Outbreak of Ralstonia bacteraemia among chronic kidney disease patients in a haemodialysis unit in the Philippines.

Ralstonia insidiosa is an opportunistic pathogen considered an emerging problem among clinically vulnerable populations such as those with chronic kidney disease. This study presents three cases of Ralstonia bacteraemia among chronic kidney disease patients in a haemodialysis unit in Baguio City, the Philippines. Case 1 was an elderly male who experienced chills during two concurrent dialysis sessions. Case 2 was a young female who also experienced chills and dizziness during a dialysis session; as this was thought to be related to hypotension, she was admitted. Case 3 was an elderly female with known hypertension and diabetes who had been newly diagnosed with chronic kidney disease; she was brought to the emergency department hypotensive, dyspnoeic and disoriented with deranged laboratory parameters and was admitted to the intensive care unit. All three cases had blood cultures positive for R. insidiosa with an attack rate of 1.67%. Drug and device tracing were conducted and environmental samples collected to identify the source of infection. A sample from the faucet of the reprocessing machine in the haemodialysis unit that was positive for Ralstonia spp. was the source of the outbreak. Control measures were implemented and the haemodialysis unit was thoroughly cleaned. No further cases were reported, with active surveillance continuing until January 2022. Taken with previously published outbreaks, these findings suggest that medical products and devices can be contaminated with Ralstonia spp. and cause illness. Early identification of cases and the source of infection is required to prevent large outbreaks in this vulnerable population.

Clinical characteristics and outcomes of COVID-19 patients in a tertiary hospital in Baguio City, Philippines.

OBJECTIVE: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), primarily targets the respiratory system. This study describes the characteristics associated with mortality among patients infected with SARS-CoV-2 at a single hospital in Baguio City, Philippines. METHODS: We reviewed medical records (including history, laboratory results and treatment regimen) of 280 confirmed COVID-19 patients admitted to a single hospital during March-October 2020. Clinical characteristics and outcomes (frequency and type of complication, recovery rate and mortality) were evaluated. Multiple logistic regression was used to analyse factors associated with mortality. RESULTS: The mean age of COVID-19 patients was 48.4 years and the female-to-male ratio was 1.8:1. Hypertension, cardiovascular disease (CVD) and diabetes were the most frequent comorbidities reported. Common presenting symptoms were respiratory and constitutional, with 41% of patients not reporting symptoms on admission. Patients with moderate, severe and critical disease comprised 45%, 8% and 4%, respectively. A total of 15% had complications, health care-associated pneumonia being the most frequent complication. The recovery rate was 95%; 5% of patients died, with multiorgan failure being the most common cause. The presence of CVD, chronic kidney disease, prolonged prothrombin time and elevated lactate dehydrogenase (LDH) were associated with mortality. DISCUSSION: Most COVID-19 patients in our population had asymptomatic to moderate disease on admission. Mortality from COVID-19 was associated with having CVD, chronic kidney disease, elevated LDH and prolonged prothrombin time. Based on these results, we emphasize that people should take all necessary precautions to avoid infection with SARS-CoV-2.