Third generation cephalosporin use in a tertiary hospital in Port of Spain, Trinidad: need for an antibiotic policy

BACKGROUND: Tertiary care hospitals are a potential source for development and spread of bacterial resistance being in the loop to receive outpatients and referrals from community nursing homes and hospitals. The liberal use of third-generation cephalosporins (3GCs) in these hospitals has been associated with the emergence of extended-spectrum beta- lactamases (ESBLs) presenting concerns for bacterial resistance in therapeutics. We studied the 3GC utilization in a tertiary care teaching hospital, in warded patients (medical, surgical, gynaecology, orthopedic) prescribed these drugs. METHODS: Clinical data of patients (≥ 13 years) admitted to the General Hospital, Port of Spain (POSGH) from January to June 2000, and who had received 3GCs based on the Pharmacy records were studied. The Sanford Antibiotic Guide 2000, was used to determine appropriateness of therapy. The agency which procures drugs for the Ministry of Health supplied the cost of drugs. RESULTS: The prevalence rate of use of 3GCs was 9.5 per 1000 admissions and was higher in surgical and gynecological admissions (21/1000) compared with medical and orthopedic (8 /1000) services (p < 0.05). Ceftriaxone was the most frequently used 3GC. Sixty-nine (36%) patients without clinical evidence of infection received 3Gcs and prescribing was based on therapeutic recommendations in 4% of patients. At least 62% of all prescriptions were inappropriate with significant associations for patients from gynaecology (p < 0.003), empirical prescribing (p < 0.48), patients with undetermined infection sites (p < 0.007), and for single drug use compared with multiple antibiotics (p < 0.001). Treatment was twice as costly when prescribing was inappropriate CONCLUSIONS: There is extensive inappropriate 3GC utilization in tertiary care in Trinidad. We recommend hospital laboratories undertake continuous surveillance of antibiotic resistance patterns so that appropriate changes in prescribing guidelines can be developed and implemented. Though guidelines for rational antibiotic use were developed they have not been re-visited or encouraged, suggesting urgent antibiotic review of the hospital formulary and instituting an infection control team. Monitoring antibiotic use with microbiology laboratory support can promote rational drug utilization, cut costs, halt inappropriate 3GC prescribing, and delay the emergence of resistant organisms. An ongoing antibiotic peer audit is suggested

Repeat-sequence turnover shifts fundamentally in species with large genomes

Given the 2,400-fold range of genome sizes (0.06–148.9 Gbp (gigabase pair)) of seed plants (angiosperms and gymnosperms) with a broadly similar gene content (amounting to approximately 0.03 Gbp), the repeat-sequence content of the genome might be expected to increase with genome size, resulting in the largest genomes consisting almost entirely of repetitive sequences. Here we test this prediction, using the same bioinformatic approach for 101 species to ensure consistency in what constitutes a repeat. We reveal a fundamental change in repeat turnover in genomes above around 10 Gbp, such that species with the largest genomes are only about 55% repetitive. Given that genome size influences many plant traits, habits and life strategies, this fundamental shift in repeat dynamics is likely to affect the evolutionary trajectory of species lineages.We thank Natural Environment Research Council (NE/G020256/1), the Czech Academy of Sciences (RVO:60077344) and Ramón y Cajal Fellowship (RYC-2017-2274) funded by the Ministerio de Ciencia y Tecnología (Gobierno de España) for support. We also thank Natural Environment Research Council for funding a studentship to S.D. and the China Scholarship Council for funding W.W.Abstract Main Methods Data availability Code availability References Acknowledgements Author information Ethics declarations Additional information Extended data Supplementary information Rights and permissions About this article Further readin

K-CLASH: Strangulation and ram pressure stripping in galaxy cluster members at 0.3 < z < 0.6

Galaxy clusters have long been theorized to quench the star formation of their members. This study uses integral-field unit observations from the K-band MultiObject Spectrograph (KMOS) &#x2013; Cluster Lensing And Supernova survey with Hubble (CLASH) survey (K-CLASH) to search for evidence of quenching in massive galaxy clusters at redshifts 0.3 < z < 0.6. We first construct mass-matched samples of exclusively star-forming cluster and field galaxies, then investigate the spatial extent of their H&#x2009;&#x3B1; emission and study their interstellar medium conditions using emission line ratios. The average ratio of H&#x2009;&#x3B1; half-light radius to optical half-light radius ($r_{\mathrm{e}, {\rm {H}\,\alpha }}/r_{\mathrm{e}, R_{\mathrm{c} } }$) for all galaxies is 1.14&#xA0;&#xB1;&#xA0;0.06, showing that star formation is taking place throughout stellar discs at these redshifts. However, on average, cluster galaxies have a smaller $r_{\mathrm{e}, {\rm {H}\alpha }}/r_{\mathrm{e}, R_{\mathrm{c} } }$ ratio than field galaxies: &#x2329;$r_{\mathrm{e}, {\rm {H}\alpha }}/r_{\mathrm{e}, R_{\mathrm{c} } }$&#x232A;&#xA0;= 0.96&#xA0;&#xB1;&#xA0;0.09 compared to 1.22&#xA0;&#xB1;&#xA0;0.08 (smaller at a 98&#x2009;per&#x2009;cent credibility level). These values are uncorrected for the wavelength difference between H&#x2009;&#x3B1; emission and Rc-band stellar light but implementing such a correction only reinforces our results. We also show that whilst the cluster and field samples follow indistinguishable mass&#x2013;metallicity (MZ) relations, the residuals around the MZ relation of cluster members correlate with cluster-centric distance; galaxies residing closer to the cluster centre tend to have enhanced metallicities (significant at the 2.6&#x3C3; level). Finally, in contrast to previous studies, we find no significant differences in electron number density between the cluster and field galaxies. We use simple chemical evolution models to conclude that the effects of disc strangulation and ram-pressure stripping can quantitatively explain our observations

The KMOS Redshift One Spectroscopic Survey (KROSS): the origin of disk turbulence in z~0.9 star-forming galaxies

We analyse the velocity dispersion properties of 472 z~0.9 star-forming galaxies observed as part of the KMOS Redshift One Spectroscopic Survey (KROSS). The majority of this sample is rotationally dominated (83 +/- 5% with v_C/sigma_0 &gt; 1) but also dynamically hot and highly turbulent. After correcting for beam smearing effects, the median intrinsic velocity dispersion for the final sample is sigma_0 = 43.2 +/- 0.8 km/s with a rotational velocity to dispersion ratio of v_C/sigma_0 = 2.6 +/- 0.1. To explore the relationship between velocity dispersion, stellar mass, star formation rate and redshift we combine KROSS with data from the SAMI survey (z~0.05) and an intermediate redshift MUSE sample (z~0.5). While there is, at most, a weak trend between velocity dispersion and stellar mass, at fixed mass there is a strong increase with redshift. At all redshifts, galaxies appear to follow the same weak trend of increasing velocity dispersion with star formation rate. Our results are consistent with an evolution of galaxy dynamics driven by disks that are more gas rich, and increasingly gravitationally unstable, as a function of increasing redshift. Finally, we test two analytic models that predict turbulence is driven by either gravitational instabilities or stellar feedback. Both provide an adequate description of the data, and further observations are required to rule out either model

KROSS–SAMI: a direct IFS comparison of the Tully–Fisher relation across 8 Gyr since z ≈ 1

We construct Tully–Fisher relations (TFRs), from large samples of galaxies with spatially resolved H α emission maps from the K-band Multi-Object Spectrograph (KMOS) Redshift One Spectroscopic Survey (KROSS) at z ≈ 1. We compare these to data from the Sydney-Australian-Astronomical-Observatory Multi-object Integral-Field Spectrograph (SAMI) Galaxy Survey at z ≈ 0. We stringently match the data quality of the latter to the former, and apply identical analysis methods and sub-sample selection criteria to both to conduct a direct comparison of the absolute K-band magnitude and stellar mass TFRs at z ≈ 1 and 0. We find that matching the quality of the SAMI data to that of KROSS results in TFRs that differ significantly in slope, zero-point, and (sometimes) scatter in comparison to the corresponding original SAMI relations. These differences are in every case as large as or larger than the differences between the KROSS z ≈ 1 and matched SAMI z ≈ 0 relations. Accounting for these differences, we compare the TFRs at z ≈ 1 and 0. For disc-like, star-forming galaxies we find no significant difference in the TFR zero-points between the two epochs. This suggests the growth of stellar mass and dark matter in these types of galaxies is intimately linked over this ≈8 Gyr period