Establishing a laboratory for surveillance of invasive bacterial infections in a tertiary care government hospital in a rural province in the Philippines.

Abstract

Abstract. A clinical bacteriologic laboratory was established in a tertiary care government hospital in The Philippines, where expert bacteriologic laboratories do not usually exist at this level of health care. The laboratory was jointly established by the Research Institute for Tropical Medicine (RITM) (Manila, The Philippines) and the National Public Health Institute (KTL) (Helsinki, Finland). The laboratory was planned, its personnel were trained, and its functioning was continuously supported by the RITM and KTL. The following aspects were of utmost importance in establishing the laboratory and launching its work: 1) the support of the RITM bacteriologic laboratory, with backup and consultations from KTL; 2) creation and maintenance of personal contacts between clinicians and laboratory staff with an emphasis on clinical relevance and rapid reporting of laboratory results; 3) the consideration of the quality aspects of the work from the start; and 4) keen follow-up of the bacteriologic results and their clinical significance and use, of practical laboratory work, and of quality assurance aspects. In the first two years of its operation, the laboratory identified Streptococcus pneumoniae and Haemophilus influenzae as the most important causes of severe pneumonia, sepsis or meningitis in children less than two years of age, and Salmonella typhi as the most frequent significant isolate from the blood cultures, being found most often in school age children and young adults.

Invasive bacterial infections of children in a rural province in the central Philippines.

“…8 A considerable effort was made to obtain reliable bacteriologic results from a clinically well-defined patient population to provide baseline information on invasive bacterial disease before a proposed vaccine evaluation. 14 The blood culture isolation rate of S. pneumoniae (1.3%) was lower than that (3.7%) in another study from The Philippines, 5 and much lower than the figures (6-14%) reported in studies on pneumonia in other developing countries. [22][23][24] The even higher isolation rate of S. pneumoniae reported by Shann and others 8 from Papua New Guinea can be attributed to their selected patient population of 83 children Ͼ 1 year of age with cough, intercostal recession, and opacity on chest radiograph accessible for lung aspiration.…”

“…Quality of clinical and laboratory work was monitored through monthly visits by consultants from the RITM and semiannual visits from the KTL. 14 Study patients. Different sets of enrollment criteria were used for children 2-59 months old and those less than two months old; the signs and symptoms were prospectively recorded in study forms by the admitting pediatric resident and confirmed by the project physician.…”

Serious community-acquired neonatal infections in rural Southeast Asia (Bohol Island, Philippines)

“…Antimicrobial susceptibility tests were performed as previously reported. 27,28 Radiological investigation Postero-anterior and lateral chest radiographs were obtained for most infants and read by the study radiologist, blinded to clinical information, and classified for the presence and type of infiltrates. A dense infiltrate was defined as fluffy opacities with ill-defined margins, with lobar, segmental or patchy distribution.…”

“…27,28 The study was approved by the Institutional Review Board of the Research Institute for Tropical Medicine. As part of a large prospective study on serious infections in children under 5 years of age, infants below 2 months were enrolled using criteria, partly based on the WHO case management protocol for Acute Respiratory Infections, 29 or our definitions, 28 if they had: (1) clinically defined severe pneumonia (cough or difficult breathing and respiratory rate X60/min or severe lower chest wall indrawing), 29 (2) suspected meningitis indicated by convulsions, abnormal sleepiness or difficulty in waking, or neurologic abnormalities 28 or (3) clinical suspicion of sepsis (any of the following: fever >38.01C or hypothermia <36.01C, poor feeding, distended and tense abdomen, apneic episodes, grunting, central cyanosis and jaundice).…”

The Clinical Characteristics of Neonatal Sepsis Infection in Southwest China

“…The antibiotic sensitivity of these pathogens is continuously changing, and resistance patterns are poorly characterized due to the lack of appropriate laboratory facilities in community settings (2,9,10). Therefore, the present study was designed to investigate the pathogens responsible for neonatal sepsis in Chengdu, China.…”