DNA sequence-based identification of pathogens from ocular samples of patients with clinically suspected eye infections was accomplished using 16S and internal transcribed spacer (ITS) ribosomal RNA gene sequence analysis. PCR was positive for 24 of 99 samples tested. Both culture and 16S rDNA sequence analysis identified Pseudomonas aeruginosa, streptococci and Enterobacteriaceae. Isolates misidentified as Burkholderia cepacia by biochemical tests were identified as Ralstonia mannitolilytica by 16S rDNA sequence analysis. Sequence analysis identified the following microorganisms from 19 culture-negative samples: Haemophilus influenzae, Sphingomonas sp., Klebsiella pneumoniae, Staphylococcus haemolyticus, Morganella morganii, Mycobacterium sp., Chryseobacterium sp., Pseudomonas saccharophila (Xanthomonas) and the fungus, Phaeoacremonium inflatipes.

Cholera continues to be a global threat, with high rates of morbidity and mortality. In 2011, a cholera outbreak occurred in Palawan, Philippines, affecting more than 500 people, and 20 individuals died. Vibrio cholerae O1 was confirmed as the etiological agent. Source attribution is critical in cholera outbreaks for proper management of the disease, as well as to control spread. In this study, three V. cholerae O1 isolates from a Philippines cholera outbreak were sequenced and their genomes analyzed to determine phylogenetic relatedness to V. cholerae O1 isolates from recent outbreaks of cholera elsewhere. The Philippines V. cholerae O1 isolates were determined to be V. cholerae O1 hybrid El Tor belonging to the seventh-pandemic clade. They clustered tightly, forming a monophyletic clade closely related to V. cholerae O1 hybrid El Tor from Asia and Africa. The isolates possess a unique multilocus variable-number tandem repeat analysis (MLVA) genotype (12-7-9-18-25 and 12-7-10-14-21) and lack SXT. In addition, they possess a novel 15-kb genomic island (GI-119) containing a predicted type I restriction-modification system. The CTXΦ-RS1 array of the Philippines isolates was similar to that of V. cholerae O1 MG116926, a hybrid El Tor strain isolated in Bangladesh in 1991. Overall, the data indicate that the Philippines V. cholerae O1 isolates are unique, differing from recent V. cholerae O1 isolates from Asia, Africa, and Haiti. Furthermore, the results of this study support the hypothesis that the Philippines isolates of V. cholerae O1 are indigenous and exist locally in the aquatic ecosystem of the Philippines.

We sought to determine the epidemiology of carbapenem-resistant Enterobacteriaceae and to investigate the emergence of carbapenem-resistant Klebsiella pneumoniae in two teaching hospitals in Manila, Philippines. We screened 364 Enterobacteriaceae for carbapenem resistance between 2012 and 2013 and detected four carbapenem-resistant K. pneumoniae isolates from three different patients. We used whole genome sequencing to determine the antibiotic resistance profiles and confirmed the presence of carbapenemase genes by multiplex PCR. We used multilocus sequence typing and PCR-based replicon typing to genetically characterize the carbapenem-resistant isolates. The carbapenemase gene blaNDM was detected in K. pneumoniae isolates from two patients. The first patient had ventilator-associated pneumonia and lumbar shunt infection from K. pneumoniae ST273 carrying blaNDM-7. The second patient had asymptomatic genitourinary colonization with K. pneumoniae ST656 carrying blaNDM-1. The third patient had a gluteal abscess with K. pneumoniae ST1 that did not carry a carbapenemase gene, but did carry blaDHA-1, blaOXA-1, and blaSHV-1. In this study, we report the first cases of blaNDM-carrying pathogens in the Philippines and add to the growing evidence of the worldwide spread of ST273 and NDM-7, a more efficient carbapenem hydrolyzer than NDM-1.

Background: After five years of development and formal evaluation, the Health Protection Agency in England deployed a national web-based system for communicable disease control in January 2010. HPZone is now used in all 26 local health protection units covering 9 regions and the national centre for infections. Various challenges were encountered during the rollout and included standards, governance, workflows, integration with other software suites and IT infrastructure. Crucial to the deployment was winning the hearts and minds of users.Methods: HPZone was developed bottom-up with the users in mind from the start and began with the development of a structured risk assessment. The implementation included the collection of national contextual data sets, procedures for improved security of access, direct import of laboratory data and implementation of recent notification legislation, together with systems for enhanced software flexibility, server resilience and reliability. Nominated disease boards were tasked to populate workflow templates consisting of conditioned actions for cases (possible, probable, confirmed), enquiries and outbreaks.Results: HPZone was successfully deployed across 26 HPUs from December 2009 to March 2010. Laboratory data from across the country has been linked directly to HPZone. From January 2010 to mid-February 2012, 136,487 confirmed cases have been recorded (including Food poisoning: 102,031, Mumps: 20,166, Measles: 8,358), 13,112 outbreaks and 108,970 enquiries. 4,409 schools and 3,531 care homes have been affected. Lessons have been learned in respect of clinical and surveillance issues, integration with laboratory data and notifications, case and outbreak management, and enhanced IT infrastructure resilience and scalability. Coincidence and threshold alerts were implemented and facilities for automated notifications developed realising the enter-once-use-many paradigm.Conclusion: HPZone has enabled decision support without replacing professional judgment and provided improved detection, surveillance and control. It has facilitated transparency underpinning national resource allocation. HPZone has enabled targeted support and training, and provided opportunities to capture and share best practice. With a national award received in November 2011, HPZone has been recognised as an innovative web-based decision support system for harnessing infectious disease data, information and knowledge management and for improving service quality and public health outcomes.

Here, we report the draft assemblies of 11 clinical isolates of Klebsiella pneumoniae that are resistant to cephalosporins, carbapenems, and/or colistin. The assemblies ranged from 5.37 Mbp to 5.70 Mbp in size. Several plasmid sequences were present, and resistance genes spanning multiple classes of antibiotics were predicted.