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Park S, Thursky K, Zosky-Shiller L, James R, Cheah R, Hall L, Ierano C. The quality of antimicrobial prescribing in skin and soft tissue management in Australian hospitals: an analysis of the National Antimicrobial Prescribing Survey data. J Hosp Infect 2024; 152:142-149. [PMID: 39032563 DOI: 10.1016/j.jhin.2024.06.016] [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: 05/27/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Skin and soft tissue infections (SSTIs) are among the most common indications for antimicrobial prescribing in hospitals. Inappropriate antimicrobial use can lead to increased morbidity, unnecessary hospital re-admission and increased antimicrobial resistance. This study aimed to assess the quality of antimicrobial prescribing practices in SSTI management within Australian hospitals to provide guidance for future practice. METHODS A retrospective analysis was conducted with data from the National Antimicrobial Prescribing Survey (NAPS). SSTI prescribing data from Hospital NAPS (2013-2022) and surgical site infection data from Surgical NAPS (2016-2022) datasets were analysed. Variables assessed included guideline compliance, appropriateness as per the structured NAPS algorithm, and reasons for inappropriateness. RESULTS From the Hospital NAPS dataset, 40,535 antimicrobial prescriptions for SSTIs were analysed. The most common indication was cellulitis (34.1%, N=13,822), and the most prescribed antimicrobial was flucloxacillin (18.8%, N=7,638). SSTI indications had a lower rate of guideline compliance but a higher rate of appropriateness compared with all other indications for antimicrobial prescriptions (guideline compliance 66.3%, N=21,035 vs 67.4%, N=156,285; appropriateness 75.6%, N=30,639 vs 72.7%, N=209,383). The most common reason for inappropriateness was incorrect dose or frequency (29.3%, N=2367). From the Surgical NAPS dataset, 5674 prescriptions for surgical site infections were analysed. Of these, 68.2% (N=3867) were deemed to be appropriate. The most common reason for inappropriateness was incorrect dose or frequency (27.7%, N=350). CONCLUSIONS As SSTIs are a common indication for prescribing an antimicrobial in Australian hospitals, identifying effective antimicrobial stewardship strategies to optimize antimicrobial use for SSTI management is recommended to improve patient outcomes.
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Affiliation(s)
- S Park
- Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - K Thursky
- Melbourne Medical School, University of Melbourne, Melbourne, Australia; National Centre for Antimicrobial Stewardship at the Department of Infectious Diseases, University of Melbourne, Melbourne, Australia; Royal Melbourne Hospital Guidance Group, Melbourne Health, Melbourne, Australia
| | - L Zosky-Shiller
- Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - R James
- Melbourne Medical School, University of Melbourne, Melbourne, Australia; National Centre for Antimicrobial Stewardship at the Department of Infectious Diseases, University of Melbourne, Melbourne, Australia; Royal Melbourne Hospital Guidance Group, Melbourne Health, Melbourne, Australia
| | - R Cheah
- Melbourne Medical School, University of Melbourne, Melbourne, Australia; National Centre for Antimicrobial Stewardship at the Department of Infectious Diseases, University of Melbourne, Melbourne, Australia; Royal Melbourne Hospital Guidance Group, Melbourne Health, Melbourne, Australia
| | - L Hall
- Royal Melbourne Hospital Guidance Group, Melbourne Health, Melbourne, Australia; School of Public Health, The University of Queensland, Herston, Australia
| | - C Ierano
- Melbourne Medical School, University of Melbourne, Melbourne, Australia; National Centre for Antimicrobial Stewardship at the Department of Infectious Diseases, University of Melbourne, Melbourne, Australia; Royal Melbourne Hospital Guidance Group, Melbourne Health, Melbourne, Australia.
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Rahbi FA, Salmi IA, Khamis F, Balushi ZA, Pandak N, Petersen E, Hannawi S. Physicians' attitudes, knowledge, and practices regarding antibiotic prescriptions. J Glob Antimicrob Resist 2023; 32:58-65. [PMID: 36584969 DOI: 10.1016/j.jgar.2022.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 12/06/2022] [Accepted: 12/17/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Inappropriate and overuse of antimicrobials, incorrect dosing, and extended duration are some of the leading causes of antibiotic-resistance that have led to the development of antimicrobial resistance (AMR). We aimed to evaluate knowledge, attitudes, and practices regarding rational antibiotic prescribing among physicians in a teaching hospital in Oman, with the goal of identifying knowledge gaps and interventions that could lead to judicious use of antimicrobials and reduce the emergence of resistant organisms METHODS: A cross-sectional study assessing physicians' knowledge of and attitudes towards prescribing antibiotics was conducted at the Royal Hospital from 15 January to 31 March 2020. Likert scales were used to evaluate physicians' awareness and perception of personal performance regarding the care of patients with infections and rational use of antibiotics. RESULTS Inadequate hand washing was regarded as the most important factor contributing to AMR (51.6%), followed by widespread use of antibiotics (49%), prescribing broad-spectrum antibiotics (47.3%), lack of effective narrow-spectrum antibiotics (47.3%), inappropriate duration of antibiotic therapy (46.2%), inappropriate empirical choice of antibiotics (45.1%), poor access to information on local antibiotic resistance patterns (40.8%), and inadequate restrictions on antibiotic prescribing (34.4%). Other factors contributing to AMR such as lack of local hospital guidelines on antibiotic usage, random mutations in microbes, patient demands and expectations for antibiotics, and the role of pharmaceutical companies in advertising and promoting use of antibiotics were deemed important by 33.3%, 26.8%, 22.5% and 20.4%, respectively. CONCLUSIONS AMR is a global health threat with significant effect on the health system and the economy. Misuse and overuse of antimicrobials remain the main drivers for the development of drug-resistant pathogens. Identifying knowledge gaps and planning interventions that could lead to judicious use of antimicrobials including establishing an Antimicrobial Stewardship Program are of paramount importance in reducing AMR in the twenty-first century and beyond.
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Affiliation(s)
| | - Issa Al Salmi
- Renal Medicine, The Royal Hospital, Muscat, Oman; Internal Medicine, Oman Medical Specialty Board, Muscat, Oman.
| | - Faryal Khamis
- Infectious Disease Unit, Department of Medicine , The Royal Hospital, Muscat, Oman
| | - Zakaria Al Balushi
- Infectious Disease Unit, Department of Medicine , The Royal Hospital, Muscat, Oman
| | - Nenad Pandak
- Infectious Disease Unit, Department of Medicine , The Royal Hospital, Muscat, Oman
| | - Eskild Petersen
- European Society for Clinical Microbiology and Infectious Diseases, Basel, Switzerland; Department of Molecular Medicine, The University of Pavia, Pavia, Italy; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Suad Hannawi
- Internal Medicine Department, Ministry of Health and Prevention, Dubai, UAE
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de With K, Allerberger F, Amann S, Apfalter P, Brodt HR, Eckmanns T, Fellhauer M, Geiss HK, Janata O, Krause R, Lemmen S, Meyer E, Mittermayer H, Porsche U, Presterl E, Reuter S, Sinha B, Strauß R, Wechsler-Fördös A, Wenisch C, Kern WV. Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases. Infection 2017; 44:395-439. [PMID: 27066980 PMCID: PMC4889644 DOI: 10.1007/s15010-016-0885-z] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction In the time of increasing resistance and paucity of new drug development there is a growing need for strategies to enhance rational use of antibiotics in German and Austrian hospitals. An evidence-based guideline on recommendations for implementation of antibiotic stewardship (ABS) programmes was developed by the German Society for Infectious Diseases in association with the following societies, associations and institutions: German Society of Hospital Pharmacists, German Society for Hygiene and Microbiology, Paul Ehrlich Society for Chemotherapy, The Austrian Association of Hospital Pharmacists, Austrian Society for Infectious Diseases and Tropical Medicine, Austrian Society for Antimicrobial Chemotherapy, Robert Koch Institute. Materials and methods A structured literature research was performed in the databases EMBASE, BIOSIS, MEDLINE and The Cochrane Library from January 2006 to November 2010 with an update to April 2012 (MEDLINE and The Cochrane Library). The grading of recommendations in relation to their evidence is according to the AWMF Guidance Manual and Rules for Guideline Development. Conclusion The guideline provides the grounds for rational use of antibiotics in hospital to counteract antimicrobial resistance and to improve the quality of care of patients with infections by maximising clinical outcomes while minimising toxicity. Requirements for a successful implementation of ABS programmes as well as core and supplemental ABS strategies are outlined. The German version of the guideline was published by the German Association of the Scientific Medical Societies (AWMF) in December 2013.
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Affiliation(s)
- K de With
- Division of Infectious Diseases, University Hospital Carl Gustav Carus at the TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - F Allerberger
- Division Public Health, Austrian Agency for Health and Food Safety (AGES), Vienna, Austria
| | - S Amann
- Hospital Pharmacy, Munich Municipal Hospital, Munich, Germany
| | - P Apfalter
- Institute for Hygiene, Microbiology and Tropical Medicine (IHMT), National Reference Centre for Nosocomial Infections and Antimicrobial Resistance, Elisabethinen Hospital Linz, Linz, Austria
| | - H-R Brodt
- Department of Infectious Disease Medical Clinic II, Goethe-University Frankfurt, Frankfurt, Germany
| | - T Eckmanns
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - M Fellhauer
- Hospital Pharmacy, Schwarzwald-Baar Hospital, Villingen-Schwenningen, Germany
| | - H K Geiss
- Department of Hospital Epidemiology and Infectiology, Sana Kliniken AG, Ismaning, Germany
| | - O Janata
- Department for Hygiene and Infection Control, Danube Hospital, Vienna, Austria
| | - R Krause
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - S Lemmen
- Division of Infection Control and Infectious Diseases, University Hospital RWTH Aachen, Aachen, Germany
| | - E Meyer
- Institute of Hygiene and Environmental Medicine, Charité, University Medicine Berlin, Berlin, Germany
| | - H Mittermayer
- Institute for Hygiene, Microbiology and Tropical Medicine (IHMT), National Reference Centre for Nosocomial Infections and Antimicrobial Resistance, Elisabethinen Hospital Linz, Linz, Austria
| | - U Porsche
- Department for Clinical Pharmacy and Drug Information, Landesapotheke, Landeskliniken Salzburg (SALK), Salzburg, Austria
| | - E Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - S Reuter
- Clinic for General Internal Medicine, Infectious Diseases, Pneumology and Osteology, Klinikum Leverkusen, Leverkusen, Germany
| | - B Sinha
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R Strauß
- Department of Medicine 1, Gastroenterology, Pneumology and Endocrinology, University Hospital Erlangen, Erlangen, Germany
| | - A Wechsler-Fördös
- Department of Antibiotics and Infection Control, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - C Wenisch
- Medical Department of Infection and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | - W V Kern
- Division of Infectious Diseases, Department of Medicine, Freiburg University Medical Center, Freiburg, Germany
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Perut V, Aumaître H, Pichard E, Patey O, Andre P, Welker Y, Bouchaud O, Rabaud C, Salmon Ceron D. Transversal infectious disease activity in French hospitals. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2016.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bedini A, De Maria N, Del Buono M, Bianchini M, Mancini M, Binda C, Brasacchio A, Orlando G, Franceschini E, Meschiari M, Sartini A, Zona S, Paioli S, Villa E, Gyssens IC, Mussini C. Antimicrobial stewardship in a Gastroenterology Department: Impact on antimicrobial consumption, antimicrobial resistance and clinical outcome. Dig Liver Dis 2016; 48:1142-7. [PMID: 27453168 DOI: 10.1016/j.dld.2016.06.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/04/2016] [Accepted: 06/20/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND A major cause of the increase in antimicrobial resistance is the inappropriate use of antimicrobials. AIMS To evaluate the impact on antimicrobial consumption and clinical outcome of an antimicrobial stewardship program in an Italian Gastroenterology Department. METHODS Between October 2014 and September 2015 (period B), a specialist in infectious diseases (ID) controlled all antimicrobial prescriptions and decided about the therapy in agreement with gastroenterologists. The defined daily doses of antimicrobials (DDDs), incidence of MDR-infections, mean length of stay and overall in-hospital mortality rate were compared with those of the same period in the previous 12-months (period A). RESULTS During period B, the ID specialist performed 304 consultations: antimicrobials were continued in 44.4% of the cases, discontinued in 13.8%, not recommended in 12.1%, de-escalated 9.9%, escalated in 7.9%, and started in 4.0%. Comparing the 2 periods, we observed a decreased of antibiotics consumption (from 109.81 to 78.45 DDDs/100 patient-days, p=0.0005), antifungals (from 41.28 to 24.75 DDDs/100pd, p=0.0004), carbapenems (from 15.99 to 6.80 DDDsx100pd, p=0.0032), quinolones (from 35.79 to 17.82 DDDsx100pd, p=0.0079). No differences were observed in incidence of MDR-infections, length of hospital stay (LOS), and mortality rate. CONCLUSIONS ASP program had a positive impact on reducing the consumption of antimicrobials, without an increase in LOS and mortality.
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Affiliation(s)
- Andrea Bedini
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy.
| | - Nicola De Maria
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Mariagrazia Del Buono
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Marcello Bianchini
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Mauro Mancini
- Pharmaceutical Department, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Cecilia Binda
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Andrea Brasacchio
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Gabriella Orlando
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Erica Franceschini
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Marianna Meschiari
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Alessandro Sartini
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Stefano Zona
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Serena Paioli
- Pharmaceutical Department, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Erica Villa
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Inge C Gyssens
- Department of Infectious Diseases, Hasselt University, Belgium
| | - Cristina Mussini
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
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Alothman A, Algwizani A, Alsulaiman M, Alalwan A, Binsalih S, Bosaeed M. Knowledge and Attitude of Physicians Toward Prescribing Antibiotics and the Risk of Resistance in Two Reference Hospitals. Infect Dis (Lond) 2016; 9:33-8. [PMID: 27429557 PMCID: PMC4941866 DOI: 10.4137/idrt.s40047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/15/2016] [Accepted: 06/19/2016] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Antibiotics are essential and abundantly prescribed in hospitals because of their effectiveness and lifesaving benefits. However, the unnecessary use of antibiotics has been observed in earlier studies, and it has persisted through recent years as a major issue since it is one of the leading causes of antibiotic resistance. The increase in antibiotic resistance nowadays is one of the most critical concerns in global public health around the world. The objective of this study was to evaluate the knowledge and perceptions related to antibiotic prescription among physicians at our medical centers. METHOD A cross-sectional survey of non-infectious diseases specialized physicians. The study was conducted during 2015 at two tertiary care centers in Riyadh, Saudi Arabia. RESULT Of the 107 returned questionnaires, 93 were complete and valuable. Most respondents (82%) perceived antibiotic resistance to be a critical problem globally, and 78% also think that it is a very important national problem. These attitudes did not differ across specialty or level of training. Widespread antibiotic use and inappropriate empirical choices were believed by 81% of the participants to be important general causes of resistance. Only half of respondents thought that antibiotic restriction is a useful intervention to decrease the antibiotic resistance. The physicians believed educational interventions are the most useful and effective way to improve prescription patterns and decrease antibiotic resistance. Complications due to infection with resistant organisms were acknowledged by almost all of the participants, with some differences in their estimations of how often it will occur. CONCLUSION Antimicrobial resistance, globally and nationally, is considered as a serious threat, and physicians in this survey acknowledged that. Among the most significant factors is antimicrobial misuse, either by overprescribing or providing inappropriate drugs with some ambivalence, as well as the importance of hand hygiene and antibiotic restrictions. By adhering to local guidelines, continuous education, and other practical interventions, the burden of resistance can be alleviated, as highlighted in this survey.
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Affiliation(s)
- Adel Alothman
- Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia.; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdullah Algwizani
- Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohammed Alsulaiman
- Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alalwan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Salih Binsalih
- Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia.; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammad Bosaeed
- Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia.; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Al-Tawfiq JA. The pattern and impact of infectious diseases consultation on antimicrobial prescription. J Glob Infect Dis 2013; 5:45-8. [PMID: 23853430 PMCID: PMC3703209 DOI: 10.4103/0974-777x.112266] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objectives: Inclusion of infectious disease (ID) physicians in the care of patients with possible infection can favorably affect antibiotic usage. The aim of this study was to evaluate the role of the ID consultations in reducing inappropriate antibiotic usage. Materials and Methods: This is a prospective study evaluating all adult ID consultations from January 2006 to December 2009. A total of 1444 consultation requests were recorded during the 4-year period. Results: The most frequent consultations were from cardiology (23.1%), orthopedics (8.2%), general medicine (7.8%), hematology-oncology (7.8%), gastroenterology (7.3%), and pulmonary/critical care (7.1%). The main reason for consultation was for the choice of antibiotics (75%). The commonest diagnoses prior to consultation were fever (14.7%), bacteremia (9.1%), and urinary tract infection (8.4%). Bacteremia was documented in 21.4% of cases and 12.9% were found to have no identifiable focus of infection. Antimicrobial therapy was changed in 58.7% and antimicrobials were discontinued in 14.7% of cases. The number of antimicrobial therapy was one (49.7% and 49.9%) and two (24% and 17.6%, P = 0.0001) before and after the consultation, respectively. In addition, 17.3% and 26.9% (P = 0.0001) received no antimicrobial agents before and after ID consultation. Conclusion: ID consultation is important to reduce inappropriate antimicrobial therapy and to limit the number of dual therapy.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Medical Department, Specialty Internal Medicine Unit, Dhahran Health Center, Saudi Aramco Medical Services Organization, Saudi Aramco, Dhahran, Saudi Arabia
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