ABSTRACT
@#Antimicrobial resistance is a worldwide public health concern. Rise in the number of antimicrobial resistant organisms, such as extended spectrum β-lactamase- (ESBL) and carbapenemase-producing Escherichia coli and Klebsiella pneumoniae, continue to burden millions of people worldwide. E. coli and K. pneumoniae were isolated and collected for four months from a teaching hospital in the Philippines. All isolates were subjected to ESBL and carbapenemase testing using the double disk synergy test and modified Hodge test, respectively. Their pattern of resistance among different classes of antimicrobial agents was also investigated using the Kirby-Bauer disk diffusion test. Among the 32 clinical isolates tested, 28.1% were positive for ESBL production and 6.3% were positive for carbapenemase production. Species-specific classification showed that E. coli (44.4%) has the highest rate of ESBL production whereas both E. coli (5.6%) and K. pneumoniae (7.1%) showed almost similar rates of carbapenemase production. Antimicrobial resistance pattern of drug resistant isolates showed that all organisms were resistant to ampicillin, and majority showed resistance towards ciprofloxacin, cefotaxime, ceftriaxone, and sulfamethoxazole/trimethoprim. ESBL production is seen highest among E. coli isolates while similar rates of carbapenemase production was observed to both E. coli and K. pneumoniae isolates. Overall, antimicrobial resistance continues to rise and poses a huge threat in public health worldwide. Efforts should be made in developing rapid tests for antimicrobial resistance and to search for effective treatment from infections caused by multidrug resistant organisms.
ABSTRACT
This study aimed to determine the correlation between the GFR estimates from plasma-derived formulas (Cockroft-Gault, MDRD, AASK, Nankivell) and the GFR estimates from the clinically conventional 24-hour creatinine clearance method and identify which formula could become a potential substitute for the creatinine clearance method. Another aim was to propose adjusted plasma-derived formulae that apply to the Filipino populationOne hundred and nine volunteers were asked to undergo 24-hour urine collection and blood extraction. The urine and blood samples were then examined by the PGH laboratories, where serum BUN. serum albumin, and serum and urine creatinine were determined. These values, in addition to age, weight, sex, and body surface area, were used to calculate GFR via the Cockroft-Gault, MDRD7, AASK, and Nankivell formulas, as well as via the creatinine clearance method. Subjects whose calculated total creatinine was lower than normal were excluded. A total of 44 subjects were included in the data analysisRegressional analysis was used to measure correlation. The null hypothesis is a=alpha and b=beta or the y-intercept and slope of the formulas and creatinine clearance are equal. A paired t-test with 42 degrees of freedom was used to calculate significance with the critical values t -2.0289 and t2.0189. Among the formulas evaluated, both the AASK formula (r=0.8836, a=0.0056, b=-0.4994) and the MDRD formula for African-Americans (r=0.8589, a=2.4514, b=-0.5998) consistently overestimate the creatinine clearance values. However, the overestimation of the AASK formula is statistically insignificant, while that of the MDRD for African Americans is significant. However, upon the addition of -21.3 for MDRD-African American and -12.99 for AASK equations, respectively, yielded a closer approximation of creatinine clearance values in the sample population (MDRD r=0.8545, a=-0.0004, b=0.1995; AASK: r=0.8589, a=-0.0001 , b=-0.5998), thus formula effectiveness studies on other populations are recommended. Both the Nankivell formula (r=0.8462, a=4.3836, b=-6.2810) and standard MDRD (r=0.8589, a=2.4514, b=-2.6643) formula do not closely correlate with creatinine clearance. The Cockroft-Gault equation (r=0.8836, a=0.0056, b=-0.4994) shows the highest correlation, unadjusted, with corrected creatinine clearance in the selected population and could be recommended as a substitute for creatinine clearance. (Author)