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Background: This study was conducted to assess the variation in prescription practices for systemic antimicrobial agents used for prophylaxis among pediatric patients hospitalized in 41 countries worldwide. Methods: Using the standardized Antibiotic Resistance and Prescribing in European Children Point Prevalence Survey protocol, a cross-sectional point-prevalence survey was conducted at 226 pediatric hospitals in 41 countries from October 1 to November 30, 2012. Results: Overall, 17693 pediatric patients were surveyed and 36.7% of them received antibiotics (n = 6499). Of 6818 inpatient children, 2242 (32.9%) received at least 1 antimicrobial for prophylactic use. Of 11899 prescriptions for antimicrobials, 3400 (28.6%) were provided for prophylactic use. Prophylaxis for medical diseases was the indication in 73.4% of cases (2495 of 3400), whereas 26.6% of prescriptions were for surgical diseases (905 of 3400). In approximately half the cases (48.7% [1656 of 3400]), a combination of 2 or more antimicrobials was prescribed. The use of broad-spectrum antibiotics (BSAs), which included tetracyclines, macrolides, lincosamides, and sulfonamides/trimethoprim, was high (51.8% [1761 of 3400]). Broad-spectrum antibiotic use for medical prophylaxis was more common in Asia (risk ratio [RR], 1.322; 95% confidence interval [CI], 1.202-1.653) and more restricted in Australia (RR, 0.619; 95% CI, 0.521-0.736). Prescription of BSA for surgical prophylaxis also varied according to United Nations region. Finally, a high percentage of surgical patients (79.7% [721 of 905]) received their prophylaxis for longer than 1 day. Conclusions: A high proportion of hospitalized children received prophylactic BSAs. This represents a clear target for quality improvement. Collectively speaking, it is critical to reduce total prophylactic prescribing, BSA use, and prolonged prescription.

ObjectiveTo assess the availability and source of guidelines for common infections in European paediatric hospitals and determine their content and characteristics.DesignParticipating hospitals completed an online questionnaire on the availability and characteristics of antibiotic prescribing guidelines and on empirical antibiotic treatment including duration of therapy for 5 common infection syndromes: respiratory tract, urinary tract, skin and soft tissue, osteoarticular and sepsis in neonates and children.Results84 hospitals from 19 European countries participated in the survey of which 74 confirmed the existence of guidelines. Complete guidelines (existing guidelines for all requested infection syndromes) were reported by 20% of hospitals and the majority (71%) used a range of different sources. Guidelines most commonly available were those for urinary tract infection (UTI) (74%), neonatal sepsis (71%) and sepsis in children (65%). Penicillin and amoxicillin were the antibiotics most commonly recommended for respiratory tract infections (RTIs) (up to 76%), cephalosporin for UTI (up to 50%) and for skin and soft tissue infection (SSTI) and bone infection (20% and 30%, respectively). Antistaphylococcal penicillins were recommended for SSTIs and bone infections in 43% and 36%, respectively. Recommendations for neonatal sepsis included 20 different antibiotic combinations. Duration of therapy guidelines was mostly available for RTI and UTI (82%). A third of hospitals with guidelines for sepsis provided recommendations for length of therapy.ConclusionsComprehensive antibiotic guideline recommendations are generally lacking from European paediatric hospitals. We documented multiple antibiotics and combinations for most infections. Considerable improvement in the quality of guidelines and their evidence base is required, linking empirical therapy to resistance rates.

International audience; West Nile disease, caused by the West Nile virus (WNV), is a mosquito-borne zoonotic disease affecting humans and horses that involves wild birds as amplifying hosts. The mechanisms of WNV transmission remain unclear in Europe where the occurrence of outbreaks has dramatically increased in recent years. We used a dataset on the competence, distribution, abundance, diversity and dispersal of wild bird hosts and mosquito vectors to test alternative hypotheses concerning the transmission of WNV in Southern France. We modelled the successive processes of introduction, amplification, dispersal and spillover of WNV to incidental hosts based on host-vector contact rates on various land cover types and over four seasons. We evaluated the relative importance of the mechanisms tested using two independent serological datasets of WNV antibodies collected in wild birds and horses. We found that the same transmission processes (seasonal virus introduction by migratory birds, Culex modestus mosquitoes as amplifying vectors, heterogeneity in avian host competence, absence of 'dilution effect') best explain the spatial variations in WNV seroprevalence in the two serological datasets. Our results provide new insights on the pathways of WNV introduction, amplification and spillover and the contribution of bird and mosquito species to WNV transmission in Southern France.

Pour saisir la portée et l'intérêt du projet GNB, il ne suffit pas de connaître ses objectifs, dûment fondés sur un bilan circonstancié de l'état des connaissances. Il faut aussi appréhender sa démarche « expérimentale », à commencer par la stratégie d'échantillonnage et d'inventaires ; il faut comprendre le choix de méthodes d'analyse statistique innovantes mais complexes, avec en particulier la notion de magnitude des effets pour que les résultats puissent avoir une « lecture » opérationnelle. Impossible de résumer en quelques mots la réflexion exigeante qui a présidé à la conception du projet.

Le réseau des réserves forestières a plus de 150 ans. Il s'est beaucoup étoffé durant les dernières décennies. Outil de conservation de la Nature, il permet aussi d'inspirer la gestion courante. Pour cela une observation rigoureuse de la biodiversité et des peuplements est nécessaire. C'est ce que propose le projet GNB.

Objectives: Previously, web-based tools for cross-sectional antimicrobial point prevalence surveys (PPSs) have been used in adults to develop indicators of quality improvement. We aimed to determine the feasibility of developing similar quality indicators of improved antimicrobial prescribing focusing specifically on hospitalized neonates and children worldwide. Methods: A standardized antimicrobial PPS method was employed. Included were all inpatient children and neonates receiving an antimicrobial at 8:00 am on the day of the PPS. Denominators included the total number of inpatients. A web-based application was used for data entry, validation and reporting. We analysed 2012 data from 226 hospitals (H) in 41 countries (C) from Europe (174H; 24C), Africa (6H; 4C), Asia (25H; 8C), Australia (6H), Latin America (11H; 3C) and North America (4H). Results: Of 17 693 admissions, 6499 (36.7%) inpatients received at least one antimicrobial, but this varied considerably between wards and regions. Potential indicators included very high broad-spectrum antibiotic prescribing in children of mainly ceftriaxone (ranked first in Eastern Europe, 31.3%; Asia, 13.0%; Southern Europe, 9.8%), cefepime (ranked third in North America, 7.8%) and meropenem (ranked first in Latin America, 13.1%). The survey identified worryingly high use of critically important antibiotics for hospital-acquired infections in neonates (34.9%; range from 14.2% in Africa to 68.0% in Latin America) compared with children (28.3%; range from 14.5% in Africa to 48.9% in Latin America). Parenteral administration was very common among children in Asia (88%), Latin America (81%) and Europe (67%). Documentation of the reasons for antibiotic prescribing was lowest in Latin America (52%). Prolonged surgical prophylaxis rates ranged from 78% (Europe) to 84% (Latin America). Conclusions: Simple web-based PPS tools provide a feasible method to identify areas for improvement of antibiotic use, to set benchmarks and to monitor future interventions in hospitalized neonates and children. To our knowledge, this study has derived the first global quality indicators for antibiotic use in hospitalized neonates and children. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

Objective: To assess the availability and source of guidelines for common infections in European paediatric hospitals and determine their content and characteristics. Design: Participating hospitals completed an online questionnaire on the availability and characteristics of antibiotic prescribing guidelines and on empirical antibiotic treatment including duration of therapy for 5 common infection syndromes: respiratory tract, urinary tract, skin and soft tissue, osteoarticular and sepsis in neonates and children. Results: 84 hospitals from 19 European countries participated in the survey of which 74 confirmed the existence of guidelines. Complete guidelines (existing guidelines for all requested infection syndromes) were reported by 20% of hospitals and the majority (71%) used a range of different sources. Guidelines most commonly available were those for urinary tract infection (UTI) (74%), neonatal sepsis (71%) and sepsis in children (65%). Penicillin and amoxicillin were the antibiotics most commonly recommended for respiratory tract infections (RTIs) (up to 76%), cephalosporin for UTI (up to 50%) and for skin and soft tissue infection (SSTI) and bone infection (20% and 30%, respectively). Antistaphylococcal penicillins were recommended for SSTIs and bone infections in 43% and 36%, respectively. Recommendations for neonatal sepsis included 20 different antibiotic combinations. Duration of therapy guidelines was mostly available for RTI and UTI (82%). A third of hospitals with guidelines for sepsis provided recommendations for length of therapy. Conclusions: Comprehensive antibiotic guideline recommendations are generally lacking from European paediatric hospitals. We documented multiple antibiotics and combinations for most infections. Considerable improvement in the quality of guidelines and their evidence base is required, linking empirical therapy to resistance rates.

Extending the network of strict forest reserves is one of the conservation measures promoted by the French National Strategy for Biodiversity improvement. According to the scientific literature, strict forest reserves may help preserving a part of the biodiversity that is threatened by forest management. However, this management choice is based on poor knowledge in the French context and the studies concerned may suffer from methodological shortcomings. The national-scale project named “Forest management, Naturalness and Biodiversity” aims at quantifying the effects on forest structure and biodiversity of management abandonment in the strict reserves. Based on a worldwide meta-analysis and 213 study plots set up in 15 forest sites throughout France, we analysed the response of 7 taxonomic groups to management abandonment. On the one hand, we show that forest management affects total richness of saproxylic taxa worldwide, in particular bryophytes and saproxylic fungi. On the other hand, this trend is verified on our dataset. However, management abandonment per se is not always the best explanation of the differences between managed and unmanaged forests, but other variables, notably linked to deadwood, better explain the observed patterns for these groups. For the other taxa, the response is weakest but depends more on structural features than on management abandonment. In terms of policy, our project has allowed methodological advances thanks to the development of inventory and remote sensing protocols, as well as statistical methods. The dataset we have gathered is also a first comparison of structure and biodiversity between strict forest reserves and managed forest for France. This network may therefore constitute a first basis for long term biodiversity monitoring in French forests., L'extension raisonnée du réseau de réserves forestières intégrales fait partie des mesures adoptées par la Stratégie Nationale pour la Biodiversité pour améliorer la biodiversité forestière métropolitaine française. Au regard de la littérature scientifique, la non-exploitation favoriserait une partie de la biodiversité forestière menacée par la gestion forestière traditionnelle, mais les connaissances qui sous-tendent ce choix se révèlent très partielles et souffrent de problèmes méthodologiques. D’envergure nationale, le projet « Gestion forestière, Naturalité et Biodiversité » (GNB ; http://gnb.irstea.fr) a pour objectif principal d’étudier l’impact de l’arrêt d’exploitation forestière dans le réseau des réserves forestières intégrales sur la structure des peuplements et sur la biodiversité Sur la base d’une méta-analyse et de 213 placettes installées dans 15 massifs forestiers français, nous avons analysé la réponse de 7 groupes taxonomiques à l’arrêt d’exploitation. Nous montrons d’une part que les résultats mondiaux confirment que l’exploitation affecte la richesse des taxons saproxyliques, notamment bryophytes et champignons, et que, d’autre part, cette tendance se vérifie pour le jeu de données issu du projet. Cependant, la mise en réserve en tant que telle n’est la plupart du temps pas la meilleure explication des différences entre peuplements exploités et non exploités, mais d’autres variables, liées au bois mort notamment, expliquent mieux les patrons pour ces groupes. Pour les autres taxons, la réponse est plus faible mais dépend plus de la structure du peuplement que de la mise en réserve. En termes d’appui aux politiques publiques, le projet a permis des avancées méthodologiques notamment grâce au développement de protocoles d’inventaires et de télédétection, et de méthodes statistiques. Le jeu de données acquis constitue par ailleurs un premier état des lieux de la structure forestière et de la biodiversité des réserves forestières intégrales en France, en comparaison avec des forêts exploitées. Ce dispositif pourrait ainsi servir de première base à un suivi au long cours de la biodiversité des forêts françaises.

National audience; Le réseau des réserves forestières (naturelles et biologiques) constitue un formidable support d’étude de la dynamique et de la biodiversité forestière. Néanmoins, et jusque récemment, seuls quelques sites avaient fait l’objet d’une évaluation précise du bois mort, dont l’importance pour la survie de nombreuses espèces forestières n’est plus à démontrer. Dans ce contexte et à la demande des gestionnaires, un protocole de suivi dendrométrique destiné aux réserves forestières (PSDRF) a été élaboré en 2005, sous la conduite de l’ENGREF. Par le biais de placettes permanentes, sa mise en oe½uvre permet non seulement de décrire les peuplements forestiers échantillonnés mais aussi d’approfondir les connaissances sur la dynamique de ces peuplements dans le temps et l’espace. Coordonné depuis 2008 dans le cadre d’un partenariat entre l’ONF et RNF, ce protocole a, à ce jour, été appliqué sur plus de 80 réserves, soit plus de 7000 placettes relevées sur près de 40 000 ha et couvrant ainsi la majorité des grands types d'habitats forestiers français. En moyenne, on observe que les réserves contiennent un volume de bois mort non négligeable (moyenne : 37,1 m3/ha, variant de 5 à 150 m3/ha). A quelques exceptions près, les réserves intégrales contiennent plus de bois mort que les réserves qui font l’objet d’une exploitation.

International audience; In Western Europe, the long history of forest management over the past centuries has shaped both landscape and local scale forest structure, presumably altering the biodiversity of forest dwelling species. In France, the strict forest reserves network has been created to serve as a witness to gauge the effects of management on forest structures and dynamics: it currently covers 0.3% of national territory, distributed over 200 sites representative of the main forest types. However, to date, research comparing biodiversity in managed and unmanaged forests remains strikingly poor in Western Europe, and hardly proposes a broad taxonomic assessment. In order to fill the gap in knowledge in the French context, we studied forest structure and biodiversity in lowland oak-beech-hornbeam forests, and in montane beech-fir-spruce forests. We compared living and dead wood amounts and biodiversity of 6 taxa (vascular plants, saproxylic fungi, birds, bats, carabids and saproxylic beetles) 15 strict forest reserves where forest management has been abandoned for at least 20 years and adjacent managed forests, totalizing 213 plots. Relatively to managed forest, stands in unmanaged forest host larger amounts of old-growth components (deadwood volumes, number of large trees) as well as higher basal areas, whereas other stand characteristics did not differ significantly. Saproxylic fungi responded significantly to management abandonment, their total richness increasing with time since last harvesting. Responses of the other taxonomic groups were less clear and further analyses correlating forest structure with taxa or ecological groups are necessary to better understand the mechanisms associating biodiversity and forest management. The applied outcome of this multitaxonomic approach is to validate indirect biodiversity indicators on a broad gradient of forest management. This project constitutes the first reference for mixed beech forests in France and may help managers to define thresholds in terms of biodiversity oriented measures.

National audience; Au carrefour entre différentes régions biogéographiques, la France héberge une grande diversité d'habitats et de peuplements forestiers. Cette diversité résulte non seulement de la combinaison de facteurs géographiques, géologiques et climatiques, mais également de siècles d’exploitation qui ont façonné le paysage forestier. Supports de la présente étude, les réserves biologiques (gérées par l’ONF) et les réserves naturelles (regroupées au sein de RNF), à forte composante forestière, sont représentatives de cette diversité des forêts françaises. Elles présentent également un gradient de gestion important, allant de l’exploitation mécanique à la libre évolution. Jusqu'à récemment, les estimations du volume de bois morts dans les forêts françaises étaient extrêmement imprécises. En cause : (1°) une prise en compte inadaptée dans les méthodes courantes d'inventaires, tournées vers le suivi de la ressource et (2°) un très faible nombre de sites étudiés de façon précise (e.g. Fontainebleau, Massane). Dans ce contexte, à la demande des gestionnaires et sous l'égide du ministère de l'Ecologie, le protocole de suivi dendrométrique des réserves forestières (PSDRF) a été élaboré en 2005. Coordonné depuis 2008 dans le cadre d’un partenariat entre l’ONF et RNF, ce protocole a, à ce jour, été appliqué sur plus de 80 réserves, représentant près de 7000 placettes et couvrant ainsi la majorité des grands types d'habitats forestiers français. Par le biais de placettes permanentes, sa mise en oeuvre permet non seulement de décrire les peuplements forestiers échantillonnés (et donc de participer à l’évaluation de l'état de conservation des habitats) mais aussi, et c’est la principale originalité de ce protocole, d’approfondir les connaissances sur la dynamique de ces peuplements dans le temps et l’espace (accroissement naturel, vitesse de décomposition, flux de nécromasse, etc.). Basés sur des données dendrométriques collectées dans quelques 60 réserves, les premiers résultats montrent que la plupart des réserves forestières contiennent un volume de bois mort nonnégligeable (moyenne : 37,1 m3/ha, fourchette allant de 5 à 150 m3/ha). A quelques exceptions près, les réserves intégrales (soustraites à toute exploitation) contiennent plus de bois mort que les réserves qui font l’objet d’une exploitation. Comparé aux résultats préliminaires du dernier inventaire IGN (2008-2010), les réserves forestières se trouvent à des niveaux de bois mort globalement plus élevés que pour la forêt française dans son ensemble (23,1 m3/ha). C’est particulièrement le cas pour les arbres morts sur pied mais certaines différences qualitatives sont également identifiées pour le bois mort au sol. Par ailleurs, dans sa phase initiale de description, des inventaires taxonomiques peuvent venir se superposer au PSDRF. Ce type de recherche-action, impliquant gestionnaires et chercheurs, permet de valoriser des données dendrométriques en leur associant des données de biodiversité. Initié en 2008 sous l'impulsion d'Irstea, de l'ONF et de RNF, le projet "Gestion forestière, Naturalité et Biodiversité" (GNB) vise ainsi à mieux appréhender les effets de l’arrêt de l’exploitation forestière sur la biodiversité de 7 groupes taxonomiques (plantes vasculaires, bryophytes, champignons lignicoles, oiseaux, chauve-souris, carabes et coléoptères saproxyliques) en comparant des forêts couramment exploitées et des réserves où l'exploitation a été stoppée depuis au moins 20 ans. A ce jour, 213 placettes ont été échantillonnées sur 15 massifs (gnb.irstea.fr). Restreint aux habitats de hêtraies-chênaies en plaine et de hêtraies-sapinières de montagne, les résultats préliminaires du projet GNB montrent les mêmes tendances pour le bois mort. En effet, les volumes de bois mort sont les caractéristiques qui diffèrent le plus entre zones exploitées et non exploitées, avec en moyenne 4,5 fois plus de bois mort en zone non exploitée. En termes de biodiversité, les premiers résultats montrent que la mise en réserve a une influence différente en fonction du taxon étudié. Un approfondissement des analyses devrait mettre en évidence les meilleurs facteurs structurant la biodiversité forestière.

Background The neonatal and pediatric antimicrobial point prevalence survey (PPS) of the Antibiotic Resistance and Prescribing in European Children project (http://www.arpecproject.eu/) aims to standardize a method for surveillance of antimicrobial use in children and neonates admitted to the hospital within Europe. This article describes the audit criteria used and reports overall country-specific proportions of antimicrobial use. An analytical review presents methodologies on antimicrobial use. Methods A 1-day PPS on antimicrobial use in hospitalized children was organized in September 2011, using a previously validated and standardized method. The survey included all inpatient pediatric and neonatal beds and identified all children receiving an antimicrobial treatment on the day of survey. Mandatory data were age, gender, (birth) weight, underlying diagnosis, antimicrobial agent, dose and indication for treatment. Data were entered through a web-based system for data-entry and reporting, based on the WebPPS program developed for the European Surveillance of Antimicrobial Consumption project. Results There were 2760 and 1565 pediatric versus 1154 and 589 neonatal inpatients reported among 50 European (n = 14 countries) and 23 non-European hospitals (n = 9 countries), respectively. Overall, antibiotic pediatric and neonatal use was significantly higher in non-European (43.8%; 95% confidence interval [CI]: 41.3-46.3% and 39.4%; 95% CI: 35.5-43.4%) compared with that in European hospitals (35.4; 95% CI: 33.6-37.2% and 21.8%; 95% CI: 19.4-24.2%). Proportions of antibiotic use were highest in hematology/oncology wards (61.3%; 95% CI: 56.2-66.4%) and pediatric intensive care units (55.8%; 95% CI: 50.3-61.3%). Conclusions An Antibiotic Resistance and Prescribing in European Children standardized web-based method for a 1-day PPS was successfully developed and conducted in 73 hospitals worldwide. It offers a simple, feasible and sustainable way of data collection that can be used globally.

International audience; Deadwood, whether expressed in volume, diversity or continuity, is nowadays widely acknowledged as being an important component of forest ecosystems, and has therefore been addressed in most recent studies dealing with forest conservation and management. However, and despite the growing use of the concept of naturalness in the management plans of French forest reserves, the dynamics of deadwood remains greatly unknown in West European temperate forests. In this context, and in order to answer a growing demand arising from the managers of forest reserves, a specific long-term monitoring scheme has been implemented in all main forest habitats since its launch in 2005. Our talk will present some preliminary results of this country-wide monitoring based on data from 36 Biological Reserves and 18 National Nature Reserves. In this network, a comprehensive data set of living and dead tree measurements has already been collected on >5.000 permanent plots covering a wide range of situations. Although most of the sites showed significant amounts of deadwood (mean: 38.1 m3/ha), we will focus our presentation on the important differences that were found between sites and within sites. We analyze the relationships between these differences and habitat types, altitude and management practices. Future surveys will allow us to better understand the driving forces behind these differences and will provide us with management tools to assess how these values will/can increase in the future.

International audience; Deadwood, whether expressed in volume, diversity or continuity, is nowadays widely acknowledged as being an important component of forest ecosystems and has therefore been addressed in most recent studies dealing with forest conservation and management. However, and despite the growing use of the concept of naturalness in the management plans of French forest reserves, deadwood dynamics remain greatly unknown in European temperate forests. In this context and to answer a growing demand arising from reserve managers, a long-term monitoring scheme has been launched in 2005. Preliminary results from 42 French forest reserves will be presented in this talk. A comprehensive data set of living and dead tree measurements have so far been collected on more than 4000 permanent plots. Sampling is systematic but the density of plots is adjusted to the reserve size, habitat diversity and management practices. Overall, French forest reserves host an average of 35.1 m3/ha of deadwood. More than 2/3 of the reserves had deadwood volumes between 20 and 40 m3/ha, and were considered deadwood rich. For more than 1/3 of these reserves, the estimated volume was even greater than 40 m3/ha, indicative of forests growing under nearly natural conditions. Although most of the reserves showed a significant amount of deadwood, the gap with old-growth forests is still of great magnitude. The following surveys should allow us to better understand these differences.

20 ref.; National audience

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 lowermiddle-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., peer-reviewed