Epidemiología de los casos de candidemia en un hospital universitario en Colombia, 2008-2014
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dic 18, 2018
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Resumen
Introducción: Candida spp. es una levadura comensal de la microbiota humana. Por características del hospedero, las infecciones del torrente sanguíneo pueden aparecer y causar una gran morbimortalidad. Métodos: Estudio restrospectivo transversal analítico de los cultivos positivos para Candida spp. entre 2008 y 2014 en un hospital universitario en Bogotá, Colombia. Se evaluaron las características clínicas y microbiológicas presentes previo a la toma de la primera muestra de sangre positiva y se determinaron asociaciones con infecciones por especies no C. albicans (NCA). Resultados: Se incluyeron 123 casos de candidemia. C. albicans fue la especie más aislada (42 %). Sin embargo, las especies NCA como grupo fueron observadas más frecuentemente. Más del 70 % de los casos presentaron manejo en la unidad de cuidado intensivo, con una mediana de estancia de 14 días previo a la primera muestra de sangre positiva. Se detectaron numerosas características médicas; sin embargo, ninguna estuvo asociada con candidemia por especies NCA. Se observó resistencia a por lo menos un antifúngico en el 29 % de los casos, aunque en una muestra reducida de pruebas de sensibilidad. Conclusiones: Nuestros resultados sustentan el viraje mundial hacia la candidemia por especies NCA; pero no encontramos asociaciones clínicas en este grupo. Debe dársele prioridad a la identificación de factores de riesgo y a la optimización de los puntajes de predicción, que permitan identificar pacientes en riesgo que se beneficien de terapia preventiva.
Keywords
candida; candidemia; fungal drug resistance; epidemiology; risk factorsCandida; candidemia; farmacorresistencia fúngica; epidemiología; factores de riesgo
References
1. Falagas ME, Roussos N, Vardakas KZ. Relative frequency of albicans and the various non-albicans Candida spp. among candidemia isolates from inpatients in various parts of the world: A systematic review. Int J Infect Dis. 2010;14(11):e954-66.
2. Colombo AL, Cortes JA, Zurita J, et al. Recommendations for the diagnosis of candidemia in Latin America. Rev Iberoam Micol. 2013;30(3):150-7.
3. Mikulska M, Del Bono V, Ratto S, Viscoli C. Occurrence, presentation and treatment of candidemia. Expert Rev Clin Immunol. 2012;8(8):755-65.
4. Arendrup MC. Epidemiology of invasive candidiasis. Curr Opin Crit Care. 2010;16:445-52.
5. Zhang X-BB, Yu S-JJ, Yu J-XX, et al. Retrospective analysis of epidemiology and prognostic factors for candidemia at a hospital in China, 2000-2009. Jpn J Infect Dis. 2012;65(6):510-5.
6. Cortés JA, Reyes P, Gómez CH, et al. Clinical and epidemiological characteristics and risk factors for mortality in patients with candidemia in hospitals from Bogotá, Colombia. Brazilian J Infect Dis. 2014;18(6):631-7.
7. Quindós G. Epidemiology of candidaemia and invasive candidiasis: A changing face. Rev Iberoam Micol. 2014;31(1):42-8.
8. Botero MC, Puentes-Herrera M, Cortés JA. [Lipid formulations of amphotericin]. Rev Chilena Infectol. 2014;31(5):518-27.
9. Cortés JA, Reyes P, Gómez C, Buitrago G, Leal AL. Fungal bloodstream infections in tertiary care hospitals in Colombia. Rev Iberoam Micol. 2011;28(2):74-8.
10. Guinea J. Global trends in the distribution of Candida species causing candidemia. Clin Microbiol Infect. 2014;20(Suppl 6):5-10.
11. Antinori S, Milazzo L, Sollima S, Galli M, Corbellino M. Candidemia and invasive candidiasis in adults: A narrative review. Eur J Intern Med. 2016;34:21-8.
12. Hermsen ED, Zapapas MK, Maiefski M, et al. Validation and comparison of clinical prediction rules for invasive candidiasis in intensive care unit patients: A matched case-control study. Crit Care. 2011;15(4):R198.
13. Ostrosky-Zeichner L, Pappas PG, Shoham S, et al. Improvement of a clinical prediction rule for clinical trials on prophylaxis for invasive candidiasis in the intensive care unit. Mycoses. 2011;54(1):46-51.
14. León C, Ruiz-Santana S, Saavedra P, et al. A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med. 2006;34(3):730-7.
15. Eggimann P, Garbino J, Pittet D. Epidemiology of Candida species infections in critically ill non-immunosuppressed patients. Lancet Infect Dis. 2003;3(11):685-702.
16. Pappas PG, Kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48:503-35.
17. Chen CY, Huang SY, Tsay W, et al. Clinical characteristics of candidaemia in adults with haematological malignancy, and antimicrobial susceptibilities of the isolates at a medical centre in Taiwan, 2001-2010. Int J Antimicrob Agents. 2012;40:533-8.
18. Chi H-W, Yang Y-S, Shang S-T, et al. Candida albicans versus non-albicans bloodstream infections: The comparison of risk factors and outcome. J Microbiol Immunol Infect. 2011;44(5):369-75.
19. Vincent J-L, Rello J, Marshall J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302:2323-9.
20. Ruan S-YY, Hsueh P-RR. Invasive candidiasis: An overview from Taiwan. J Formos Med Assoc. 2009;108(6):443-51.
21. Pfaller M, Neofutos D, Diekema D, et al. Epidemiology and outcomes of candidemia in 3648 patients: data from the Prospective Antifungal Therapy (PATH Alliance®) registry, 2004-2008. Diagn Microbiol Infect Dis. 2012;74(4):323-31.
22. Pfaller MA, Diekema DJ, Jones RN, et al. International surveillance of bloodstream infections due to Candida species: frequency of occurrence and in vitro susceptibilities to fluconazole, ravuconazole, and voriconazole of isolates collected from 1997 through 1999 in the SENTRY antimicrobial surv. J Clin Microbiol. 2001;39(9):3254-9.
23. Erdem I, Oguzoglu N, Ozturk Engin D, et al. Incidence, etiology and risk factors associated with mortality of nosocomial candidemia in a tertiary care hospital in Istanbul, Turkey. Med Princ Pract. 2010;19:463-7.
24. Nucci M, Thompson-Moya L, Guzman-Blanco M, et al. Recommendations for the management of candidemia in adults in Latin America. Rev Iberoam Micol. 2013;30(3):179-88.
25. Ben-Ami R, Olshtain-Pops K, Krieger M, et al. Antibiotic exposure as a risk factor for fluconazole-resistant Candida bloodstream infection. Antimicrob Agents Chemother. 2012;56(5):2518-23.
26. Zilberberg MD, Shorr AF, Kollef MH. Growth and geographic variation in hospitalizations with resistant infections, United States, 2000-2005. Emerg Infect Dis. 2008;14:1756-8.
27. Nucci M, Queiroz-Telles F, Alvarado-Matute T, et al. Epidemiology of Candidemia in Latin America: A Laboratory-Based Survey. PLoS One. 2013;8.
28. Adhikary R, Joshi S. Species distribution and anti-fungal susceptibility of Candidaemia at a multi super-specialty center in Southern India. Indian J Med Microbiol. 29:309-11.
29. Jutiamornlerd N, Chusri S, Sirsipaitoon P. Epidemiology of candidemia in Songklanagarind hospital. J Med Assoc Thail. 2011;94:927-32.
30. Boonyasiri A, Jearanaisilavong J, Assanasen S. Candidemia in Siriraj Hospital: epidemiology and factors associated with mortality. J Med Assoc Thai. 2013;96 Suppl 2(Suppl 2):S91-7.
31. Diazgranados CA, Martínez A, Deaza C, Valderrama S. An outbreak of Candida spp. bloodstream infection in a tertiary care center in Bogotá, Colombia. Braz J Infect Dis. 2008;12(5):390-4.
32. Ortiz Ruiz G, Osorio J, Valderrama S, et al. Risk factors for candidemia in non-neutropenic critical patients in Colombia. Med intensiva. 2016;40(3):139-44.
33. Rodríguez-Morales AJ, Sabogal-Román JA, Álvarez-Moreno CA. What has been researched about MDR-Candida auris? A bibliometric analysis on the “new kid on the block” in hospital-associated infections. J Infect Public Health. 2017;11(2):295-6.
34. Chen S, Slavin M, Nguyen Q, et al. Active surveillance for candidemia, Australia. Emerg Infect Dis. 2006;12:1508-16.
35. Asmundsdottir LR, Erlendsdottir H, Gottfredsson M. Nationwide study of candidemia, antifungal use, and antifungal drug resistance in Iceland, 2000 to 2011. J Clin Microbiol. 2013;51:841-8.
36. Yapar N, Pullukcu H, Avkan-Oguz V, et al. Evaluation of species distribution and risk factors of candidemia: a multicenter case-control study. Med Mycol. 2011;49:26-31.
37. Yapar N. Epidemiology and risk factors for invasive candidiasis. Ther Clin Risk Manag. 2014;10:95-105.
38. Tortorano AM, Peman J, Bernhardt H, et al. Epidemiology of candidaemia in Europe: results of 28-month European Confederation of Medical Mycology (ECMM) hospital-based surveillance study. Eur J Clin Microbiol Infect Dis. 2004;23(4):317-22.
39. Kreusch A, Karstaedt AS. Candidemia among adults in Soweto, South Africa, 1990-2007. Int J Infect Dis. 2013;17.
40. Deeks SG, Overbaugh J, Phillips A, Buchbinder S. HIV infection. Nat Rev Dis Prim. 2015;15035.
41. de Bedout C, Ayabaca J, Vega R, et al. Evaluation of Candida species’ susceptibility to fluconazole with the disk diffusion method. Biomedica. 2003;23(1):31-7.
42. Chen P-LL, Lo H-JJ, Wu C-JJ, et al. Species distribution and antifungal susceptibility of blood Candida isolates at a tertiary hospital in southern Taiwan, 1999-2006. Mycoses. 2011;54(4):17-23.
43. Pfaller MA, Diekema DJ. Twelve years of fluconazole in clinical practice: Global trends in species distribution and fluconazole susceptibility of bloodstream isolates of Candida. Clin Microbiol Infect. 2004;10 Suppl 1:11-23.
44. Underhill DM, Iliev ID. The mycobiota: interactions between commensal fungi and the host immune system. Nat Rev Immunol. 2014;14(6):405-16.
45. Martínez-Álvarez JA, Pérez-García LA, Flores-Carreón A, Mora-Montes HM. The immune response against Candida spp. and Sporothrix schenckii. Rev Iberoam Micol. 2013;31(1):1-5.
46. Lionakis MS, Kontoyiannis DP. Glucocorticoids and invasive fungal infections. Vol. 362, Lancet. 2003. p. 1828-38.
47. Guastalegname M, Russo A, Falcone M, Giuliano S, Venditti M. Candidemia subsequent to severe infection due to Clostridium difficile: is there a link? Clin Infect Dis. 2013;57(5):772-4.
48. Papadimitriou-Olivgeris M, Spiliopoulou A, Fligou F, et al. Association of KPC-producing Klebsiella pneumoniae colonization or infection with Candida isolation and selection of non-albicans species. Diagn Microbiol Infect Dis. 2014;80(3):227-32.
49. Russo A, Falcone M, Fantoni M, et al. Risk factors and clinical outcomes of candidaemia in patients treated for Clostridium difficile infection. Clin Microbiol Infect. 2015;21(5):493.e1-4.
50. Clancy CJ, Nguyen MH. Finding the “missing 50%” of invasive candidiasis: how nonculture diagnostics will improve understanding of disease spectrum and transform patient care. Clin Infect Dis. 2013;56(9):1284-92.
51. Haas M, Grenouillet F, Loubersac S, et al. Identification of cryptic Candida species by MALDI-TOF mass spectrometry, not all MALDI-TOF systems are the same: focus on the C. parapsilosis species complex. Diagn Microbiol Infect Dis. 2016;86(4):385-6.
52. Tsay S, Kallen A, Jackson BR, Chiller TM, Vallabhaneni S. Approach to the investigation and management of patients with Candida auris, an emerging multidrug-resistant yeast. Clin Infect Dis. 2018;66(2):306-11.
53. Parra-Giraldo CM, Valderrama SL, Cortes-Fraile G, et al. First report of sporadic cases of Candida auris in Colombia. Int J Infect Dis. 2018;69:63-7.
54. Morales-López SE, Parra-Giraldo CM, Ceballos-Garzón A, et al. Invasive infections with multidrug-resistant yeast Candida auris, Colombia. Emerg Infect Dis. 2017;23(1):162-4.
55. Mizusawa M, Miller H, Green R, et al. Can multidrug-resistant Candida auris be reliably identified in clinical microbiology laboratories? J Clin Microbiol. 2017;55(2):638-40.
2. Colombo AL, Cortes JA, Zurita J, et al. Recommendations for the diagnosis of candidemia in Latin America. Rev Iberoam Micol. 2013;30(3):150-7.
3. Mikulska M, Del Bono V, Ratto S, Viscoli C. Occurrence, presentation and treatment of candidemia. Expert Rev Clin Immunol. 2012;8(8):755-65.
4. Arendrup MC. Epidemiology of invasive candidiasis. Curr Opin Crit Care. 2010;16:445-52.
5. Zhang X-BB, Yu S-JJ, Yu J-XX, et al. Retrospective analysis of epidemiology and prognostic factors for candidemia at a hospital in China, 2000-2009. Jpn J Infect Dis. 2012;65(6):510-5.
6. Cortés JA, Reyes P, Gómez CH, et al. Clinical and epidemiological characteristics and risk factors for mortality in patients with candidemia in hospitals from Bogotá, Colombia. Brazilian J Infect Dis. 2014;18(6):631-7.
7. Quindós G. Epidemiology of candidaemia and invasive candidiasis: A changing face. Rev Iberoam Micol. 2014;31(1):42-8.
8. Botero MC, Puentes-Herrera M, Cortés JA. [Lipid formulations of amphotericin]. Rev Chilena Infectol. 2014;31(5):518-27.
9. Cortés JA, Reyes P, Gómez C, Buitrago G, Leal AL. Fungal bloodstream infections in tertiary care hospitals in Colombia. Rev Iberoam Micol. 2011;28(2):74-8.
10. Guinea J. Global trends in the distribution of Candida species causing candidemia. Clin Microbiol Infect. 2014;20(Suppl 6):5-10.
11. Antinori S, Milazzo L, Sollima S, Galli M, Corbellino M. Candidemia and invasive candidiasis in adults: A narrative review. Eur J Intern Med. 2016;34:21-8.
12. Hermsen ED, Zapapas MK, Maiefski M, et al. Validation and comparison of clinical prediction rules for invasive candidiasis in intensive care unit patients: A matched case-control study. Crit Care. 2011;15(4):R198.
13. Ostrosky-Zeichner L, Pappas PG, Shoham S, et al. Improvement of a clinical prediction rule for clinical trials on prophylaxis for invasive candidiasis in the intensive care unit. Mycoses. 2011;54(1):46-51.
14. León C, Ruiz-Santana S, Saavedra P, et al. A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med. 2006;34(3):730-7.
15. Eggimann P, Garbino J, Pittet D. Epidemiology of Candida species infections in critically ill non-immunosuppressed patients. Lancet Infect Dis. 2003;3(11):685-702.
16. Pappas PG, Kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48:503-35.
17. Chen CY, Huang SY, Tsay W, et al. Clinical characteristics of candidaemia in adults with haematological malignancy, and antimicrobial susceptibilities of the isolates at a medical centre in Taiwan, 2001-2010. Int J Antimicrob Agents. 2012;40:533-8.
18. Chi H-W, Yang Y-S, Shang S-T, et al. Candida albicans versus non-albicans bloodstream infections: The comparison of risk factors and outcome. J Microbiol Immunol Infect. 2011;44(5):369-75.
19. Vincent J-L, Rello J, Marshall J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302:2323-9.
20. Ruan S-YY, Hsueh P-RR. Invasive candidiasis: An overview from Taiwan. J Formos Med Assoc. 2009;108(6):443-51.
21. Pfaller M, Neofutos D, Diekema D, et al. Epidemiology and outcomes of candidemia in 3648 patients: data from the Prospective Antifungal Therapy (PATH Alliance®) registry, 2004-2008. Diagn Microbiol Infect Dis. 2012;74(4):323-31.
22. Pfaller MA, Diekema DJ, Jones RN, et al. International surveillance of bloodstream infections due to Candida species: frequency of occurrence and in vitro susceptibilities to fluconazole, ravuconazole, and voriconazole of isolates collected from 1997 through 1999 in the SENTRY antimicrobial surv. J Clin Microbiol. 2001;39(9):3254-9.
23. Erdem I, Oguzoglu N, Ozturk Engin D, et al. Incidence, etiology and risk factors associated with mortality of nosocomial candidemia in a tertiary care hospital in Istanbul, Turkey. Med Princ Pract. 2010;19:463-7.
24. Nucci M, Thompson-Moya L, Guzman-Blanco M, et al. Recommendations for the management of candidemia in adults in Latin America. Rev Iberoam Micol. 2013;30(3):179-88.
25. Ben-Ami R, Olshtain-Pops K, Krieger M, et al. Antibiotic exposure as a risk factor for fluconazole-resistant Candida bloodstream infection. Antimicrob Agents Chemother. 2012;56(5):2518-23.
26. Zilberberg MD, Shorr AF, Kollef MH. Growth and geographic variation in hospitalizations with resistant infections, United States, 2000-2005. Emerg Infect Dis. 2008;14:1756-8.
27. Nucci M, Queiroz-Telles F, Alvarado-Matute T, et al. Epidemiology of Candidemia in Latin America: A Laboratory-Based Survey. PLoS One. 2013;8.
28. Adhikary R, Joshi S. Species distribution and anti-fungal susceptibility of Candidaemia at a multi super-specialty center in Southern India. Indian J Med Microbiol. 29:309-11.
29. Jutiamornlerd N, Chusri S, Sirsipaitoon P. Epidemiology of candidemia in Songklanagarind hospital. J Med Assoc Thail. 2011;94:927-32.
30. Boonyasiri A, Jearanaisilavong J, Assanasen S. Candidemia in Siriraj Hospital: epidemiology and factors associated with mortality. J Med Assoc Thai. 2013;96 Suppl 2(Suppl 2):S91-7.
31. Diazgranados CA, Martínez A, Deaza C, Valderrama S. An outbreak of Candida spp. bloodstream infection in a tertiary care center in Bogotá, Colombia. Braz J Infect Dis. 2008;12(5):390-4.
32. Ortiz Ruiz G, Osorio J, Valderrama S, et al. Risk factors for candidemia in non-neutropenic critical patients in Colombia. Med intensiva. 2016;40(3):139-44.
33. Rodríguez-Morales AJ, Sabogal-Román JA, Álvarez-Moreno CA. What has been researched about MDR-Candida auris? A bibliometric analysis on the “new kid on the block” in hospital-associated infections. J Infect Public Health. 2017;11(2):295-6.
34. Chen S, Slavin M, Nguyen Q, et al. Active surveillance for candidemia, Australia. Emerg Infect Dis. 2006;12:1508-16.
35. Asmundsdottir LR, Erlendsdottir H, Gottfredsson M. Nationwide study of candidemia, antifungal use, and antifungal drug resistance in Iceland, 2000 to 2011. J Clin Microbiol. 2013;51:841-8.
36. Yapar N, Pullukcu H, Avkan-Oguz V, et al. Evaluation of species distribution and risk factors of candidemia: a multicenter case-control study. Med Mycol. 2011;49:26-31.
37. Yapar N. Epidemiology and risk factors for invasive candidiasis. Ther Clin Risk Manag. 2014;10:95-105.
38. Tortorano AM, Peman J, Bernhardt H, et al. Epidemiology of candidaemia in Europe: results of 28-month European Confederation of Medical Mycology (ECMM) hospital-based surveillance study. Eur J Clin Microbiol Infect Dis. 2004;23(4):317-22.
39. Kreusch A, Karstaedt AS. Candidemia among adults in Soweto, South Africa, 1990-2007. Int J Infect Dis. 2013;17.
40. Deeks SG, Overbaugh J, Phillips A, Buchbinder S. HIV infection. Nat Rev Dis Prim. 2015;15035.
41. de Bedout C, Ayabaca J, Vega R, et al. Evaluation of Candida species’ susceptibility to fluconazole with the disk diffusion method. Biomedica. 2003;23(1):31-7.
42. Chen P-LL, Lo H-JJ, Wu C-JJ, et al. Species distribution and antifungal susceptibility of blood Candida isolates at a tertiary hospital in southern Taiwan, 1999-2006. Mycoses. 2011;54(4):17-23.
43. Pfaller MA, Diekema DJ. Twelve years of fluconazole in clinical practice: Global trends in species distribution and fluconazole susceptibility of bloodstream isolates of Candida. Clin Microbiol Infect. 2004;10 Suppl 1:11-23.
44. Underhill DM, Iliev ID. The mycobiota: interactions between commensal fungi and the host immune system. Nat Rev Immunol. 2014;14(6):405-16.
45. Martínez-Álvarez JA, Pérez-García LA, Flores-Carreón A, Mora-Montes HM. The immune response against Candida spp. and Sporothrix schenckii. Rev Iberoam Micol. 2013;31(1):1-5.
46. Lionakis MS, Kontoyiannis DP. Glucocorticoids and invasive fungal infections. Vol. 362, Lancet. 2003. p. 1828-38.
47. Guastalegname M, Russo A, Falcone M, Giuliano S, Venditti M. Candidemia subsequent to severe infection due to Clostridium difficile: is there a link? Clin Infect Dis. 2013;57(5):772-4.
48. Papadimitriou-Olivgeris M, Spiliopoulou A, Fligou F, et al. Association of KPC-producing Klebsiella pneumoniae colonization or infection with Candida isolation and selection of non-albicans species. Diagn Microbiol Infect Dis. 2014;80(3):227-32.
49. Russo A, Falcone M, Fantoni M, et al. Risk factors and clinical outcomes of candidaemia in patients treated for Clostridium difficile infection. Clin Microbiol Infect. 2015;21(5):493.e1-4.
50. Clancy CJ, Nguyen MH. Finding the “missing 50%” of invasive candidiasis: how nonculture diagnostics will improve understanding of disease spectrum and transform patient care. Clin Infect Dis. 2013;56(9):1284-92.
51. Haas M, Grenouillet F, Loubersac S, et al. Identification of cryptic Candida species by MALDI-TOF mass spectrometry, not all MALDI-TOF systems are the same: focus on the C. parapsilosis species complex. Diagn Microbiol Infect Dis. 2016;86(4):385-6.
52. Tsay S, Kallen A, Jackson BR, Chiller TM, Vallabhaneni S. Approach to the investigation and management of patients with Candida auris, an emerging multidrug-resistant yeast. Clin Infect Dis. 2018;66(2):306-11.
53. Parra-Giraldo CM, Valderrama SL, Cortes-Fraile G, et al. First report of sporadic cases of Candida auris in Colombia. Int J Infect Dis. 2018;69:63-7.
54. Morales-López SE, Parra-Giraldo CM, Ceballos-Garzón A, et al. Invasive infections with multidrug-resistant yeast Candida auris, Colombia. Emerg Infect Dis. 2017;23(1):162-4.
55. Mizusawa M, Miller H, Green R, et al. Can multidrug-resistant Candida auris be reliably identified in clinical microbiology laboratories? J Clin Microbiol. 2017;55(2):638-40.
Cómo citar
Barahona Correa, J. E., Calvo Valderrama, M. G., Romero Alvernia, D. M., Angulo Mora, J., Alarcón Figueroa, L. F., Rodríguez Malagón, M. N., & Garzón Herazo, J. R. (2018). Epidemiología de los casos de candidemia en un hospital universitario en Colombia, 2008-2014. Universitas Medica, 60(1). https://doi.org/10.11144/Javeriana.umed60-1.cand
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