A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study

Background: Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. Methods: We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. Findings: On July 1, 2019, 26 of infants (580/2,265; range, 0�100; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received �1 antimicrobial agent (92, antibacterial; 19, antifungal; 4, antiviral). The most common reasons for antibiotic therapy were �rule-out� sepsis (32) and �culture-negative� sepsis (16) with ampicillin (40), gentamicin (35), amikacin (19), vancomycin (15), and meropenem (9) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26), amikacin (20), and meropenem (16) were the most prescribed agents. Length of therapy for culture-positive and �culture-negative� infections was 12 days (median; IQR, 8�14) and 7 days (median; IQR, 5�10), respectively. Mortality was 6 (42, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0·02). Interpretation: Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide. Funding: Merck & Co.; The Ohio State University College of Medicine Barnes Medical Student Research Scholarship © 2021 The Author

Reclaimed wastewater: Effects on citrus nutrition

The effects of irrigation with reclaimed wastewater (RWW) were compared with well water (WW) on citrus (Citrus paradisi Macfad. X Citrus aurantium L.) nutrition. The deviation from the optimum percentage (DOP) index of macro- and micro-nutrients were used to evaluate the nutritional status: optimal (DOP = 0), deficiency (DOP   0). After 11 years of RWW irrigation the influence on nutrient concentration in plants decreased in the order: B > Zn > Mn = Ca > Cu > Mg > P > K. Reclaimed wastewater irritation positively affected citrus nutrition as it rendered the concentration of macro-nutrients, i.e. P, Ca, and K. closer to their optimum levels ([Sigma]DOPmacro = 7). However micro-nutrients tended to be excessive in plants ([Sigma]DOPmicro = 753) due to imbalanced supply of these elements in the RWW, particularly, for B and Cu. Citrus groves with long-term RWW irrigation may exercised caution in monitoring concentrations of B and Cu to avoid plant toxicity and soil quality degradation.Citrus paradisi Macro-nutrients Micro-nutrients Plant nutrition Wastewater irrigation Water reuse

Phosphorus availability in sediments from a tidal river receiving runoff water from agricultural fields

Eutrophication of surface water is a worldwide concern. Sediments may play an important role in buffering phosphorus (P) concentration in the overlying water column. However, information on the spatial variation of sediment P availability as affected by agricultural water discharge and hydrological conditions is limited. In this study river sediments were sampled in spring, summer, fall and winter, respectively from seven locations along a main tributary (Ten Mile Creek, TMC), which receives surface runoff water from agricultural lands and discharges into the Indian River Lagoon, south Florida, USA, and analyzed for P availability. Simultaneously, hydrological variables were measured on the spot and river water samples were collected for analyses of water quality. The results demonstrated that available P in the sediments of TMC as measured by several commonly used extraction procedures had a large spatial variation. The downstream locations had a greater amount of available P in the sediments than the upstream locations, which is attributable to the settlement of finer particles due to slower water flow and increased influence from salt water in the downstream locations where the fresh river water gradually mixed with salt water from the Indian River Lagoon. Phosphorus availability in the sediments appeared to be related to P sorption by iron and aluminum oxides and the competition for adsorbing sites between SO42- and PO43-. This spatial variation of P availability agrees with the elevation of chlorophyll a (Chla) in overlying water body in the downstream locations of TMC, indicating that the internal P source plays an important role in triggering an algal boom in surface water systems.Chlorophyll a Sediment phosphorus Availability indicators Sulfate reduction Anion competition