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To evaluate temporal trends in the prevalence of gram-negative bacteria (GNB) with difficult-to-treat resistance (DTR) in the southeastern United States. Secondary objective was to examine the use of novel β-lactams for GNB with DTR by both antimicrobial use (AU) and a novel metric of adjusted AU by microbiological burden (am-AU).
Retrospective, multicenter, cohort.
Ten hospitals in the southeastern United States.
GNB with DTR including Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter spp. from 2015 to 2020 were tracked at each institution. Cumulative AU of novel β-lactams including ceftolozane/tazobactam, ceftazidime/avibactam, meropenem/vaborbactam, imipenem/cilastatin/relebactam, and cefiderocol in days of therapy (DOT) per 1,000 patient-days was calculated. Linear regression was utilized to examine temporal trends in the prevalence of GNB with DTR and cumulative AU of novel β-lactams.
The overall prevalence of GNB with DTR was 0.85% (1,223/143,638) with numerical increase from 0.77% to 1.00% between 2015 and 2020 (P = .06). There was a statistically significant increase in DTR Enterobacterales (0.11% to 0.28%, P = .023) and DTR Acinetobacter spp. (4.2% to 18.8%, P = .002). Cumulative AU of novel β-lactams was 1.91 ± 1.95 DOT per 1,000 patient-days. When comparing cumulative mean AU and am-AU, there was an increase from 1.91 to 2.36 DOT/1,000 patient-days, with more than half of the hospitals shifting in ranking after adjustment for microbiological burden.
The overall prevalence of GNB with DTR and the use of novel β-lactams remain low. However, the uptrend in the use of novel β-lactams after adjusting for microbiological burden suggests a higher utilization relative to the prevalence of GNB with DTR.
After a rapid survey of the contents of the Baboon Catacomb at Saqqara in Egypt, most of the remains of an estimated 180 monkey individuals (the surviving 40%) were temporarily removed for further study. The predominant species is Papio anubis, but 21 Macaca sylvanus and 2 Chlorocebus aethiops were present. Late Dynastic Egyptians employed a unique method of encasing linen-wrapped baboon mummies in plaster at the catacomb, but most of the monkey corpses were probably macerated before interment. Most of the skulls show symptoms of dietary deficiency or sunlight deprivation; some show signs of violence. The disproportionate male representation indicates that little breeding occurred. Males were probably preferred because of human reverence for the characteristic sitting posture, often with penis erect, that monkeys adopt when advertising land occupancy. Humans once displayed in a similar manner, later using effigies as stand-ins, but as civilization developed, this territorial behavior was suppressed.
Cage paralysis, Herodotus, Imhotep, Osteomalacia, Sun worship, Thoth
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