| WHO categorization . | Bacterial pathogens . | Key features . | References . |
|---|---|---|---|
| Critical | Acinetobacter baumannii, carbapenem-resistant | Most associated with HAIs worldwide, accounting for up to 20% of ICU infections worldwide. Causes pneumonia and bloodstream and wound infections, particularly in mechanically ventilated patients. Around 45% isolates are MDR, including resistance to last-resort carbapenems most often linked to the production of carbapenemases. | Potron, Poirel and Nordmann 2015; Harding, Hennon and Feldman 2017; Lee et al. 2017 |
| P. aeruginosa, carbapenem-resistant | Common cause of HAIs, including pneumonia, bloodstream, urinary tract and surgical site infections. Carbapenem resistance mostly related to porin (OprD) deficiency. Invasive isolates resistant to carbapenems were 17.8% in Europe (2015) and 19.2% in the USA (2014). | Potron, Poirel and Nordmann 2015; WHO 2017b | |
| Enterobacteriaceae, carbapenem-resistant, third-generation cephalosporin-resistant | Enterobacteriaceae include K. pneumonia, E. coli, Enterobacter spp., Serratia spp., Proteus spp., Providencia spp. and Morganella spp. K. pneumoniae invasive isolates resistant to carbapenems were reported from all WHO regions, with some countries reporting up to 50%. Human isolates resistant to colistin, a last-resort antimicrobial against carbapenem-resistant Enterobacteriaceae, were already reported. 10–20% of Enterobacteriaceae isolated in the USA are resistant to ceftazidime. | Arizpe et al. 2016; Castanheira et al. 2016; WHO 2017b | |
| M. tuberculosis | M. tuberculosis infection is the precursor to tuberculosis disease, responsible for 1.5 million deaths/year. Aerial dissemination, with infection typically occurring in the lungs. Sometimes treatable with first-line drugs (isoniazid, rifampicin) but mostly resistant to several antibiotics (fluoroquinolones) and to second-line injectable drugs (amikacin, capreomycin and kanamycin). | WHO 2018a | |
| High | Enterococcus faecium, vancomycin-resistant | Most commonly isolated Gram-positive nosocomial pathogen worldwide with highly flexible genome that enables rapid adaption. Vancomycin-resistant isolates rose from 0% to more than 80% from 1980 to 2007, in the USA. Vancomycin resistance arises from reduced vancomycin-binding affinity, involving alterations in the peptidoglycan synthesis pathway. | Arias and Murray 2012; Gao, Howden and Stinear 2018 |
| S. aureus, methicillin-resistant | Among the most frequent of all antibiotic-resistant threats and leading cause of bacteremia. Outstanding versatility in adapting to different epidemiological settings (healthcare, community, animal). Characteristically MDR, with infections spreading across the globe. Infections commonly involve the skin, soft tissue, bone, joints and indwelling catheters or prosthetic devices. | Monaco et al. 2016; Hassoun, Linden and Friedman 2017 | |
| S. aureus, vancomycin- intermediate (VISA) and -resistant (VRSA) | VISA (MIC = 4–8 µg/mL) appeared in MRSA infected patients due to mutations during prolonged vancomycin therapy. VISA are associated with persistent infections, vancomycin treatment failure and poor clinical outcome. VRSA (MIC ≥ 16 µg/mL) appeared by acquisition of plasmid-borne copies of the transposon Tn1546, from vancomycin-resistant Enterococcus faecalis. VRSA infection numbers are still limited to date (14 in the USA). | Gardete and Tomasz 2014 | |
| Helicobacter pylori, clarithromycin-resistant | Most successful human gastric pathogen able to resist stomach acids, colonizing over 50% of the population. Related to gastritis, peptic ulcers, gastric adenocarcinoma, iron deficiency anemia, idiopathic thrombocytopenic purpura and vitamin B12 deficiency. Sequential, bismuth quadruple and non-bismuth quadruple therapies seam effective in high clarithromycin-resistance countries. | Alba, Blanco and Alarcón 2017; Goderska, Agudo Pena and Alarcon 2018 | |
| Campylobacter spp., fluoroquinolone-resistant | Leading cause of foodborne illnesses, majorly gastroenteritis, primarily caused by Campylobacter jejuni. Antibiotic treatment is only recommended in vulnerable patients, such as the young, the elderly and patients with weakened immunity. Macrolides (e.g. erythromycin and azithromycin) are considered as fluoroquinolone alternatives. | Bolinger and Kathariou 2017 | |
| Salmonella spp., fluoroquinolone-resistant | Leading cause of foodborne illnesses/diarrheal diseases, namely gastroenteritis. Antibiotic treatment is only recommended in vulnerable patients, such as the young, the elderly and patients with weakened immunity. | Kim et al. 2016; WHO 2018b | |
| N. gonorrhoeae, third-generation cephalosporin-resistant, fluoroquinolone-resistant | Causes gonorrhea, an obligate human infection, usually transmitted during sexual activity, often resulting in urethritis in men and cervicitis in women. Gonorrhea is rising, with 18.6% increase during 2016–17 and 75.2% increase since 2009 in the USA. Asymptomatic men (two-thirds of infected men) constitute the principal source of dissemination. | CDC 2017; Rice et al. 2017 | |
| Medium | S. pneumoniae, penicillin nonsusceptible | Encapsulated bacteria causes meningitis, septicemia and pneumonia, but also milder infections, such as sinusitis and otitis media. Major cause of morbidity and mortality worldwide, mainly in poor countries and in children under the age of 2. There are two available vaccines that target the most prevalent serotypes. | WHO 2014 |
| Haemophilus influenzae, ampicillin-resistant | Serotype b, an obligate human pathogen, is the most pathogenic, responsible for respiratory infections, ocular infection, sepsis and meningitis. Leading worldwide cause of meningitis morbidity and mortality in unimmunized populations. Highly related to chronic obstructive pulmonary disease, a leading cause of morbidity and mortality worldwide. Third-generation cephalosporins are the empiric treatment of choice. | ECDC 2017a; Sriram et al. 2018 | |
| Shigella spp., fluoroquinolone-resistant | Causes shigellosis, a major cause of diarrhea affecting mainly children under the age of 5. Between 80 and 165 million cases of shigellosis occur annually worldwide, majorly in developing countries. | ECDC 2017b; CDC 2018 |
| WHO categorization . | Bacterial pathogens . | Key features . | References . |
|---|---|---|---|
| Critical | Acinetobacter baumannii, carbapenem-resistant | Most associated with HAIs worldwide, accounting for up to 20% of ICU infections worldwide. Causes pneumonia and bloodstream and wound infections, particularly in mechanically ventilated patients. Around 45% isolates are MDR, including resistance to last-resort carbapenems most often linked to the production of carbapenemases. | Potron, Poirel and Nordmann 2015; Harding, Hennon and Feldman 2017; Lee et al. 2017 |
| P. aeruginosa, carbapenem-resistant | Common cause of HAIs, including pneumonia, bloodstream, urinary tract and surgical site infections. Carbapenem resistance mostly related to porin (OprD) deficiency. Invasive isolates resistant to carbapenems were 17.8% in Europe (2015) and 19.2% in the USA (2014). | Potron, Poirel and Nordmann 2015; WHO 2017b | |
| Enterobacteriaceae, carbapenem-resistant, third-generation cephalosporin-resistant | Enterobacteriaceae include K. pneumonia, E. coli, Enterobacter spp., Serratia spp., Proteus spp., Providencia spp. and Morganella spp. K. pneumoniae invasive isolates resistant to carbapenems were reported from all WHO regions, with some countries reporting up to 50%. Human isolates resistant to colistin, a last-resort antimicrobial against carbapenem-resistant Enterobacteriaceae, were already reported. 10–20% of Enterobacteriaceae isolated in the USA are resistant to ceftazidime. | Arizpe et al. 2016; Castanheira et al. 2016; WHO 2017b | |
| M. tuberculosis | M. tuberculosis infection is the precursor to tuberculosis disease, responsible for 1.5 million deaths/year. Aerial dissemination, with infection typically occurring in the lungs. Sometimes treatable with first-line drugs (isoniazid, rifampicin) but mostly resistant to several antibiotics (fluoroquinolones) and to second-line injectable drugs (amikacin, capreomycin and kanamycin). | WHO 2018a | |
| High | Enterococcus faecium, vancomycin-resistant | Most commonly isolated Gram-positive nosocomial pathogen worldwide with highly flexible genome that enables rapid adaption. Vancomycin-resistant isolates rose from 0% to more than 80% from 1980 to 2007, in the USA. Vancomycin resistance arises from reduced vancomycin-binding affinity, involving alterations in the peptidoglycan synthesis pathway. | Arias and Murray 2012; Gao, Howden and Stinear 2018 |
| S. aureus, methicillin-resistant | Among the most frequent of all antibiotic-resistant threats and leading cause of bacteremia. Outstanding versatility in adapting to different epidemiological settings (healthcare, community, animal). Characteristically MDR, with infections spreading across the globe. Infections commonly involve the skin, soft tissue, bone, joints and indwelling catheters or prosthetic devices. | Monaco et al. 2016; Hassoun, Linden and Friedman 2017 | |
| S. aureus, vancomycin- intermediate (VISA) and -resistant (VRSA) | VISA (MIC = 4–8 µg/mL) appeared in MRSA infected patients due to mutations during prolonged vancomycin therapy. VISA are associated with persistent infections, vancomycin treatment failure and poor clinical outcome. VRSA (MIC ≥ 16 µg/mL) appeared by acquisition of plasmid-borne copies of the transposon Tn1546, from vancomycin-resistant Enterococcus faecalis. VRSA infection numbers are still limited to date (14 in the USA). | Gardete and Tomasz 2014 | |
| Helicobacter pylori, clarithromycin-resistant | Most successful human gastric pathogen able to resist stomach acids, colonizing over 50% of the population. Related to gastritis, peptic ulcers, gastric adenocarcinoma, iron deficiency anemia, idiopathic thrombocytopenic purpura and vitamin B12 deficiency. Sequential, bismuth quadruple and non-bismuth quadruple therapies seam effective in high clarithromycin-resistance countries. | Alba, Blanco and Alarcón 2017; Goderska, Agudo Pena and Alarcon 2018 | |
| Campylobacter spp., fluoroquinolone-resistant | Leading cause of foodborne illnesses, majorly gastroenteritis, primarily caused by Campylobacter jejuni. Antibiotic treatment is only recommended in vulnerable patients, such as the young, the elderly and patients with weakened immunity. Macrolides (e.g. erythromycin and azithromycin) are considered as fluoroquinolone alternatives. | Bolinger and Kathariou 2017 | |
| Salmonella spp., fluoroquinolone-resistant | Leading cause of foodborne illnesses/diarrheal diseases, namely gastroenteritis. Antibiotic treatment is only recommended in vulnerable patients, such as the young, the elderly and patients with weakened immunity. | Kim et al. 2016; WHO 2018b | |
| N. gonorrhoeae, third-generation cephalosporin-resistant, fluoroquinolone-resistant | Causes gonorrhea, an obligate human infection, usually transmitted during sexual activity, often resulting in urethritis in men and cervicitis in women. Gonorrhea is rising, with 18.6% increase during 2016–17 and 75.2% increase since 2009 in the USA. Asymptomatic men (two-thirds of infected men) constitute the principal source of dissemination. | CDC 2017; Rice et al. 2017 | |
| Medium | S. pneumoniae, penicillin nonsusceptible | Encapsulated bacteria causes meningitis, septicemia and pneumonia, but also milder infections, such as sinusitis and otitis media. Major cause of morbidity and mortality worldwide, mainly in poor countries and in children under the age of 2. There are two available vaccines that target the most prevalent serotypes. | WHO 2014 |
| Haemophilus influenzae, ampicillin-resistant | Serotype b, an obligate human pathogen, is the most pathogenic, responsible for respiratory infections, ocular infection, sepsis and meningitis. Leading worldwide cause of meningitis morbidity and mortality in unimmunized populations. Highly related to chronic obstructive pulmonary disease, a leading cause of morbidity and mortality worldwide. Third-generation cephalosporins are the empiric treatment of choice. | ECDC 2017a; Sriram et al. 2018 | |
| Shigella spp., fluoroquinolone-resistant | Causes shigellosis, a major cause of diarrhea affecting mainly children under the age of 5. Between 80 and 165 million cases of shigellosis occur annually worldwide, majorly in developing countries. | ECDC 2017b; CDC 2018 |
Abbreviations: HAIs, hospital acquired infections; ICU, intensive care unit; MIC, minimum inhibitory concentration.
| WHO categorization . | Bacterial pathogens . | Key features . | References . |
|---|---|---|---|
| Critical | Acinetobacter baumannii, carbapenem-resistant | Most associated with HAIs worldwide, accounting for up to 20% of ICU infections worldwide. Causes pneumonia and bloodstream and wound infections, particularly in mechanically ventilated patients. Around 45% isolates are MDR, including resistance to last-resort carbapenems most often linked to the production of carbapenemases. | Potron, Poirel and Nordmann 2015; Harding, Hennon and Feldman 2017; Lee et al. 2017 |
| P. aeruginosa, carbapenem-resistant | Common cause of HAIs, including pneumonia, bloodstream, urinary tract and surgical site infections. Carbapenem resistance mostly related to porin (OprD) deficiency. Invasive isolates resistant to carbapenems were 17.8% in Europe (2015) and 19.2% in the USA (2014). | Potron, Poirel and Nordmann 2015; WHO 2017b | |
| Enterobacteriaceae, carbapenem-resistant, third-generation cephalosporin-resistant | Enterobacteriaceae include K. pneumonia, E. coli, Enterobacter spp., Serratia spp., Proteus spp., Providencia spp. and Morganella spp. K. pneumoniae invasive isolates resistant to carbapenems were reported from all WHO regions, with some countries reporting up to 50%. Human isolates resistant to colistin, a last-resort antimicrobial against carbapenem-resistant Enterobacteriaceae, were already reported. 10–20% of Enterobacteriaceae isolated in the USA are resistant to ceftazidime. | Arizpe et al. 2016; Castanheira et al. 2016; WHO 2017b | |
| M. tuberculosis | M. tuberculosis infection is the precursor to tuberculosis disease, responsible for 1.5 million deaths/year. Aerial dissemination, with infection typically occurring in the lungs. Sometimes treatable with first-line drugs (isoniazid, rifampicin) but mostly resistant to several antibiotics (fluoroquinolones) and to second-line injectable drugs (amikacin, capreomycin and kanamycin). | WHO 2018a | |
| High | Enterococcus faecium, vancomycin-resistant | Most commonly isolated Gram-positive nosocomial pathogen worldwide with highly flexible genome that enables rapid adaption. Vancomycin-resistant isolates rose from 0% to more than 80% from 1980 to 2007, in the USA. Vancomycin resistance arises from reduced vancomycin-binding affinity, involving alterations in the peptidoglycan synthesis pathway. | Arias and Murray 2012; Gao, Howden and Stinear 2018 |
| S. aureus, methicillin-resistant | Among the most frequent of all antibiotic-resistant threats and leading cause of bacteremia. Outstanding versatility in adapting to different epidemiological settings (healthcare, community, animal). Characteristically MDR, with infections spreading across the globe. Infections commonly involve the skin, soft tissue, bone, joints and indwelling catheters or prosthetic devices. | Monaco et al. 2016; Hassoun, Linden and Friedman 2017 | |
| S. aureus, vancomycin- intermediate (VISA) and -resistant (VRSA) | VISA (MIC = 4–8 µg/mL) appeared in MRSA infected patients due to mutations during prolonged vancomycin therapy. VISA are associated with persistent infections, vancomycin treatment failure and poor clinical outcome. VRSA (MIC ≥ 16 µg/mL) appeared by acquisition of plasmid-borne copies of the transposon Tn1546, from vancomycin-resistant Enterococcus faecalis. VRSA infection numbers are still limited to date (14 in the USA). | Gardete and Tomasz 2014 | |
| Helicobacter pylori, clarithromycin-resistant | Most successful human gastric pathogen able to resist stomach acids, colonizing over 50% of the population. Related to gastritis, peptic ulcers, gastric adenocarcinoma, iron deficiency anemia, idiopathic thrombocytopenic purpura and vitamin B12 deficiency. Sequential, bismuth quadruple and non-bismuth quadruple therapies seam effective in high clarithromycin-resistance countries. | Alba, Blanco and Alarcón 2017; Goderska, Agudo Pena and Alarcon 2018 | |
| Campylobacter spp., fluoroquinolone-resistant | Leading cause of foodborne illnesses, majorly gastroenteritis, primarily caused by Campylobacter jejuni. Antibiotic treatment is only recommended in vulnerable patients, such as the young, the elderly and patients with weakened immunity. Macrolides (e.g. erythromycin and azithromycin) are considered as fluoroquinolone alternatives. | Bolinger and Kathariou 2017 | |
| Salmonella spp., fluoroquinolone-resistant | Leading cause of foodborne illnesses/diarrheal diseases, namely gastroenteritis. Antibiotic treatment is only recommended in vulnerable patients, such as the young, the elderly and patients with weakened immunity. | Kim et al. 2016; WHO 2018b | |
| N. gonorrhoeae, third-generation cephalosporin-resistant, fluoroquinolone-resistant | Causes gonorrhea, an obligate human infection, usually transmitted during sexual activity, often resulting in urethritis in men and cervicitis in women. Gonorrhea is rising, with 18.6% increase during 2016–17 and 75.2% increase since 2009 in the USA. Asymptomatic men (two-thirds of infected men) constitute the principal source of dissemination. | CDC 2017; Rice et al. 2017 | |
| Medium | S. pneumoniae, penicillin nonsusceptible | Encapsulated bacteria causes meningitis, septicemia and pneumonia, but also milder infections, such as sinusitis and otitis media. Major cause of morbidity and mortality worldwide, mainly in poor countries and in children under the age of 2. There are two available vaccines that target the most prevalent serotypes. | WHO 2014 |
| Haemophilus influenzae, ampicillin-resistant | Serotype b, an obligate human pathogen, is the most pathogenic, responsible for respiratory infections, ocular infection, sepsis and meningitis. Leading worldwide cause of meningitis morbidity and mortality in unimmunized populations. Highly related to chronic obstructive pulmonary disease, a leading cause of morbidity and mortality worldwide. Third-generation cephalosporins are the empiric treatment of choice. | ECDC 2017a; Sriram et al. 2018 | |
| Shigella spp., fluoroquinolone-resistant | Causes shigellosis, a major cause of diarrhea affecting mainly children under the age of 5. Between 80 and 165 million cases of shigellosis occur annually worldwide, majorly in developing countries. | ECDC 2017b; CDC 2018 |
| WHO categorization . | Bacterial pathogens . | Key features . | References . |
|---|---|---|---|
| Critical | Acinetobacter baumannii, carbapenem-resistant | Most associated with HAIs worldwide, accounting for up to 20% of ICU infections worldwide. Causes pneumonia and bloodstream and wound infections, particularly in mechanically ventilated patients. Around 45% isolates are MDR, including resistance to last-resort carbapenems most often linked to the production of carbapenemases. | Potron, Poirel and Nordmann 2015; Harding, Hennon and Feldman 2017; Lee et al. 2017 |
| P. aeruginosa, carbapenem-resistant | Common cause of HAIs, including pneumonia, bloodstream, urinary tract and surgical site infections. Carbapenem resistance mostly related to porin (OprD) deficiency. Invasive isolates resistant to carbapenems were 17.8% in Europe (2015) and 19.2% in the USA (2014). | Potron, Poirel and Nordmann 2015; WHO 2017b | |
| Enterobacteriaceae, carbapenem-resistant, third-generation cephalosporin-resistant | Enterobacteriaceae include K. pneumonia, E. coli, Enterobacter spp., Serratia spp., Proteus spp., Providencia spp. and Morganella spp. K. pneumoniae invasive isolates resistant to carbapenems were reported from all WHO regions, with some countries reporting up to 50%. Human isolates resistant to colistin, a last-resort antimicrobial against carbapenem-resistant Enterobacteriaceae, were already reported. 10–20% of Enterobacteriaceae isolated in the USA are resistant to ceftazidime. | Arizpe et al. 2016; Castanheira et al. 2016; WHO 2017b | |
| M. tuberculosis | M. tuberculosis infection is the precursor to tuberculosis disease, responsible for 1.5 million deaths/year. Aerial dissemination, with infection typically occurring in the lungs. Sometimes treatable with first-line drugs (isoniazid, rifampicin) but mostly resistant to several antibiotics (fluoroquinolones) and to second-line injectable drugs (amikacin, capreomycin and kanamycin). | WHO 2018a | |
| High | Enterococcus faecium, vancomycin-resistant | Most commonly isolated Gram-positive nosocomial pathogen worldwide with highly flexible genome that enables rapid adaption. Vancomycin-resistant isolates rose from 0% to more than 80% from 1980 to 2007, in the USA. Vancomycin resistance arises from reduced vancomycin-binding affinity, involving alterations in the peptidoglycan synthesis pathway. | Arias and Murray 2012; Gao, Howden and Stinear 2018 |
| S. aureus, methicillin-resistant | Among the most frequent of all antibiotic-resistant threats and leading cause of bacteremia. Outstanding versatility in adapting to different epidemiological settings (healthcare, community, animal). Characteristically MDR, with infections spreading across the globe. Infections commonly involve the skin, soft tissue, bone, joints and indwelling catheters or prosthetic devices. | Monaco et al. 2016; Hassoun, Linden and Friedman 2017 | |
| S. aureus, vancomycin- intermediate (VISA) and -resistant (VRSA) | VISA (MIC = 4–8 µg/mL) appeared in MRSA infected patients due to mutations during prolonged vancomycin therapy. VISA are associated with persistent infections, vancomycin treatment failure and poor clinical outcome. VRSA (MIC ≥ 16 µg/mL) appeared by acquisition of plasmid-borne copies of the transposon Tn1546, from vancomycin-resistant Enterococcus faecalis. VRSA infection numbers are still limited to date (14 in the USA). | Gardete and Tomasz 2014 | |
| Helicobacter pylori, clarithromycin-resistant | Most successful human gastric pathogen able to resist stomach acids, colonizing over 50% of the population. Related to gastritis, peptic ulcers, gastric adenocarcinoma, iron deficiency anemia, idiopathic thrombocytopenic purpura and vitamin B12 deficiency. Sequential, bismuth quadruple and non-bismuth quadruple therapies seam effective in high clarithromycin-resistance countries. | Alba, Blanco and Alarcón 2017; Goderska, Agudo Pena and Alarcon 2018 | |
| Campylobacter spp., fluoroquinolone-resistant | Leading cause of foodborne illnesses, majorly gastroenteritis, primarily caused by Campylobacter jejuni. Antibiotic treatment is only recommended in vulnerable patients, such as the young, the elderly and patients with weakened immunity. Macrolides (e.g. erythromycin and azithromycin) are considered as fluoroquinolone alternatives. | Bolinger and Kathariou 2017 | |
| Salmonella spp., fluoroquinolone-resistant | Leading cause of foodborne illnesses/diarrheal diseases, namely gastroenteritis. Antibiotic treatment is only recommended in vulnerable patients, such as the young, the elderly and patients with weakened immunity. | Kim et al. 2016; WHO 2018b | |
| N. gonorrhoeae, third-generation cephalosporin-resistant, fluoroquinolone-resistant | Causes gonorrhea, an obligate human infection, usually transmitted during sexual activity, often resulting in urethritis in men and cervicitis in women. Gonorrhea is rising, with 18.6% increase during 2016–17 and 75.2% increase since 2009 in the USA. Asymptomatic men (two-thirds of infected men) constitute the principal source of dissemination. | CDC 2017; Rice et al. 2017 | |
| Medium | S. pneumoniae, penicillin nonsusceptible | Encapsulated bacteria causes meningitis, septicemia and pneumonia, but also milder infections, such as sinusitis and otitis media. Major cause of morbidity and mortality worldwide, mainly in poor countries and in children under the age of 2. There are two available vaccines that target the most prevalent serotypes. | WHO 2014 |
| Haemophilus influenzae, ampicillin-resistant | Serotype b, an obligate human pathogen, is the most pathogenic, responsible for respiratory infections, ocular infection, sepsis and meningitis. Leading worldwide cause of meningitis morbidity and mortality in unimmunized populations. Highly related to chronic obstructive pulmonary disease, a leading cause of morbidity and mortality worldwide. Third-generation cephalosporins are the empiric treatment of choice. | ECDC 2017a; Sriram et al. 2018 | |
| Shigella spp., fluoroquinolone-resistant | Causes shigellosis, a major cause of diarrhea affecting mainly children under the age of 5. Between 80 and 165 million cases of shigellosis occur annually worldwide, majorly in developing countries. | ECDC 2017b; CDC 2018 |
Abbreviations: HAIs, hospital acquired infections; ICU, intensive care unit; MIC, minimum inhibitory concentration.
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