinico-bacteriologic profile of sepsis of this study population.
Methods: This is a retrospective, descriptive study where medical records of all admitted potentially septic neonates from July 1, 2004 to June 30, 2006 were reviewed. Neonates who were preterm, asphyxiated, with congenital anomalies and with incomplete charts were excluded. Data such as demographics, maternal risk factors, and clinical course were recorded using a standardized clinical assessment form.
Results: Out of 217 subjects, 74% (204) were included in the study. 53% were males, with birth weights of 2500 to (-) 3800 grams (85.29%) and delivered via normal, spontaneous delivery (63.24%). The more common maternal risk factor identified included premature rupture of membranes (77%), non-institutional delivery (9.2%), and maternal urinary tract infection (4.2%). 85.78% of subjects had culture negative results, while 14.22% had culture positive results . Among patients with culture negative results, 22.29% developed clinical signs of sepsis such as poor suck, pneumonia, fever, shock, and thrombocytopenia. In patients with culture positive results, the most common organisms isolated were Enterobacter aerogenes (55%), Acinetobacter baumanii (14%) and Coagulase negative staphylococcus (14%). Among these patients, 10 % presented with meningitis, pneumonia, and poor suck. Empiric antibiotics used at the time of study were Penicillin G and an aminoglycoside. 66% of the asymptomatic patients with culture negative results had 3 days duration of treatment. 94.6% went home improved.
Conclusion: Pediatricians should have a high index of suspicion for the possibility of sepsis guided by complete perinatal history, thorough physical examination, and laboratory work-up. Even with negative blood culture results, neonates with maternal risk factors can develop signs and symptoms of sepsis; and with the emergence of new pathogens that may cause early neonatal sepsis, it is prudent to do blood culture and sensitivity and start empiric antibiotics.
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Journal 2012 Vol.13 No.2
Dengue: A Growing Global Health Threat
Usa Thisyakorn M.D., Chule Thisyakorn, M.D. Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Keywords: dengue, dengue fever
Abstract:
Dengue infection, one of the most devastating mosquito-borne viral diseases in humans, is now a significant problem in many countries. The disease, caused by the four dengue virus serotypes, ranges from asymptomatic infection to undifferentiated fever, dengue fever (DF), and severe dengue hemorrhagic fever (DHF) with or without shock. DHF is characterized by fever, bleeding diathesis and a tendency to develop a potentially fatal shock syndrome. Dengue infection with organ impairment mainly involves central nervous system and liver. Consistent hematological Findings include vasculopathy, coagulopathy, and thrombocytopenia. Laboratory diagnosis includes virus isolation, serology, and detection of dengue ribonucleic acid. Successful treatment, which is mainly supportive, depends on early recognition of the disease and careful monitoring for shock. A severity-based revised dengue classification for medical interventions has been developed and validated in many countries. Prevention depends primarily on control of the mosquito vector. The feasibility of a dengue vaccine is high.
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A Case Control Study of the Demographic Characteristics, Risk Factors, Clinical Findings, Treatment and Outcome Among Children 18 Years and Below Who are Confirmed to have Influenza A H1N1/09 Virus
Romina D. Gerolaga, M.D.*, Robert Dennis Garcia, M.D.*,*Makati Medical Center
Keywords: H1N1/09, Influenza A, Oseltamivir
Abstract
Background: The H1N1/09 virus was reported to be similar to the seasonal flu. However, the World Health Organization (WHO) documented a substantial proportion of patients with H1N1/09 who developed severe illness and death particularly among those with underlying medical conditions.1 Presently, to our knowledge, there is no data in the Philippines where the demographic and clinical characteristics, risk factors and outcome of children positive for H1N1/09 virus were compared to those with influenza but were negative for H1N1/09.
Objective: The objective of this study was to compare the demographic and clinical characteristics, risk factors, treatment and outcome of the two groups.
Methods: A review was done of the charts of 162 patients who were tested for H1N1/09 virus by RT-PCR assay at the Makati Medical Center from May 5 to July 16, 2009. Demographic characteristics, risk factors, clinical features, treatment and outcomes were compared between the two groups. Categorical variables used between the two groups were compared using Fisher’s exact test or Chi square test while quantitative variables were compared using T-test; odds ratio was determined.
Results: A total of 162 patients were included in this study. The largest group of patients positive for H1N1/09 was from the age group of 11-15 years old (35.8%). Risk factors such as travel history and exposure to a confirmed case showed no association to having a positive H1N1/09 test. Clinical features such as fever (100%) and cough (82.1%) were the most common presenting symptoms for both groups. Majority of these patients were given supportive treatment and out of 162 subjects, 91.4 % were treated as outpatient. Clinical outcome showed one mortality from the case group and none from the controls.
Conclusion: Thus, the demographic characteristics and clinical findings were similar for both groups. Future studies are recommended to include those with influenza-like illness not tested for H1N1/09 virus.
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The Clinical Outcome and Antibiotic Sensitivity Pattern of Enterobacter Spp. Culture Positive Neonates Admitted at Cebu Doctors’ University Hospital – Neonatal Intensive Care Unit (2005-2008)
Lalaine Amor H. Maderal, M.D.*, Barbra Charina V. Cavan, M.D.* Cebu Doctors’ University Hospital
Keywords: Enterobacter, neonatal sepsis, neonatal bacteremia
Abstract
Introduction: Enterobacter spp., a gram negative organism, is an important nosocomial pathogen. It is capable of developing resistance during ß-lactam therapy by expressing genes that encode for Extended- Spectrum ß-lactamases (ESBLs).
Objectives: This aim of this research is to determine the clinical outcome of neonates with Enterobacter spp. positive blood culture and the antibiotic sensitivity pattern of these isolates at Cebu Doctors’ University Hospital Neonatal Intensive Care Unit.
Methods: This descriptive, cross-sectional, retrospective study retrieved the list of neonates admitted at Cebu Doctors’ Hospital –Neonatal Intensive Care Unit (CDUH-NICU) from January 2005 to December 2008 whose bloods were taken for culture. The antibiotic sensitivity patterns of the Enterobacter positive cases were reviewed, along with broad-spectrum cephalosporin (BSC) resistant and multiresistant Enterobacter spp. (MRE) determination and clinical outcome. The relationship between outcome and MRE was analyzed using the Pearson Chi-square test.
Results: Out of 1312 samples, only 110 (8.4%) had positive bacterial isolates. Twenty-five grew Enterobacter spp. The overall mortality rate among the neonates with Enterobacter spp. was 56%. It was statistically significant (p<0.013). The organism was most sensitive to Imipenem (100%), followed by Meropenem (92%), and then Cefepime and Piperacillin-Tazobactam (80%). Of the 25 isolates, 60% were BSC resistant, 16% non-BSC resistant, and 24% were MRE. For the six neonates with MRE, the mortality rate was 50% and survival rate was 33.3%. One patient with MRE was brought home against medical advice. The mortality rate among MRE cases was not statistically significant.
Conclusion: Most isolates were BSC-resistant while 24% were MRE. Enterobacter was most sensitive to Imipenem, Meropenem, Cefepime, and Piperacillin-Tazobactam.
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Haemophilus Influenzae Type B Conjugate Vaccine (HiBCV) And Heptavalent Pneumococcal Conjugate Vaccine (PCV7) Immunization Status Of Patients 5 Years And Below Hospitalized For Pneumonia
Lou Ver Leigh A. Manzon, M.D.,* Robert Dennis J. Garcia, M.D.,* Sally Victoria B. King, M.D* *Department of Pediatrics, Makati Medical Center
Keywords: childhood pneumonia, Haemophilus influenzae type b conjugate vaccine, heptavalent pneumococcal conjugate vaccine
Abstract
Introduction: Community-acquired pneumonia remains to be an important cause of morbidity and mortality among the pediatric age group with Streptococcus pneumoniae and Haemophilus influenzae type B being the predominant bacteria identified. Conjugate vaccines against these organisms are available however, the prevalence of pneumonia in our country continues to be high. Objectives: The aim of this research is to determine the HiBCV and PCV 7 immunization status of children 5 years and below who were hospitalized due to pneumonia compared to controls. This study also aims to describe the clinical outcome of pneumonia among children who were vaccinated with HiBCV and/or PCV7 compared to those without vaccination.
Methods: This retrospective case-control study was conducted in Makati Medical Center from January 1, 2009 to August 31, 2010. Cases were children five years old and below discharged with the final diagnosis of pneumonia. Controls were patients five years and below discharged without pneumonia during the same study period. Medical records were reviewed for information on age, gender, clinical findings upon admission, laboratory results, vaccination status, interventions and outcomes.
Results: Two hundred twenty seven charts were reviewed (127 cases and 100 controls). The mean age of patients on admission was 1.9 years (SD ± 1.4). In 98.4% of the cases, chest roentgenograms showed infiltrates. The mean white blood cell count for cases was normal with 11.4 x 103/uL (SD + 6.3). None of the case patients had positive blood culture results. Only 34.6% and 5% of the cases completed age- appropriate doses of HiBCV and PCV7, respectively. No statistical difference was found between the length of hospital stay and duration of antibiotic use and the vaccination coverage for the two vaccines. Children without vaccination coverage had the odds of 1.2-1.3 to develop pneumonia compared to children with at least one dose of either vaccine (HiBCV: OR 1.3, 95% Cl 0.8 to 2.3; PCV7: OR 1.2, 95% CI 0.6 to 2.6).
Conclusion: The findings indicated that clinical and radiologically-confirmed pneumonia still occurred among children with complete vaccination with HiBCV and PCV7. Although not statistically significant, those without vaccination had higher odds of having pneumonia.
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POST DISASTER INTERIM ADVICE ON THE PREVENTION OF LEPTOSPIROSIS IN CHILDREN by the Pediatric Infectious Disease Society of the Philippines, Inc.
Abstract:
The purpose of this advice is to provide guidelines for physicians and parents on the prevention of leptospirosis in the pediatric age group. Leptospirosis is an infectious disease caused by pathogenic bacteria called leptospires. The main carriers of leptospires are animals such as rats, mice, dogs, cats and livestock. Human leptospiral infections can occur when mucus membranes and skin are contaminated by the urine of infected animals, or upon ingestion of contaminated food and water, all of which may occur when an individual is exposed to flood waters. Thus the occurrence of freshwater flooding after typhoons or increased rainfall can lead to an increased risk of leptospirosis. Initial symptoms of leptospirosis may range from mild to severe, or may even be fatal. Manifestations of the disease include: (1) a mild influenza-like illness; (2) Weil’s syndrome, characterized by jaundice, renal failure, hemorrhage, and arrhythmias; (3) meningitis/meningoencephalitis; or (4) pulmonary hemorrhage with respiratory failure. Case fatality rates range from 12-14% in the Philippines. In studies in India, case fatality rates were lower in the pediatric age group compared to adults.
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OUTBREAK OF SERRATIA MARCESCENS IN THE NEWBORN CARE UNIT IN A LOCAL TERTIARY HOSPITAL
Sandra Joyce Pena, M.D.,* Xenia Cathrine Fabay, M.D.* *Baguio General Hospital and Medical Center
Keywords: Outbreak, Serratia marcescens, neonatal infections, neonatal sepsis
Abstract
Objectives: This study was performed to investigate the Serratia marcescens outbreak in the Newborn Care Unit of a tertiary hospital. Methods: This is a retrospective, descriptive study. Charts of all neonates with S. marcescens growth in their blood culture were retrieved from the Records Section of the Baguio General Hospital and Medical Center (BHGMC) from July 2002 to July 2003. During the outbreak period, the following interventions were performed: 1) orientation and re- orientation of the entire health care team, especially, the staff of the unit on infection control and prevention; 2) aerobic culture of possibly contaminated hands of concerned staff and equipment of both the delivery room and the intensive care unit; 3) closing of the pediatric newborn care unit for general cleaning and disinfection.
Results: Of the 132 cases reported to have grown S. marcescens in their blood cultures, 63 (48%) charts were available for review: 63% were term; 51% male; 81% were appropriate for gestational age; and 30% had birth weights of 2500 to 2999 grams and delivered via normal spontaneous delivery. The most common reasons for admission were: respiratory distress syndrome (5%), multiple congenital anomalies (5%), congenital heart disease (5%), urinary tract infection (5%), severe asphyxia (3%), and pneumonia (3%). The clinical manifestations seen during the first 4 days of life were respiratory distress (51%), poor suck (25%), bleeding (22%), jaundice (6%), sclerema (5%), and vomiting (5%). Blood transfusion (46%), such as fresh frozen plasma and packed red blood cells, was the prevalent invasive procedure done, followed by endotracheal intubation (41%), and umbilical catheterization (38%). Eighteen out of 63 cases died with a case fatality rate of 29%; 28% died of septic shock. S. marcescens showed 100% sensitivity to Piperacillin- Tazobactam, Cefepime, Imipenem, and Meropenem. Environmental cultures showed isolation of S. marcescens from the suction machines used in the aseptic and septic areas of the neonatal intensive care unit. Furthermore, this study showed that the following factors contributed to the occurrence of an outbreak: paucity of manpower, lack of equipment and area assigned for the pediatric newborn care unit.
Conclusion: This investigation showed that the S. marcescens outbreak in the pediatric newborn care unit has been associated with environmental contamination and breakdown in infection control measures such as overcrowding, understaffing, and other major disruptions of routine nursery care, particularly hand hygiene.
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THE USE OF MEROPENEM AMONG NEONATES: A ONE-YEAR RETROSPECTIVE STUDY IN THE NURSERY OF A LOCAL TERTIARY HOSPITAL
Ferdinand P. Ganggangan, M.D.,* Xenia Cathrine Fabay, M.D.* *Baguio General Hospital and Medical Center
Keywords: sepsis, neonatal sepsis, meropenem
Abstract
Objectives: This study was conducted to determine profile of neonates being treated with meropenem as well as to assess its clinical efficacy in the treatment of neonatal infections. Methods: This is a retrospective review of the records of sick neonates admitted at the Newborn Care Unit of a tertiary hospital and treated with meropenem. Those discharged against advice were excluded. Frequency and percentage were used in comparing the following variables: sex, 5-minute APGAR score, age of gestation, birth weight, type of infection, culture results, treatment outcome, and adverse reactions.
Results: There were 34 charts available for review, but two were excluded. There were 62.5 % females and 37.5 % males: 28.1 % of them had a 5-minute APGAR score of 10; 37.5 % had 9; 21.9% had 8; and 12.5 % had 7. Sixty-two percent (62.5%) of the subjects were between 32 to 35 weeks age of gestation: 46.9 % were of low birth weight; 34.4 % were of very low birth weight; and 18.7 % had normal weights. Sepsis was the most common indication in the use of meropenem, followed by sepsis with pneumonia, pneumonia then sepsis with meningitis. Majority (68.75%) of the patients had no growth in their blood while 60% had no growth in the CSF. Enterobacter aerogenes (15.6%) was the most common blood isolate while Enterobacter gergeviae (20%) and Klebsiella pneumoniae (20%) were the isolates in the CSF culture. Treatment outcomes were favorable; 84.4% were improved, while 9.4% were unimproved and shifted to other antibiotics, and 6.2% died.
Conclusion: The use of meropenem is effective in the treatment of life-threatening infections among newborns.
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PIDSP AT THE APAME CONGRESS 2012
The Asia Pacific Association of Medical Journal Editors (APAME) held its annual convention on August 31 to September 3, 2012 at the University of Malaya in Kuala Lumpur, Malaysia. One hundred thirty seven delegates from 21 countries attended the congress. The Philippines had the most delegates from a foreign country (13 delegates) and the PIDSP Journal was represented by Professor Cecilia Maramba Lazarte and Xenia Jaramillo Fabay.
The 2012 Board of Directors of APAME are as follows: President: Professor John Arokiasamy (Malaysia); Executive Vice President: Professor Wilfred CG Peh (Singapore); Vice President for
Internal Affairs; Professor Chang-Ok Suh (Republic of Korea); Vice President for External Affairs: Professor Kiyoshi Kitamura (Japan); Secretary-General: Professor Jose Florencio Lapena, Jr (Philippines). A new set of officers were elected during the congress with Professor Kitamura as President and Ms. Merlita Opena as a new board member.
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PIDSP Joins the PPS Total Family Healthcare Expo
As part of the Philippine Pediatric Society (PPS) Diamond Jubilee celebration, the PPS held its first ever health expo last September 1 and 2, 2012 at the SMX Convention Center, Pasay City. It was a privilege for PIDSP to be a part of this momentous affair. In preparation for the event, the PIDSP members assigned to be in charge of the society’s participation to the expo prepared selected infectious disease primers to be distributed to the expo’s participants.
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Journal 2012 Vol 13 Supplement 1
Abstracts Of Poster Presentations At ASCODD
Since its launch in February 1981 in Dhaka, Bangladesh, the Asian Conference on Diarrhoeal Diseases (ASCODD) was being hosted every two years in an Asian country. The first-ever ASCODD was held in Dhaka and was hosted by the International Centre for Diarrhoeal Disease Research, Bangladesh, (ICDDR,B), which organization later became the secretariat for this prestigious scientific meeting.
The first conference had a limited geographical scope and it was decided during that meeting the need to extend the scope of the conference Asia-wide to encourage international participation. The second conference was held in Calcutta, India and was hosted by the National Institute of Cholera and Enteric Diseases (NICED).
Subsequently, eleven equally successful Conferences were held in seven different Asian countries. Later on, the name of the conference was changed to Asian Conference on Diarrhoeal Disease and Nutrition, while keeping the same acronym ASCODD. In 2009, the12th ASCODD was held in Yogyakarta, Indonesia.
On January 10-12, 2012, the 13th ASCODD again made history by bringing together a broad range of stakeholders in a lively and interactive sharing of ideas and knowledge with the aim of re-focusing and doubling the efforts to prevent and manage diarrhea, coupled with preventive nutrition interventions. It was the first time that this scientific meeting was held in the Philippines. Other highlight of the conference included the following: 1. Formal launching of the inclusion of the rotavirus vaccine in the Philippine national Immunization Program with Secretary of Health Ona with the approval from Congress and the Budget department; 2. Updates on Improved ORS and rational use of Antidiarrheals and Antimicrobials; Strategies to Improve Breastfeeding and Infant Nutrition; Emerging Diarrheal Pathogens; and Vaccines Against Diarrheal Diseases.
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