#Report on two #hypervirulent #Klebsiella pneumoniae producing a #blaKPC-2 carbapenemase from a #Canadian patient (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Report on two hypervirulent Klebsiella pneumoniae producing a blaKPC-2carbapenemase from a Canadian patient

Laura F. Mataseje [(M.Sc)], David A. Boyd [(M.Sc)], Michael R. Mulvey [(Ph.D)], Yves Longtin [(MD, FRCPC)]

DOI: 10.1128/AAC.00517-19

 

ABSTRACT

This report describes two hypervirulent Klebsiella pneumoniae producing KPC identified from a rectal swab and urine culture upon hospital admission. The patient had recent travel to Greece where he was hospitalized. The isolates were sequence type 86, contained an IncHI1B, IncFIB(K) hypervirulent plasmid and an IncFII(K) plasmid harbouring KPC.

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Klebsiella pneumoniae; Canada; Greece.

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#Mortality attributable to seasonal #influenza in #Greece, 2013 to 2017: variation by type/subtype and age, and a possible harvesting effect (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Mortality attributable to seasonal influenza in Greece, 2013 to 2017: variation by type/subtype and age, and a possible harvesting effect

Theodore Lytras1, Katerina Pantavou2, Elisavet Mouratidou1, Sotirios Tsiodras1,3
Affiliations: 1 Hellenic Centre for Disease Control and Prevention, Athens, Greece; 2 Medical School, University of Cyprus, Nicosia, Cyprus; 3 4th Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School, Athens, Greece

Correspondence:  Theodore Lytras

Citation style for this article: Lytras Theodore, Pantavou Katerina, Mouratidou Elisavet, Tsiodras Sotirios. Mortality attributable to seasonal influenza in Greece, 2013 to 2017: variation by type/subtype and age, and a possible harvesting effect. Euro Surveill. 2019;24(14):pii=1800118. https://doi.org/10.2807/1560-7917.ES.2019.24.14.1800118

Received: 14 Mar 2018;   Accepted: 21 Mar 2019

 

Abstract

Introduction

Estimating the contribution of influenza to excess mortality in the population presents substantial methodological challenges.

Aim

In a modelling study we combined environmental, epidemiological and laboratory surveillance data to estimate influenza-attributable mortality in Greece, over four seasons (2013/14 to 2016/17), specifically addressing the lag dimension and the confounding effect of temperature.

Methods

Associations of influenza type/subtype-specific incidence proxies and of daily mean temperature with mortality were estimated with a distributed-lag nonlinear model with 30 days of maximum lag, separately by age group (all ages, 15–64 and ≥ 65 years old). Total and weekly deaths attributable to influenza and cold temperatures were calculated.

Results

Overall influenza-attributable mortality was 23.6 deaths per 100,000 population per year (95% confidence interval (CI): 17.8 to 29.2), and varied greatly between seasons, by influenza type/subtype and by age group, with the vast majority occurring in persons aged ≥ 65 years. Most deaths were attributable to A(H3N2), followed by influenza B. During periods of A(H1N1)pdm09 circulation, weekly attributable mortality to this subtype among people ≥ 65 years old increased rapidly at first, but then fell to zero and even negative, suggesting a mortality displacement (harvesting) effect. Mortality attributable to cold temperatures was much higher than that attributable to influenza.

Conclusions

Studies of influenza-attributable mortality need to consider distributed-lag effects, stratify by age group and adjust both for circulating influenza virus types/subtypes and daily mean temperatures, in order to produce reliable estimates. Our approach addresses these issues, is readily applicable in the context of influenza surveillance, and can be useful for other countries.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Seasonal Influenza; Greece.

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High #incidence of #MDR and #XDR #Pseudomonas aeruginosa isolates obtained from #patients with #ventilator-associated #pneumonia in #Greece, #Italy and #Spain as part of the MagicBullet clinical trial (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

High incidence of MDR and XDR Pseudomonas aeruginosa isolates obtained from patients with ventilator-associated pneumonia in Greece, Italy and Spain as part of the MagicBullet clinical trial

Astrid Pérez, Eva Gato, José Pérez-Llarena, Felipe Fernández-Cuenca, María José Gude, Marina Oviaño, María Eugenia Pachón, José Garnacho, Verónica González, Álvaro Pascual, José Miguel Cisneros, Germán Bou

Journal of Antimicrobial Chemotherapy, dkz030, https://doi.org/10.1093/jac/dkz030

Published: 08 February 2019

 

Abstract

Objectives

To characterize the antimicrobial susceptibility, molecular epidemiology and carbapenem resistance mechanisms in Pseudomonas aeruginosa isolates recovered from respiratory tract samples from patients with ventilator-associated pneumonia enrolled in the MagicBullet clinical trial.

Methods

Isolates were collected from 53 patients from 12 hospitals in Spain, Italy and Greece. Susceptibility was determined using broth microdilution and Etest. MALDI-TOF MS was used to detect carbapenemase activity and carbapenemases were identified by PCR and sequencing. Molecular epidemiology was investigated using PFGE and MLST.

Results

Of the 53 isolates, 2 (3.8%) were considered pandrug resistant (PDR), 19 (35.8%) were XDR and 16 (30.2%) were MDR. Most (88.9%) of the isolates from Greece were MDR, XDR or PDR, whereas fewer of the isolates from Spain (33.3%) and Italy (43.5%) showed antibiotic resistance. Three Greek isolates were resistant to colistin. Overall, the rates of resistance of P. aeruginosa isolates to imipenem, ciprofloxacin, ceftolozane/tazobactam and ceftazidime/avibactam were 64.1%, 54.7%, 22.6% and 24.5%, respectively. All isolates resistant to ceftolozane/tazobactam and ceftazidime/avibactam (Greece, n = 10; and Italy, n = 2) carried blaVIM-2. Spanish isolates were susceptible to the new drug combinations. Forty-eight restriction patterns and 27 STs were documented. Sixty percent of isolates belonged to six STs, including the high-risk clones ST-111, ST-175 and ST-235.

Conclusions

MDR/XDR isolates were highly prevalent, particularly in Greece. The most effective antibiotic against P. aeruginosa was colistin, followed by ceftolozane/tazobactam and ceftazidime/avibactam. blaVIM-2 is associated with resistance to ceftolozane/tazobactam and ceftazidime/avibactam, and related to highly resistant phenotypes. ST-111 was the most frequent and disseminated clone and the clonal diversity was lower in XDR and PDR strains.

Topic: antibiotics – phenotype – polymerase chain reaction – pseudomonas aeruginosa – antibiotic resistance, bacterial – colistin – ciprofloxacin – ceftazidime – clone cells – drug combinations – electrophoresis, gel, pulsed-field – epidemiology, molecular – greece – ichthyosis, x-linked – imipenem – italy – respiratory system – sequence tagged sites – spain – spectrometry, mass, matrix-assisted laser desorption-ionization – sodium thiosulfate – antimicrobial susceptibility – tazobactam – ventilator-associated pneumonia – ceftolozane – avibactam – carbapenem resistance

Issue Section:

ORIGINAL RESEARCH

© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Antibiotics; Drugs Resistance; Pseudomonas aeruginosa; Pneumonia; Italy; Spain; Greece; Colistin; Ciprofloxacin; Ceftazidime; Iminpenem; Tazobactam; Ceftolozane; Avibactam.

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Attributable #deaths and #disability-adjusted life-years caused by #infections with #antibiotic-resistant bacteria in the #EU and the #EEA in 2015: a population-level modelling analysis (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis

Alessandro Cassini, MD,  Liselotte Diaz Högberg, PhD, Diamantis Plachouras, PhD, Annalisa Quattrocchi, PhD, Ana Hoxha, MSc, Gunnar Skov Simonsen, PhD, Mélanie Colomb-Cotinat, PhD, Mirjam E Kretzschmar, PhD, Brecht Devleesschauwer, PhD, Michele Cecchini, PhD, Driss Ait Ouakrim, PhD, Tiago Cravo Oliveira, PhD, Marc J Struelens, PhD, Carl Suetens, MD, Dominique L Monnet, PhD, theBurden of AMR Collaborative Group †

Open Access / Published: November 05, 2018 / DOI: https://doi.org/10.1016/S1473-3099(18)30605-4

 

Summary

Background

Infections due to antibiotic-resistant bacteria are threatening modern health care. However, estimating their incidence, complications, and attributable mortality is challenging. We aimed to estimate the burden of infections caused by antibiotic-resistant bacteria of public health concern in countries of the EU and European Economic Area (EEA) in 2015, measured in number of cases, attributable deaths, and disability-adjusted life-years (DALYs).

Methods

We estimated the incidence of infections with 16 antibiotic resistance–bacterium combinations from European Antimicrobial Resistance Surveillance Network (EARS-Net) 2015 data that was country-corrected for population coverage. We multiplied the number of bloodstream infections (BSIs) by a conversion factor derived from the European Centre for Disease Prevention and Control point prevalence survey of health-care-associated infections in European acute care hospitals in 2011–12 to estimate the number of non-BSIs. We developed disease outcome models for five types of infection on the basis of systematic reviews of the literature.

Findings

From EARS-Net data collected between Jan 1, 2015, and Dec 31, 2015, we estimated 671 689 (95% uncertainty interval [UI] 583 148–763 966) infections with antibiotic-resistant bacteria, of which 63·5% (426 277 of 671 689) were associated with health care. These infections accounted for an estimated 33 110 (28 480–38 430) attributable deaths and 874 541 (768 837–989 068) DALYs. The burden for the EU and EEA was highest in infants (aged <1 year) and people aged 65 years or older, had increased since 2007, and was highest in Italy and Greece.

Interpretation

Our results present the health burden of five types of infection with antibiotic-resistant bacteria expressed, for the first time, in DALYs. The estimated burden of infections with antibiotic-resistant bacteria in the EU and EEA is substantial compared with that of other infectious diseases, and has increased since 2007. Our burden estimates provide useful information for public health decision-makers prioritising interventions for infectious diseases.

Funding

European Centre for Disease Prevention and Control.

Keywords: Antibiotics; Drugs Resistance; EU; Excess mortality.

——

#Epidemiology and #resistance phenotypes of #carbapenemase-producing #Klebsiella pneumoniae in #Greece, 2014 to 2016 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Epidemiology and resistance phenotypes of carbapenemase-producing Klebsiella pneumoniae in Greece, 2014 to 2016

Irene Galani1, Ilias Karaiskos2, Irene Karantani3, Vassiliki Papoutsaki3, Sofia Maraki4, Vassiliki Papaioannou5,Polyzo Kazila6, Helen Tsorlini7, Nikoletta Charalampaki8, Marina Toutouza9, Helen Vagiakou10, Konstantinos Pappas11, Anna Kyratsa12,Konstantina Kontopoulou13, Olga Legga14, Efthymia Petinaki15, Helen Papadogeorgaki3, Efrosini Chinou16, Maria Souli1, Helen Giamarellou2,on behalf of the study collaborators17

Affiliations: 1 Infectious Diseases Laboratory, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; 2 6th Department of Internal Medicine, Hygeia General Hospital, Athens, Greece; 3 Microbiology Laboratory, Hygeia General Hospital, Athens, Greece; 4 Department of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, University Hospital of Heraklion, Heraklion, Greece; 5 Microbiology Department, KAT Hospital, Athens, Greece; 6 Cancer Hospital of Thessaloniki ‘THEAGENEIO’, Thessaloniki, Greece; 7 Microbiological Laboratories, Bacteriology Department ‘G. Papanikolaou’ General Hospital of Thessaloniki, Thessaloniki, Greece; 8 Department of Clinical Μicrobiology, Thriassio General Hospital, Elefsina, Athens, Greece; 9 Department of Microbiology, Hippokration Athens General Hospital, Athens, Greece; 10 Microbiology Laboratory, General Hospital of Athens ‘G. Gennimatas’, Athens, Greece; 11 Athens Naval Hospital, Athens, Greece; 12 Microbiology Laboratory, General Hospital of Corfu, Corfu, Greece; 13 Department of Microbiology, General Hospital of Thessaloniki ‘G. Gennimatas’, Thessaloniki, Greece; 14 Department of Microbiology, General Hospital of Lamia, Lamia, Greece; 15 Department of Microbiology, University Hospital of Larissa, Larissa, Greece; 16 Department of Microbiology, St Savvas Cancer Hospital, Athens, Greece; 17 The study collaborators are acknowledged at the end of the article

Citation style for this article: Galani Irene, Karaiskos Ilias, Karantani Irene, Papoutsaki Vassiliki, Maraki Sofia, Papaioannou Vassiliki, Kazila Polyzo, Tsorlini Helen,Charalampaki Nikoletta, Toutouza Marina, Vagiakou Helen, Pappas Konstantinos, Kyratsa Anna, Kontopoulou Konstantina, Legga Olga, Petinaki Efthymia,Papadogeorgaki Helen, Chinou Efrosini, Souli Maria, Giamarellou Helen, on behalf of the study collaborators. Epidemiology and resistance phenotypes of carbapenemase-producing Klebsiella pneumoniae in Greece, 2014 to 2016. Euro Surveill. 2018;23(31):pii=1700775. https://doi.org/10.2807/1560-7917.ES.2018.23.30.1700775

Received: 17 Nov 2017;   Accepted: 29 Mar 2018

 

Abstract

Background and aim

A multicentre nationwide surveillance study was conducted in Greek hospitals to evaluate epidemiology of carbapenemase-producing Klebsiella pneumoniae clinical isolates, and their susceptibilities to last-line antibiotics.

Methods:

Minimum inhibitory concentrations (MICs) were evaluated by Etest, colistin MICs were also evaluated by broth microdilution SensiTest (now known as ComASP) Colistin. Carbapenemase genes were detected by PCR. Clonal relatedness was assessed by PFGE. Isolates were prospectively collected between November 2014 and April 2016, from 15 hospitals.

Results:

Among 394 isolates, K. pneumoniae carbepenemase (KPC) remained the most prevalent carbapenemase (66.5%). NDM was the second most prevalent (13.7%), identified in 12 hospitals, followed by VIM (8.6%). OXA-48- and double carbapenemase-producers remained rare (3.6%, 6.3%, respectively). Carbapenemase-producing K. pneumoniae isolates showed high resistance to last-line antibiotics. Gentamicin and colistin were the most active in vitro with 61.9% and 59.6% of the isolates to be inhibited at ≤ 2mg/L, followed by fosfomycin (susceptibility (S): 58.4%) and tigecycline (S: 51.5%). Ceftazidime/avibactam inhibited 99.6% of KPC and 100% of OXA-48-like-producing isolates, while temocillin was active against 58% of KPC isolates at urinary breakpoint of ≤ 2mg/L and only 2.7% at systemic breakpoint of ≤ 8mg/L. NDM-producing isolates belonged mainly to one clone, whereas KPC, VIM, OXA-48 and double carbapenemase-producers were mainly polyclonal.

Conclusions:

KPC remains the predominant carbapenemase among K. pneumoniae in Greece, followed by NDM, whereas changing trends of resistance rates to last-line antimicrobials against carbapenemase-producing K. pneumoniae with the exception of ceftazidime/avibactam mandates continuing surveillance to support clinical practice.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Klebsiella pneumoniae; Antibiotics; Drugs Resistance; Greece; Carbapenem.

——

#Colistin alone versus colistin plus #meropenem for treatment of severe #infections caused by #carbapenem-resistant Gram-negative bacteria: an open-label, randomised controlled trial (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Colistin alone versus colistin plus meropenem for treatment of severe infections caused by carbapenem-resistant Gram-negative bacteria: an open-label, randomised controlled trial

Mical Paul, MD, Prof George L Daikos, MD, Emanuele Durante-Mangoni, MD, Dafna Yahav, MD, Prof Yehuda Carmeli, MD, Yael Dishon Benattar, MA, Anna Skiada, MD, Roberto Andini, MD, Noa Eliakim-Raz, MD, Amir Nutman, MD, Oren Zusman, MD, Anastasia Antoniadou, MD, Pia Clara Pafundi, Amos Adler, MD, Yaakov Dickstein, MD, Ioannis Pavleas, MD, Rosa Zampino, MD, Vered Daitch, MA, Roni Bitterman, MD, Hiba Zayyad, MD, Fidi Koppel, BA, Inbar Levi, MA, Tanya Babich, MA, Prof Lena E Friberg, PhD, Prof Johan W Mouton, MD, Ursula Theuretzbacher, PhD, Prof Leonard Leibovici, MD

Published: 15 February 2018 / DOI: https://doi.org/10.1016/S1473-3099(18)30099-9

© 2018 Elsevier Ltd. All rights reserved.

 

Summary

Background

Colistin–carbapenem combinations are synergistic in vitro against carbapenem-resistant Gram-negative bacteria. We aimed to test whether combination therapy improves clinical outcomes for adults with infections caused by carbapenem-resistant or carbapenemase-producing Gram-negative bacteria.

Methods

A randomised controlled superiority trial was done in six hospitals in Israel, Greece, and Italy. We included adults with bacteraemia, ventilator-associated pneumonia, hospital-acquired pneumonia, or urosepsis caused by carbapenem-non-susceptible Gram-negative bacteria. Patients were randomly assigned (1:1) centrally, by computer-generated permuted blocks stratified by centre, to intravenous colistin (9-million unit loading dose, followed by 4·5 million units twice per day) or colistin with meropenem (2-g prolonged infusion three times per day). The trial was open-label, with blinded outcome assessment. Treatment success was defined as survival, haemodynamic stability, improved or stable Sequential Organ Failure Assessment score, stable or improved ratio of partial pressure of arterial oxygen to fraction of expired oxygen for patients with pneumonia, and microbiological cure for patients with bacteraemia. The primary outcome was clinical failure, defined as not meeting all success criteria by intention-to-treat analysis, at 14 days after randomisation. This trial is registered at ClinicalTrials.gov, number NCT01732250, and is closed to accrual.

Findings

Between Oct 1, 2013, and Dec 31, 2016, we randomly assigned 406 patients to the two treatment groups. Most patients had pneumonia or bacteraemia (355/406, 87%), and most infections were caused by Acinetobacter baumannii (312/406, 77%). No significant difference between colistin monotherapy (156/198, 79%) and combination therapy (152/208, 73%) was observed for clinical failure at 14 days after randomisation (risk difference −5·7%, 95% CI −13·9 to 2·4; risk ratio [RR] 0·93, 95% CI 0·83–1·03). Results were similar among patients with A baumannii infections (RR 0·97, 95% CI 0·87–1·09). Combination therapy increased the incidence of diarrhoea (56 [27%] vs 32 [16%] patients) and decreased the incidence of mild renal failure (37 [30%] of 124 vs 25 [20%] of 125 patients at risk of or with kidney injury).

Interpretation

Combination therapy was not superior to monotherapy. The addition of meropenem to colistin did not improve clinical failure in severe A baumannii infections. The trial was unpowered to specifically address other bacteria.

Funding

EU AIDA grant Health-F3-2011-278348.

Keywords: Antibiotics; Drugs Resistance; Italy; Greece; Israel; Colistin; Carbapenem; Meropenem.

——

High incidence of #pandrug #resistant #Acinetobacter baumannii isolates collected from #patients with ventilator-associated #pneumonia in #Greece, #Italy and #Spain as part of the MagicBullet clinical trial (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

High incidence of pandrug-resistant Acinetobacter baumannii isolates collected from patients with ventilator-associated pneumonia in Greece, Italy and Spain as part of the MagicBullet clinical trial

J. Nowak, E. Zander, D. Stefanik, P. G. Higgins, I. Roca, J. Vila, M. J. McConnell, J. M. Cisneros, H. Seifert, on behalf of the MagicBullet Working Group WP4

Journal of Antimicrobial Chemotherapy, dkx322, https://doi.org/10.1093/jac/dkx322

Published: 08 September 2017 – Received: 01 June 2017 – Revision Requested: 20 June 2017 – Revision Received: 01 August 2017 – Accepted: 01 August 2017

Citation: J. Nowak, E. Zander, D. Stefanik, P. G. Higgins, I. Roca, J. Vila, M. J. McConnell, J. M. Cisneros, H. Seifert, on behalf of the MagicBullet Working Group WP4; High incidence of pandrug-resistant Acinetobacter baumannii isolates collected from patients with ventilator-associated pneumonia in Greece, Italy and Spain as part of the MagicBullet clinical trial, Journal of Antimicrobial Chemotherapy, , dkx322, https://doi.org/10.1093/jac/dkx322

© 2017 Oxford University Press

 

Abstract

Objectives:

To investigate the molecular epidemiology, antimicrobial susceptibility and carbapenem resistance determinants of Acinetobacter baumannii isolates from respiratory tract samples of patients diagnosed with ventilator-associated pneumonia (VAP) who were enrolled in the MagicBullet clinical trial.

Methods:

A. baumannii isolates were prospectively cultured from respiratory tract samples from 65 patients from 15 hospitals in Greece, Italy and Spain. Susceptibility testing was performed by broth microdilution. Carbapenem resistance determinants were identified by PCR and sequencing. Molecular epidemiology was investigated using rep-PCR (DiversiLab) and international clones (IC) were identified using our in-house database.

Results:

Of 65 isolates, all but two isolates (97%) were resistant to imipenem and these were always associated with an acquired carbapenemase, OXA-23 (80%), OXA-40 (4.6%), OXA-58 (1.5%) or OXA-23/58 (1.5%). Resistance to colistin was 47.7%. Twenty-two isolates were XDR, and 20 isolates were pandrug-resistant (PDR). The majority of isolates clustered with IC2 (n = 54) with one major subtype comprising isolates from 12 hospitals in the three countries, which included 19 XDR and 16 PDR isolates.

Conclusions:

Carbapenem resistance rates were very high in A. baumannii recovered from patients with VAP. Almost half of the isolates were colistin resistant, and 42 (64.6%) isolates were XDR or PDR. Rep-PCR confirmed IC2 is the predominant clonal lineage in Europe and suggests the presence of an epidemic XDR/PDR A. baumannii clone that has spread in Greece, Italy and Spain. These data highlight the difficulty in empirical treatment of patients with A. baumannii VAP in centres with a high prevalence of carbapenem-resistant A. baumannii.

Topic: polymerase chain reaction – colistin – clone cells – epidemiology, molecular – greece – imipenem – italy – respiratory system – spain – epidemic – acinetobacter baumannii – antimicrobial susceptibility – ventilator-associated pneumonia – carbapenem resistance

Issue Section: ORIGINAL RESEARCH

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Imipenem; Colistin; Acinetobacter Baumannii; Italy; Greece; Spain; Nosocomial Outbreaks; Pneumonioa.

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