scholarly journals Etiology and resistance patterns of bacteria causing ventilator-associated pneumonia in a respiratory intensive care unit

2017 ◽  
Vol 74 (10) ◽  
pp. 954-962 ◽  
Author(s):  
Vlada Injac ◽  
Uros Batranovic ◽  
Jovan Matijasevic ◽  
Marija Vukoja ◽  
Mirjana Hadnadjev ◽  
...  
Keyword(s):  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Early Onset ◽  
Late Onset ◽  
Resistance Rate ◽  
Ventilator Associated Pneumonia ◽  
Gram Negative ◽  
Resistance Patterns ◽  
Acinetobacter Spp ◽  
Gram Negative Organisms

Background/Aim. Ventilator-associated pneumonia (VAP) incidence, causative pathogens, and resistance patterns are different among countries and intensive care units (ICUs). In Europe, resistant organisms have progressively increased in the last decade. However, there is a lack of data from Serbian ICUs. The aims of this study were to evaluate etiology and antimicrobial resistance for pathogens causing VAP in ICU patients, to examine whether there were differences among pathogens in early-onset and late-onset VAP and to identify mortality in patients with VAP after 30 and 60 days of hospitalization. Methods. A retrospective cohort study was conducted in the respiratory ICU and all adult patients diagnosed with VAP from 2009 to 2014 were included. Results. Gram negative organisms were the major pathogens (80.3%). The most commonly isolated was Acinetobacter spp (59.8%). There was a statistically significant increase in the incidence of infection with Klebsiella pneumoniae (8.9% vs 25.6%; p = 0.019). Extensively drugresistant strains (XDR) were the most common (78.7%). Lateonset VAP was developed in 81.1% of patients without differences among pathogens in comparison with early-onset VAP. Acinetobacter spp was susceptible to tigecycline and colistin with a significant increase in resistance to ampicillin/sulbactam (30.2% vs 58.6%; p = 0.01). Resistance rate of Pseudomonas aeruginosa and Klebsiella pneumoniae to carbapenems was 38% and 11%, respectively. In methicillin-resistant Staphylococcus aureus no resistance was observed against vancomycin and linezolid. There was no difference in mortality rate between patients with earlyonset and late-onset VAP after 30 and 60 days of hospitalization. Conclusion. Gram negative organisms were the primary cause of bacterial VAP of which the most common was the XDR strain of Acinetobacter spp. Patients with early- and late-onset VAP had the same pathogens. There was no difference in mortality between this two group of patients during 60 days of hospitalization.

scholarly journals Emergence of blaNDM-1 and blaVIM producing Gram-negative bacilli in ventilator-associated pneumonia at AMR Surveillance Regional Reference Laboratory in India

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0256308
Author(s):  
Mithlesh Kumari ◽  
Sheetal Verma ◽  
Vimala Venkatesh ◽  
Prashant Gupta ◽  
Piyush Tripathi ◽  
...  
Keyword(s):  
Early Onset ◽  
Late Onset ◽  
Antibiotic Resistance Genes ◽  
Health Concern ◽  
Reference Laboratory ◽  
Ventilator Associated Pneumonia ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Resistance Patterns ◽  
Prior Surgery

Introduction Ventilator-associated pneumonia (VAP) may be a life threatening nosocomial infection encountered in intensive care units. Currently the emergence of carbapenem-resistant Gram-negative pathogens has become worrisome threat worldwide. Material and methods Endotracheal aspirates samples were collected from patients who were under mechanical ventilation for > 48 h. The bacterial isolates were identified by MALDI-TOF-MS and antibiotic susceptibility testing performed. All carbapenem resistant isolates were tested by Modified Hodge test (MHT), modified carbapenem inactivation method (mCIM), and EDTA-CIM (eCIM) and PCR were performed to detect blaIMP, blaVIM and blaNDM producing MBL genes. Results VAP occurred in 172/353(48.7%), 23.3% had early-onset VAP and 76.7% had late-onset VAP. Males (69.2%) were found to suffer more from VAP. Prior antibiotic therapy, CPI>6, prior surgery and tracheostomy were associated with VAP. The mortality in VAP (58.1%) contrasted with non-VAP (40%). 99/169 (58.6%) Gram-negative isolates were resistant to carbapenems. Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae were common pathogens found in late onset VAP, whereas K. pneumoniae, A. baumannii and Staphylococcus aureus were common in early onset VAP. The PCR results detected blaNDM in 37/172(21.5%) and blaVIM in 30/172(17.4%); 15/172(8.7%) isolates carried both genes. Conclusion The blaNDM-1 and blaVIM genes are the main antibiotic-resistance genes that induce resistance patterns to carbapenems in VAP, highlighting CRE strains of potential public health concern and therapeutic challenge. Diagnostic laboratories in India must get on high caution for early MBL detection as it may limit the wide dispersal of MBL genes.

scholarly journals Study of quantitative bacterial cultures of non-bronchoscopic samples in ventilator associated pneumonia

2018 ◽  
Vol 5 (5) ◽  
pp. 1837 ◽  
Author(s):  
Mohamed Azarudeen ◽  
B. S. Sharma ◽  
Pankaj Kumar Jain ◽  
Alok Kumar Goyal ◽  
Bharti Malhotra
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Early Onset ◽  
Late Onset ◽  
Sampling Techniques ◽  
Ventilator Associated Pneumonia ◽  
Quantitative Culture ◽  
Gram Negative ◽  
Bacterial Cultures ◽  
Causative Agents

Background: Diagnosis of VAP based on non bronchoscopic samples-ETA, NB-BAL culture. The aim is to study quantitative culture of the non-bronchoscopic sampling techniques such as Blind Broncho-alveolar lavage (NB-BAL) and endotracheal aspirates (ETA)in Ventilator Associated Pneumonia. It is a hospital based, observational study conducted in SPMCHI, Jaipur from September 2015 to September 2016.Methods: Seventy patients who were under mechanical ventilation for more than 48 hours and clinically suspected for VAP were included in the study and divided into early and late onset VAP. The NB-BAL and ETA were obtained from these patients and quantitative cultures were performed.Results: Out of the 70 samples analysed, 60 patients were found positive in BAL and 61 positive in ETA. The agreement between NB-BAL and ETA is 86.8%. GNBs remain the main burden of both early and late onset VAP. Most common organisms isolated were Enterobacter and Acinetobacter in early onset and Pseudomonas and Acinetobacter in late onset VAP. All the GNB isolates were sensitive to Polymyxin and Colistin and were resistant to majority of routinely used antibiotics.Conclusions: The quantitative culture of   non-bronchoscopic samples is a useful alternative to bronchoscopy, in the diagnosis of VAP in resource deprived centers. MDR gram negative bacilli are the main causative agents of VAP. 

Neonatal Bacteremia: Patterns of Antibiotic Resistance

2001 ◽  
Vol 22 (12) ◽  
pp. 767-770 ◽  
Author(s):  
Ruben Bromiker ◽  
Ilan Arad ◽  
Ofra Peleg ◽  
Aviya Preminger ◽  
Dan Engelhard
Keyword(s):  
Antibiotic Resistance ◽  
Early Onset ◽  
Bacterial Infections ◽  
Bacterial Resistance ◽  
Late Onset ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Gram Negative ◽  
Live Births ◽  
Gram Negative Organisms

AbstractObjective:To determine the incidence and evaluate the antimicrobial-susceptibility patterns of bacterial infections in our neonatal units.Design:Retrospective surveillance study.Setting:The neonatal units of the Hadassah University Hospitals, Jerusalem, Israel.Patients:All newborns admitted from January 1994 through February 1999.Methods:The records of all patients with positive blood and cerebrospinal fluid cultures were reviewed. Bacteremia was considered early-onset (vertical) when occurring within the first 72 hours of life and late-onset (nosocomial) when occurring later. The prevalence and antibiotic-resistance patterns of vertically transmitted and nosocomially acquired strains were compared and studied over time.Results:219 of 35,691 newborn infants had at least one episode of bacteremia (6.13/1,000 live births). There were 305 identified organisms, of which 21% (1.29/1,000 live births) were considered vertically transmitted and 79% nosocomially acquired. The most common organism causing early-onset disease (29.2%) was group B streptococcus (0.38/1,000 live births), whereas coagulase-negative staphylococci (51%) were the most prevalent in late-onset disease. All gram-positive bacteria were susceptible to vancomycin. Most gram-positive organisms other than staphylococci were susceptible to ampicillin. Gram-negative organisms represented 31% of all isolates. Generally, there was a trend of increasing resistance to commonly used antibiotics among nosocomially acquired gram-negative organisms, compared to those vertically transmitted, with statistically significant differences for ampicillin and mezlocillin (P<.05 andP<.01, respectively). Over the years, a trend toward an increasing resistance to antibiotics was observed among gram-negative organisms.Conclusions:The trend of increasing bacterial resistance to commonly used antibiotics necessitates the implementation of a rational empirical treatment strategy, based on local susceptibility data, reserving certain agents for emerging resistant pathogens.

scholarly journals Clinical, Bacteriological Profile & Outcome of Neonatal Sepsis in a Tertiary Care Hospital

2014 ◽  
Vol 26 (1) ◽  
pp. 18-21 ◽  
Author(s):  
Biplob Kumar Raha ◽  
Md Abdul Baki ◽  
Tahmina Begum ◽  
Nazmun Nahar ◽  
Nasim Jahan ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Klebsiella Pneumoniae ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Late Onset ◽  
Gram Negative ◽  
Common Pathogen ◽  
Late Onset Sepsis ◽  
Early Onset Sepsis

Neonatal sepsis is a major cause of mortality and morbidity in newborn, particularly in developing countries. The spectrum of bacteria which causes neonatal sepsis varies in different parts of the world. The organisms responsible for early onset and late onset sepsis are different. The objective of the study was undertaken to determine the pattern of bacterial isolates responsible for early and late onset neonatal sepsis based on the presence of one or more clinical signs, and its outcome. A cross- sectional prospective study was carried out in the special care baby unit (SCABU) from November 2008 to September 2009 under department of Paediatrics and Neonatology, BIRDEM General Hospital, Dhaka, Bangladesh. Organisms were isolated from 8.9% of collected blood samples. The male female ratio of culture proven sepsis was 1.7:1. Most of the culture proven septic neonates(71.88%) were preterm & 65.63% had low birth weight. The most frequent clinical presentations of patients with culture-proven sepsis were poor moro reflex (92.2%), feeding intolerance (90.6%), jaundice (87.5%), abdominal distention (76.6%), and lathergy (73.4%). The Gram positive and Gram negative bacteria accounted for 6 (9.4% ) and 58 (90.6%) of the isolates respectively. Around two third of the culture-proven septic neonates (70.3%) presented with early onset sepsis, while 29.7% presented with late onset sepsis. Klebsiella pneumoniae was the most common pathogen both in early onset (31.25%) and late onset (6.25%) sepsis. Serratia (18.75%) was the second most common pathogen in early onset sepsis. Total mortality rate was 9.38%. Preterm, low birth weight and Gram negative sepsis contributes majority of mortality. Gram negative organism especially Klebsiella pneumoniae contributed highest in early onset sepsis and neonatal death (6.25%) due to sepsis. DOI: http://dx.doi.org/10.3329/medtoday.v26i1.21306 Medicine Today 2014 Vol.26(1): 18-21

scholarly journals 590. Reduction of Endotracheal Colonization by Gram-Negative Bacilli in a Neonatal Intensive Care Unit Through Use of a Novel Drain Cover

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S279-S279
Author(s):  
Melissa Buck ◽  
Michael Antunes ◽  
Brewster Kingham ◽  
Shawn W Polson ◽  
Stephen C Eppes
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Healthcare Providers ◽  
Gram Negative ◽  
Endotracheal Tubes ◽  
Acinetobacter Spp ◽  
Klebsiella Spp

Abstract Background Splash and aerosolization from sink drains are a source of contamination, particularly by Gram-negative bacilli (GNB), in healthcare facilities. Neonatal Intensive Care Unit (NICU) outbreaks of infection due to GNB have been attributed to NICU sinks. Recent studies found that a dome-shaped drain cover placed in sinks in an adult ICU prevented dispersal of sink drain bacteria to the environment and hands of healthcare providers. Our NICU routinely performs weekly surveillance cultures of all endotracheal tubes (ETT) and has previously reported a correlation of ETT colonizing organisms with bacteria isolated from blood in late onset sepsis. Our objective was to determine whether the use of a drain cover in every sink in a level III 72 bed NICU could lead to a decrease in the isolation of GNB in the ETTs of hospitalized infants. Methods All 34 sink drains and basins in an open layout NICU were cultured. Drain covers were then installed and replaced on a routine basis. Weekly endotracheal tube cultures were performed for all intubated infants. Results Prior to implementation of drain covers, the most common GNBs cultured from ETTs were, in order, E. cloacae, Klebsiella spp., Acinetobacter spp., and S. maltophilia. The most common organisms isolated from sinks were, in order, P. aeruginosa, Acinetobacter spp. and S. maltophilia. An unusual species, Acinetobacter ursingii, was common in both sinks and endotracheal tubes. Before and after the implementation of drain covers, the median time to first isolation of a GNB was 14 and 17 days, respectively. Prior to draining cover implementation, there were 31 new GNB isolates during 700 ventilator days (rate of 44.3/1000 ventilator days) among infants with any positive ETT cultures. Post drain cover there were 26 new GNB isolates during 900 ventilator days (rate of 28.9/1000 ventilator days). There was a shift in microbial species isolated from ETTs with Klebsiella spp. and S. marcescens predominating after implementation of drain covers. Conclusion The use of a novel drain cover in the sinks in a NICU can reduce the frequency of GNB colonizing the ETTs of patients and can lengthen the time to first positivity. Mitigating sinks as a reservoir for GNB may reduce the likelihood of these bacteria infecting a vulnerable population. Disclosures All authors: No reported disclosures.

scholarly journals Antibiotic Resistance Pattern among Bacteria causing Ventilator Associated Pneumonia in An Intensive Care Unit of Bangladesh

2016 ◽  
Vol 4 (2) ◽  
pp. 69-73
Author(s):  
ASM Areef Ahsan ◽  
Lovely Barai ◽  
Mohammad Omar Faruq ◽  
Kaniz Fatema ◽  
Fatema Ahmed ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Antibiotic Resistance ◽  
Intensive Care ◽  
Resistance Pattern ◽  
Ventilator Associated Pneumonia ◽  
Pseudomonas Sp ◽  
Gram Negative ◽  
Acinetobacter Sp ◽  
Gram Negative Organisms ◽  
Gram Positive Cocci

Background : Ventilator-associated pneumonia (VAP) is the most common type of nosocomial infection in critical care practice with high morbidity and mortality. Microorganisms responsible for VAP vary from place to place. So, identification of causative organism and knowledge of their resistance pattern is very important for empirical choice of antibiotic in managing VAP. The aim of this survey was to evaluate the quantitative cultures of endotracheal aspirates to determine the microorganisms responsible for VAP and to study their antibiotic resistance pattern.Materials and Methods: This cross sectional study was performed over a period of six month starting from November, 2015 to April, 2016 in the Intensive Care Unit (ICU) of BIRDEM General Hospital. Patients with a clinical and radiological diagnosis of VAP were included in this study.Result: A total of 51 patients with a clinical diagnosis of VAP were included in this study. Growth was obtained in100% of the samples yielding 88 organisms. Gram-negative organisms were the mostly isolated organism (76.13%), followed by fungi (17.04%) and gram-positive cocci (6.81%). The most common pathogen was Acinetobacter sp. followed by Klebsiella sp., Candida sp. and Pseudomonas sp. respectively. Among the gram negative organisms, Acinetobacter sp., Klebsiella sp. and Pseudomonas sp. were highly resistant (>80%) to third generation cephalosporins and fluoroquinolones. Resistance to aminoglycosides (>68%) and imipenem (>60%) was also high. Resistance of Pseudomonas sp. to piperacillin-tazobactum was lower (18.2%) in comparison to Acinetobacter sp. and Klebsiella sp. All the Gram-negative organisms were 100% sensitive to colistin except proteus. Regarding gram-positive cocci,Staphylococcus aureus is 100% sensitive to netilmycin and vancomycin with variable resistance pattern to other antibiotics.Conclusion: Emergence of drug resistance against the microorganism causing VAP is a serious concern in most of the ICUs. A knowledge of antibiotic susceptibility pattern will avoid its irrational use in order to control the spread of infection and for proper management of VAP.Bangladesh Crit Care J September 2016; 4 (2): 69-73

scholarly journals “NEWS ON AIR!” - AIR SURVEILLANCE REPORT FROM INTENSIVE CARE UNITS OF A TERTIARY CARE HOSPITAL

2016 ◽  
Vol 9 (9) ◽  
pp. 247 ◽  
Author(s):  
Barnini Banerjee ◽  
Chiranjay Mukhopadhyay ◽  
Vandana Ke ◽  
Archana Bupendra ◽  
Muralidhar Varma
Keyword(s):  
Intensive Care ◽  
Nosocomial Infection ◽  
Intensive Care Units ◽  
Nosocomial Infections ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Care Hospital ◽  
Gram Negative ◽  
Acinetobacter Spp ◽  
Gram Negative Organisms

ABSTRACTBackground: The role of airborne microorganisms in the nosocomial infections is debatable since past. Very limited and inconclusive data availableabout the contribution of the air microflora, especially the multidrug resistant (MDR) one, to the hospital-acquired infections in the Intensive CareUnits (ICUs).Objective: To analyze the microbial population and their antimicrobial susceptibility pattern of the indoor air in relation to the nosocomial infectionsin the different ICUs at different periods in the tertiary care hospital.Methods: Microbial monitoring of the air was performed in 5 different ICUs for 1 year by passive sampling method.Results: A total of 221 air samples were collected for 1 year from five different ICUs. 92.53% were Gram-positive bacteria and 8.11% were Gramnegativebacteria. Staphylococcus spp. (34.21%) and Acinetobacter spp. (63.04%) were the most common isolated bacteria among Gram-positiveand Gram-negative organisms, respectively, and among the fungal isolates, all of them were Aspergillus spp. (5.84%) from the air sample. Ventilatorassociatedpneumonia was the most common nosocomial infection and Acinetobacter spp. was the frequently isolated MDR organism.Conclusion: Air could be the major source of nosocomial infections by MDR Gram-negative organisms in the ICUs which require special attention andsurveillance.Keywords: Air sampling, Intensive Care Units, Multidrug-resistant organisms, Nosocomial infection.

scholarly journals Time to positivity of neonatal blood cultures: fast and furious?

2011 ◽  
Vol 60 (4) ◽  
pp. 446-453 ◽  
Author(s):  
Khadija Guerti ◽  
Helena Devos ◽  
Margareta M. Ieven ◽  
Ludo M. Mahieu
Keyword(s):  
Incubation Time ◽  
Early Onset ◽  
Late Onset ◽  
Blood Cultures ◽  
Gram Positive ◽  
Suspected Sepsis ◽  
Gram Negative ◽  
Late Onset Sepsis ◽  
Neonatal Blood ◽  
Gram Negative Organisms

The aim of this study was to determine the time to positivity (TTP) of neonatal blood cultures, to investigate differences between early onset versus late-onset sepsis, and non-proven versus proven sepsis, and to examine differences in TTP by organism type using a retrospective observational study at the Neonatal Intensive Care Unit, Antwerp University Hospital, Belgium. The subjects were 1828 neonates with suspected sepsis who were treated with antimicrobials for at least 3 days. The TTP was recorded for all episodes of suspected sepsis in an approximately 6.5 year period. A total of 2916 blood cultures were collected, of which 437 (15 %) became positive. The overall TTP was 21.33 h (Q1–Q3 13.17–32.46). The difference between the median TTP in early onset versus late-onset sepsis was 0.83 h (22.00 versus 21.17 h, P=0.75). The median TTP for Gram-negative organisms was 11.17 h (Q1–Q3 8.84–15.67), whereas the median TTP for Gram-positive organisms was 23.59 h (Q1–Q3 15.29–34.58, P<0.001). In Gram-positive isolates, the median TTP for coagulase-negative staphylococci (CNS) was 26.67 h (Q1–Q3 19.00–38.17), whereas the median TTP for non-CNS was 12.83 h (Q1–Q3 10.50–18.17, P<0.001). The median TTP in proven sepsis was 20.17 h (Q1–Q3 13.00–30.37), whereas it was 29.67 h (Q1–Q3 21.17–50.63, P<0.001) in non-proven sepsis. TTP of neonatal blood cultures was significantly shorter for Gram-negative organisms. We suggest shortening the total incubation time of neonatal blood cultures to a maximum of 3 days. However, blood cultures collected in infants <72 h of age might require a longer incubation time. According to our results, it may be safe to narrow the antimicrobial spectrum to solely target Gram-positive bacteria when the culture is still negative after 48 h, and to cease antimicrobial therapy when the culture is still negative after 72 h in clinically well infants.

scholarly journals Patterns of Antimicrobial Resistance Among Intensive Care Unit Patients of A Private Medical College Hospital in Dhaka

2015 ◽  
Vol 25 (2) ◽  
pp. 47-51 ◽  
Author(s):  
Quazi Tarikul Islam ◽  
Md Mahmudur Rahman Siddiqui ◽  
Farhana Raz ◽  
Mohammad Asrafuzzaman ◽  
Md Robed Amin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tracheal Aspirate ◽  
College Hospital ◽  
Icu Patients ◽  
Gram Negative ◽  
Pseudomonas Spp ◽  
Medical College ◽  
Acinetobacter Spp ◽  
Klebsiella Spp

Because of importance of Hospital acquired infections (HAIs), it is critical to conduct surveillance studies to obtain the required data about the regional microorganisms and their susceptibility to antibiotics. This study to investigate antimicrobial resistance pattern among Intensive Care Unit (ICU) patients in a private medical college hospital setup. In a cross sectional study, 100 specimens from patients admitted in the ICU who had signs or symptoms of nosocomial infection were collected from 2012 - 2013. For each patient, samples of blood, urine, tracheal aspirate, sputum, wound swab, pus, and endotracheal tubes were obtained, cultured and analyzed with antibiogram. The most common primary diagnosis were aspiration pneumonia (49%) and UTI (20%) respectively. The most common locations for infection were tracheal aspirate (54%). The most frequent gram negative microorganisms derived from samples were Acinetobacter spp (29%), Klebsiella spp (26%) and Pseudomonas spp (18%). Klebsiella spp, Acinetobacter spp and Pseudomonas spp were most common resistant organisms among all. Klebsiella spp were resistant against Ceftriaxone (84.6%), Ceftazidime (82.6%), Amikacin (46.1%), Gentamicin (66.6%) and Quinolones (65-66.6%) respectively. Acinetobacter spp were resistant against Ceftriaxone (85%), Ceftazidime (88.8%), Cefotaxime (85.7%), Meropenem (79.3%),Amikacin (86.2%), Gentamicin (84.5%) and Quinolons (86.2-89.2%) respectively. Pseudomonas spp were resistant against Ceftriaxone (70.5%), Ceftazidime (66.6%), Amikacin (68.7%), Gentamicin (58.8%), Meropenem (52.9%) and Quinolones (81.2-86.6%) respectively. Meropenem was the most sensitive antibiotic against Klebsiella spp (84.6%) but Cotrimoxazole in case of Acinetobacter spp (60%) respectively. Escherichia coli were mostly isolated from urine, which was sensitive to Amikacin (73.3%) and Meropenem (86.6%) respectively. Gram-negative pathogens obtained from ICU patients in our settings show high resistance to antibiotics. Regular monitoring of the pattern of resistance of common pathogens in the ICUs is essential to up-to-date the use of rational antibiotics regiments.Bangladesh J Medicine Jul 2014; 25 (2) : 47-51

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