Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries:results of an internet-based global point prevalence survey

Summary: Background: The Global Point Prevalence Survey (Global-PPS) established an international network of hospitals to measure antimicrobial prescribing and resistance worldwide. We aimed to assess antimicrobial prescribing and resistance in hospital inpatients. Methods: We used a standardised surveillance method to collect detailed data about antimicrobial prescribing and resistance from hospitals worldwide, which were grouped by UN region. The internet-based survey included all inpatients (adults, children, and neonates) receiving an antimicrobial who were on the ward at 0800 h on one specific day between January and September, 2015. Hospitals were classified as primary, secondary, tertiary (including infectious diseases hospitals), and paediatric hospitals. Five main ward types were defined: medical wards, surgical wards, intensive-care units, haematology oncology wards, and medical transplantation (bone marrow or solid transplants) wards. Data recorded included patient characteristics, antimicrobials received, diagnosis, therapeutic indication according to predefined lists, and markers of prescribing quality (eg, whether a stop or review date were recorded, and whether local prescribing guidelines existed and were adhered to). We report findings for adult inpatients. Findings: The Global-PPS for 2015 included adult data from 303 hospitals in 53 countries, including eight lower-middle-income and 17 upper-middle-income countries. 86 776 inpatients were admitted to 3315 adult wards, of whom 29 891 (34·4%) received at least one antimicrobial. 41 213 antimicrobial prescriptions were issued, of which 36 792 (89·3%) were antibacterial agents for systemic use. The top three antibiotics prescribed worldwide were penicillins with β-lactamase inhibitors, third-generation cephalosporins, and fluoroquinolones. Carbapenems were most frequently prescribed in Latin America and west and central Asia. Of patients who received at least one antimicrobial, 5926 (19·8%) received a targeted antibacterial treatment for systemic use, and 1769 (5·9%) received a treatment targeting at least one multidrug-resistant organism. The frequency of health-care-associated infections was highest in Latin America (1518 [11·9%]) and east and south Asia (5363 [10·1%]). Overall, the reason for treatment was recorded in 31 694 (76·9%) of antimicrobial prescriptions, and a stop or review date in 15 778 (38·3%). Local antibiotic guidelines were missing for 7050 (19·2%) of the 36 792 antibiotic prescriptions, and guideline compliance was 77·4%. Interpretation: The Global-PPS showed that worldwide surveillance can be accomplished with voluntary participation. It provided quantifiable measures to assess and compare the quantity and quality of antibiotic prescribing and resistance in hospital patients worldwide. These data will help to improve the quality of antibiotic prescribing through education and practice changes, particularly in low-income and middle-income countries that have no tools to monitor antibiotic prescribing in hospitals. Funding: bioMérieux

Upper molar morphology, homologies and evolutionary patterns of chinchilloid rodents (Mammalia, Caviomorpha)

Chinchilloidea are a clade of caviomorph rodents that includes seven living species, the Dinomyidae Dinomys branickii, the Chinchillidae Lagostomus maximus, two species of Chinchilla and three species of Lagidium. In addition, two extinct families are traditionally considered chinchilloids – Neoepiblemidae and Cephalomyidae. The phylogeny of the Chinchilloidea has so far not been well established and is based on partial analyses. Studying the anatomy and ontogeny of extinct and extant taxa, we propose homologies for the upper molars of Chinchilloidea for which these homologies have not been previously proposed: that is the Chinchillidae Prolagostomus, Lagostomus, Lagidium and Chinchilla, and the Neoepiblemidae Neoepiblema and Phoberomys. We identify patterns of occlusal simplification within Chinchilloidea and evaluate its importance in an evolutionary context. A phylogenetic analysis recovered Dinomyidae, Chinchillidae and Neoepiblemidae as clades. ‘Cephalomyidae’ have not been not recovered as a monophyletic group and ‘cephalomyids’ are closely related to Neoepiblemidae. Branisamys is not included within the Dinomyidae and appears to be a basal chinchilloid.Fil: Rasia, Luciano Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. División Paleontología Vertebrados; ArgentinaFil: Candela, Adriana Magdalena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. División Paleontología Vertebrados; Argentin

A New Pliocene Capybara (Rodentia, Caviidae) from Northern South America (Guajira, Colombia), and its Implications for the Great American Biotic Interchange

One of the most striking components of the modern assemblage of South American mammals is the semiaquatic capybara (Caviidae, Hydrochoerinae), the biggest rodent in the world. The large hydrochoerines are recorded from the middle Miocene to the present, mainly in high latitudes of South America. Although less known, they are also recorded in low latitudes of South America, and in Central and North America. We report the first record of capybaras from the late Pliocene of Colombia, found in deposits of the Ware Formation, Guajira Peninsula in northeastern Colombia. We analyze the phylogenetic position within Caviidae, the possible environmental changes in the Guajira Peninsula, and the implications of this finding for the understanding of the Great American Biotic Interchange. The morphological and phylogenetic analyses indicate that the hydrochoerine of the Guajira Peninsula is a new species, ?Hydrochoeropsis wayuu, and this genus is most closely related to Phugatherium. According to the latest phylogenetic results, this clade is the sister group of the lineage of the recent capybaras (Neochoerus and Hydrochoerus). ?Hydrochoeropsis wayuu is the northernmost South American Pliocene hydrochoerine record and the nearest to the Panamanian bridge. The presence of this hydrochoerine, together with the fluvio-deltaic environment of the Ware Formation, suggests that during the late Pliocene, the environment that dominated the Guajira Peninsula was more humid and with permanent water bodies, in contrast with its modern desert habitats

The earliest burst of necrophagous dung beetles in South America revealed by the Cenozoic record of Coprinisphaera

New ichnological, sedimentological and palaeobotanical information from a Miocene palaeosol succession from Patagonia bearing abundant fossil brood balls of dung beetles (Coprinisphaera) allow inferring novel aspects of the evolutionary history, biology and feeding habits of Scarabaeinae, along with the palaeoenvironmental and palaeoclimatic conditions in which they nested. Coprinisphaera tonnii and Coprinisphaera akatanka, both attributed to necrophagous dung beetles, represent 40.2% of the specimens. Considering their scarce or null record in older Cenozoic units from South America, these high values reveal that the first burst of necrophagous Scarabaeinae took place during the Miocene. Some Coprinisphaera preserve characters that indicate the developmental stage of the ball occupant and the adult emergence success. Both ichnospecies show the egg chamber isolated from the provision chamber, which was associated with a higher preference of cleptoparasites for necrophagous balls. The comparison among the abundance of traces of nest intruders in Coprinisphaera attributed both to necrophagous and to coprophagous beetles from different units of South America indicates that the presence of such intruders would be independent of the nature of the organic matter contained within the balls. Phytolith analyses performed in Coprinisphaera and extant necrophagous and coprophagous balls indicate that the comparison between the relative abundance of phytoliths in the wall of the brood ball, their infilling and the bearing palaeosol is a useful tool for inferring the feeding behaviour of the trace makers and support the attribution of Coprinisphaera tonnii and Coprinisphaera akatanka to necrophagous Scarabaeinae. Sedimentary and palaeosol analyses indicate that the beetles would have nested in well-drained soils showing mollic-like features, in grass-dominated habitats, under a seasonal sub-humid, temperate–warm climate.Fil: Cantil, Liliana Fernanda. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; ArgentinaFil: Bellosi, Eduardo Sergio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; ArgentinaFil: Sánchez, María Victoria. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; ArgentinaFil: Gonzalez, Mirta Gladys. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; ArgentinaFil: Genise, Jorge Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; Argentin