Early experience with COVID-19 patients in a private tertiary hospital in the Philippines: Implications on surge capacity, healthcare systems response, and clinical care.

BACKGROUND: Our healthcare institution was one of the first to see SARS CoV-2 cases in the country. We describe the early COVID-19 experience of a private hospital in the Philippines and discuss the healthcare system response in the setting of surge capacity. METHODS: We reviewed the medical records of adult COVID-19 hospitalized patients admitted in March 2020. We reported their demographic and clinical characteristics using descriptive statistics. RESULTS: Of 40 patients admitted, 23 (57.5%) were male and 19 (47.5%) were aged <60 years. Most (n = 27, 67.5%) had moderate-risk, 9 (22.5%) had high-risk, and 4 (10%) had low-risk COVID-19. SARS-CoV-2 testing took 5.5 (range 1-10) days. Overall mortality rate was 6/40 (15.0%). Clinical cure was documented in all low-risk patients, 25 (92.6%) moderate-risk patients, and only 1 (11.1%) high-risk patient. In response to the surge, the hospital rapidly introduced one-way traffic systems, dedicated screening, triage and Emergency Department areas for COVID-19, a clinical pathway, engineering controls, patient cohorting, and strict infection prevention and control measures. CONCLUSION: Majority of patients recovered from COVID-19. Older age and high-risk pneumonia were associated with poor outcomes. Adaptations to hospital structure and staff were quickly made in response to surge capacity, although our response was hampered by prolonged time to COVID-19 confirmation. Our study underscores the urgent need for rapid adaptive response by the healthcare system to address the surge of cases.

Counterfeit Rabies Vaccines: The Philippine Experience.

BACKGROUND: In December 2018, a large, tertiary, university-affiliated hospital in the Philippines discovered that their legitimate supply chain was infiltrated with counterfeit rabies vaccines. METHODS: All vials suspected to be counterfeit were quarantined and surrendered to the Philippine Food and Drug Administration. Patients who may have received the counterfeit products were recalled, evaluated, and revaccinated accordingly. Vials of the counterfeit vaccines were sent to various laboratories for testing. RESULTS: Two batches of counterfeit rabies vaccines were found to have infiltrated the hospital's supply chain between December 2017 and December 2018. Of the 1711 patients who may have received counterfeit vaccines, 1397 patients were successfully contacted, and 734 were revaccinated with at least 1 dose of authentic rabies vaccine. The counterfeit vials were sterile, contained no toxic substances, and both contained active antirabies ingredient. No report of rabies infection or other adverse events were noted. CONCLUSIONS: Our experience demonstrates the need for strong intervention and collaborative response from all stakeholders-government and regulatory bodies, the pharmaceutical industry, and individual institutions and consumers-to effectively eradicate counterfeiting and protect our patients.

ß-Lactamase Inhibitors Enhance the Synergy between ß-Lactam Antibiotics and Daptomycin against Methicillin-Resistant Staphylococcus aureus.

The evidence for using combination therapy for the treatment of serious methicillin-resistant Staphylococcus aureus (MRSA) infections is growing. In this study, we investigated the synergistic effect of daptomycin (DAP) combined with piperacillin-tazobactam and ampicillin-sulbactam against MRSA in time-kill experiments. Six of eight strains demonstrated synergy between DAP and the ß-lactam-ß-lactamase inhibitor (BLI) combination. In 5/8 strains, the synergy occurred only in the presence of the BLI, highlighting a role for BLIs in peptide-ß-lactam synergy.

Glycopeptide antibiotics: evolving resistance, pharmacology and adverse event profile.

The first glycopeptide antibiotic was vancomycin, isolated from the soil in the 1950s; since then, the class has expanded to include teicoplanin and the new semisynthetic glycopeptides dalbavancin, oritavancin and telavancin. They are bactericidal, active against most Gram-positive organisms, and in a concentration-dependent manner, inhibit cell wall synthesis. Resistance to vancomycin has emerged, especially among enterococci and Staphylococcus aureus through a variety of mechanisms. This emerging resistance to vancomycin makes proper dosing and monitoring of the area under the curve/MIC critically important. The chief adverse effect of vancomycin is nephrotoxicity, which is also intricately related to its dose. The efficacy of the semisynthetic glycopeptides has been demonstrated in skin and soft-tissue infections, but remains to be seen in serious methicillin-resistant Staphylococcus aureus infections.