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Casale R, Boattini M, Comini S, Bastos P, Corcione S, De Rosa FG, Bianco G, Costa C. Clinical and microbiological features of positive blood culture episodes caused by non-fermenting gram-negative bacilli other than Pseudomonas and Acinetobacter species (2020-2023). Infection 2024:10.1007/s15010-024-02342-6. [PMID: 38990473 DOI: 10.1007/s15010-024-02342-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Non-fermenting Gram-negative bacilli (NFGNB) other than Pseudomonas aeruginosa and Acinetobacter baumannii complex are pathogens of interest due to their ability to cause health-care associated infections and display complex drug resistance phenotypes. However, their clinical and microbiological landscape is still poorly characterized. METHODS Observational retrospective study including all hospitalized patients presenting with a positive positive blood culture (BC) episode caused by less common NFGNB over a four-year period (January 2020-December 2023). Clinical-microbiological features and factors associated with mortality were investigated. RESULTS Sixty-six less common NFGNB isolates other than Pseudomonas and Acinetobacter species causing 63 positive BC episodes were recovered from 60 patients. Positive BC episodes were predominantly sustained by Stenotrophomonas maltophilia (49.2%) followed by Achromobacter species (15.9%) that exhibited the most complex resistance phenotype. Positive BC episodes had bloodstream infection criteria in 95.2% of cases (60 out 63), being intravascular device (30.2%) and respiratory tract (19.1%) the main sources of infection. Fourteen-day, 30-day, and in-hospital mortality rates were 6.4%, 9.5%, and 15.9%, respectively. The longer time from admission to the positive BC episode, older age, diabetes, admission due to sepsis, and higher Charlson Comorbidity Index were identified as the main predictors of in-hospital mortality. CONCLUSIONS Positive BC episodes sustained by NFGNB other than Pseudomonas and Acinetobacter species were predominantly sustained by Stenotrophomonas maltophilia and Achromobacter species, having bloodstream infection criteria in the vast majority of cases. Factors that have emerged to be associated with mortality highlighted how these species may have more room in prolonged hospitalisation and at the end of life for patients with chronic organ diseases.
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Affiliation(s)
- Roberto Casale
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Corso Bramante 88/90, Turin, 10126, Italy
| | - Matteo Boattini
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy.
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Corso Bramante 88/90, Turin, 10126, Italy.
- Lisbon Academic Medical Centre, Lisbon, Portugal.
| | - Sara Comini
- Operative Unit of Clinical Pathology, Carlo Urbani Hospital, Jesi, 60035, Italy
| | - Paulo Bastos
- Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, 10124, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, 10124, Italy
- Unit of Infectious Diseases, Cardinal Massaia Hospital, Asti, 14100, Italy
| | - Gabriele Bianco
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
- Department of Experimental Medicine, University of Salento, Via Provinciale Monteroni n. 165, Lecce, 73100, Italy
| | - Cristina Costa
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Corso Bramante 88/90, Turin, 10126, Italy
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Kazak E, Önal U, Tüzemen NÜ, Aslan F, Çalışkan G, Şimşek H, Bakkaloğlu Z, Çevik YN, Heper Y, Çelebi S, Yılmaz E, Hacımustafaoğlu MK, Özakın C, Akalın EH. An evaluation of a Stenotrophomonas maltophilia outbreak due to commercial arterial blood gas collection kit. Antimicrob Resist Infect Control 2024; 13:53. [PMID: 38764050 PMCID: PMC11103820 DOI: 10.1186/s13756-024-01410-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 05/10/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Stenotrophomonas maltophilia is a gram-negative bacterium that can cause hospital infections and outbreaks within hospitals. This study aimed to evaluate an outbreak of Stenotrophomonas maltophilia, caused by ready-to-use commercial syringes containing liquid lithium and heparin for arterial blood gas collection in a university hospital. METHODS Upon detecting an increase in Stenotrophomonas maltophilia growth in blood cultures between 15.09.2021 and 19.11.2021, an outbreak analysis and a case-control study (52 patients for the case group, 56 patients for the control group) were performed considering risk factors for bacteremia. Samples from possible foci for bacteremia were also cultured. Growing bacteria were identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. The genetic linkage and clonal relationship isolates were investigated with pulsed-field gel electrophoresis (PFGE) in the reference laboratory. RESULTS In the case-control study, the odds ratio for the central venous catheter [3.38 (95% confidence interval [CI]: 1.444, 8.705 ; p = 0.006)], for surgery [3.387 (95% confidence interval [CI]: 1.370, 8.373 ; p = 0.008)] and for arterial blood gas collection history [18.584 (95% confidence interval [CI]:4.086, 84.197; p < 0.001)] were identified as significant risk factors. Stenotrophomonas maltophilia growth was found in ready-to-use commercial syringes used for arterial blood gas collection. Molecular analysis showed that the growths in the samples taken from commercial syringes and the growths from blood cultures were the same. It was decided that the epidemic occurred because the method for sterilization of heparinized liquid preparations were not suitable. After discontinuing the use of the kits with this lot number, the outbreak was brought under control. CONCLUSIONS According to our results, disposable or sterile medical equipment should be included as a risk factor in outbreak analyses. The method by which injectors containing liquids, such as heparin, are sterilized should be reviewed. Our study also revealed the importance of the cooperation of the infection control team with the microbiology laboratory.
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Affiliation(s)
- Esra Kazak
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bursa Uludag University, Gorukle, Nilufer, Bursa, Turkey.
- Infection Control Team, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey.
| | - Uğur Önal
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bursa Uludag University, Gorukle, Nilufer, Bursa, Turkey
- Infection Control Team, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Nazmiye Ülkü Tüzemen
- Department of Medical Microbiology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
- Infection Control Team, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Funda Aslan
- Infection Control Team, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Gül Çalışkan
- Infection Control Team, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Hüsniye Şimşek
- Molecular Microbiology and Reference Laboratory, General Directorate of Public Health, Ministry of Health, Republic of Turkey, Ankara, Turkey
| | - Zekiye Bakkaloğlu
- Molecular Microbiology and Reference Laboratory, General Directorate of Public Health, Ministry of Health, Republic of Turkey, Ankara, Turkey
| | - Yasemin Numanoğlu Çevik
- Molecular Microbiology and Reference Laboratory, General Directorate of Public Health, Ministry of Health, Republic of Turkey, Ankara, Turkey
| | - Yasemin Heper
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bursa Uludag University, Gorukle, Nilufer, Bursa, Turkey
| | - Solmaz Çelebi
- Infection Control Team, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Emel Yılmaz
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bursa Uludag University, Gorukle, Nilufer, Bursa, Turkey
- Infection Control Team, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Mustafa Kemal Hacımustafaoğlu
- Infection Control Team, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Cüneyt Özakın
- Department of Medical Microbiology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
- Infection Control Team, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Emin Halis Akalın
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bursa Uludag University, Gorukle, Nilufer, Bursa, Turkey
- Infection Control Team, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
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Croke L. Guideline for Sterile Technique. AORN J 2024; 119:P4-P6. [PMID: 38536412 DOI: 10.1002/aorn.14120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 06/12/2024]
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Lee YL, Hsueh PR. Emerging infections in vulnerable hosts: Stenotrophomonas maltophilia and Elizabethkingia anophelis. Curr Opin Infect Dis 2023; 36:481-494. [PMID: 37548375 DOI: 10.1097/qco.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
PURPOSE OF REVIEW This systematic review aimed to explore the recent trends in the epidemiology, risk factors, and antimicrobial susceptibility of two emerging opportunistic pathogens, Stenotrophomonas maltophilia and Elizabethkingia anophelis . RECENT FINDINGS Since 2020, numerous outbreaks of S. maltophilia and E. anophelis have been reported worldwide. Most of these outbreaks have been associated with healthcare facilities, although one outbreak caused by E. anophelis in France was considered a community-associated infection. In terms of antimicrobial susceptibility, trimethoprim/sulfamethoxazole (TMP-SMZ), levofloxacin, and minocycline have exhibited good efficacy against S. maltophilia . Additionally, cefiderocol and a combination of aztreonam and avibactam have shown promising results in in vitro susceptibility testing. For E. anophelis , there is currently no consensus on the optimal treatment. Although some studies have reported good efficacy with rifampin, TMP-SMZ, piperacillin/tazobactam, and cefoperazone/sulbactam, minocycline had the most favourable in vitro susceptibility rates. Cefiderocol may serve as an alternative due to its low minimum inhibitory concentration (MIC) against E. anophelis . The role of vancomycin in treatment is still uncertain, although several successful cases with vancomycin treatment, even with high MIC values, have been reported. SUMMARY Immunocompromised patients are particularly vulnerable to infections caused by S. maltophilia and E. anophelis , but the optimal treatment strategy remains inconclusive. Further research is necessary to determine the most effective use of conventional and novel antimicrobial agents in combatting these multidrug-resistant pathogens.
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Affiliation(s)
- Yu-Lin Lee
- Department of Internal Medicine, Chung Shan Medical University Hospital
- School of Medicine, Chung Shan Medical University
- PhD Program in Medical Biotechnology, National Chung-Hsing University
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, China Medical University Hospital
- School of Medicine
- PhD Program for Aging, School of Medicine, China Medical University, Taichung
- Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Şenol FF, Tanrıverdi ES, Aytaç Ö, Aşçı Toraman Z, Otlu B. An Outbreak of Vancomycin-Resistant Enterococci in a City Hospital Intensive Care Unit: Molecular Characterization of Resistance. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2081. [PMID: 38138184 PMCID: PMC10744602 DOI: 10.3390/medicina59122081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/21/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Vancomisin-resistant Enterococci (VRE), is a resistant microorganism that colonizes and causes infections in hospitalized patients. The aim of this study was to show the spread of vancomycin-resistant Enterococcus faecium (VREfm) step-by-step in all intensive care units, which started with the growth of VREfm on 2 December 2021 in the blood culture of a patient hospitalized in the anesthesia intensive care unit of our hospital and was found to have reached epidemic size in the surveys. Materials and Methods: Rectal swab samples were taken from all patients hospitalized in intensive care units, VRE colonization was determined, the VanA and VanB resistance genes associated with the vancomycin resistance of VREfm isolates were determined by PCR method, and clonal association analysis was performed by Arbitrarily Primed-PCR (AP-PCR) and PFGE (pulsed-field gel electrophoresis). Results: In our study, VRE were detected in 61 of 2601 rectal swab samples. In total, fifty-four (85.52%) of the VRE isolates were Enterococcus faecium, three (4.91%) was Enterococcus faecalis, three (4.91%) was Enterococcus gallinorum, and one (1.63%) was Enterococcus casseliflavus. It was determined that all of the 54 VREfm isolates, which were the most detected among all VRE isolates, carried the vanA gene. In the clonal association analysis of the isolates by AP-PCR and PFGE methods, it was found that they had 12 different genotypes, 48 of them were included in any cluster, the clustering rate was 88.8%, and the largest cluster was the genotype 1 cluster, with 36 isolates. Of the 54 patients with VREfm isolated recently, 18.51 percent of the clinical samples were isolated before the survey, and 9.25% were isolated after the survey. It was determined that 100% of VREfm isolates were resistant to ampicillin, levofloxacin, ciprofloxacin, high-level gentamicin, trimethoprimsulfamethoxazole, and teicoplanin, 7.4% to tigecycline, and 1.85% to linezolid. Conclusions: In our study, in the clonal association analysis performed by isolating VREfm in rectal swab samples, it was found that 88.8% of the samples were indistinguishably similar, and that the increase in the number of VREfm infections after the index case in our hospital was associated with the epidemic. VREfm infections cause long-term hospitalization, costs and also deaths, which shows the seriousness of the event, and the importance of the combination of epidemiological and molecular analysis in epidemic research.
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Affiliation(s)
- Feray Ferda Şenol
- Microbiology Laboratory Unit, Elazığ Fethi Sekin City Hospital, 23280 Elazığ, Turkey;
| | - Elif Seren Tanrıverdi
- Microbiology Laboratory Unit, Malatya Training and Research Hospital, 44210 Malatya, Turkey
| | - Özlem Aytaç
- Microbiology Laboratory Unit, Elazığ Fethi Sekin City Hospital, 23280 Elazığ, Turkey;
| | - Zulal Aşçı Toraman
- Department of Microbiology, Faculty of Medicine, Fırat University, 23200 Elazığ, Turkey;
| | - Barış Otlu
- Department of Medical Microbiology, Faculty of Medicine, Inonu University, 44280 Malatya, Turkey;
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Telli Dizman G, Metan G, Karahan G, Tanrıverdi ES, Hazırolan G, Otlu B, Sönmezer MÇ, Gül ND, Çınar B, Ünal S. Does marking as sterile mean really sterile? Stenotrophomonas maltophilia outbreak caused by a blood-gas injector containing liquid heparin. Infect Control Hosp Epidemiol 2023; 44:1683-1685. [PMID: 36775899 DOI: 10.1017/ice.2023.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
An outbreak investigation was initiated after detecting an increase in the number of patients with Stenotrophomonas maltophilia bloodstream infections (SM-BSIs) througout the hospital. S. maltophilia was isolated from the cultures of blood-gas ınjectors containing liquid heparin. The incidence density of SM-BSIs decreased significantly after prohibiting the use of those injectors.
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Affiliation(s)
- Gülçin Telli Dizman
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- Infection Control Committee, Hospitals of Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gökhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- Infection Control Committee, Hospitals of Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gizem Karahan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elif Seren Tanrıverdi
- Department of Medical Microbiology, Molecular Microbiology Laboratory, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Gülşen Hazırolan
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe UniversityAnkara, Turkey
| | - Barış Otlu
- Department of Medical Microbiology, Molecular Microbiology Laboratory, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Meliha Çağla Sönmezer
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nur Dilek Gül
- Infection Control Committee, Hospitals of Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Burcu Çınar
- Infection Control Committee, Hospitals of Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Serhat Ünal
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- Infection Control Committee, Hospitals of Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Menekşe Ş, Tanrıverdi ES, Altınay E, Oğuş H, Aydoğan AA, Sağlam D, Çelik Ö, Otlu B, Kırali MK. A long-lasting Sphingomonas paucimobilis outbreak: a potential for pathogens to persist on environmental devices despite disinfection measures. Am J Infect Control 2022:S0196-6553(22)00782-9. [DOI: 10.1016/j.ajic.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
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Menekşe Ş, Altınay E, Oğuş H, Kaya Ç, Işık ME, Kırali K. Risk Factors for Mortality in Patients with Stenotrophomonas maltophilia Bloodstream Infections in Immunocompetent Patients. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2022; 4:178-184. [PMID: 38633400 PMCID: PMC10986715 DOI: 10.36519/idcm.2022.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/10/2022] [Indexed: 04/19/2024]
Abstract
Objective This study aimed to evaluate bloodstream infections caused by Stenotrophomonas maltophilia in immunocompetent patients with respect to clinical features and risk factors for mortality. Methods We reviewed bloodstream infections detected between January 1, 2012, and July 1, 2021, to identify nosocomial S. maltophilia bacteremia in Koşuyolu Research and Training Hospital. Results We identified a total of 97 patients with S. maltophilia bloodstream infections. Of these, 17 patients were excluded because of community-acquired infections (n=9), contamination with S. maltophilia (n=3), and insufficient data (n=5), with 80 (57.5% males) patients remaining for analysis. The source of infection was the respiratory tract in 28 (35%) patients. A central venous catheter was used in 60 (75%) patients, which required replacement in 23 patients within five days after detecting S. maltophilia bacteremia. On antimicrobial susceptibility testing, 71 strains were found to be susceptible and 9 (11.3%) resistant to trimethoprim-sulfamethoxazole. Thirty-day mortality was 33.8%. Non-survivors differed significantly from survivors with respect to higher rates of central venous catheters ( p=0.020), mechanical ventilation (p=0.006), urinary catheters (p=0.021), septic shock (p=0.001), hypoalbuminemia (p=0.026) and thrombocytopenia (p =0.039). S. maltophilia bacteremia was independently associated with mortality in patients with hypoalbuminemia, and replacement of central venous catheters had a protective role in reducing mortality. Conclusion As with other bacterial infections, S. maltophilia bacteremia is associated with a considerably high mortality rate in patients with cardiac conditions. The replacement of the catheter seems to play a beneficial role in 30-day survival.
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Affiliation(s)
- Şirin Menekşe
- Infection Control Unit, Kartal Koşuyolu High Speciality Training and Research Hospital, İstanbul, Turkey
| | - Ece Altınay
- Department of Anesthesia, Kartal Koşuyolu High Speciality Training and Research Hospital, İstanbul, Turkey
| | - Halide Oğuş
- Department of Anesthesia, Kartal Koşuyolu High Speciality Training and Research Hospital, İstanbul, Turkey
| | - Çiğdem Kaya
- Infection Control Unit, Kartal Koşuyolu High Speciality Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Emirhan Işık
- Infection Control Unit, Kartal Koşuyolu High Speciality Training and Research Hospital, İstanbul, Turkey
| | - Kaan Kırali
- Department of Cardiovascular Surgery, Kartal Koşuyolu Heart and Research Hospital, İstanbul, Turkey
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