Journal of Infection and Chemotherapy最新文献

{"title":"Retrospective study on penicillin allergy delabeling and evaluation of an antibiotic allergy assessment tool.","authors":"Ryoko Honda, Kazuhiro Ishikawa, Hiroki Ozawa, Emilie Louise Akiko Matsumoto-Takahashi, Nobuyoshi Mori","doi":"10.1016/j.jiac.2024.09.015","DOIUrl":"10.1016/j.jiac.2024.09.015","url":null,"abstract":"<p><strong>Background: </strong>It has been reported that 95 % of patients labeled as penicillin-allergic may be mislabeled. However, the process of delabeling has not advanced due to a shortage of allergy specialists capable of conducting accurate assessments. To address this issue, The Antibiotics Allergy Assessment Tool (AAAT) has been proposed as a tool to evaluate patients who can be delabeled by non-specialists.</p><p><strong>Objective: </strong>This study aims to identify patients who can be delabeled and to evaluate patients who are likely to be delabeled using AAAT.</p><p><strong>Methods: </strong>Patients admitted to the hospital between January 1, 2017, and December 31, 2021, with documented penicillin allergy labels were included in the study. Patients who demonstrated tolerance to labeled antibiotics or were labeled without explicit allergy declarations were defined as delabeling. Subsequently, patients who did not meet the criteria for delabeling were evaluated for their potential to be delabeled using the AAAT, retrospectively.</p><p><strong>Results: </strong>530 patients were selected, of which 62 (11.7 %) were delabeled. The AAAT evaluation of the remaining patients indicated that at least an additional 137 (25.8 %) patients could potentially be delabeled.</p><p><strong>Conclusion: </strong>The use of AAAT demonstrated the potential to delabel approximately third as many patients without the need for specialist evaluation. To promote broader delabeling efforts in the future, prospective studies should investigate the safety and effectiveness of evaluation tools such as the AAAT.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"102526"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended-spectrum β-lactamase-producing Plesiomonas shigelloides isolated from the stool of a Japanese traveler returning from Rwanda: A case report.","authors":"Shigeyuki Notake, Norihiko Terada, Kodai Tayama, Asami Sugie, Mariko Abe, Shiori Ikeda, Hiroatsu Iinuma, Yoshihiro Toeda, Atsuo Ueda, Koji Nakamura, Yoko Kurihara, Shigemi Hitomi","doi":"10.1016/j.jiac.2024.06.012","DOIUrl":"10.1016/j.jiac.2024.06.012","url":null,"abstract":"<p><p>A 21-year-old previously healthy Japanese woman visited an outpatient clinic because of abdominal pain, watery diarrhea, vomiting, and mild fever that had started on the previous day. She traveled to rural and urban areas of Rwanda and returned to Japan 3 days before. Stool culture yielded the Plesiomonas shigelloides strain TMCH301018, against which minimum inhibitory concentrations of cefotaxime and cefotaxime-clavulanate were 128 and ≤0.12/4 μg/mL, respectively. The strain had the bla_CTX-M-27 gene and an IncA/C replicon-type plasmid. Moreover, a transformant produced by introduction of an IncA/C plasmid extracted from TMCH301018 into Escherichia coli DH5α was positive for the bla_CTX-M-27 gene and fulfilled the criteria of extended-spectrum β-lactamase (ESBL) production described by the Clinical and Laboratory Standards Institute, indicating that TMCH301018 produced ESBL of CTX-M-27 and the ESBL-encoding gene was located on an IncA/C plasmid. Pathogenicity of TMCH301018 for the patient's complaints was uncertain because a molecular assay detected other enteropathogens in the stool specimen and the symptoms improved within 2 days with administration of oral ciprofloxacin, to which TMCH301018 was not susceptible. To our knowledge, this is the first report describing the isolation of ESBL-producing P. shigelloides.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"102449"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extensive folliculitis and abscesses with a sporotrichoid distribution in a parenteral drug user.","authors":"Victoria Lobo-Antuña, Andrés Grau-Echevarría, Marta Lobo-Antuña, Sofia Russo-Botero, Laura Mascarell-Escrivá, Violeta Zaragoza-Ninet, Josep Marí-Alexandre, Esther Jaén-Ferrer, Jose Ignacio Mateo-González","doi":"10.1016/j.jiac.2024.06.022","DOIUrl":"10.1016/j.jiac.2024.06.022","url":null,"abstract":"<p><p>We present the case of a 53-year-old Caucasian man with a history of intravenous drug use who presented with fever and multiple pustules predominantly affecting hairy areas of the body, with no clinical improvement despite previous antibiotic treatment. Culture of the pustules confirmed Candida albicans infection and histological examination of skin biopsies revealed suppurative granulomas compatible with candidomycetic folliculitis. The patient was successfully treated with systemic antifungals and discharged with resolution of symptoms. Candidomycetic folliculitis is a condition typically associated with brown heroin consumption due to the use of acidic solvent that promotes Candida growth. Clinical manifestations include fever followed by skin lesions, with possible systemic involvement if untreated. Extensive folliculitis with associated fever in an IVDU should raise suspicion of this pathology since early diagnosis and appropriate treatment are crucial to prevent complications.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"102459"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141537929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dalbavancin for the treatment of bone and joint infections: A meta-analysis.","authors":"Thamer A Almangour, Marwan A Alrasheed","doi":"10.1016/j.jiac.2024.07.013","DOIUrl":"10.1016/j.jiac.2024.07.013","url":null,"abstract":"<p><strong>Background: </strong>Bone and joint infections are challenging infectious diseases to treat and require prolonged antimicrobial treatment. Dalbavancin demonstrated promising pharmacokinetic/pharmacodynamic properties for the treatment of these infections. The objective of this meta-analysis is to compare the effectiveness of dalbavancin to standard of care (SOC) for the treatment of bone and joint infections.</p><p><strong>Methods: </strong>Two independent authors performed a comprehensive search through the major databases up to September 2023. Interventional and observational studies that compared the clinical success of dalbavancin to SOC for the treatment of osteoarticular infections (OAI) were included.</p><p><strong>Results: </strong>A total of 6 studies and 581 patients were included, 282 in dalbavancin group and 299 in SOC group. Only one study was randomized clinical trial. When the data from the 6 studies were pooled in a meta-analysis, clinical success did not differ in those who received dalbavancin versus SOC (OR = 1.55, 95 % CI = 0.95-2.55, I-squared = 15.89 %) for the treatment of OAI infections. Four studies compared the two groups in terms of hospital length of stay and demonstrated a significant shorter length of stay in dalbavancin group compared to SOC group. Treatment-emergent adverse effects were reported in up to 21.4 % of patients in the dalbavancin group and up to 36.7 % of patients in the SOC group.</p><p><strong>Conclusion: </strong>This meta-analysis showed that dalbavancin is as effective as SOC for the treatment of patients with OAI infections. More data are needed to validate these findings.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"102473"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concerns about vaccines and vaccination behavior among Japanese budget travelers to India.","authors":"Michiyo Yamakawa, Yuko Tanaka, Akiko Tokinobu, Toshihide Tsuda","doi":"10.1016/j.jiac.2024.07.011","DOIUrl":"10.1016/j.jiac.2024.07.011","url":null,"abstract":"<p><strong>Background: </strong>Low vaccination coverage among travelers poses a critical challenge to global health security. Indeed, public concerns regarding vaccines can lead to vaccine reluctance and refusal, but evidence about the impacts of concerns regarding vaccines on the uptake of travel vaccinations remains sparse. We examined the associations between concerns about vaccines and vaccination behavior among travelers.</p><p><strong>Methods: </strong>Japanese travelers aged 18 years or older, who stayed at a guesthouse in New Delhi, India, were targeted (n = 153). We conducted cross-sectional surveys from August 23 to September 2, 2019, and from February 19 to March 5, 2020. We examined the associations of three concerns regarding vaccines (5-point scale)-serious side effects from vaccines, vaccine safety, and vaccine effectiveness-with the uptake of travel vaccinations.</p><p><strong>Results: </strong>In total, 60 participants (39.2 %) had been vaccinated for this or a past trip. After adjusting for all potential confounding variables, concerns about serious side effects from vaccines and vaccine safety were negatively associated with the uptake of travel vaccinations. The ORs (95 % CIs) for 1-point increases in concerns about serious side effects from vaccines and vaccine safety were 0.72 (0.52, 0.99) and 0.71 (0.52, 0.96), respectively. Sensitivity analyses did not change the results substantially.</p><p><strong>Conclusions: </strong>Concerns about vaccine safety issues were negatively associated with the uptake of travel vaccinations among the participants, with no corresponding association observed for vaccine effectiveness. Addressing concerns about vaccine safety issues, rather than vaccine effectiveness may contribute to an increased uptake of travel vaccinations.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"102471"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141616664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal effects of lascufloxacin on human gut and salivary microbiota: Analysis using next-generation sequencing method.","authors":"Kengo Mukuda, Ryo Inoue, Miyako Takata, Kenji Takazawa, Hisashi Noma, So Morishima, Machi Oda, Athok Shofiudin Ma'arif, Yusuke Endo, Hiroshi Sunada, Ayumu Doi, Risa Matsuda, Yukari Nishikawa, Kensaku Okada, Tsuyoshi Kitaura, Masaki Nakamoto, Akira Yamasaki, Hiroki Chikumi","doi":"10.1016/j.jiac.2024.07.023","DOIUrl":"10.1016/j.jiac.2024.07.023","url":null,"abstract":"<p><strong>Introduction: </strong>Antimicrobial treatment disrupts human microbiota. The effects of lascufloxacin (LSFX), a new fluoroquinolone, on human microbiota remains unknown. Therefore, in this study, we aimed to evaluate the effects of LSFX administration on the gut and salivary microbiota of healthy participants and those with pneumonia.</p><p><strong>Methods: </strong>LSFX (75 mg, once a day, orally) was administered to healthy adults (healthy group) and adult patients with pneumonia (pneumonia group), and fecal and saliva samples were collected at five time points (Days 0, 3, 7, 14, and 28). Using the collected samples, α- and β-diversity indices, as well as bacterial composition of the gut microbiota and salivary microbiota were analyzed using next-generation sequencing.</p><p><strong>Results: </strong>In the healthy group, α-diversity indices of the gut and salivary microbiota were reduced and the lowest values on Day 3. For the gut microbiota, the Chao1 index (richness) recovered on Day 28, whereas the Shannon index (evenness) did not. In the salivary microbiota, the Chao1 and Shannon indices did not recover within the 28 day period. The β-diversity indices changed after LSFX administration and subsequently recovered on Day 28. After LSFX administration, the abundance of the Lachnospiraceae family decreased in the gut microbiota, and the abundance of Granulicatella, Streptococcus, Prevotella, Absconditabacteriales(SR1), and Saccharimonadales decreased in the salivary microbiota. In the pneumonia group, the α-diversity indices were lowest on Day 14 after LSFX administration.</p><p><strong>Conclusions: </strong>We elucidated that LSFX administration differentially affected the gut and salivary microbiota; however, the richness and beta diversity recovered within 28 days.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"102483"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative genomic and morphological analyses of capsular and capsular-deficient pneumococcal strains simultaneously isolated from a patient with invasive pneumococcal disease.","authors":"Noriko Takeuchi, Misako Ohkusu, Yoko Kusuya, Hiroki Takahashi, Masashi Yamaguchi, Yuko Omata, Tomoko Nakazawa, Naruhiko Ishiwada","doi":"10.1016/j.jiac.2024.08.001","DOIUrl":"10.1016/j.jiac.2024.08.001","url":null,"abstract":"<p><strong>Introduction: </strong>To understand the in-vivo dynamics in pneumococci, investigation into the carriage in patients with invasive pneumococcal disease (IPD) is extremely important.</p><p><strong>Methods: </strong>To clarify genomic and morphological differences between pneumococcal strains simultaneously isolated from different sites in a patient with IPD, we conducted comparative analyses of two strains. A capsular strain isolated from the blood and a non-capsular strain isolated from the sputum of a patient with IPD were used.</p><p><strong>Results: </strong>The strain isolated from blood was serotype 24B with capsule. The strain isolated from sputum with capsular type 24 genes was non-encapsulated, and genomic analysis revealed an insertion region in the wcxK gene. Its biofilm-forming capacity was higher than that of the capsular strain, as was that of the pspK-positive true non-encapsulated strain. Furthermore, observing the microbe using transmission electron microscopy revealed that the strain isolated from sputum lacked a capsule, like the pspK-positive true non-encapsulated strain.</p><p><strong>Conclusions: </strong>Our analysis of the two strains isolated from the blood and sputum of a patient with IPD showed one possible in-vivo morphological change in Streptococcus pneumoniae.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"102486"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two cases of iatrogenic levofloxacin-resistant pre-XDR tuberculosis in Japan.","authors":"Tomohiko Ukai, Akihiro Ohkado, Masao Okumura, Takashi Yoshiyama","doi":"10.1016/j.jiac.2024.08.003","DOIUrl":"10.1016/j.jiac.2024.08.003","url":null,"abstract":"<p><p>This case report discusses two instances of iatrogenically induced pre-extensively drug-resistant tuberculosis (pre-XDR TB). In both cases, the patients were initially diagnosed with tuberculosis and hospitalized in university hospitals. Nucleic acid amplification tests identified rifampicin-resistant tuberculosis, leading to a deviation from clinical guidelines. Without prior verification of susceptibility to other drugs, levofloxacin was added to the standard antituberculosis regimen, which included isoniazid, pyrazinamide, ethambutol, and rifampicin. Subsequent phenotypic drug susceptibility tests (DST) revealed resistance to isoniazid but susceptibility to levofloxacin, thus reclassifying the condition as multidrug-resistant tuberculosis (MDR-TB). However, by the time these patients were transferred to our hospital and began MDR-TB treatment, they had already developed resistance to levofloxacin, escalating their condition to pre-XDR TB. These cases underscore the importance of rapid access to comprehensive DST upon the identification of rifampicin resistance and adherence to established clinical guidelines.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"102488"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Daptomycin treatment for persistent bacteremia in a pediatric solid organ transplant recipient: Case report and literature review.","authors":"Shota Myojin, Kensuke Shoji, Jumpei Saito, Chiaki Tao, Hiroki Kato, Hajime Uchida, Akinari Fukuda, Seisuke Sakamoto, Mureo Kasahara, Isao Miyairi","doi":"10.1016/j.jiac.2024.08.021","DOIUrl":"10.1016/j.jiac.2024.08.021","url":null,"abstract":"<p><strong>Introduction: </strong>Information on the clinical utility of daptomycin in patients with persistent bacteremia and daptomycin's pharmacokinetic data in pediatric patients has been sparse. In addition, reports on the experience of using daptomycin in children undergoing solid organ transplantation have been extremely limited. The authors describe a pediatric case of persistent bacteremia after solid organ transplantation successfully treated by daptomycin. Blood daptomycin concentrations were measured by liquid chromatography-mass spectrometry and pharmacokinetic analysis was performed. We also conducted a literature review on the use of daptomycin in children with persistent bacteremia.</p><p><strong>Case report: </strong>An eight-year-old girl who underwent small bowel and liver transplantation experienced persistent bacteremia due to Staphylococcus epidermidis. The bacteremia persisted despite standard therapy; however, it finally resolved with the addition of daptomycin. The patient had renal dysfunction and the initial dosing resulted in excessive drug exposure. The dosage was adjusted based on the pharmacokinetic analysis. The dosage of administrated teicoplanin was also adjusted according to trough concentration values. In the literature review, we identified 12 cases of neonates and 24 cases of post-neonatal children with the experience of using daptomycin for persistent bacteremia; however, no solid organ transplant recipient was identified. Similar trends in blood concentrations and dose ratios of teicoplanin and daptomycin were observed over time.</p><p><strong>Discussion: </strong>More information is required regarding the clinical utility and pharmacokinetics of daptomycin in pediatric patients with persistent bacteremia. Referring to the exposure to renally excreted drugs that are routinely measured and pharmacokinetic analysis of daptomycin may be useful in optimizing the dose of daptomycin in special patient populations, including those with renal impairment.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"102506"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatal hepatic mucormycosis in an allogeneic hematopoietic-stem cell transplanted patient: Case report of a rare presentation and review of the literature.","authors":"Bruno Azevedo Randi, Vitor Falcão de Oliveira, Marjorie Marini Rapozo, Hermes Ryoiti Higashino, Gilda Maria Barbaro Del Negro, Marcelo Mihailenko Chaves Magri, Vanderson Rocha, Silvia Figueiredo Costa","doi":"10.1016/j.jiac.2024.06.006","DOIUrl":"10.1016/j.jiac.2024.06.006","url":null,"abstract":"<p><p>Hepatic mucormycosis is a rare condition. Our objective is to report a case in a HSCT patient and to perform a review of the literature. A 36-year-old man with acute myeloid leukemia, performed a haploidentical HSCT. In D+132, when treating acute GVHD with methylprednisolone and etanercept, a hepatic abscess was diagnosed. Puncture of the abscess was performed, and fungal hyphae were visualized. The culture of the aspirate identified Mucor sp. Sequencing confirmed the isolate as Mucor indicus. The patient died despite the use of Amphotericin B. Our search identified 24 hepatic mucormycosis reports. Fifteen (62.5 %) were male and 79.1 % were immunocompromised. Fever accompanied with abdominal pain was present in 41.6 %. Twelve (50.0 %) had multiple hepatic lesions. Mortality rate was 45.8 % (n = 11/24). In conclusion, the most common clinical presentation of hepatic mucormycosis in immunocompromised patients might be abdominal pain and fever, along with hepatic abscess findings in abdominal imaging exams.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"102443"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}