A prospective observational study of community-acquired bacterial bloodstream infections in Metro Manila, the Philippines

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.

Assessing generalizability of a dengue classifier across multiple datasets

“…The AUCs for Dataset 1 (0.83, 95% CI: (0.81, 0.84)) and Dataset 4, Day-3 (0.82, 95% CI: 0.77, 0.88)) were close to the AUCs reported by (8) and (23) (0.83 and 0.84, respectively), while the AUC for Dataset 4, Day-1 (0.86, 95% CI: (0.81, 0.90)) was slightly lower than the value of 0.93 reported by Park et al (23). AUC values were not reported by Gasem et al (25) and Saito et al (21) for Datasets 2 and 3; we found respective AUC values of 0.89 (95% CI: (0.87, 0.91)) and 0.85 (95% CI: (0.83, 0.87)), demonstrating relatively good predictive performance.…”

“…Saito et al (21) collected data on 1573 patients aged 1–85, with a fever lasting at most 21 days and suspected of bloodstream infection, in the Philippines from 2015 to 2019. Of these patients, 256 (16.3%) were diagnosed with dengue.…”

“…For example, Tuan et al (8), Ngim et al (2), and Andries et al (19) recorded counts of white blood cells, platelets, and lymphocytes. Physical symptoms recorded include rashes, body temperature, bleeding, arthralgia, asthenia, cough, and headache, and demographic variables include sex and age (2; 8; 20; 21).…”