As part of an ongoing natural products discovery program focused on actinomycetes collected from west-central Philippine seas, we screened 122 marine sediment-derived bacterial isolates. Using a microbroth combination treatment assay, strain DSD2580T was identified as the top candidate for in vitro β-lactamase inhibition. Subsequent 16S rRNA and multilocus (atpD and trpB) gene sequencing with phylogenetic analysis identified strain DSD2580T as Streptomyces mutabilis. The identification was bolstered by high sequence identity (≥99%) from concatenated gene sequences and strong phylogenetic support (>86%). Profiling of the ethyl acetate extract using mass spectrometry, NMR spectroscopy, and GNPS dereplication led to the identification of rubiginone B2 (1), 8-O-methyltetrangomycin (2), and N-acetyltyramine (3). Compounds 1–3 are reported from S. mutabilis DSD2580T for the first time and their co-occurrence is proposed as a potential chemotaxonomic marker.

BACKGROUND:This study describes the clinical profiles, phenotypic and genotypic resistance mechanisms, and outcomes of patients with carbapenem-resistant infections (CRIs) using a registry. METHODS:Hospitalized adults with CRIs in two tertiary institutions were included in this prospective study from January 1, 2023, to December 31, 2025. RESULTS:A total of 411 patients were included. Half were male (207/411, 50.4%), with median age 59 (range 19-98) years. Hypertension (251, 65.5%), diabetes mellitus (150, 39.2%), and cancer (133, 34.7%) were frequent comorbidities. Of 518 CRIs, half were respiratory (n = 284/518, 49.8%) from ventilator-associated pneumonia (VAP) (163/284, 57.4%) or hospital-acquired pneumonia (HAP) (117/284, 41.2%). Carbapanem-resistant Enterobacterales (CRE) (301/518, 58.1%) and carbapenem-resistant Acinetobacter baumannii (CRAB) (154/518, 29.7%) were the most common pathogens. The majority expressed efflux pumps (388/411, 94.4%). Class B metallo β-lactamase (blaNDM) for CRE and Class D blaOXA-51-like for CRAB were frequent. Overall mortality at the end of hospital stay was 46%. CONCLUSION:Most CRIs in this cohort were CRE and CRAB from HAP/VAP. Organisms possessed multiple mechanisms of resistance, with phenotypic expression of efflux pumps and blaNDM and blaOXA-51-like predominating. High mortality rate was independent of the mechanism of resistance. Novel antimicrobials directed against these specific resistance mechanisms are urgently needed. This registry can be expanded to provide a real-world view of clinical practices.

The genomes of six methicillin-resistant Staphylococcus aureus (MRSA) revealed CC5(ST5)-SCCmec-IVc-spa-t105-PVL+ (n = 3), CC5(ST6)-SCCmec-IVc-spa-t10002 (n = 1), CC5(ST5)-SCCmec-IVa-spa-t002 (n = 1), and CC8(ST8)-SCCmec-IVa-spa-t008-PVL+ (n = 1) genotypes. All possessed multiple antibiotic resistance genes (putative mecA and blaZ, and dfrG for cotrimoxazole-resistant strains), intact staphylococcal prophages, and putative antiphage systems. The results could aid in MRSA infection management and control.

The Emergency Department (ED) is a primary source of healthcare services for patients with non-urgent conditions in the Philippines. The adaptation of physician group practice (GP) in the ED has gained popularity in the country due to its potential advantage to patient management and physicians compared to independent consultancy (IC). This study aimed to determine the impacts of GP in a non-urgent ED setting in terms of operations, quality of care, and service satisfaction compared to IC. Historical data collection focusing on operations, service costs, patient outcomes, and satisfaction was performed between 2021 and 2022 at a tertiary for-profit private hospital in Metro Manila, Philippines. In addition, patient surveys on demographics, perception, ED accessibility, and descriptive satisfaction ratings were also administered in 2023 (n = 310). These aspects were compared between patients managed by GP and IC quantitatively using univariate descriptive statistics, Mann-Whitney U tests, and ANCOVA to compare operational metrics, financial data, and patient outcomes. Qualitative data from patient surveys were analyzed using a sequential-explanatory approach. Our analysis of the historical data showed high rates of positive outcomes for non-urgent ED patients in both GP and IC. Total (PhP587,812 vs. PhP379,699; p < 0.001) and per patient (PhP1,801 vs. PhP554; p < 0.001) operational costs were higher for the GPs. However, GPs incurred shorter mean length of stay (165.5 vs. 214.2 min; p < 0.001). There appears to be no difference in service satisfaction and overall patient outcomes between patients managed by GP or IC, although patients of GP physicians assessed the level of care of the ED to be higher (5 vs. 4; p-value = 0.019). In the quantitative and qualitative ratings, most patients provided positive citations on ED service quality, staff, structure, system, physician competency and compassion. While GPs were associated with higher operational costs, they improved the ED efficiency and perceived quality of care without compromising patient outcomes. These findings support GP as a viable alternative model for improving ED operations. However, more research is needed to examine its long-term impacts.

The known intrinsic and polymorphic bla OXA-51-like genes of Acinetobacter baumannii were recently reported in other non-A. baumannii Gram-negative pathogens. Accurate detection of this potentially transferrable carbapenemase gene in the clinical setting is critical. This study developed a loop-mediated isothermal amplification (LAMP) assay targetting multiple alleles of bla OXA-51-like genes. Specifically, an alignment-based primer design, in silico primer screening, and in vitro assay confirmation were conducted. Both in silico and in vitro results revealed the tolerance of the LAMP assay to up to five primer-template mismatches outside the 3'-end primer regions. Within 90 min, the LAMP assay also detected the gene targets in other Gram-negative bacteria with known and novel bla OXA-51-like genes. Finally, it showed a superior limit of detection (as low as 101 CFU/mL) compared with polymerase chain reaction, and high specificity against non-targets. This study developed a highly adaptable LAMP assay to monitor bla OXA-51-like genes in the clinical setting and provided important insights into LAMP primer design and screening.

Abstract Background Acinetobacter baumannii continued to be an important Gram-negative pathogen of concern in the clinical context. The resistance of this pathogen to carbapenems due to the production of carbapenemases is considered a global threat. Despite the efforts to track carbapenemase synthesis among A. baumannii in the Philippines, local data on its molecular features are very scarce. This study aims to characterize A. baumannii clinical isolates from a Philippine tertiary hospital through genotyping of the pathogen’s carbapenemase genes. Methods Antibiotic susceptibility profiling, phenotypic testing of carbapenemase production, and polymerase chain reaction assays to detect the different classes of carbapenemase genes (class A blaKPC, class B blaNDM, blaIMP, blaVIM, and class D blaOXA-23-like, blaOXA-24/40-like, blaOXA-48-like, blaOXA-51-like, ISAba1-blaOXA-51-like, blaOXA-58-like) were performed in all collected A. baumannii, both carbapenem resistant and susceptible (n = 52). Results Results showed that the majority of the carbapenem-resistant strains phenotypically produced carbapenemases (up to 84% in carbapenem inactivation methods) and possessed the ISAba1-blaOXA-51-like gene complex (80%). Meanwhile, both carbapenem-resistant and carbapenem-susceptible isolates possessed multi-class carbapenemase genes including blaNDM (1.9%), blaVIM (3.9%), blaOXA-24/40-like (5.8%), blaOXA-58-like (5.8%), blaKPC (11.5%), and blaOXA-23-like (94.2%), which coexist with each other in some strains (17.3%). In terms of the intrinsic blaOXA-51-like (oxaAb) genes, 23 unique alleles were reported (blaOXA-1058 to blaOXA-1080), the majority of which are closely related to blaOXA-66. Isolates possessing these alleles showed varying carbapenem resistance profiles. Conclusions In summary, this study highlighted the importance of molecular genotyping in the characterization of A. baumannii by revealing the carbapenemase profiles of the pathogen (which may not be captured accurately in phenotypic tests), in identifying potent carriers of transferrable carbapenemase genes (which may not be expressed straightforwardly in antimicrobial susceptibility testing), and in monitoring unique pathogen epidemiology in the local clinical setting.

Carbapenem resistance in Acinetobacter baumannii is a critical global health threat attributed to transferrable carbapenemase genes. Carbapenemase genotyping using polymerase chain reaction (PCR) presents a challenge in resource-limited settings because of its technical requirements. This study designed new loop-mediated isothermal amplification (LAMP) primers using multiple sequence alignment-based workflows, validated the primer performance against multiple target variants in silico, and developed novel LAMP assays (LAntRN-OXA23 and LAntRN-ISAba1) to detect the transferable blaOXA-23-like carbapenemase genes and ISAba1 elements in pure cultures and A. baumannii-spiked serum samples. The designed LAMP primers bind to the conserved regions of their highly polymorphic targets, with their in silico performance comparable with other published primers. The in vitro LAMP assays (using 30 PCR-profiled A. baumannii and 10 standard multidrug-resistant gram-negative isolates) have 100% concordance with the PCR-positive clinical samples, limits of detection as low as 1 pg/µL (200 copies/µL), and specificities of 57.89-100%. Both assays produced positive results when testing DNA samples (extracted using a commercial kit) from blaOXA-23-like and ISAba1-blaOXA-51-like PCR-positive A. baumannii-spiked normal human sera (five set-ups per target). In summary, the LAMP assays accurately detected the target genes and have applications in infection management, control, and point-of-care testing in resource-limited healthcare settings.

Background: Burkholderia cepacia complex is an opportunistic environmental pathogen that has been linked to nosocomial outbreaks. We describe an outbreak of bacteremia caused by Burkholderia cenocepacia from a contaminated chlorhexidine gluconate solution. Methods: The hospital infection control team carried out an outbreak investigation on February 21, 2021, when 3 adult hemodialysis patients developed B. cenocepacia bacteremia. Patient demographics and clinical profile were reviewed retrospectively. Potential sources of infection were identified, and environmental screening was performed in several units. Processes of catheter care in the hemodialysis unit were reviewed. Water samples from the hemodialysis unit, and samples of solutions used in patient care were sent for culture. Isolates from patients and from environmental samples were sent for 16S rRNA gene sequencing to determine genetic relatedness. Results: In total, 16 patients, 8 of whom were male, developed B. cenocepacia bacteremia during the investigated period. The median age was 68 years (range, 19–83), and 15 of 16 had at least 1 comorbidity. All patients used a central venous catheter (CVC) for hemodialysis, and 11 (70%) of these 16 were temporary. Chlorhexidine gluconate solution was routinely used as part of CVC care and 1 bottle was shared among 4 hemodialysis stations. On suspicion of contamination, all identified chlorhexidine bottles were recalled on February 26, 2021, and random samples from 15 opened and 19 unopened bottles were sent for culture from the following units: hemodialysis (n = 2), ICU (n = 14), wards (n = 6), and 4 each from transplant surgery, and delivery suites. O0f 34 sampled bottles, 17 grew B. cenocepacia : 8 opened and 9 unopened bottles. The Bayesian inference tree (Fig. 1) supports the hypothesis that patient samples and the samples from the chlorhexidine solutions were most probably related to each other based on the 16S rRNA sequences. However, the individual identities of the specific sample sequences could not be determined using the analyzed region of the gene, possibly due to low quality of the sequences received. No new cases of B. cenocepacia were identified after recall of the chlorhexidine solution, and the outbreak was deemed resolved on March 24, 2021. Conclusions: Medical solutions routinely used in patient care can cause outbreaks and should be suspected as a potential source of infection by infection control teams. Disclosures: None

The Emergency Department (ED) plays the role of providing efficient and quality healthcare services to patients. During the COVID-19 pandemic, there were observed changes in the ED's utilisation and management reflecting the underlying challenges faced by most tertiary hospitals in the Philippines. This study aims to describe the changes in the utilisation and management of ED in a major COVID-19 hospital in the Philippines, its implications for inpatient admissions, and effect on ED staff. Patient data from 2019 (pre-pandemic) and 2020 (pandemic) were compared. In addition, this study administered a COVID-19-specific psychometric tool to assess the pandemic's effect on ED staff. Comparing the pre-pandemic and pandemic census, this study found a 59.0% and 67.6% decrease in ED consultations and hospital admissions, respectively. ED consultations significantly shifted to older patients, with longer length of stay, increased out-of-pocket payment, and mostly presenting with respiratory-related chief complaints. There is a decrease in general hospital unit utilisation, and the addition of a COVID-19 ward and an ICU. Despite the changes, 63.6% of the ED staff exhibited good emotional adjustment to the stress brought by the pandemic. This study reported the situation of Philippine ED amid the pandemic and indicated the important management changes in ED.

In the Philippines, data are scarce on the co-occurrence of multiple β-lactamases (BLs) in clinically isolated Gram-negative bacilli. To investigate this phenomenon, we characterized BLs from various β-lactam-resistant Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii, and Pseudomonas aeruginosa isolated from a Philippine tertiary care hospital. The selected Gram-negative bacilli (n = 29) were resistant to either third-generation cephalosporins (resistance category 1 (RC1)), cephalosporins and penicillin-β-lactamase inhibitors (RC2), or carbapenems (RC3). Isolates resistant to other classes of antibiotics but susceptible to early-generation β-lactams were also selected (RC4). All isolates underwent antibiotic susceptibility testing, disk-diffusion-based BL detection assays, and PCR with sequence analysis of extended-spectrum BLs (ESBLs), metallo-BLs, AmpC BLs, and oxacillinases. Among the study isolates, 26/29 harbored multi-class BLs. All RC1 isolates produced ESBLs, with blaCTX-M as the dominant (19/29) gene. RC2 isolates produced ESBLs, four of which harbored blaTEM plus blaOXA-1 or other ESBL genes. RC3 isolates carried blaNDM and blaIMP, particularly in three of the metallo-BL producers. RC4 Enterobacteriaceae carried blaCTX-M, blaTEM, and blaOXA-24-like, while A. baumannii and P. aeruginosa in this category carried either blaIMP or blaOXA-24. Genotypic profiling, in complement with phenotypic characterization, revealed multi-class BLs and cryptic metallo-BLs among β-lactam-resistant Gram-negative bacilli.

Abstract Background The ability to predict severe/critical Coronavirus Diseases 2019 (COVID-19) infection in fully vaccinated individuals is an incompletely defined area of research and a scoring tool is lacking. Most scoring systems are validated against unvaccinated patients making it less clinically applicable in today’s global landscape. Our study validated an existing clinical prediction tool using data from vaccinated individuals, and created a new model that could provide improved prediction accuracy. Methods Consecutive adult patients fully vaccinated against COVID-19 and admitted to a tertiary hospital from March 2021 to August 2022 for a breakthrough infection were enrolled. Clinical characteristics, type and number of vaccine doses, and RT-PCR cycle-threshold (CT) values were collected. Primary outcome of interest was development of severe/critical COVID-19. An existing severe/critical COVID-19 prediction tool was validated using study data as a comparator prediction tool. Multivariable logistic regression analysis was performed to create a simpler scoring system to predict COVID-19 severity. Results Among 390 adults with COVID-19, 106 (27%) received at least 1 booster dose and 54 (14%) progressed to severe/critical disease. The existing prediction tool had a sensitivity (Sn) of 98.1%, specificity (Sp) of 7.5% and area under the receiver-operator curve (AUROC) of 0.58. Multivariable logistic regression showed that age >75y (OR 2.15; 95% CI 1.04 - 4.47), diabetes mellitus (OR 1.98, 95% CI 1.07-3.67), CT value < 20 (OR 3.48; 95% CI: 1.78 - 6.79), and non-receipt of a booster dose (OR 0.26; 95% CI: 0.11 - 0.64) were independent risk factors for developing severe/critical COVID-19. The final model showed a Sn of 65%, Sp of 68% and AUROC of 0.71. Conclusion A simplified scoring tool using 4 variables may help predict progression to severe/critical COVID-19 in fully vaccinated individuals. Although the tool has modest Sn and Sp, it can be used to help triage patients and guide initial therapy. Validation of this tool in larger studies is recommended. Disclosures All Authors: No reported disclosures

COVID-19 pandemic affected the mental health of the global population. Among the most vulnerable are the healthcare workers (HCWs) who got infected but returned to the frontline after recovery. Currently, there is a dearth of information and understanding on the psychological status and actual lived experience of the recovered HCWs in the Philippines. The present study investigated the psychological status and experiences of 93 COVID-19-recovered HCWs from a tertiary hospital in the Philippines using a mixed-method approach, particularly the explanatory-sequential design. Participants completed the Impact of Event Scale-Revised, and the Depression, Anxiety, and Stress Scale-21 in the quantitative phase. Selected participants took part in focus group discussions in the qualitative phase. Integrated results showed that our participants experienced significant COVID-19-related distress (mean IES-R score = 25.5; partial impact), anxiety (mean subscale score = 7.4; mild), and depression (mean subscale score = 8.1; mild). Certain sociodemographic and professional characteristics and the length of quarantine days appear to affect the psychometric scores. The quantitative results are supported by the participant's description of recovery experiences as living in uncertainty, distress, fatigue, dissociation, and valuation of life. In summary, adequate psychological support and intervention program should be prioritized and provided by hospital management for recovered HCWs to prevent the development of more serious mental health concerns that may significantly affect their tasks in caring for patients and in-hospital management.

Southeast Asia (SEA) can be considered a hotspot of antimicrobial resistance (AMR) worldwide. As recent surveillance efforts in the region reported the emergence of multidrug-resistant (MDR) pathogens, the pursuit of therapeutic alternatives against AMR becomes a matter of utmost importance. Phage therapy, or the use of bacterial viruses called bacteriophages to kill bacterial pathogens, is among the standout therapeutic prospects. This narrative review highlights the current understanding of phages and strategies for a phage revolution in SEA. We define phage revolution as the radical use of phage therapy in infectious disease treatment against MDR infections, considering the scientific and regulatory standpoints of the region. We present a three-phase strategy to encourage a phage revolution in the SEA clinical setting, which involves: (1) enhancing phage discovery and characterization efforts, (2) creating and implementing laboratory protocols and clinical guidelines for the evaluation of phage activity, and (3) adapting regulatory standards for therapeutic phage formulations. We hope that this review will open avenues for scientific and policy-based discussions on phage therapy in SEA and eventually lead the way to its fullest potential in countering the threat of MDR pathogens in the region and worldwide.

Flu, a viral infection caused by the influenza virus, is still a global public health concern with potential to cause seasonal epidemics and pandemics. Vaccination is considered the most effective protective strategy against the infection. However, given the high plasticity of the virus and the suboptimal immunogenicity of existing influenza vaccines, scientists are moving toward the development of universal vaccines. An important property of universal vaccines is their ability to induce heterosubtypic immunity, i.e., a wide immune response coverage toward different influenza subtypes. With the increasing number of studies and mounting evidence on the safety and efficacy of recombinant influenza vaccines (RIVs), they have been proposed as promising platforms for the development of universal vaccines. This review highlights the current progress and advances in the development of RIVs in the context of heterosubtypic immunity induction toward universal vaccine production. In particular, this review discussed existing knowledge on influenza and vaccine development, current hemagglutinin-based RIVs in the market and in the pipeline, other potential vaccine targets for RIVs (neuraminidase, matrix 1 and 2, nucleoprotein, polymerase acidic, and basic 1 and 2 antigens), and deantigenization process. This review also provided discussion points and future perspectives in looking at RIVs as potential universal vaccine candidates for influenza.

The Ibaloi fire mummies are preserved ancient remains of Ibaloi, one of the indigenous peo ples of the northern Philippines. The locals kept the traditional Ibaloi mummification through oral tradi -tions, but the current generation no longer conducts the actual practice. We categorized the mummifica tion steps into preprocessing, smoking, and postprocessing. The preprocessing involved a ‘saltwater purge,’ washing, positioning the body onto a ‘death chair,’ removing the epidermis, and ‘deworming.’ The smoking process, from which the name ‘fire mummy’ was derived, involved the smoking of a body under a low-lit woodfire. The postprocessing involved sun-drying and application of a plant concoction to the body. Notably, the traditional Ibaloi mummification process shares similarities with other mummi fication practices elsewhere. This paper provides a systematic review of the traditional Ibaloi mummifi cation and highlights the essential physical and chemical processes involved in body preservation. We want to encourage more interdisciplinary studies on the Ibaloi fire mummies to identify potential appli cations of the traditional process in corpse preservation. We also hope to contribute to discourses with people from multicultural backgrounds to increase our understanding of the history and culture of an cient human settlements in the Philippines and the Asia-Pacific.

Objectives: The non-standard emergency medicine services and the limited utilisation of primary care providers in the Philippines may contribute towards the ED being a preferred area for patients with non-urgent conditions. Our study aims to determine the factors associated with non-urgent consultations in the ED of a tertiary hospital in the Philippines. Methods: From 7 January to 15 February 2020, we surveyed non-urgent ED patients (n = 757) presenting to a tertiary hospital in the Philippines. We evaluated the data using descriptive statistics, while chi-squared and multivariate analyses versus urgent ED patients (n = 281) were used to show the association of factors. Results: Our recruited non-urgent patients were mostly 21-40 years old (n = 576 [76%]), single (n = 437 [58%]), with full-time employment (n = 654 [86%]), have Health Maintenance Organization coverage (n = 684 [90%]), self-referred (n = 498 [66%]), and have private means of getting to ED (n = 414 [55%]). They had moderate scores of social support-seeking behaviours (mean 3.92/5; 95% confidence interval [CI] 3.88-3.96), health literacy (mean 3.58/5; 95% CI 3.56-3.61), self-efficacy (mean 3.09/5; 95% CI 3.56-3.61), whereas their ED access score (mean 4.10/5; 95% CI 4.06-4.14) was high. They had moderate self-assessed severity (mean 3.75/6; 95% CI 3.70-3.80), urgency (mean 3.83/6; 95% CI 3.78-3.88), and anxiety (mean 3.88/6; 95% CI 3.83-3.93) scores and high ED satisfaction rating (mean 4.73/6; 95% CI 4.69-4.77). They mostly had digestive (n = 203 [26.8%]) and infection-related (n = 172 [22.7%]) chief complaints and final diagnoses (n = 198 [26.2%] and n = 145 [19.2%], respectively), without previous consultations (n = 577 [76%]), and eventually discharged (n = 755 [99%]). Our urgent patients had similar characteristics, but with higher assessed patient severity, urgency, anxiety and satisfaction with ED services (P < 0.001). Conclusion: Non-urgent consultations in ED are attributed to multiple factors encompassing socio-demographic, socio-economic and psychosocial dimensions. These factors must be considered in improving the current healthcare management system for the appropriate utilisation of ED in the Philippines.

Owing to the non-specific signs and symptoms of patients during the acute phase of dengue illness, accurate detection of dengue virus (DENV) infection by a reliable yet simple laboratory test during the early phase of illness is crucial for proper management and better clinical outcome of patients. In order to address this need, a miniature loop mediated amplification (LAMP) kit, BIOTEK-M (TM) Dengue Aqua kit, was developed and evaluated at four hospitals in the Philippines among 517 patients greater than six months of age who presented with prior fever of no longer than seven days. Diagnostic accuracy was determined by comparing with the gold standard of a combination of dengue heminested RT-PCR, IgM ELISA, and NS1 and paired acute-convalescent IgG ELISA, with 91.7% meeting the criteria for true DENV infection. Sensitivity, specificity, positive predictive value, and negative predictive value were 81.9% (95% confidence interval (CI): 89.3-94.1), 85.7% (95% CI: 46.7-99.3), 99.7% (95% CI: 98.3-100), and 7.5% (95% CI: 3.3-15.4), respectively. The positive likelihood ratio was 6.549 (95% CI: 1.046-40.981) and the negative likelihood ratio was 0.207 (95% CI: 0.165-0.260). These results validate the application of BIOTEK-M (TM) Dengue Aqua kit for detection of early DENV infection and should be a useful tool in dengue control and elimination programs in the Philippines and other dengue endemic countries.

Owing to the non-specific signs and symptoms of patients during the acute phase of dengue illness, accurate detection of dengue virus (DENV) infection by a reliable yet simple laboratory test during the early phase of illness is crucial for proper management and better clinical outcome of patients. In order to address this need, a miniature loop mediated amplification (LAMP) kit, BIOTEK-MTM Dengue Aqua kit, was developed and evaluated at four hospitals in the Philippines among 517 patients greater than six months of age who presented with prior fever of no longer than seven days. Diagnostic accuracy was determined by comparing with the gold standard of a combination of dengue heminested RT-PCR, IgM ELISA, and NS1 and paired acute-convalescent IgG ELISA, with 91.7% meeting the criteria for true DENV infection. Sensitivity, specificity, positive predictive value, and negative predictive value were 81.9% (95% confidence interval (CI): 89.3-94.1), 85.7% (95% CI: 46.7-99.3), 99.7% (95% CI: 98.3-100), and 7.5% (95% CI: 3.3-15.4), respectively. The positive likelihood ratio was 6.549 (95% CI: 1.046-40.981) and the negative likelihood ratio was 0.207 (95% CI: 0.165-0.260). These results validate the application of BIOTEK-MTM Dengue Aqua kit for detection of early DENV infection and should be a useful tool in dengue control and elimination programs in the Philippines and other dengue endemic countries.

Objectives. This study aimed to analyze if the indicator 72-hours Unplanned Return Visits after EmergencyDepartment (ED) index discharge was influenced by the patient’s age, triage severity, month, payment methods,and length of stay. Likewise, it aimed to determine if the 72-hour Unplanned Return Visits was a robust indicator inassessing the quality of Emergency Department services. Methods. This was a retrospective single-center study from January to December 2017. Data were retrievedfrom a tertiary hospital in the Philippines. All Emergency Department patients discharged on their index visitwere monitored for Unplanned Return Visits within 72 hours in the hospital. A univariate and multivariate logisticregression model was used to assess the variables associated with the 72-hour Unplanned Return Visits. Results. The 72-hour Unplanned Return Visits rate was measured at 2.67%, with the highest occurrence on thefirst 24 hours, and with predominance on third-party payer (p.<.0001), pediatrics (p.<0001), January (p<.0001),February (p<.0001), November (p<.0001), December (p<0001), and shorter length of stay (p<.0001) dischargedafter ED index visit. Conclusions. Strong association of Unplanned Return Visits during the first 72 hours after Emergency Departmentindex discharge was found for patients financed through third party-payers, with seasonal variations andinclination to the younger population with shorter length of stay. These findings warrant exploratory studies todetermine the reasons for the 72-hour Unplanned Return Visits after Emergency Department index discharge andinvestigation on the association of premature discharge, socio-economic, health structure, and illness progression.