Microbiology and resistance in first episodes of spontaneous bacterial peritonitis: implications for management and prognosis
Purpose International guidelines for antibiotic treatment of spontaneous bacterial peritonitis (SBP) are based on studies conducted decades ago and do not reflect regional differences of bacterial epidemiology. Methods We retrospectively analyzed epidemiology of agents, antibiotic resistance pattern...
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| Veröffentlicht in: | Journal of gastroenterology and hepatology 2016-06, Vol.31 (6), p.1191-1195 |
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| creator | Friedrich, Kilian Nüssle, Simone Rehlen, Tobias Stremmel, Wolfgang Mischnik, Alexander Eisenbach, Christoph |
| description | Purpose
International guidelines for antibiotic treatment of spontaneous bacterial peritonitis (SBP) are based on studies conducted decades ago and do not reflect regional differences of bacterial epidemiology.
Methods
We retrospectively analyzed epidemiology of agents, antibiotic resistance patterns, and survival in liver cirrhosis patients with their first episode of SBP during the years 2007–2013.
Results
Of the 311 patients included, 114 patients had a positive ascites culture, and 197 had an ascitic neutrophil count >250 μL. Gram‐positive bacteria (47.8%) were more frequently found than Gram‐negatives (44.9%), fungi in 7.2%. Enterobacter spp. (40.6%), Enterococcus spp. (26.1%), and Staphylcoccus spp. (13.8%) were the most frequently isolated agents. Third‐generation cephalosporins covered 70.2% of non‐nosocomial and 56.3% of nosocomial‐acquired SBP cases.When SBP was diagnosed by a positive ascitic culture, survival was highly significantly reduced (mean: 13.9 ± 2.9 months; 95% confidence interval [CI]: 8.1–19.8) compared with culture‐negative SBP patients (mean: 44.1 ± 5.4 months; 95% CI: 33.4–54.9; P = 0.000). Along with model of end‐stage liver disease score and intensive care unit contact, a positive ascites culture remained an independent risk factor associated with poor survival (odds ratio: 1.49; 95% CI: 1.09–2.03) in multivariate analysis; piperacillin/tazobactam proved to be an adequate antibiotic for nosocomial and non‐nosocomial SBP in 85.1% and 92.5%, respectively. SBP infection with Enterococcus spp. was associated with poor patient survival (P = 0.048).
Conclusions
Third‐generation cephalosporins have poor microbial coverage for treatment of SBP. Current guidelines need to adapt for the emerging number of Gram‐positive infectious agents in SBP patients. |
| doi_str_mv | 10.1111/jgh.13266 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1846410671</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1846410671</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3966-96faaa5d6459f28b9ccb0e2c8d3a8ef7fd9eb08ecdc6749cb63a1dd42e401f393</originalsourceid><addsrcrecordid>eNqFkUFvFCEYhonR2LV68A8YjvYwLQwMM3gzjd1qqsZEXW-EgY-VOgMjzKbuof9d7LS9NXL5Djzf-wYehF5SckzLObnc_jymrBbiEVpRzklFWy4eoxXpaFNJRuUBepbzJSGEk7Z5ig4K2oqmYSt0_dGbFHsfh7jdYx0sTpB9nnUwgH3Azqc8Y5h8jhYyjg7nKYZyDXGXca_NDMnrAU9lzDH42ec32I_T4I2efQwZu5jwqIPewghhvqmYUtyGWGqeoydODxle3M5D9O3s3dfT8-ri8_r96duLyjApRCWF01o3VvBGurrrpTE9gdp0lukOXOushJ50YKwRLZemF0xTa3kNnFDHJDtEr5fc0vx7B3lWo88GhmF5h6IdF5wS0dL_o61kNRVU8oIeLWj5wZwTODUlP-q0V5Sof2JUEaNuxBT21W3srh_B3pN3JgpwsgBXfoD9w0nqw_r8LrJaNoou-HO_odMvJVrWNmrzaa02a3bGN19-qO_sL2p_qoc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1793216194</pqid></control><display><type>article</type><title>Microbiology and resistance in first episodes of spontaneous bacterial peritonitis: implications for management and prognosis</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Friedrich, Kilian ; Nüssle, Simone ; Rehlen, Tobias ; Stremmel, Wolfgang ; Mischnik, Alexander ; Eisenbach, Christoph</creator><creatorcontrib>Friedrich, Kilian ; Nüssle, Simone ; Rehlen, Tobias ; Stremmel, Wolfgang ; Mischnik, Alexander ; Eisenbach, Christoph</creatorcontrib><description>Purpose
International guidelines for antibiotic treatment of spontaneous bacterial peritonitis (SBP) are based on studies conducted decades ago and do not reflect regional differences of bacterial epidemiology.
Methods
We retrospectively analyzed epidemiology of agents, antibiotic resistance patterns, and survival in liver cirrhosis patients with their first episode of SBP during the years 2007–2013.
Results
Of the 311 patients included, 114 patients had a positive ascites culture, and 197 had an ascitic neutrophil count >250 μL. Gram‐positive bacteria (47.8%) were more frequently found than Gram‐negatives (44.9%), fungi in 7.2%. Enterobacter spp. (40.6%), Enterococcus spp. (26.1%), and Staphylcoccus spp. (13.8%) were the most frequently isolated agents. Third‐generation cephalosporins covered 70.2% of non‐nosocomial and 56.3% of nosocomial‐acquired SBP cases.When SBP was diagnosed by a positive ascitic culture, survival was highly significantly reduced (mean: 13.9 ± 2.9 months; 95% confidence interval [CI]: 8.1–19.8) compared with culture‐negative SBP patients (mean: 44.1 ± 5.4 months; 95% CI: 33.4–54.9; P = 0.000). Along with model of end‐stage liver disease score and intensive care unit contact, a positive ascites culture remained an independent risk factor associated with poor survival (odds ratio: 1.49; 95% CI: 1.09–2.03) in multivariate analysis; piperacillin/tazobactam proved to be an adequate antibiotic for nosocomial and non‐nosocomial SBP in 85.1% and 92.5%, respectively. SBP infection with Enterococcus spp. was associated with poor patient survival (P = 0.048).
Conclusions
Third‐generation cephalosporins have poor microbial coverage for treatment of SBP. Current guidelines need to adapt for the emerging number of Gram‐positive infectious agents in SBP patients.</description><identifier>ISSN: 0815-9319</identifier><identifier>EISSN: 1440-1746</identifier><identifier>DOI: 10.1111/jgh.13266</identifier><identifier>PMID: 26676553</identifier><language>eng</language><publisher>Australia: Blackwell Publishing Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents - therapeutic use ; antibiotic resistance ; Ascitic Fluid - microbiology ; Bacterial Infections - diagnosis ; Bacterial Infections - drug therapy ; Bacterial Infections - microbiology ; Bacterial Infections - mortality ; Community-Acquired Infections - diagnosis ; Community-Acquired Infections - drug therapy ; Community-Acquired Infections - microbiology ; Community-Acquired Infections - mortality ; Cross Infection - diagnosis ; Cross Infection - drug therapy ; Cross Infection - microbiology ; Cross Infection - mortality ; culture-positive SBP ; Drug Resistance, Bacterial ; Female ; Germany - epidemiology ; Gram-positive SBP ; Hospital Bed Capacity ; Hospitals, University ; Humans ; Kaplan-Meier Estimate ; Leukocyte Count ; Liver Cirrhosis - complications ; Liver Cirrhosis - diagnosis ; Liver Cirrhosis - mortality ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Multivariate Analysis ; Neutrophils ; Odds Ratio ; Peritonitis - diagnosis ; Peritonitis - drug therapy ; Peritonitis - microbiology ; Peritonitis - mortality ; Predictive Value of Tests ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; spontaneous bacterial peritonitis ; third-generation cephalosporins ; Time Factors ; Treatment Outcome</subject><ispartof>Journal of gastroenterology and hepatology, 2016-06, Vol.31 (6), p.1191-1195</ispartof><rights>2015 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd</rights><rights>2015 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3966-96faaa5d6459f28b9ccb0e2c8d3a8ef7fd9eb08ecdc6749cb63a1dd42e401f393</citedby><cites>FETCH-LOGICAL-c3966-96faaa5d6459f28b9ccb0e2c8d3a8ef7fd9eb08ecdc6749cb63a1dd42e401f393</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjgh.13266$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjgh.13266$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,781,785,1418,27929,27930,45579,45580</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26676553$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Friedrich, Kilian</creatorcontrib><creatorcontrib>Nüssle, Simone</creatorcontrib><creatorcontrib>Rehlen, Tobias</creatorcontrib><creatorcontrib>Stremmel, Wolfgang</creatorcontrib><creatorcontrib>Mischnik, Alexander</creatorcontrib><creatorcontrib>Eisenbach, Christoph</creatorcontrib><title>Microbiology and resistance in first episodes of spontaneous bacterial peritonitis: implications for management and prognosis</title><title>Journal of gastroenterology and hepatology</title><addtitle>Journal of Gastroenterology and Hepatology</addtitle><description>Purpose
International guidelines for antibiotic treatment of spontaneous bacterial peritonitis (SBP) are based on studies conducted decades ago and do not reflect regional differences of bacterial epidemiology.
Methods
We retrospectively analyzed epidemiology of agents, antibiotic resistance patterns, and survival in liver cirrhosis patients with their first episode of SBP during the years 2007–2013.
Results
Of the 311 patients included, 114 patients had a positive ascites culture, and 197 had an ascitic neutrophil count >250 μL. Gram‐positive bacteria (47.8%) were more frequently found than Gram‐negatives (44.9%), fungi in 7.2%. Enterobacter spp. (40.6%), Enterococcus spp. (26.1%), and Staphylcoccus spp. (13.8%) were the most frequently isolated agents. Third‐generation cephalosporins covered 70.2% of non‐nosocomial and 56.3% of nosocomial‐acquired SBP cases.When SBP was diagnosed by a positive ascitic culture, survival was highly significantly reduced (mean: 13.9 ± 2.9 months; 95% confidence interval [CI]: 8.1–19.8) compared with culture‐negative SBP patients (mean: 44.1 ± 5.4 months; 95% CI: 33.4–54.9; P = 0.000). Along with model of end‐stage liver disease score and intensive care unit contact, a positive ascites culture remained an independent risk factor associated with poor survival (odds ratio: 1.49; 95% CI: 1.09–2.03) in multivariate analysis; piperacillin/tazobactam proved to be an adequate antibiotic for nosocomial and non‐nosocomial SBP in 85.1% and 92.5%, respectively. SBP infection with Enterococcus spp. was associated with poor patient survival (P = 0.048).
Conclusions
Third‐generation cephalosporins have poor microbial coverage for treatment of SBP. Current guidelines need to adapt for the emerging number of Gram‐positive infectious agents in SBP patients.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>antibiotic resistance</subject><subject>Ascitic Fluid - microbiology</subject><subject>Bacterial Infections - diagnosis</subject><subject>Bacterial Infections - drug therapy</subject><subject>Bacterial Infections - microbiology</subject><subject>Bacterial Infections - mortality</subject><subject>Community-Acquired Infections - diagnosis</subject><subject>Community-Acquired Infections - drug therapy</subject><subject>Community-Acquired Infections - microbiology</subject><subject>Community-Acquired Infections - mortality</subject><subject>Cross Infection - diagnosis</subject><subject>Cross Infection - drug therapy</subject><subject>Cross Infection - microbiology</subject><subject>Cross Infection - mortality</subject><subject>culture-positive SBP</subject><subject>Drug Resistance, Bacterial</subject><subject>Female</subject><subject>Germany - epidemiology</subject><subject>Gram-positive SBP</subject><subject>Hospital Bed Capacity</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Leukocyte Count</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver Cirrhosis - diagnosis</subject><subject>Liver Cirrhosis - mortality</subject><subject>Male</subject><subject>Microbial Sensitivity Tests</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neutrophils</subject><subject>Odds Ratio</subject><subject>Peritonitis - diagnosis</subject><subject>Peritonitis - drug therapy</subject><subject>Peritonitis - microbiology</subject><subject>Peritonitis - mortality</subject><subject>Predictive Value of Tests</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>spontaneous bacterial peritonitis</subject><subject>third-generation cephalosporins</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0815-9319</issn><issn>1440-1746</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUFvFCEYhonR2LV68A8YjvYwLQwMM3gzjd1qqsZEXW-EgY-VOgMjzKbuof9d7LS9NXL5Djzf-wYehF5SckzLObnc_jymrBbiEVpRzklFWy4eoxXpaFNJRuUBepbzJSGEk7Z5ig4K2oqmYSt0_dGbFHsfh7jdYx0sTpB9nnUwgH3Azqc8Y5h8jhYyjg7nKYZyDXGXca_NDMnrAU9lzDH42ec32I_T4I2efQwZu5jwqIPewghhvqmYUtyGWGqeoydODxle3M5D9O3s3dfT8-ri8_r96duLyjApRCWF01o3VvBGurrrpTE9gdp0lukOXOushJ50YKwRLZemF0xTa3kNnFDHJDtEr5fc0vx7B3lWo88GhmF5h6IdF5wS0dL_o61kNRVU8oIeLWj5wZwTODUlP-q0V5Sof2JUEaNuxBT21W3srh_B3pN3JgpwsgBXfoD9w0nqw_r8LrJaNoou-HO_odMvJVrWNmrzaa02a3bGN19-qO_sL2p_qoc</recordid><startdate>201606</startdate><enddate>201606</enddate><creator>Friedrich, Kilian</creator><creator>Nüssle, Simone</creator><creator>Rehlen, Tobias</creator><creator>Stremmel, Wolfgang</creator><creator>Mischnik, Alexander</creator><creator>Eisenbach, Christoph</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7QL</scope><scope>C1K</scope></search><sort><creationdate>201606</creationdate><title>Microbiology and resistance in first episodes of spontaneous bacterial peritonitis: implications for management and prognosis</title><author>Friedrich, Kilian ; Nüssle, Simone ; Rehlen, Tobias ; Stremmel, Wolfgang ; Mischnik, Alexander ; Eisenbach, Christoph</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3966-96faaa5d6459f28b9ccb0e2c8d3a8ef7fd9eb08ecdc6749cb63a1dd42e401f393</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>antibiotic resistance</topic><topic>Ascitic Fluid - microbiology</topic><topic>Bacterial Infections - diagnosis</topic><topic>Bacterial Infections - drug therapy</topic><topic>Bacterial Infections - microbiology</topic><topic>Bacterial Infections - mortality</topic><topic>Community-Acquired Infections - diagnosis</topic><topic>Community-Acquired Infections - drug therapy</topic><topic>Community-Acquired Infections - microbiology</topic><topic>Community-Acquired Infections - mortality</topic><topic>Cross Infection - diagnosis</topic><topic>Cross Infection - drug therapy</topic><topic>Cross Infection - microbiology</topic><topic>Cross Infection - mortality</topic><topic>culture-positive SBP</topic><topic>Drug Resistance, Bacterial</topic><topic>Female</topic><topic>Germany - epidemiology</topic><topic>Gram-positive SBP</topic><topic>Hospital Bed Capacity</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Leukocyte Count</topic><topic>Liver Cirrhosis - complications</topic><topic>Liver Cirrhosis - diagnosis</topic><topic>Liver Cirrhosis - mortality</topic><topic>Male</topic><topic>Microbial Sensitivity Tests</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neutrophils</topic><topic>Odds Ratio</topic><topic>Peritonitis - diagnosis</topic><topic>Peritonitis - drug therapy</topic><topic>Peritonitis - microbiology</topic><topic>Peritonitis - mortality</topic><topic>Predictive Value of Tests</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>spontaneous bacterial peritonitis</topic><topic>third-generation cephalosporins</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Friedrich, Kilian</creatorcontrib><creatorcontrib>Nüssle, Simone</creatorcontrib><creatorcontrib>Rehlen, Tobias</creatorcontrib><creatorcontrib>Stremmel, Wolfgang</creatorcontrib><creatorcontrib>Mischnik, Alexander</creatorcontrib><creatorcontrib>Eisenbach, Christoph</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>Journal of gastroenterology and hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Friedrich, Kilian</au><au>Nüssle, Simone</au><au>Rehlen, Tobias</au><au>Stremmel, Wolfgang</au><au>Mischnik, Alexander</au><au>Eisenbach, Christoph</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Microbiology and resistance in first episodes of spontaneous bacterial peritonitis: implications for management and prognosis</atitle><jtitle>Journal of gastroenterology and hepatology</jtitle><addtitle>Journal of Gastroenterology and Hepatology</addtitle><date>2016-06</date><risdate>2016</risdate><volume>31</volume><issue>6</issue><spage>1191</spage><epage>1195</epage><pages>1191-1195</pages><issn>0815-9319</issn><eissn>1440-1746</eissn><abstract>Purpose
International guidelines for antibiotic treatment of spontaneous bacterial peritonitis (SBP) are based on studies conducted decades ago and do not reflect regional differences of bacterial epidemiology.
Methods
We retrospectively analyzed epidemiology of agents, antibiotic resistance patterns, and survival in liver cirrhosis patients with their first episode of SBP during the years 2007–2013.
Results
Of the 311 patients included, 114 patients had a positive ascites culture, and 197 had an ascitic neutrophil count >250 μL. Gram‐positive bacteria (47.8%) were more frequently found than Gram‐negatives (44.9%), fungi in 7.2%. Enterobacter spp. (40.6%), Enterococcus spp. (26.1%), and Staphylcoccus spp. (13.8%) were the most frequently isolated agents. Third‐generation cephalosporins covered 70.2% of non‐nosocomial and 56.3% of nosocomial‐acquired SBP cases.When SBP was diagnosed by a positive ascitic culture, survival was highly significantly reduced (mean: 13.9 ± 2.9 months; 95% confidence interval [CI]: 8.1–19.8) compared with culture‐negative SBP patients (mean: 44.1 ± 5.4 months; 95% CI: 33.4–54.9; P = 0.000). Along with model of end‐stage liver disease score and intensive care unit contact, a positive ascites culture remained an independent risk factor associated with poor survival (odds ratio: 1.49; 95% CI: 1.09–2.03) in multivariate analysis; piperacillin/tazobactam proved to be an adequate antibiotic for nosocomial and non‐nosocomial SBP in 85.1% and 92.5%, respectively. SBP infection with Enterococcus spp. was associated with poor patient survival (P = 0.048).
Conclusions
Third‐generation cephalosporins have poor microbial coverage for treatment of SBP. Current guidelines need to adapt for the emerging number of Gram‐positive infectious agents in SBP patients.</abstract><cop>Australia</cop><pub>Blackwell Publishing Ltd</pub><pmid>26676553</pmid><doi>10.1111/jgh.13266</doi><tpages>5</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Anti-Bacterial Agents - therapeutic use antibiotic resistance Ascitic Fluid - microbiology Bacterial Infections - diagnosis Bacterial Infections - drug therapy Bacterial Infections - microbiology Bacterial Infections - mortality Community-Acquired Infections - diagnosis Community-Acquired Infections - drug therapy Community-Acquired Infections - microbiology Community-Acquired Infections - mortality Cross Infection - diagnosis Cross Infection - drug therapy Cross Infection - microbiology Cross Infection - mortality culture-positive SBP Drug Resistance, Bacterial Female Germany - epidemiology Gram-positive SBP Hospital Bed Capacity Hospitals, University Humans Kaplan-Meier Estimate Leukocyte Count Liver Cirrhosis - complications Liver Cirrhosis - diagnosis Liver Cirrhosis - mortality Male Microbial Sensitivity Tests Middle Aged Multivariate Analysis Neutrophils Odds Ratio Peritonitis - diagnosis Peritonitis - drug therapy Peritonitis - microbiology Peritonitis - mortality Predictive Value of Tests Proportional Hazards Models Retrospective Studies Risk Factors spontaneous bacterial peritonitis third-generation cephalosporins Time Factors Treatment Outcome |
| title | Microbiology and resistance in first episodes of spontaneous bacterial peritonitis: implications for management and prognosis |
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