The impact of the COVID-19 pandemic on antimicrobial usage: an international patient-level cohort study

Background This study aimed to evaluate the trends in antimicrobial prescription during the first 1.5 years of COVID-19 pandemic. Methods This was an observational, retrospective cohort study using patient-level data from Bangladesh, Brazil, India, Italy, Malawi, Nigeria, South Korea, Switzerland and Turkey from patients with pneumonia and/or acute respiratory distress syndrome and/or sepsis, regardless of COVID-19 positivity, who were admitted to critical care units or COVID-19 specialized wards. The changes of antimicrobial prescription between pre-pandemic and pandemic were estimated using logistic or linear regression. Pandemic effects on month-wise antimicrobial usage were evaluated using interrupted time series analyses (ITSAs). Results Antimicrobials for which prescriptions significantly increased during the pandemic were as follows: meropenem in Bangladesh (95% CI: 1.94–4.07) with increased prescribed daily dose (PDD) (95% CI: 1.17–1.58) and Turkey (95% CI: 1.09–1.58), moxifloxacin in Bangladesh (95% CI: 4.11–11.87) with increased days of therapy (DOT) (95% CI: 1.14–2.56), piperacillin/tazobactam in Italy (95% CI: 1.07–1.48) with increased DOT (95% CI: 1.01–1.25) and PDD (95% CI: 1.05–1.21) and azithromycin in Bangladesh (95% CI: 3.36–21.77) and Brazil (95% CI: 2.33–8.42). ITSA showed a significant drop in azithromycin usage in India (95% CI: −8.38 to −3.49 g/100 patients) and South Korea (95% CI: −2.83 to −1.89 g/100 patients) after WHO guidelines v1 release and increased meropenem usage (95% CI: 93.40–126.48 g/100 patients) and moxifloxacin (95% CI: 5.40–13.98 g/100 patients) in Bangladesh and sulfamethoxazole/trimethoprim in India (95% CI: 0.92–9.32 g/100 patients) following the Delta variant emergence. Conclusions This study reinforces the importance of developing antimicrobial stewardship in the clinical settings during inter-pandemic periods

Permo-Carboniferous granitoids with Jurassic high temperature metamorphism in Central Pontides, Northern Turkey

In the northern part of the Central Pontides (N Turkey) there are different metamorphic rocks exposed, notably the Devrekani metamorphic rocks. Here, upper amphibolite-lower granulite facies metamorphic rocks contain predominantly paragneiss, orthogneiss and metacarbonate, and to a lesser extent, amphibolite and quartzite, with cross-cutting aplite, pegmatite and granite veins. This is the first report of these rocks and includes new data on the petrochemistry, geochronology and metamorphic evolution of the Devrekani orthogneisses from the Central Pontides. The orthogneisses show five different mineral parageneses with the characteristic mineral assemblage quartz + K-feldspar + plagioclase + biotite ± hornblende ± opaque (± ilmenite and ± magnetite), and accessory minerals (zircon, sphene and apatite). These metamorphic rocks exhibit generally granoblastic, lepidogranoblastic and nematolepidogranoblastic with locally migmatitic and relic micrographic textures. They have well-developed centimeter-spaced gneissic banding and display gneissose structure with symmetric, asymmetric and irregular folds. The petrographic features, mineralogical assemblages and weak migmatization reflect high temperature conditions. Thermometric calculations in the orthogneisses indicate metamorphic temperatures reached 744 ± 33 °C. Field relations, petrography and petrochemistry suggest that the orthogneisses have predominantly granodioritic and some granitic protoliths, that show features of I-type, medium to high-potassic calc-alkaline volcanic arc granitoids. The orthogneisses have high contents of LILEs and low contents of HFSEs with negative Nb and Ti anomalies, which are typical of subduction-related magmas. The orthogneisses also show significant LREE enrichment relative to HREE with negative Eu anomalies (EuN/Eu* = 0.33–1.07) with LaN/LuN = 6.98–20.47 values. Based on U-Pb zircon dating data, the protoliths are related to Permo-Carboniferous (316–252 Ma) magmatism. It is likely that peak metamorphism took place during the Jurassic as reflected by the U-Pb zircon ages (199–158 Ma) and also 40Ar/39Ar from hornblende/biotite (163–152 Ma). The four biotite 40Ar/39Ar average ages from the rock samples are ca. 156 Ma, suggesting that the metamorphic rocks cooled to 350–400 °C at ca. 156 Ma. Conclusively, the Devrekani metamorphic rocks can be ascribed as products of Permo-Carboniferous continental arc magmatism overprinted by Jurassic metamorphism in the northern Central Pontides

The impact of the COVID-19 pandemic on antimicrobial usage:an international patient-level cohort study

Background: This study aimed to evaluate the trends in antimicrobial prescription during the first 1.5 years of COVID-19 pandemic.Methods: This was an observational, retrospective cohort study using patient-level data from Bangladesh, Brazil, India, Italy, Malawi, Nigeria, South Korea, Switzerland and Turkey from patients with pneumonia and/or acute respiratory distress syndrome and/or sepsis, regardless of COVID-19 positivity, who were admitted to critical care units or COVID-19 specialized wards. The changes of antimicrobial prescription between pre-pandemic and pandemic were estimated using logistic or linear regression. Pandemic effects on month-wise antimicrobial usage were evaluated using interrupted time series analyses (ITSAs).Results: Antimicrobials for which prescriptions significantly increased during the pandemic were as follows: meropenem in Bangladesh (95% CI: 1.94-4.07) with increased prescribed daily dose (PDD) (95% CI: 1.17-1.58) and Turkey (95% CI: 1.09-1.58), moxifloxacin in Bangladesh (95% CI: 4.11-11.87) with increased days of therapy (DOT) (95% CI: 1.14-2.56), piperacillin/tazobactam in Italy (95% CI: 1.07-1.48) with increased DOT (95% CI: 1.01-1.25) and PDD (95% CI: 1.05-1.21) and azithromycin in Bangladesh (95% CI: 3.36-21.77) and Brazil (95% CI: 2.33-8.42). ITSA showed a significant drop in azithromycin usage in India (95% CI: -8.38 to -3.49 g/100 patients) and South Korea (95% CI: -2.83 to -1.89 g/100 patients) after WHO guidelines v1 release and increased meropenem usage (95% CI: 93.40-126.48 g/100 patients) and moxifloxacin (95% CI: 5.40-13.98 g/100 patients) in Bangladesh and sulfamethoxazole/trimethoprim in India (95% CI: 0.92-9.32 g/100 patients) following the Delta variant emergence.Conclusions: This study reinforces the importance of developing antimicrobial stewardship in the clinical settings during inter-pandemic periods.</p