Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries

BACKGROUND: Improving the quality of hospital antibiotic use is a major goal of WHO's global action plan to combat antimicrobial resistance. The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate simple stewardship interventions that are widely applicable globally. We aimed to present data on patterns of paediatric AWaRe antibiotic use that could be used for local and national stewardship interventions. METHODS: 1-day point prevalence survey antibiotic prescription data were combined from two independent global networks: the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children and the Global Point Prevalence Survey on Antimicrobial Consumption and Resistance networks. We included hospital inpatients aged younger than 19 years receiving at least one antibiotic on the day of the survey. The WHO AWaRe classification was used to describe overall antibiotic use as assessed by the variation between use of Access, Watch, and Reserve antibiotics, for neonates and children and for the commonest clinical indications. FINDINGS: Of the 23 572 patients included from 56 countries, 18 305 were children (77·7%) and 5267 were neonates (22·3%). Access antibiotic use in children ranged from 7·8% (China) to 61·2% (Slovenia) of all antibiotic prescriptions. The use of Watch antibiotics in children was highest in Iran (77·3%) and lowest in Finland (23·0%). In neonates, Access antibiotic use was highest in Singapore (100·0%) and lowest in China (24·2%). Reserve antibiotic use was low in all countries. Major differences in clinical syndrome-specific patterns of AWaRe antibiotic use in lower respiratory tract infection and neonatal sepsis were observed between WHO regions and countries. INTERPRETATION: There is substantial global variation in the proportion of AWaRe antibiotics used in hospitalised neonates and children. The AWaRe classification could potentially be used as a simple traffic light metric of appropriate antibiotic use. Future efforts should focus on developing and evaluating paediatric antibiotic stewardship programmes on the basis of the AWaRe index. FUNDING: GARPEC was funded by the PENTA Foundation. GARPEC-China data collection was funded by the Sanming Project of Medicine in Shenzhen (SZSM2015120330). bioMérieux provided unrestricted funding support for the Global-PPS

Fauna of Noctuidae (Lepidoptera: Noctuoidea) in a pasture area in Altamira, Eastern Amazon, Pará, Brazil

This study evaluated the nocturnal fauna of Noctuidae in a pasture area in Altamira, Pará. Samples were collected monthly for two nights at the new moon period, from August 2007 to July 2008. We collected a total of 345 specimens (N) of 66 species (S). The most abundant species were Ptichodes basilans (Guenée) (n = 87), Leucania jaliscana (Schaus), Spodoptera frugiperda (JE Smith) (n = 28) and Argidia palmipes Guenée (n = 21). For the entire period, the following indexes were found: Shannon diversity H′= 3.20 and Brillouin H = 2.94, evenness of Shannon E′= 0.76 and Brillouin E= 0.76, and Berger-Parker dominance BP= 0.252. The greatest diversity was found in the dry season. According to the estimates of species richness, it is possible that between 14 to 72 more species exist in the region

Bionomy of Anicla mahalpa Schaus, 1898 (Lepidoptera: Noctuidae: Noctuinae), in the laboratory

The genus Anicla Grote, 1874 is composed of eleven species; their larvae are harmful, mainly to native and cultivated grasses, but up to now, there is information available of only two species. This study aims at detailing the bionomy of A. mahalpa Schaus; the data were obtained from a laboratory rearing under the following settings: 20 ± 2 ºC, 70 ± 10% relative humidity and 12 hours of photoperiod. Larvae were fed on ryegrass, Lolium multiflorum Lam. (Poaceae). The results expressed by the mean and respective standard error for the periods of each phase, in days, were the following: egg 6.00 ± 0.00, larva 36.47 ± 0.44, pre-pupa 5.23 ± 0.21, pupa 23.60 ± 0.37, and adult: longevity 15.24 ± 0.75 with pre-egg-laying-periods of 5.29 ± 0.32; egg-laying period, 9.64 ± 0.81, and post-egg-laying period, 0.71 ± 0.27 days. The mean number of egg-laying cycles per female was 7.36 ± 0.20 and 2,014.21 ± 78.93 eggs per female. Eggs, which are subspheric, have a diameter of 0.76 ± 0.01 mm; larvae passed through six instars; their head capsules width, provided a mean ratio of growth of 1.482. Pupae presented a mean width and length of 6.07 ± 0.06 and 17.24 ± 0.19 mm, respectively and weight of 0.33 ± 0.01 g

Diversity and composition of Arctiinae moth assemblages along elevational and spatial dimensions in Brazilian Atlantic Forest

When considering Neotropical Lepidoptera for conservation purposes moths are usually neglected because little is known about their biology, ecology and taxonomy. Using light-traps, we sampled moths in the subfamily Arctiinae (Noctuoidea: Erebidae) along an elevational transect (7–927 m asl) on a steep slope of Atlantic Forest in the southern region of Serra do Mar, Brazil. Serra do Mar assemblages clustered according to three elevational zones. We recorded 294 species of Arctiinae in Serra do Mar, and an approach using rarefaction and extrapolation indicated that species richness decreases with increasing elevation, similarly to patterns found in southern Ecuador and Costa Rica, although diversity in Serra do Mar is lower than in southern Ecuador. The elevational transect samples from Serra do Mar were compared with available data for two other biomes. For such comparative analyses, we focused on the tribe Arctiini, for which assemblages were partitioned into Serra do Mar, Interior Atlantic forest and Pampa. The Brazilian Pampa was expected to be less diverse due to low habitat complexity, but it was not possible to explain the higher diversity of Arctiines in Serra do Mar compared to Interior Atlantic Forest. This discrepancy and the probable reasons behind it are discussed, and directions for future research are proposed. Undoubtedly, there is a great need of extensive taxonomical revisions and basic biology research on Arctiines in the Atlantic Forest, Pampa and probably in other tropical and subtropical habitats. 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