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Saito N, Solante RM, Guzman FD, Telan EO, Umipig DV, Calayo JP, Frayco CH, Lazaro JC, Ribo MR, Dimapilis AQ, Dimapilis VO, Villanueva AM, Mauhay JL, Suzuki M, Yasunami M, Koizumi N, Kitashoji E, Sakashita K, Yasuda I, Nishiyama A, Smith C, Ariyoshi K, Parry CM. A prospective observational study of community-acquired bacterial bloodstream infections in Metro Manila, the Philippines. PLoS Negl Trop Dis 2022; 16:e0010414. [PMID: 35613181 PMCID: PMC9173634 DOI: 10.1371/journal.pntd.0010414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 06/07/2022] [Accepted: 04/12/2022] [Indexed: 11/18/2022] Open
Abstract
Community-acquired bacterial bloodstream infections are caused by diverse pathogens with changing antimicrobial-resistance patterns. In low-middle income countries in Southeast Asia, where dengue fever is endemic and a leading cause of fever, limited information is available about bacterial bloodstream infections due to challenges of implementing a blood culture service. This study describes bacterial bloodstream pathogens and antimicrobial-resistance patterns in Metro Manila, the Philippines. We aimed to identify the proportion of patients with a positive blood culture, the bacteria isolated and their antimicrobial resistance patterns, and the clinical characteristics of these patients, in this dengue endemic area. We conducted a prospective observational study in a single hospital enrolling febrile patients clinically suspected of having a community-acquired bacterial bloodstream infection between 1st July 2015 and 30th June 2019. Each patient had a blood culture and additional diagnostic tests according to their clinical presentation. We enrolled 1315 patients and a significant positive blood culture was found in 77 (5.9%) including Staphylococcus aureus (n = 20), Salmonella enterica Typhi (n = 18), Escherichia coli (n = 16), Streptococcus pneumoniae (n = 3) and Burkholderia pseudomallei (n = 2). Thirty-four patients had meningococcal disease diagnosed by culture (n = 8) or blood PCR (n = 26). Additional confirmed diagnoses included leptospirosis (n = 177), dengue virus infection (n = 159) and respiratory diphtheria (n = 50). There were 79 (6.0%, 95%CI 4.8%−7.4%) patients who died within 28 days of enrollment. Patients with a positive blood culture were significantly more likely to die than patients with negative culture (15.2% vs 4.4%, P<0.01). Among S. aureus isolates, 11/20 (55%) were methicillin-resistant (MRSA) and ST30: USA1100 was dominant sequence type (88.9%). Antimicrobial-susceptibility was well preserved in S. enterica Typhi. Among hospitalized patients with clinically suspected community-acquired bacterial bloodstream infection in Metro Manila, the Philippines, 5.9% had a blood culture confirmed infection of whom 15.6% died. S. aureus, including a significant number of MRSA (USA1100 clones), S. enterica Typhi, E.coli and Neisseria meningitidis were frequently identified pathogens.
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Affiliation(s)
- Nobuo Saito
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Department of Microbiology, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | | | | | | | | | | | | | | | | | | | | | - Annavi M. Villanueva
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- San Lazaro Hospital, Manila, the Philippines
| | - Jaira L. Mauhay
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Motoi Suzuki
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Michio Yasunami
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Nobuo Koizumi
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Emi Kitashoji
- Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Kentaro Sakashita
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Ikkoh Yasuda
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Akira Nishiyama
- Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Koya Ariyoshi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- * E-mail: (KA); (CMP)
| | - Christopher M. Parry
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail: (KA); (CMP)
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Abstract
In 1993, the Medical College of Pennsylvania (MCP), mindful of the rapidly changing environments of health care delivery, created three surveys to gather information from outside the school that would help the faculty plan how the curriculum and advising system could better prepare students and residents for the demands of twenty-first-century medicine. The first survey focused on the MCP seniors graduating that year and asked about their perceptions of their medical education and their specialty and residency choices. The second survey, directed to 40 medical residency program directors in family medicine, internal medicine, pediatrics, and surgery, sought to identify the characteristics of applicants that these directors valued when selecting entrants to their programs. The third survey, of 30 employers of physicians representing four practice environments (private practice, hospitals/other health systems, academic medical centers, and health maintenance organizations), sought information on hiring and recruitment practices and the skills, competencies, and attitudes these employers valued most when hiring recently graduated physicians. The responses showed several differences and/or misperceptions among the views held by the three groups surveyed and suggest that medical educators have not adapted as rapidly as have employers to changes in the health care environment. Academic health centers must broaden their missions and make changes in their own institutional cultures, both to maintain their own viability and to train physicians who have the balance between scientific and technical competency and essential personal characteristics (such as empathy) that the next century's practice will probably demand.
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Affiliation(s)
- A M Villanueva
- School of Public Health, Medical College of Pennsylvania, Philadelphia 19129, USA
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