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Procalcitonin for selecting the antibiotic regimen in outpatients with low-risk community-acquired pneumonia using a rapid point-of-care testing: A single-arm clinical trial. PLoS One 2017; 12:e0175634. [PMID: 28426811 PMCID: PMC5398537 DOI: 10.1371/journal.pone.0175634] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 03/27/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We aimed to assess the role of procalcitonin (PCT) to guide the initial selection of the antibiotic regimen for low-risk community-acquired pneumonia (CAP). METHODS A single-arm clinical trial was conducted including outpatients with CAP and Pneumonia Severity Index risk classes I-II. Antimicrobial selection was based on the results of PCT measured with a rapid point-of-care testing. According to serum PCT levels, patients were assigned to two treatment strategies: oral azithromycin if PCT was <0.5 ng/ml, or levofloxacin if levels were ≥0.5 ng/ml. Primary outcome was clinical cure rate. Short-term and long-term outcomes were assessed. Results were compared with those of a historical standard-of-care control-group treated in our centre. RESULTS Of 253 subjects included, 216 (85.4%) were assigned to azithromycin. Pneumococcal infection was diagnosed in 26 (12%) and 21 (56.8%) patients allocated to azithromycin and levofloxacin groups, respectively. No patients in the azithromycin group developed bacteraemia. Atypical organisms were more common in patients given azithromycin (18.5% vs 8.1%, respectively). The majority (93%) of patients with atypical pneumonia had low PCT levels. Clinical cure rates were 95.8% in the azithromycin group, 94.6% in the levofloxacin group, and 94.4% in the historical control group. No 30-day mortality or recurrences were observed, and the 3-year rates of recurrence and mortality were very low in both groups. Adverse events occurrence was also infrequent. CONCLUSION A PCT-guided strategy with a rapid point-of-care testing safely allowed selecting empirical narrow-spectrum antibiotics in outpatients with CAP. TRIAL REGISTRATION The study is registered with ClinicalTrials.gov, number NCT02600806.
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Llor C, Boada A, Pons-Vigués M, Grenzner E, Juvé R, Almeda J. [Antibiotic susceptibility of Staphylococcus aureus and Streptococcus pneumoniae in healthy carrier individuals in primary care in Barcelona area]. Aten Primaria 2017; 50:44-52. [PMID: 28413102 PMCID: PMC6836987 DOI: 10.1016/j.aprim.2016.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/14/2016] [Accepted: 12/21/2016] [Indexed: 11/29/2022] Open
Abstract
Introducción La información existente sobre la resistencia a los antibióticos se basa habitualmente en muestras de personas hospitalizadas. El objetivo fue evaluar la prevalencia de resistencia antibiótica de cepas de Staphylococcus aureus y Streptococcus pneumoniae de personas portadores nasales atendidas en las consultas de atención primaria según edad y sexo. Diseño Estudio transversal. Emplazamiento Siete centros de salud del área de Barcelona. Participantes Personas portadoras nasales a partir de 4 años de edad, sin signos de enfermedad infecciosa y que no habían tomado antibióticos ni habían estado hospitalizados en los 3 meses anteriores. Mediciones principales Se recogieron 3.969 frotis nasales válidos para identificación entre 2010 y 2011 y fueron enviados a un laboratorio central de microbiología para el aislamiento de ambos gérmenes. La resistencia a los antibióticos se estableció según los puntos de corte actuales de la guía del European Committee on Antimicrobial Susceptibility Testing. Resultados La prevalencia de S. aureus resistente a meticilina fue del 1,3% (IC 95%: 0,5-2,1%), con porcentajes de resistencia frente a fenoximetilpenicilina del 87,1% y a azitromicina del 11,6%, sin observar diferencias significativas según edad y sexo. Un 2,4% (IC 95%: 0,1-4,7%) de las cepas de neumococo fueron altamente resistentes a fenoximetilpenicilina y macrólidos, mientras que las mayores resistencias se observaron frente a cefaclor (53,3%), tetraciclina (20%) y cefuroxima (12,1%). Conclusiones Estos patógenos tienen resistencias más bajas en la comunidad que las que se observan en el medio hospitalario. Es importante que se conozca la resistencia antibiótica actual para poder hacer un uso más prudente de los antibióticos.
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Affiliation(s)
- Carles Llor
- Centro de Salud Via Roma, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, España.
| | - Albert Boada
- Centro de Salud Guinardó, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, España
| | - Mariona Pons-Vigués
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España; Universitat de Girona, Girona, España
| | - Elisabet Grenzner
- Laboratori Clínic l'Hospitalet, ICS Metropolitana Sud, Hospitalet de Llobregat, Barcelona, España
| | - Rosa Juvé
- Departament de Microbiologia, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - Jesús Almeda
- Unitat de Suport a la Recerca Metropolitana Sud, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Cornellà de Llobregat, Barcelona, España; CIBER Epidemiología y Salud Pública (CIBERES), España
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Kim T, Park SJ, Chong YP, Park KH, Lee YM, Hong HL, Kim HS, Kim ES, Lee S, Choi DR, Kim SH, Jeong JY, Lee SO, Choi SH, Woo JH, Kim YS. Fluoroquinolone resistance of Streptococcus pneumoniae isolates causing invasive disease: special focus on zabofloxacin. Diagn Microbiol Infect Dis 2016; 86:181-3. [PMID: 27498611 DOI: 10.1016/j.diagmicrobio.2016.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 07/18/2016] [Accepted: 07/19/2016] [Indexed: 11/20/2022]
Abstract
The present study examined the in vitro activity of various antibiotics including zabofloxacin, against isolates responsible for invasive pneumococcal diseases. Between 1997 and 2008, a total of 208 isolates were collected from sterile fluids, including blood (n=196, 94.2%), pleural fluid (n=5, 2.4%), cerebrospinal fluid (n=5, 2.4%), and ascites (n=2, 1.0%). Zabofloxacin showed the lowest MIC50 (0.015μg/mL) and MIC90 (0.025μg/mL) values of all the tested antibiotics. Rates of isolates resistant to penicillin (MIC ≥8μg/mL), ceftriaxone (MIC ≥4μg/mL) and levofloxacin (MIC ≥8μg/mL) were 3.4%, 0.4% and 2.0%, respectively. Four isolates (2.0%) were resistant to levofloxacin, and zabofloxacin showed low MICs (range, 0.025-0.125μg/mL). Zabofloxacin shows potent in vitro activity against S. pneumoniae isolates that caused invasive disease, even strains that are resistant to levofloxacin.
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Affiliation(s)
- Tark Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea; Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Su-Jin Park
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea; Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea
| | - Ki-Ho Park
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea; Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea
| | - Yu-Mi Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Hyo-Lim Hong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Hee Seung Kim
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea
| | - Eun Sil Kim
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea
| | - Sungkyoung Lee
- Division of Bacterial Respiratory Infections, National Institute of Health, Korea Centers for Disease Control and Prevention, Cheongwon-gun, Republic of Korea
| | - Dong Rack Choi
- Project Team, Dongwha Pharm Co. Ltd, Seoul, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Jin-Yong Jeong
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Jun Hee Woo
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea; Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea.
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Phongsamart W, Srifeungfung S, Chatsuwan T, Nunthapisud P, Treerauthaweeraphong V, Rungnobhakhun P, Sricharoenchai S, Chokephaibulkit K. Changing trends in serotype distribution and antimicrobial susceptibility of Streptococcus pneumoniae causing invasive diseases in Central Thailand, 2009-2012. Hum Vaccin Immunother 2015; 10:1866-73. [PMID: 25424794 DOI: 10.4161/hv.28675] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To describe the trends in serotype distribution and antimicrobial susceptibility of S. pneumoniae causing invasive pneumococcal diseases (IPD) we tested 238 pneumococci isolates from normally sterile sites between 2009 and 2012 and compared these findings with previous data collected within our network. Serotyping was performed for 15 serotypes contained in the 7-,10-, 13-, and experimental 15-valent pneumococcal conjugate vaccines (PCV). The most common serotypes found were 6B (13.9%), 19A (12.6%), 14 (8.0%), 18C (5.9%), and 6A (3.8%); and 39.9% were non-PCV15 serotypes. One of 81 patients with available data had breakthrough infection with vaccine serotype (19F). There was a significant increase of serotype 19A among children ≤5 years (5.6% in 2000-2009 vs 18.3% in 2009-2012, P = 0.003). The all-age serotype coverage was 36.4%, 41.5%, 59.3%, and 59.7% for PCV7, PCV10, PCV13, and PCV 15, respectively. The corresponding coverage in children ≤5 years were 46.4%, 48.8%, 73.2%, and 73.2% respectively. High susceptibilities to penicillin (89.7%), cefotaxime (95.7%), cefditoren (90.2% by Spanish breakpoints), ofloxacin (97.9%), and levofloxacin (100%), but low to cefdinir (50.0%), cefditoren (45.1% by US-FDA breakpoints), macrolides (<50%), clindamycin (67.7%), tetracycline (41.4%), and trimethoprim-sulfamethoxazole (32.4%) were observed. Serotype 19A was less susceptible to penicillin (80.0 vs 91.2%, P = 0.046), cefditoren (66.7 vs 95.5% by Spanish breakpoints, P = 0.004), and tetracycline (9.1 vs 45.5%, P = 0.024) than non-19A isolates. These data emphasize the need for continued surveillance to monitor changes in serotypes as well as antimicrobial susceptibilities in order to guide strategies for prevention and treatment.
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Affiliation(s)
- Wanatpreeya Phongsamart
- a Department of Pediatrics; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok, Thailand
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Walls A, Pierce M, Krishnan N, Steehler M, Harley EH. Pediatric head and neck complications of Streptococcus pneumoniae before and after PCV7 vaccination. Otolaryngol Head Neck Surg 2014; 152:336-41. [PMID: 25385805 DOI: 10.1177/0194599814557777] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To discuss pediatric head and neck complications of pneumococcal infections before and after the introduction of the PCV7 vaccine. STUDY DESIGN Cross-sectional analysis of a national database. STUDY SETTING Kids National Inpatient Database. METHODS A retrospective review of the Kids National Inpatient Database yielded 31,738 pediatric reports involving complications of meningitis, mastoiditis, periorbital cellulitis, and Bezold abscesses due to Streptococcus pneumoniae diagnoses. Each report was analyzed for incidence, length of stay, mean hospital cost, and inpatient admittance from the emergency department. Finally, we calculated the expected annual incidence of each complication via variance-weighted analysis to determine the expected incidence if the vaccine was not administered. RESULTS We identified a significant decrease in the incidence of several complications after the introduction of the PCV7 vaccine and also when comparing these findings to our predicted incidence calculations if the vaccine was not administered. Inpatient admittance from the emergency department for Bezold abscess, periorbital cellulitis, mastoiditis, and meningitis was significantly increased in the pediatric age group (ages 1-4; P < .05). Furthermore, there was a significant increase in the cost to provide care for each of the described conditions (P < .05). CONCLUSIONS The PCV7 vaccine produced a measurable reduction in head and neck complications associated with S pneumoniae. However, our data suggest that these benefits were also met with increased inpatient admittance from the emergency department, hospital costs, and length of stay, each of which may be attributed to the selection of a more pathogenic subtype.
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Affiliation(s)
- Andrew Walls
- Georgetown University School of Medicine, Washington, DC
| | - Matthew Pierce
- Department of Otolaryngology-Head & Neck Surgery, Georgetown University Hospital, Washington, DC
| | | | - Matthew Steehler
- Ear, Nose, & Throat Associates of Corpus Christi, Otolaryngology-Head and Neck Surgery, Corpus Christi, Texas
| | - Earl H Harley
- Georgetown University School of Medicine, Washington, DC Department of Otolaryngology-Head & Neck Surgery and Pediatrics, Georgetown University Hospital, Washington, DC
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Changes in the incidence of Streptococcus pneumoniae bacteremia and its serotypes over 10 years in one hospital in South Korea. Vaccine 2014; 32:6403-7. [DOI: 10.1016/j.vaccine.2014.09.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/11/2014] [Accepted: 09/26/2014] [Indexed: 11/17/2022]
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McElligott M, Vickers I, Cafferkey M, Cunney R, Humphreys H. Non-invasive pneumococcal serotypes and antimicrobial susceptibilities in a paediatric hospital in the era of conjugate vaccines. Vaccine 2014; 32:3495-500. [PMID: 24795223 DOI: 10.1016/j.vaccine.2014.04.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 04/09/2014] [Accepted: 04/17/2014] [Indexed: 11/15/2022]
Abstract
To evaluate the effects of 7-valent pneumococcal conjugate vaccine (PCV7) introduction to the routine childhood immunisation schedule in 2008 and its replacement by PCV13 in 2010 in Ireland, we surveyed the serotypes and antimicrobial susceptibilities of 339 pneumococci associated with carriage and non-invasive infection (NII) in a Dublin paediatric hospital from 2009 to 2012. Furthermore, we compared the distribution of pneumococcal serotypes collected from 2009 to 2012 to 105 NII pneumococci isolated in 2007, the year before conjugate vaccine introduction. PCV7 serotypes declined from 2007 to 2012 as follows: carriage, 67-23% (p=0.0004); conjunctivitis, 58-0% (p<0.0001); non-bacteraemic lower respiratory tract infection, 50-19% (p=0.0363) and otitis media 54-27%. Notably, antimicrobial resistant (AMR) PCV7 serotypes showed a significant decrease by the end of the study period (i.e. 2012) (p<0.0001). Compared with 2007 the overall occurrence of serotype 19A increased from 1.9 to 10% in 2010 (p=0.0132) and to 15% in 2011 (p=0.0005). Importantly, serotype 19A declined significantly from 2011 levels to an overall prevalence of 4.8% in 2012 (p=0.0243). Most striking was the significant reduction of AMR 19A (p=0.0195). Conversely, increases were observed in non-vaccine type (NVT) pneumococci in 2009-2012, of which serotypes 11A (n=30), 15B/C (n=17), 22F (n=14), 35Bn=13), non-typeable pneumococci (n=13) and 23A (n=12) were the most prevalent. Moreover, an increase in NVT non-susceptible to at least one antimicrobial in 2009-2012 was noted, attributable to serotypes 35B (n=10) and 15A (n=7). In summary, this study has shown that PCV7 and PCV13 introduction has had a positive impact on their target serotypes and antimicrobial resistance amongst pneumococci within a paediatric hospital within a short time period. However, the increase in NVT prevalence highlights the need for continued surveillance.
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Affiliation(s)
- Martha McElligott
- Epidemiology and Molecular Biology Unit and Irish Meningococcal and Meningitis Reference Laboratory, Temple Street Children's University Hospital, Dublin, Ireland; Department of Clinical Microbiology, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland.
| | - Imelda Vickers
- Epidemiology and Molecular Biology Unit and Irish Meningococcal and Meningitis Reference Laboratory, Temple Street Children's University Hospital, Dublin, Ireland; Department of Clinical Microbiology, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Mary Cafferkey
- Epidemiology and Molecular Biology Unit and Irish Meningococcal and Meningitis Reference Laboratory, Temple Street Children's University Hospital, Dublin, Ireland; Department of Clinical Microbiology, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Robert Cunney
- Epidemiology and Molecular Biology Unit and Irish Meningococcal and Meningitis Reference Laboratory, Temple Street Children's University Hospital, Dublin, Ireland; Health Protection Surveillance Centre, Dublin, Ireland
| | - Hilary Humphreys
- Department of Clinical Microbiology, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland
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Picazo J, Dueñas J, Ramirez A, Perez AR, Padilla E, Herrero S, Gallegos C, Culebras E, Balseiro C, Mendez C. Incidence of pediatric invasive pneumococcal disease in the Island of Majorca (2008-2010), an area with non-universal vaccination, and estimations of serotype & children population coverage by available conjugate vaccines. BMC Infect Dis 2013; 13:503. [PMID: 24498901 PMCID: PMC3826596 DOI: 10.1186/1471-2334-13-503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 10/22/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization reported in 2007 that inclusion of PCV7 in national immunization programs should be seen as a priority, also encouraging countries to conduct appropriate surveillances for monitoring the impact of vaccination. These analyses should be conducted in specific geographical areas and should be aimed to evolution of invasive pneumococcal disease (IPD), by age groups, clinical presentation, and vaccine serotypes (and non-vaccine serotypes to detect possible replacement). This study aimed to monitor the evolution of IPD incidence in children <15 years requiring hospitalization in the Island of Majorca. METHODS A prospective clinical surveillance of all culture and/or PCR-confirmed IPD in children <15 years was performed in all hospitals in the Island of Majorca (approximately 900,000 inhabitants) from January 2008 to December 2010. Incidence rate (IR) was calculated as cases/100,000 inhabitants using children population data. RESULTS 66 IPDs were identified: 39 (59.1%) parapneumonic pneumococcal empyema (PPE), 16 (24.2%) bacteremic pneumonia (BP), 7 (10.6%) primary bacteremia, 3 (4.5%) meningitis, and 1 (1.5%) osteomyelitis. IRs in the three-year study period were: 64.22 for children 12- < 24 months, 37.21 for those 24-59 months, 22.62 for those <12 months, and 3.98 for children >59 months. By study year, IRs were 21.25 in 2008, 19.89 in 2009 and 9.80 in 2010. The reduction found in 2010 was significant and due to significant reductions in IRs of IPDs caused by serotypes included in PCV10 and PCV13. Overall, estimated serotype coverage by conjugate vaccines was 12.1% for PCV7, 37.9% for PCV10 and 65.2% for PCV13. Of the 66 hospitalized children with IPD, 20 had received at least one dose of PCV7 (13 cases with identified serotype). None of these 13 cases was caused by PCV7 serotypes, all were caused by PCV13 serotypes and only 53.8% by PCV10 serotypes. CONCLUSIONS The results of the present study evidence the importance of expanding the number of serotypes covered by PCV, and the added value of PCV13 with respect to PCV10 and PCV7, even in an area of low prevalence of 19A as the Island of Majorca.
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Affiliation(s)
- Juan Picazo
- Microbiology Deparment, Hospital Clínico San Carlos, c/ Martín Lagos s/n, 28040 Madrid, Spain.
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