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Urin
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ti
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n
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s
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a
rd
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icro
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teria
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rs
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n
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a
m
o
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g
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lt
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rg
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n
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sm
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sh
o
we
d
g
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o
d
su
sc
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p
ti
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il
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to
Ce
ftaz
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ime
/Cl
a
v
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c
id
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ro
fl
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x
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c
in
,
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n
c
o
m
y
c
in
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ik
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c
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,
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ip
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ra
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il
li
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a
c
tam
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ip
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e
m
,
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lan
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n
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a
n
d
Li
n
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z
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li
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e
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n
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a
n
si
g
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e
a
n
ten
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tal
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re
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:
An
tib
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Asy
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atic
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ac
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Pre
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Ur
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Ur
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CC B
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C
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A
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K.
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Me
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Aca
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Hig
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p
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in
1.
I
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UCT
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Ur
in
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in
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in
p
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an
cy
d
u
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to
p
h
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s
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lo
g
ica
l
[
1
]
an
d
m
o
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p
h
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lo
g
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ch
an
g
es.
Pro
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ester
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tasi
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cr
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ak
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an
ten
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wo
m
en
m
o
r
e
s
u
s
ce
p
tib
le
to
UT
I
s
[
2
]
.
Asy
m
p
to
m
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b
ac
ter
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r
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(
ASB
)
is
d
ef
in
ed
as
s
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if
ican
t
b
ac
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r
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(
≥
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⁵
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FU/m
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in
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ch
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s
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r
ia,
u
r
g
e
n
cy
,
o
r
f
r
e
q
u
en
cy
[
3
]
.
T
h
o
u
g
h
clin
ically
s
ilen
t,
AS
B
ca
n
r
esu
lt
in
m
ater
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s
,
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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8
8
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6
A
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133
in
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[
4
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,
[
5
]
.
G
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[
4
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T
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v
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6
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,
a
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[
7
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.
U
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s
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b
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m
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r
a
n
d
f
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s
[
8
]
,
[
9
]
.
Alth
o
u
g
h
m
ater
n
al
UT
I
r
ar
ely
lead
s
to
d
ir
ec
t f
etal
b
lo
o
d
s
tr
e
am
in
f
ec
tio
n
,
ad
v
e
r
s
e
f
etal
o
u
tco
m
es
ca
n
o
cc
u
r
th
r
o
u
g
h
m
ec
h
a
n
is
m
s
s
u
ch
as
u
ter
i
n
e
h
y
p
o
p
er
f
u
s
io
n
,
m
ater
n
al
d
eh
y
d
r
atio
n
,
a
n
em
ia,
o
r
b
ac
ter
ial
en
d
o
to
x
in
-
me
d
iated
p
lace
n
tal
v
ascu
lar
d
am
ag
e
,
p
o
ten
tially
r
esu
ltin
g
in
f
etal
ce
r
e
b
r
al
h
y
p
o
p
er
f
u
s
io
n
[
1
0
]
.
UT
I
s
ar
e
p
ar
ticu
lar
ly
co
m
m
o
n
d
u
r
i
n
g
th
e
f
ir
s
t
2
2
wee
k
s
o
f
p
r
eg
n
an
cy
,
an
d
u
n
tr
ea
ted
in
f
ec
tio
n
s
in
th
is
p
er
io
d
h
av
e
b
ee
n
lin
k
ed
t
o
in
tr
au
ter
in
e
g
r
o
wth
r
estrictio
n
,
p
r
ee
clam
p
s
ia,
p
r
eter
m
d
eliv
er
y
,
an
d
i
n
cr
ea
s
ed
ce
s
ar
ea
n
s
ec
tio
n
r
ates
[
1
1
]
,
[
1
2
]
.
B
o
th
s
y
m
p
to
m
atic
an
d
asy
m
p
to
m
atic
UT
I
s
h
av
e
b
ee
n
ass
o
ciate
d
with
ad
v
er
s
e
o
b
s
tetr
ic
an
d
n
eo
n
atal
o
u
tco
m
es,
in
clu
d
in
g
s
till
b
ir
th
,
s
ep
s
is
,
m
ater
n
al
an
em
ia,
am
n
io
n
itis
,
an
d
n
eo
n
at
al
d
ea
th
,
em
p
h
asizin
g
th
e
n
ee
d
f
o
r
ea
r
l
y
d
iag
n
o
s
is
an
d
tr
ea
tm
en
t [
1
3
]
.
Sev
er
al
r
is
k
f
ac
to
r
s
in
cr
ea
s
e
s
u
s
ce
p
tib
ilit
y
to
UT
I
d
u
r
in
g
p
r
eg
n
a
n
cy
,
s
u
ch
as
lo
w
s
o
cio
ec
o
n
o
m
ic
s
tatu
s
,
d
iab
etes
m
ellitu
s
,
r
ec
u
r
r
en
t
in
f
ec
tio
n
s
,
ea
r
ly
o
n
s
et
o
f
UT
I
(
<1
5
y
ea
r
s
)
,
a
n
d
s
tr
u
ctu
r
al
ab
n
o
r
m
alities
o
f
th
e
u
r
o
g
e
n
ital
s
y
s
tem
[
1
4
]
,
[
1
5
]
.
ASB
is
m
o
r
e
co
m
m
o
n
l
y
r
ep
o
r
ted
in
p
ar
o
u
s
wo
m
en
,
an
d
th
o
s
e
f
r
o
m
lo
wer
s
o
cio
ec
o
n
o
m
ic
b
ac
k
g
r
o
u
n
d
s
,
a
n
d
wo
m
en
with
s
ick
le
ce
ll
tr
ait
ar
e
also
at
h
ig
h
e
r
r
is
k
[
1
6
]
.
He
n
ce
,
s
cr
ee
n
in
g
an
d
tr
ea
tm
en
t
o
f
ASB
s
h
o
u
ld
f
o
r
m
an
ess
en
tial
co
m
p
o
n
en
t
o
f
r
o
u
t
in
e
an
ten
atal
ca
r
e,
s
u
p
p
o
r
ted
b
y
h
ea
lth
ed
u
ca
ti
o
n
,
p
er
s
o
n
al
h
y
g
ie
n
e
p
r
o
m
o
tio
n
,
an
d
n
u
tr
itio
n
al
co
u
n
s
elin
g
.
C
o
n
s
id
er
in
g
its
asy
m
p
to
m
atic
n
atu
r
e
an
d
p
o
s
s
ib
le
co
m
p
licatio
n
s
,
th
is
s
tu
d
y
aim
ed
to
d
eter
m
in
e
th
e
p
r
ev
alen
ce
o
f
ASB
am
o
n
g
p
r
eg
n
an
t
wo
m
en
,
id
e
n
tify
th
e
p
r
im
ar
y
ca
u
s
ativ
e
o
r
g
a
n
is
m
s
,
an
d
ev
alu
ate
t
h
eir
an
tib
io
tic
s
u
s
ce
p
tib
ilit
y
p
atter
n
s
.
2.
M
E
T
H
O
D
Af
ter
o
b
tain
i
n
g
t
h
e
eth
ical
clea
r
an
ce
f
r
o
m
th
e
i
n
s
titu
tio
n
al
eth
ical
co
m
m
ittee,
a
to
tal
o
f
1
0
0
m
id
s
tr
ea
m
clea
n
-
ca
tch
u
r
in
e
s
am
p
les we
r
e
co
llected
f
r
o
m
asy
m
p
to
m
ati
c
an
ten
atal
wo
m
e
n
,
a
g
ed
1
8
to
4
5
y
ea
r
s
,
atten
d
in
g
th
e
Ou
tp
atien
t
Dep
ar
tm
en
t
o
f
Ob
s
tetr
ics
an
d
Gy
n
ec
o
lo
g
y
at
th
e
Dis
tr
ict
Ho
s
p
ital,
C
h
am
a
r
ajan
ag
ar
,
d
u
r
in
g
a
s
tu
d
y
p
er
io
d
o
f
two
m
o
n
t
h
s
(
J
u
n
e
an
d
J
u
ly
2
0
2
3
)
.
I
n
f
o
r
m
e
d
wr
itten
co
n
s
en
t
was
o
b
tain
ed
f
r
o
m
all
p
ar
ticip
an
ts
af
ter
clea
r
ly
e
x
p
lain
in
g
th
e
p
u
r
p
o
s
e
a
n
d
p
r
o
ce
d
u
r
e
o
f
t
h
e
s
tu
d
y
.
R
elev
an
t
clin
ical
an
d
o
b
s
tetr
ic
h
is
to
r
y
was
r
ec
o
r
d
e
d
f
o
r
ea
ch
p
ar
ticip
an
t.
2
.
1
.
S
t
u
d
y
de
s
i
g
n
a
nd
s
a
mp
l
in
g
t
e
c
hn
i
qu
e
T
h
is
s
tu
d
y
em
p
lo
y
ed
a
cr
o
s
s
-
s
ec
tio
n
al
o
b
s
er
v
atio
n
al
r
esear
c
h
d
esig
n
.
T
h
e
d
ata
co
llected
wer
e
en
ter
ed
in
to
an
d
an
aly
ze
d
u
s
in
g
Mic
r
o
s
o
f
t
W
o
r
d
an
d
Mic
r
o
s
o
f
t
E
x
ce
l.
Descr
ip
tiv
e
s
tatis
tics
s
u
ch
as
f
r
eq
u
en
cy
,
p
er
ce
n
tag
e,
an
d
m
ea
n
wer
e
u
s
ed
f
o
r
an
al
y
s
is
an
d
p
r
ese
n
tatio
n
o
f
f
in
d
in
g
s
.
Pu
r
p
o
s
iv
e
s
am
p
l
in
g
:
Ap
p
r
o
x
im
atel
y
2
0
m
L
o
f
m
id
s
tr
ea
m
clea
n
-
ca
tch
u
r
in
e
was
co
llected
f
r
o
m
e
ac
h
p
ar
ticip
an
t
u
s
in
g
a
s
ter
ile
u
n
iv
er
s
al
co
n
tain
er
.
T
h
e
s
tan
d
ar
d
u
r
i
n
e
co
llectio
n
p
r
o
to
c
o
l
was
f
o
llo
wed
to
m
in
im
ize
co
n
tam
in
atio
n
.
A
ll
s
p
ec
im
en
s
wer
e
ap
p
r
o
p
r
iately
lab
ele
d
an
d
tr
a
n
s
p
o
r
ted
to
th
e
Mic
r
o
b
io
lo
g
y
L
ab
o
r
ato
r
y
with
in
o
n
e
h
o
u
r
o
f
c
o
llectio
n
.
I
f
im
m
ed
iate
p
r
o
ce
s
s
in
g
was
n
o
t
f
ea
s
ib
le,
s
am
p
les
wer
e
r
ef
r
i
g
e
r
ated
at
4
°C
f
o
r
u
p
to
2
4
h
o
u
r
s
to
m
ain
tain
th
eir
in
teg
r
ity
.
E
ac
h
u
r
in
e
s
am
p
le
w
as in
i
tially
s
u
b
jecte
d
to
m
ac
r
o
s
co
p
ic
ex
am
in
atio
n
to
ass
ess
c
o
lo
r
,
tu
r
b
id
ity
,
an
d
th
e
p
r
esen
ce
o
f
d
ep
o
s
its
.
Sa
m
p
les
wer
e
t
h
en
p
r
o
ce
s
s
ed
f
o
r
u
r
in
e
cu
ltu
r
e
u
s
in
g
s
tan
d
a
r
d
m
ic
r
o
b
io
l
o
g
ical
p
r
o
ce
d
u
r
es to
d
etec
t sig
n
if
ican
t b
ac
ter
iu
r
ia
an
d
to
id
e
n
tify
th
e
u
r
o
p
at
h
o
g
e
n
s
in
v
o
lv
e
d
.
2.
2
.
I
nclus
io
n c
rit
er
ia
-
Pre
g
n
an
t w
o
m
en
a
g
ed
1
8
–
4
5
y
ea
r
s
atten
d
in
g
th
e
an
ten
atal
c
lin
ic
at
an
y
g
estatio
n
al
a
g
e,
wi
th
o
u
t sy
m
p
to
m
s
o
f
u
r
in
ar
y
tr
ac
t i
n
f
ec
tio
n
(
e.
g
.
,
d
y
s
u
r
ia,
lo
i
n
p
ain
,
o
r
in
c
r
ea
s
ed
f
r
eq
u
en
cy
o
f
m
ictu
r
itio
n
)
.
-
Par
ticip
an
ts
n
o
t
tr
ea
ted
with
an
tib
io
tics
(
o
r
al,
p
ar
e
n
ter
al,
o
r
l
o
ca
l)
in
th
e
p
r
ec
e
d
in
g
o
n
e
m
o
n
t
h
b
ef
o
r
e
s
am
p
le
co
llectio
n
.
2.
3
.
E
x
clus
io
n c
rit
er
ia
-
Patien
ts
p
r
esen
tin
g
with
v
ag
in
al
d
is
ch
ar
g
e
o
r
p
er
v
ag
in
al
b
leed
in
g
.
-
Pre
g
n
an
t
wo
m
en
with
p
r
e
-
ex
is
tin
g
m
ed
ical
co
n
d
itio
n
s
s
u
ch
as
d
iab
etes
m
ellitu
s
,
h
y
p
er
ten
s
io
n
,
o
r
c
o
n
g
e
n
ital
an
o
m
alies.
2.
4
.
Scre
ening
pro
ce
du
re
s
A
d
r
o
p
o
f
well
-
m
i
x
ed
u
n
ce
n
t
r
if
u
g
ed
u
r
i
n
e
was
p
lace
d
o
n
a
cl
ea
n
g
lass
s
lid
e,
air
-
d
r
ied
,
h
ea
t
-
f
ix
ed
,
an
d
th
en
Gr
am
-
s
tain
ed
f
o
r
m
icr
o
s
co
p
ic
ex
am
i
n
atio
n
u
n
d
er
o
il
i
m
m
er
s
io
n
.
T
h
e
p
r
esen
ce
o
f
at
least
o
n
e
o
r
g
an
is
m
p
er
o
il
im
m
er
s
io
n
f
ield
(
o
b
s
e
r
v
ed
ac
r
o
s
s
2
0
f
ield
s
)
was
co
n
s
id
er
ed
in
d
icativ
e
o
f
s
ig
n
if
ic
an
t
b
ac
ter
iu
r
ia.
Fo
r
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
1
5
,
No
.
1
,
Ma
r
ch
20
2
6
:
1
3
2
-
1
39
134
cu
ltu
r
e,
u
r
in
e
s
p
ec
im
e
n
s
wer
e
in
o
cu
lated
u
s
in
g
th
e
s
tan
d
ar
d
lo
o
p
tech
n
iq
u
e
o
n
C
y
s
tein
e
L
a
cto
s
e
E
lectr
o
ly
te
Def
icien
t
(
C
L
E
D)
ag
ar
,
b
l
o
o
d
ag
ar
,
an
d
Ma
cCo
n
k
e
y
ag
a
r
.
A
ca
lib
r
ated
lo
o
p
with
a
3
m
m
in
ter
n
al
d
iam
eter
,
ca
p
ab
le
o
f
d
eliv
er
in
g
0
.
0
0
1
m
L
o
f
u
r
in
e,
was u
s
ed
to
e
n
s
u
r
e
q
u
an
titativ
e
an
aly
s
is
.
T
h
e
in
o
c
u
lated
p
lates
wer
e
in
c
u
b
ated
at
3
7
°C
f
o
r
1
8
–
2
4
h
o
u
r
s
.
Fo
llo
win
g
in
c
u
b
atio
n
,
co
l
o
n
y
co
u
n
ts
wer
e
p
er
f
o
r
m
ed
,
an
d
th
e
b
ac
ter
ial
co
n
ce
n
tr
atio
n
was
ca
lcu
late
d
b
y
m
u
ltip
ly
in
g
th
e
n
u
m
b
er
o
f
co
lo
n
ies
b
y
1
,
0
0
0
,
ex
p
r
ess
in
g
th
e
r
esu
lt
in
c
o
lo
n
y
-
f
o
r
m
in
g
u
n
its
p
er
m
illi
liter
(
C
FU/m
L
)
.
A
u
r
in
e
s
am
p
le
was
co
n
s
id
e
r
ed
t
o
s
h
o
w
s
ig
n
if
ican
t
b
ac
ter
iu
r
ia
i
f
th
e
c
o
lo
n
y
c
o
u
n
t
ex
ce
ed
e
d
1
0
⁵
C
FU/m
L
.
I
s
o
lated
co
lo
n
ies
wer
e
f
u
r
th
e
r
id
en
tifie
d
b
ased
o
n
co
lo
n
y
m
o
r
p
h
o
lo
g
y
,
cu
ltu
r
al
c
h
ar
ac
ter
is
tics
,
Gr
am
s
tain
in
g
,
a
n
d
a
s
er
ies
o
f
b
io
ch
em
ical
test
s
to
co
n
f
ir
m
t
h
e
b
ac
ter
ial
s
p
ec
ies.
T
h
e
an
tim
icr
o
b
ial
s
u
s
ce
p
tib
ilit
y
o
f
ea
c
h
is
o
late
was
test
ed
u
s
in
g
th
e
Kir
b
y
-
B
au
er
d
is
c
d
if
f
u
s
io
n
m
eth
o
d
o
n
Mu
eller
-
Hin
to
n
ag
ar
,
an
d
r
esu
lts
wer
e
in
ter
p
r
eted
ac
co
r
d
in
g
to
th
e
C
lin
ical
an
d
L
ab
o
r
ato
r
y
Stan
d
ar
d
s
I
n
s
titu
te
(
C
L
SI)
g
u
id
elin
es [
1
7
]
.
T
h
e
a
n
tib
io
tics
wer
e
u
s
ed
i
n
t
h
e
an
tib
io
tic
s
u
s
ce
p
tib
ilit
y
test
in
g
wer
e,
Am
ik
ac
in
(
AM
K)
(
3
0
m
cg
)
,
Am
p
icillin
(
AM
P)
(
3
0
m
cg
)
,
C
ef
tazid
im
e
(
C
AZ
)
(
3
0
m
cg
)
,
C
ef
tazid
im
e/C
lav
u
lan
ic
ac
id
(
C
AZ
/C
L
A)
(
3
0
m
cg
)
,
C
ep
h
o
tax
im
e
(
C
T
X)
(
3
0
m
cg
)
,
C
o
tr
im
o
x
az
o
le
(
S
XT
)
(
3
0
m
cg
)
,
C
i
p
r
o
f
lo
x
ac
in
(
C
I
P)
(
3
0
m
cg
)
,
I
m
ip
en
am
(
I
PM)
(
1
0
m
c
g
)
,
Pip
er
ac
illi
n
/Ta
zo
b
ac
tam
(
T
Z
P)
(
3
0
m
c
g
)
,
T
etr
ac
y
clin
e
(
T
C
Y)
(
3
0
m
cg
)
,
L
ev
o
f
lo
x
ac
in
(
L
E
)
(
3
0
m
c
g
)
,
C
ef
ix
im
e
(
C
FM)
(
3
0
m
c
g
)
,
C
l
in
d
am
y
cin
(
C
L
I
)
(
3
0
m
c
g
)
,
E
r
y
th
r
o
m
y
cin
(
E
R
Y)
(
3
0
m
cg
)
,
Nitr
o
f
u
r
an
to
i
n
(
N
F)
(
3
0
m
cg
)
,
N
o
r
f
lo
x
ac
in
(
NX)
(
3
0
m
cg
)
,
T
eico
p
lan
in
(
T
E
C
)
(
1
5
m
cg
)
,
Van
co
m
y
cin
(
VAN)
(
3
0
m
cg
)
,
L
in
ez
o
lid
(
L
NZ
)
(
3
0
m
cg
)
,
a
n
d
Am
o
x
y
clav
(
AM
C
)
(
3
0
m
c
g
)
.
3.
RE
SU
L
T
S
Am
o
n
g
t
h
e
1
0
0
u
r
in
e
s
p
ec
im
en
s
co
llected
f
r
o
m
asy
m
p
to
m
atic
p
r
eg
n
a
n
t
wo
m
e
n
,
1
4
s
am
p
les
(
1
4
%)
wer
e
p
o
s
itiv
e
f
o
r
s
ig
n
if
ican
t
b
ac
ter
iu
r
ia,
in
d
icatin
g
th
e
p
r
esen
ce
o
f
asy
m
p
to
m
atic
b
ac
t
er
iu
r
ia
(
ASB
)
.
T
h
e
r
em
ain
in
g
8
6
s
am
p
les
(
8
6
%)
wer
e
s
ter
ile
an
d
s
h
o
wed
n
o
g
r
o
wth
.
Am
o
n
g
th
e
1
4
u
r
o
p
ath
o
g
e
n
s
is
o
lated
,
S
ta
p
h
ylo
c
o
cc
u
s
a
u
r
eu
s
was
th
e
m
o
s
t
f
r
eq
u
en
tly
id
en
tifie
d
o
r
g
an
is
m
,
ac
co
u
n
tin
g
f
o
r
6
ca
s
es
(
4
2
.
8
%),
f
o
llo
wed
by
E
s
ch
erich
ia
co
li
an
d
K
leb
s
iella
s
p
ec
ies,
ea
ch
with
4
is
o
lates (
2
8
.
6
%),
s
h
o
wn
in
Fig
u
r
e
1
.
T
r
im
ester
-
wis
e
d
is
tr
ib
u
tio
n
o
f
ASB
r
ev
ea
led
th
at
m
o
s
t
ca
s
es
o
cc
u
r
r
e
d
i
n
th
e
f
ir
s
t
tr
im
est
er
,
with
9
wo
m
en
(
6
4
.
2
%)
a
f
f
ec
ted
.
T
h
is
was
f
o
llo
wed
b
y
3
ca
s
es
(
2
1
.
6
%)
in
th
e
th
ir
d
tr
im
ester
an
d
2
ca
s
es
(
1
4
.
2
%)
in
th
e
s
ec
o
n
d
tr
im
ester
.
Gr
av
i
d
a
s
tatu
s
an
aly
s
is
s
h
o
wed
th
at
ASB
wa
s
m
o
r
e
p
r
ev
ale
n
t
a
m
o
n
g
m
u
ltig
r
av
id
a
wo
m
en
,
co
m
p
r
is
in
g
8
o
u
t
o
f
1
4
ca
s
es
(
5
7
.
2
%),
wh
ile
th
e
r
em
ain
in
g
6
ca
s
es
(
4
2
.
8
%)
we
r
e
in
p
r
im
ig
r
a
v
id
a
wo
m
en
.
Ag
e
-
wis
e
d
is
tr
ib
u
tio
n
in
d
icate
d
th
at
5
wo
m
en
(
3
5
.
7
%)
with
AS
B
wer
e
b
etwe
en
1
8
–
2
0
y
ea
r
s
o
f
ag
e,
wh
er
ea
s
th
e
m
ajo
r
ity
,
9
wo
m
e
n
(
6
4
.
3
%),
wer
e
b
etwe
en
2
1
–
3
0
y
ea
r
s
o
ld
.
An
tib
io
tic
s
u
s
ce
p
tib
ilit
y
p
atter
n
s
h
o
wn
in
Fig
u
re
s
2
-
4
.
S
t
a
p
h
y
lo
co
cc
u
s
a
u
r
eu
s
is
o
lates
wer
e
u
n
if
o
r
m
ly
s
en
s
itiv
e
to
Am
ik
ac
in
,
Van
co
m
y
cin
,
an
d
L
in
ez
o
lid
,
with
m
o
d
er
ate
r
esis
tan
ce
to
f
lu
o
r
o
q
u
in
o
lo
n
es
an
d
m
ac
r
o
lid
es,
an
d
h
ig
h
er
r
esis
tan
ce
(
5
0
%)
to
C
ef
ix
im
e.
E
.
co
li
s
h
o
wed
co
m
p
lete
s
en
s
itiv
ity
to
Am
ik
ac
in
,
I
m
ip
en
em
,
Pip
er
ac
illi
n
/Ta
zo
b
ac
tam
,
an
d
Nitr
o
f
u
r
an
to
i
n
,
b
u
t
h
ig
h
r
esis
tan
ce
to
C
ef
tazid
im
e
an
d
Am
o
x
icillin
-
C
lav
u
lan
ate
(
7
5
%).
K
leb
s
iella
s
p
ec
ies
wer
e
f
u
lly
s
en
s
itiv
e
to
m
o
s
t
an
tib
io
tics
ex
ce
p
t
f
o
r
co
m
p
lete
r
esis
tan
ce
to
Am
p
icillin
an
d
m
o
d
er
ate
r
e
s
is
tan
ce
to
Am
o
x
icillin
-
C
lav
u
l
an
ate.
Ov
er
all,
Am
ik
ac
in
an
d
I
m
ip
en
em
wer
e
th
e
m
o
s
t c
o
n
s
is
ten
tly
ef
f
ec
tiv
e
ag
en
ts
ac
r
o
s
s
is
o
lates.
Fig
u
r
e
1
.
Pre
v
ale
n
ce
o
f
u
r
o
p
at
h
o
g
en
s
ca
u
s
in
g
asy
m
p
to
m
atic
b
ac
ter
iu
r
ia
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
A
n
tib
io
tic
s
u
s
ce
p
tib
ilit
y
p
r
o
file o
f u
r
o
p
a
t
h
o
g
e
n
s
in
p
r
eg
n
a
n
t
w
o
men
w
ith
…
(
K
.
Mu
r
u
g
esh
)
135
Fig
u
r
e
2
.
An
tib
i
o
tic
s
u
s
ce
p
tib
ilit
y
p
atter
n
o
f
E.
co
li
Fig
u
r
e
3
.
An
tib
i
o
tic
s
u
s
ce
p
tib
ilit
y
p
atter
n
o
f
K
leb
s
iella
s
p
ec
ies
Fig
u
r
e
4
.
An
tib
i
o
tic
s
u
s
ce
p
tib
ilit
y
p
atter
n
o
f
S
.
A
u
r
eu
s
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
1
5
,
No
.
1
,
Ma
r
ch
20
2
6
:
1
3
2
-
1
39
136
4.
DIS
CU
SS
I
O
N
4
.
1
.
P
re
v
a
lence
o
f
a
s
y
m
pt
o
m
a
t
ic
ba
ct
er
iuria
I
n
th
e
p
r
esen
t
s
tu
d
y
,
ASB
was
id
en
tifie
d
i
n
1
4
%
o
f
p
r
eg
n
an
t
wo
m
en
.
T
h
is
p
r
e
v
alen
ce
is
co
m
p
ar
ab
le
to
th
at
r
e
p
o
r
ted
b
y
Pra
s
an
n
a
et
a
l.
(
1
7
%)
[
1
8
]
an
d
an
o
th
er
s
tu
d
y
d
o
cu
m
en
tin
g
1
9
%
[
1
9
]
.
L
o
wer
p
r
ev
alen
ce
r
ates
h
av
e
b
ee
n
d
o
c
u
m
en
ted
in
s
ev
er
al
s
tu
d
ies,
in
clu
d
in
g
Mu
k
h
er
jee
et
a
l.
(
8
.
4
%)
[
7
]
,
J
am
b
h
u
le
an
d
De
y
(
8
.
2
8
%)
[
2
0
]
,
Alem
u
et
a
l.
(
1
0
.
4
%)
[
2
1
]
,
Go
wd
a
a
n
d
R
ajin
i
(
1
0
.
8
%)
[
6
]
,
Sh
u
b
h
as
in
i
an
d
Van
i
[
2
2
]
,
T
alu
k
d
ar
et
a
l.
(
1
0
%)
[
2
3
]
,
a
n
d
as lo
w
as 4
.
6
8
% (
2
6
ca
s
es)
i
n
an
o
th
e
r
r
ep
o
r
t [
2
4
]
.
C
o
n
v
er
s
ely
,
h
ig
h
er
p
r
e
v
alen
ce
h
as
b
ee
n
r
ep
o
r
ted
i
n
o
th
er
s
tu
d
ies,
with
r
ates
as
h
ig
h
as
2
4
.
7
%
[
2
5
]
an
d
3
1
%
[
2
6
]
.
T
h
e
r
elativ
ely
h
ig
h
e
r
p
r
e
v
alen
ce
o
b
s
er
v
e
d
in
t
h
e
p
r
esen
t
s
tu
d
y
m
a
y
b
e
attr
ib
u
ted
t
o
m
u
ltip
le
f
ac
to
r
s
,
in
clu
d
in
g
p
o
o
r
p
er
s
o
n
al
h
y
g
ien
e,
lo
w
s
o
cio
ec
o
n
o
m
ic
s
tatu
s
,
in
ad
eq
u
ate
g
en
ital
h
y
g
ie
n
e,
ce
r
tain
s
ex
u
al
p
r
ac
tices,
an
d
u
n
f
av
o
r
a
b
le
e
n
v
ir
o
n
m
en
tal
co
n
d
itio
n
s
.
T
h
ese
f
ac
to
r
s
ar
e
well
-
r
ec
o
g
n
ized
co
n
t
r
ib
u
to
r
s
to
in
cr
ea
s
ed
s
u
s
ce
p
tib
ilit
y
to
u
r
in
ar
y
tr
ac
t c
o
lo
n
izatio
n
an
d
s
u
b
s
eq
u
en
t A
SB
.
4
.
2
.
E
t
io
lo
g
ica
l a
g
ent
s
a
nd
s
hift
ing
t
re
nd
s
T
h
e
cu
r
r
e
n
t
s
tu
d
y
id
en
tifie
d
S
ta
p
h
ylo
c
o
cc
u
s
a
u
r
eu
s
as
th
e
p
r
ed
o
m
i
n
an
t
u
r
o
p
ath
o
g
en
,
f
o
llo
wed
b
y
E
s
ch
erich
ia
co
li
an
d
K
leb
s
iella
s
p
ec
ies.
Similar
o
b
s
er
v
atio
n
s
wer
e
m
ad
e
b
y
J
o
jan
et
a
l.
[
8
]
.
Ho
wev
e
r
,
m
o
s
t
ea
r
lier
s
tu
d
ies
co
n
s
is
ten
tly
r
ep
o
r
ted
E
.
co
li
as
th
e
m
o
s
t
co
m
m
o
n
ca
u
s
ativ
e
o
r
g
an
is
m
in
p
r
e
g
n
an
cy
-
r
elate
d
UT
I
s
[
4
]
,
[
8
]
,
[
1
8
]
,
[
2
1
]
,
[
2
7
]
.
T
h
is
in
d
icate
s
a
p
o
s
s
ib
le
s
h
if
t
in
etio
lo
g
ical
p
atter
n
s
,
with
S
.
a
u
r
eu
s
em
er
g
in
g
as
a
s
ig
n
if
ican
t
u
r
o
p
ath
o
g
en
alo
n
g
s
id
e
E
.
co
li
.
T
h
is
ch
an
g
in
g
tr
en
d
e
m
p
h
asizes
th
e
n
ee
d
f
o
r
co
n
tin
u
o
u
s
lo
ca
l
ep
id
em
io
lo
g
ical
s
u
r
v
eillan
ce
t
o
g
u
id
e
em
p
ir
ical
tr
ea
tm
en
t
an
d
p
r
o
m
o
te
an
tib
i
o
tic
s
tewa
r
d
s
h
ip
in
an
ten
atal
ca
r
e.
4
.
3
.
T
rim
este
r
-
wis
e
dis
t
ribu
t
io
n
ASB
was
m
o
s
t
p
r
ev
alen
t
in
th
e
f
ir
s
t
tr
im
ester
(
6
4
.
2
%),
f
o
llo
wed
b
y
th
e
t
h
ir
d
tr
i
m
ester
(
2
1
.
6
%)
an
d
th
e
s
ec
o
n
d
tr
im
ester
(
1
4
.
2
%)
.
Pra
s
an
n
a
et
a
l.
[
1
8
]
r
e
p
o
r
te
d
th
e
h
ig
h
est
p
r
ev
alen
ce
in
t
h
e
th
ir
d
tr
im
ester
,
f
o
llo
wed
b
y
th
e
f
ir
s
t
an
d
s
ec
o
n
d
.
Kala
iv
an
i
et
a
l.
[
4
]
also
d
o
cu
m
e
n
ted
p
r
ed
o
m
in
an
ce
in
th
e
th
ir
d
tr
im
ester
.
Go
wd
a
et
a
l.
[
6
]
r
ep
o
r
ted
th
e
h
ig
h
est
p
r
ev
alen
ce
in
th
e
s
ec
o
n
d
tr
im
ester
(
3
7
%),
f
o
llo
wed
b
y
th
e
th
ir
d
(
3
3
%)
an
d
f
ir
s
t
(
3
0
%).
T
h
e
v
a
r
iatio
n
in
tr
im
est
er
-
wis
e
p
r
e
v
alen
c
e
m
ay
b
e
ex
p
lain
e
d
b
y
p
h
y
s
io
lo
g
ical
ch
an
g
es
o
cc
u
r
r
in
g
ea
r
ly
i
n
p
r
e
g
n
an
c
y
.
T
h
e
r
is
k
o
f
UT
I
s
in
cr
ea
s
es
f
r
o
m
th
e
f
ir
s
t
s
ix
wee
k
s
o
f
g
estatio
n
an
d
p
ea
k
s
b
etwe
en
2
2
–
2
4
wee
k
s
d
u
e
to
p
r
o
g
ester
o
n
e
-
in
d
u
ce
d
s
m
o
o
th
m
u
s
cle
r
elax
atio
n
,
v
esico
u
r
eter
al
r
ef
lu
x
,
a
n
d
m
ec
h
an
ical
co
m
p
r
ess
io
n
o
f
t
h
e
u
r
in
ar
y
tr
ac
t [
4
]
,
[
8
]
.
4
.
4
.
G
ra
v
idi
t
y
-
wis
e
dis
t
ribu
t
io
n
T
h
is
s
tu
d
y
f
o
u
n
d
ASB
to
b
e
m
o
r
e
co
m
m
o
n
i
n
m
u
ltig
r
a
v
id
a
wo
m
e
n
,
a
f
in
d
i
n
g
c
o
n
s
is
ten
t
with
Pra
s
an
n
a
et
a
l.
[
1
8
]
.
Ho
wev
e
r
,
Go
wd
a
an
d
R
ajin
i
[
6
]
r
ep
o
r
ted
a
h
ig
h
er
p
r
e
v
alen
ce
in
p
r
im
ig
r
av
id
ae
(
6
7
%)
co
m
p
ar
ed
t
o
m
u
ltig
r
a
v
id
ae
(
3
3
%).
Par
ity
-
wis
e
d
is
tr
ib
u
tio
n
in
an
o
th
er
s
tu
d
y
s
h
o
wed
th
e
h
ig
h
est
p
r
ev
alen
ce
am
o
n
g
n
u
llip
ar
o
u
s
wo
m
en
(
5
7
.
6
9
%),
f
o
llo
wed
b
y
p
a
r
a
1
(
3
0
.
7
7
%),
p
a
r
a
2
(
7
.
6
9
%),
an
d
p
ar
a
3
(
3
.
8
5
%)
[
2
4
]
.
T
h
e
h
ig
h
est
p
r
o
p
o
r
tio
n
o
f
wo
m
en
with
UT
I
in
an
o
th
er
s
tu
d
y
was
in
th
e
th
ir
d
tr
im
ester
o
f
p
r
eg
n
a
n
cy
(
4
7
.
5
4
%),
with
m
u
ltig
r
av
id
a
(
7
2
.
3
1
%)
a
n
d
m
u
ltip
ar
ity
(
5
0
.
8
2
%)
[
2
8
]
.
T
h
e
h
ig
h
er
in
ci
d
en
ce
o
f
ASB
am
o
n
g
m
u
ltig
r
av
id
a
m
ay
b
e
attr
ib
u
ted
to
r
ep
ea
ted
h
o
r
m
o
n
al
ch
an
g
es
an
d
cu
m
u
lativ
e
alter
atio
n
s
in
th
e
u
r
in
a
r
y
tr
ac
t
f
r
o
m
p
r
e
v
io
u
s
p
r
eg
n
an
cies
.
I
t
m
a
y
also
b
e
r
e
lated
to
ch
an
g
es
in
g
en
ital tr
ac
t f
lo
r
a
.
Ad
d
itio
n
all
y
,
th
e
in
cr
ea
s
in
g
u
ter
in
e
s
ize
a
n
d
h
o
r
m
o
n
al
m
ilieu
as p
r
eg
n
a
n
cy
ad
v
an
ce
s
cr
ea
te
a
m
o
r
e
f
a
v
o
r
a
b
le
e
n
v
ir
o
n
m
e
n
t f
o
r
m
icr
o
b
ial
co
lo
n
izatio
n
[
8
]
.
4
.
5
.
Ag
e
-
wis
e
dis
t
ributio
n
I
n
th
e
p
r
esen
t
s
tu
d
y
,
ASB
was
m
o
s
t
f
r
eq
u
en
tly
o
b
s
er
v
ed
am
o
n
g
wo
m
en
ag
e
d
2
1
–
3
0
y
ea
r
s
(
6
4
.
2
9
%),
f
o
llo
wed
b
y
th
o
s
e
ag
ed
1
8
–
2
0
y
ea
r
s
(
3
5
.
7
1
%).
T
h
ese
f
in
d
in
g
s
ar
e
co
n
s
is
ten
t
wi
th
th
e
r
ep
o
r
t
s
o
f
Kala
iv
an
i
et
a
l.
[
4
]
an
d
J
o
jan
e
t a
l.
[
8
]
,
wh
o
also
d
o
c
u
m
en
te
d
a
h
ig
h
er
in
cid
en
ce
o
f
ASB
am
o
n
g
wo
m
en
in
t
h
e
ac
tiv
e
r
ep
r
o
d
u
ctiv
e
ag
e
g
r
o
u
p
.
Similar
ly
,
Dh
an
y
a
et
a
l.
[
2
6
]
r
ep
o
r
ted
th
at
5
5
.
8
%
o
f
ca
s
es
o
cc
u
r
r
ed
in
wo
m
e
n
ag
ed
1
8
–
2
5
y
ea
r
s
,
3
2
.
6
%
in
t
h
e
2
6
–
35
y
ea
r
g
r
o
u
p
,
an
d
1
1
.
6
%
in
wo
m
en
o
v
er
3
5
y
ea
r
s
.
I
n
an
o
th
e
r
s
tu
d
y
,
th
e
h
ig
h
est
p
r
o
p
o
r
tio
n
o
f
p
r
eg
n
a
n
t
wo
m
en
with
UT
I
b
elo
n
g
ed
to
th
e
2
0
–
25
y
ea
r
ag
e
g
r
o
u
p
(
4
2
.
6
2
%),
with
th
e
m
ajo
r
ity
b
ein
g
h
o
m
em
ak
e
r
s
(
5
5
.
7
4
%),
illi
ter
ate
(
6
9
.
6
7
%),
an
d
r
esid
in
g
in
r
u
r
al
ar
ea
s
(
6
7
.
2
1
%)
[
2
8
]
.
L
ik
ewise,
an
o
th
er
s
tu
d
y
d
o
cu
m
en
te
d
th
e
h
ig
h
est p
r
ev
ale
n
ce
in
th
e
1
8
–
25
y
ea
r
a
g
e
g
r
o
u
p
(
6
3
%)
[
1
9
]
.
A
r
elate
d
s
tu
d
y
f
o
u
n
d
m
o
s
t
cu
ltu
r
e
-
p
o
s
itiv
e
p
r
e
g
n
an
t
wo
m
e
n
wer
e
ag
ed
2
6
–
3
0
y
ea
r
s
(
4
8
%),
f
o
llo
wed
b
y
2
1
–
2
5
y
ea
r
s
(
3
0
%).
A
s
ig
n
i
f
ican
t p
r
o
p
o
r
ti
o
n
b
el
o
n
g
e
d
to
l
o
w
s
o
cio
ec
o
n
o
m
ic
b
ac
k
g
r
o
u
n
d
s
(
7
8
%)
a
n
d
wer
e
illi
ter
ate
(
4
9
%),
with
7
4
%
an
d
6
7
%
o
f
cu
ltu
r
e
-
p
o
s
itiv
e
ca
s
es
o
cc
u
r
r
in
g
in
t
h
ese
r
esp
ec
tiv
e
g
r
o
u
p
s
[
6
]
,
[
2
4
]
.
An
o
th
er
s
tu
d
y
r
e
p
o
r
ted
p
ar
tici
p
an
t
ag
es
r
a
n
g
in
g
f
r
o
m
1
7
to
3
9
y
ea
r
s
,
with
a
m
ea
n
ag
e
o
f
2
5
.
8
y
ea
r
s
.
M
o
s
t
wer
e
in
th
e
2
0
–
24
y
ea
r
a
g
e
g
r
o
u
p
(
4
3
.
9
%),
a
n
d
th
ei
r
ed
u
ca
tio
n
al
le
v
els
v
ar
ied
wid
ely
[
5
]
.
Alth
o
u
g
h
th
e
p
r
esen
t
s
tu
d
y
n
o
ted
h
i
g
h
er
ASB
p
r
ev
alen
ce
in
y
o
u
n
g
e
r
wo
m
e
n
,
ad
v
an
ci
n
g
m
ater
n
al
ag
e
h
as
also
b
ee
n
r
ep
o
r
ted
as
a
r
is
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Evaluation Warning : The document was created with Spire.PDF for Python.
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s
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tib
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r
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f u
r
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t
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s
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p
r
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n
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ith
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r
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137
f
ac
to
r
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T
h
e
ag
e
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r
el
ated
d
ec
li
n
e
in
g
ly
c
o
g
en
d
e
p
o
s
itio
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v
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u
s
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lo
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e
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ed
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in
cr
ea
s
e
b
ac
ter
ial
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er
en
ce
an
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p
ath
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e
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eb
y
en
h
a
n
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g
s
u
s
ce
p
t
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ilit
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s
[
1
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4
.
6
.
M
icro
bio
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ica
l pro
f
ile
o
f
is
o
la
t
es
I
n
th
is
s
tu
d
y
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S
ta
p
h
ylo
c
o
cc
u
s
a
u
r
eu
s
ac
co
u
n
ted
f
o
r
4
2
.
8
%
o
f
is
o
lates.
E
s
ch
er
ich
ia
co
li
an
d
K
leb
s
iella
s
p
ec
ies
ea
ch
ac
co
u
n
ted
f
o
r
2
8
.
6
%.
I
n
o
th
er
r
ep
o
r
ts
,
E
.
co
li
was
th
e
m
o
s
t
f
r
eq
u
en
t
is
o
late
(
4
7
.
8
%)
,
f
o
llo
wed
b
y
K
leb
s
iella
p
n
eu
m
o
n
iae
(
1
7
.
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%),
S
ta
p
h
ylo
co
c
cu
s
a
u
r
eu
s
(
8
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%),
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d
o
th
e
r
p
ath
o
g
en
s
s
u
ch
as
S
ta
p
h
ylo
c
o
cc
u
s
s
a
p
r
o
p
h
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s
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tr
ep
to
co
cc
u
s
a
g
a
l
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ctia
e
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itr
o
b
a
cter
ko
s
eri
,
E
n
tero
co
cc
u
s
fa
ec
a
lis
,
a
n
d
C
a
n
d
id
a
tr
o
p
ica
lis
[
2
4
]
,
[
2
9
]
.
4
.
7
.
Ant
ibi
o
t
ic
s
us
ce
ptibility
pa
t
t
er
ns
Stap
h
y
lo
co
cc
u
s
au
r
ei
a
r
e
h
i
g
h
ly
s
u
s
ce
p
tib
le:
Am
ik
ac
in
,
T
eico
p
lan
in
,
L
in
ez
o
lid
,
C
o
tr
i
m
o
x
az
o
le,
Nitr
o
f
u
r
an
to
i
n
,
Va
n
co
m
y
ci
n
.
Mo
d
er
ate
r
esis
tan
ce
to
C
ef
ix
im
e
(
5
0
%),
C
lin
d
am
y
cin
(
3
3
.
3
%),
N
o
r
f
lo
x
ac
in
(
3
3
.
3
%),
E
r
y
th
r
o
m
y
ci
n
(
3
3
.
3
%).
T
h
ese
f
in
d
in
g
s
ar
e
i
n
lin
e
with
J
o
jan
et
a
l.
[
8
]
,
wh
o
also
r
ep
o
r
te
d
th
e
ef
f
ec
tiv
en
ess
o
f
ca
r
b
ap
e
n
em
s
ag
ain
s
t
S
.
a
u
r
eu
s
.
E
s
ch
erich
ia
co
li
is
h
ig
h
ly
s
u
s
ce
p
tib
le:
A
m
ik
ac
in
,
I
m
ip
en
em
,
Pip
er
ac
illi
n
-
T
az
o
b
ac
tam
.
R
esis
tan
t
to
Am
o
x
y
cla
v
(
7
5
%),
A
m
p
icillin
(
5
0
%),
T
etr
ac
y
clin
e
(
5
0
%),
No
r
f
lo
x
ac
i
n
(
5
0
%),
C
o
tr
im
o
x
az
o
le
(
2
5
%),
L
ev
o
f
l
o
x
ac
in
(
2
5
%),
Nitr
o
f
u
r
an
to
in
(
2
5
%).
M
u
k
h
e
r
jee
et
a
l.
[
7
]
f
o
u
n
d
s
im
ilar
r
esis
tan
ce
to
co
m
m
o
n
ly
u
s
ed
o
r
al
ag
en
ts
,
th
o
u
g
h
C
ip
r
o
f
lo
x
ac
in
was
r
ep
o
r
te
d
as
ef
f
ec
tiv
e
.
K
leb
s
iella
s
p
ec
ies
ar
e
s
en
s
itiv
e
to
Am
ik
ac
in
,
C
ef
tazid
im
e
-
C
lav
u
lan
ic
ac
id
,
C
o
tr
im
o
x
az
o
le,
C
ip
r
o
f
lo
x
ac
in
,
I
m
ip
e
n
em
,
a
n
d
L
ev
o
f
lo
x
ac
in
.
R
esis
tan
t
to
A
m
p
icillin
(
1
0
0
%),
p
ar
tial
r
esi
s
tan
ce
to
Am
o
x
y
clav
(
5
0
%),
T
etr
ac
y
clin
e
(
7
5
%),
No
r
f
lo
x
ac
in
(
2
5
%),
Nitr
o
f
u
r
a
n
to
in
(
2
5
%).
C
o
m
p
a
r
ab
le
r
es
u
lts
wer
e
d
o
cu
m
en
ted
b
y
B
o
s
e
et
a
l.
[
2
4
]
an
d
Olu
f
ad
i
-
Ah
m
ed
et
a
l.
[
3
0
]
.
Oth
er
I
s
o
la
tes:
C
i
tr
o
b
ac
ter
k
o
s
er
i
ar
e
co
m
p
letely
r
esis
tan
t
to
C
ep
h
alex
in
,
Nitr
o
f
u
r
an
to
i
n
,
a
n
d
Am
o
x
y
clav
;
f
u
lly
s
en
s
itiv
e
to
am
in
o
g
ly
co
s
id
es,
t
h
ir
d
-
g
en
er
ati
o
n
ce
p
h
alo
s
p
o
r
in
s
,
co
tr
im
o
x
az
o
le,
f
lu
o
r
o
q
u
in
o
lo
n
es,
an
d
h
ig
h
e
r
-
g
e
n
er
atio
n
in
je
ctab
les [
2
4
]
.
Gr
am
-
n
eg
ativ
e
o
r
g
an
is
m
s
ar
e
h
ig
h
ly
s
u
s
ce
p
tib
le
to
I
m
ip
e
n
em
(
8
4
.
5
4
%),
Me
r
o
p
en
em
(
8
1
.
8
4
%),
Am
ik
ac
in
(
8
0
.
8
0
%),
a
n
d
Gen
tam
icin
(
7
8
.
7
4
%),
with
lo
w
s
u
s
ce
p
tib
ilit
y
to
C
ip
r
o
f
lo
x
ac
in
,
C
ef
ix
im
e,
an
d
C
o
tr
im
o
x
az
o
le
(
3
0
–
3
5
%).
Gr
a
m
-
p
o
s
itiv
e
b
ac
ter
ia:
Fu
lly
s
en
s
itiv
e
to
Van
co
m
y
c
in
,
with
h
ig
h
s
u
s
ce
p
tib
ilit
y
to
L
in
ez
o
lid
(
8
8
.
9
%)
an
d
T
ei
co
p
lan
in
(
9
4
.
4
%).
Nitr
o
f
u
r
an
to
i
n
s
h
o
wed
5
0
%
ef
f
icac
y
a
g
ain
s
t
GPB
,
wh
ile
lo
wer
s
en
s
itiv
ity
was
n
o
ted
to
p
e
n
icillin
s
,
C
ip
r
o
f
lo
x
ac
in
,
a
n
d
Am
in
o
g
ly
c
o
s
id
es [
2
]
.
4
.
8
.
I
m
pli
ca
t
i
o
ns
f
o
r
a
nte
na
t
a
l
ca
re
T
h
e
p
r
esen
t stu
d
y
u
n
d
er
s
co
r
es
a
ch
an
g
i
n
g
etio
lo
g
ical
tr
en
d
,
with
S
ta
p
h
ylo
c
o
cc
u
s
a
u
r
eu
s
em
er
g
in
g
as
a
s
ig
n
if
ican
t
p
ath
o
g
en
in
asy
m
p
to
m
atic
b
ac
ter
iu
r
ia
am
o
n
g
p
r
eg
n
a
n
t
wo
m
en
.
Alar
m
in
g
ly
h
ig
h
r
esis
tan
ce
was
n
o
ted
to
co
m
m
o
n
ly
p
r
escr
ib
e
d
an
tib
io
tics
s
u
ch
as
Am
p
icillin
,
Am
o
x
y
clav
,
a
n
d
N
o
r
f
lo
x
a
cin
.
T
h
ese
f
i
n
d
in
g
s
em
p
h
asize
th
e
cr
itical
im
p
o
r
t
an
ce
o
f
r
o
u
tin
e
u
r
i
n
e
cu
ltu
r
e
an
d
s
en
s
itiv
ity
test
in
g
as
p
ar
t
o
f
an
ten
atal
ca
r
e,
co
u
p
led
with
co
n
tin
u
o
u
s
lo
ca
l
s
u
r
v
eillan
ce
o
f
m
icr
o
b
ial
p
r
e
v
alen
ce
an
d
r
esis
tan
ce
p
atter
n
s
.
J
u
d
icio
u
s
an
tib
io
tic
u
s
e
an
d
th
e
tailo
r
in
g
o
f
tr
ea
tm
en
t
p
r
o
t
o
co
ls
to
lo
ca
l
r
esis
tan
ce
p
r
o
f
iles
ar
e
ess
en
tial
to
en
s
u
r
e
e
f
f
ec
tiv
e
m
an
ag
em
en
t,
r
ed
u
ce
th
e
r
is
k
o
f
co
m
p
licatio
n
s
,
a
n
d
s
af
eg
u
ar
d
m
ater
n
al
an
d
f
etal
h
ea
lth
o
u
tc
o
m
es.
5.
CO
NCLU
SI
O
N
T
h
e
p
r
esen
t
s
tu
d
y
r
ev
ea
ls
a
n
in
cr
ea
s
in
g
p
r
ev
alen
ce
o
f
a
s
y
m
p
to
m
atic
b
ac
ter
iu
r
ia
(
ASB
)
am
o
n
g
p
r
eg
n
a
n
t
wo
m
en
.
W
h
ile
p
r
ev
io
u
s
r
esear
ch
h
as
co
m
m
o
n
l
y
id
en
tifie
d
E
s
ch
erich
ia
co
li
as
th
e
p
r
ed
o
m
in
an
t
u
r
o
p
ath
o
g
en
,
th
is
s
tu
d
y
h
ig
h
li
g
h
ts
th
e
e
m
er
g
e
n
ce
o
f
S
ta
p
h
y
lo
co
cc
u
s
a
u
r
eu
s
as
a
s
ig
n
if
ica
n
t
ca
u
s
ativ
e
a
g
en
t,
in
d
icatin
g
a
s
h
if
tin
g
m
icr
o
b
ial
p
atter
n
.
ASB
was
f
o
u
n
d
to
b
e
m
o
r
e
co
m
m
o
n
am
o
n
g
wo
m
en
ag
ed
2
1
–
3
0
y
ea
r
s
,
with
h
ig
h
er
p
r
ev
alen
ce
o
b
s
er
v
ed
in
m
u
ltip
a
r
o
u
s
wo
m
en
a
n
d
with
ad
v
a
n
cin
g
m
ater
n
al
ag
e.
T
h
e
s
tu
d
y
also
d
em
o
n
s
tr
a
ted
r
is
in
g
an
tib
io
tic
r
esis
tan
ce
am
o
n
g
u
r
o
p
ath
o
g
en
s
.
R
o
u
tin
e
s
cr
ee
n
in
g
f
o
r
ASB
in
ea
ch
tr
im
ester
o
f
p
r
eg
n
a
n
cy
is
s
tr
o
n
g
ly
r
ec
o
m
m
en
d
ed
.
E
a
r
ly
d
etec
tio
n
a
n
d
ap
p
r
o
p
r
iate
tr
ea
tm
en
t
ca
n
s
ig
n
if
ican
tly
r
ed
u
ce
th
e
r
is
k
o
f
m
ater
n
al
a
n
d
f
etal
co
m
p
licatio
n
s
.
I
n
c
o
r
p
o
r
atin
g
b
a
cter
iu
r
ia
s
cr
ee
n
in
g
in
to
s
tan
d
ar
d
an
te
n
atal
ca
r
e
p
r
o
to
co
ls
ca
n
en
h
a
n
ce
m
ater
n
al
h
ea
lth
o
u
tco
m
es.
T
h
is
s
tu
d
y
was
co
n
d
u
cted
o
n
a
r
elativ
ely
lim
ited
s
am
p
le
s
ize,
wh
ich
m
ay
n
o
t
f
u
lly
r
e
p
r
esen
t
th
e
lar
g
er
an
ten
atal
p
o
p
u
latio
n
.
B
ein
g
h
o
s
p
ital
-
b
ased
,
th
e
r
esu
lts
m
ay
n
o
t
r
ef
lect
th
e
p
r
ev
alen
ce
a
n
d
m
icr
o
b
ial
p
r
o
f
ile
in
co
m
m
u
n
ity
s
ettin
g
s
.
Ad
d
itio
n
ally
,
m
o
lecu
lar
ch
a
r
ac
ter
izatio
n
o
f
r
esis
tan
t
s
tr
ain
s
an
d
ex
ten
d
ed
-
s
p
ec
tr
u
m
β
-
lacta
m
ase
(
E
SB
L
)
d
etec
tio
n
wer
e
n
o
t
p
er
f
o
r
m
e
d
,
wh
ich
c
o
u
ld
h
a
v
e
p
r
o
v
id
ed
d
ee
p
er
i
n
s
ig
h
ts
in
to
r
esis
tan
ce
m
ec
h
an
is
m
s
.
Fu
tu
r
e
s
tu
d
ies
s
h
o
u
ld
:
i)
I
n
clu
d
e
lar
g
er
,
co
m
m
u
n
ity
-
b
ased
c
o
h
o
r
ts
to
en
h
a
n
ce
g
en
er
aliza
b
ilit
y
;
ii)
E
m
p
lo
y
m
o
lecu
lar
m
eth
o
d
s
f
o
r
p
at
h
o
g
e
n
id
en
tific
atio
n
a
n
d
r
esis
tan
ce
g
en
e
p
r
o
f
ilin
g
;
iii)
E
x
p
lo
r
e
t
h
e
im
p
ac
t
o
f
p
r
e
v
en
tiv
e
s
tr
ateg
ies
s
u
ch
as
h
y
g
ien
e
ed
u
ca
tio
n
,
n
u
tr
i
tio
n
al
in
ter
v
en
tio
n
s
,
an
d
an
ti
b
io
tic
s
tewa
r
d
s
h
ip
p
r
o
g
r
a
m
s
; a
n
d
iv
)
Ass
ess
th
e
l
o
n
g
-
ter
m
m
ater
n
al
a
n
d
n
e
o
n
at
al
o
u
tco
m
es f
o
llo
win
g
ASB
tr
ea
tm
en
t
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
1
5
,
No
.
1
,
Ma
r
ch
20
2
6
:
1
3
2
-
1
39
138
RE
F
E
R
E
NC
E
S
[
1
]
C
.
C
.
E
k
w
e
a
l
o
r
,
C
.
I
.
O
k
o
n
k
w
o
,
V
.
I
.
A
n
y
a
o
h
a
,
a
n
d
M
.
N
.
N
w
o
f
o
r
,
“
U
r
i
n
a
r
y
t
r
a
c
t
i
n
f
e
c
t
i
o
n
a
n
d
a
n
t
i
b
i
o
t
i
c
s
u
s
c
e
p
t
i
b
i
l
i
t
y
p
r
o
f
i
l
e
o
f
u
r
o
p
a
t
h
o
g
e
n
s
a
mo
n
g
p
r
e
g
n
a
n
t
w
o
me
n
i
n
O
g
i
d
i
,
S
o
u
t
h
e
a
st
N
i
g
e
r
i
a
,
”
Af
r
i
c
a
n
J
o
u
r
n
a
l
o
f
Bi
o
m
e
d
i
c
a
l
Re
se
a
r
c
h
,
v
o
l
.
2
7
,
n
o
.
1
,
p
p
.
2
1
–
2
7
,
2
0
1
4
,
d
o
i
:
1
0
.
4
3
1
4
/
a
j
b
r
.
v
2
7
i
1
.
3
.
[
2
]
G
.
M
u
d
e
y
e
t
a
l
.
,
“
B
a
c
t
e
r
i
o
l
o
g
i
c
a
l
p
r
o
f
i
l
e
a
n
d
a
n
t
i
b
i
o
g
r
a
m
o
f
u
r
o
p
a
t
h
o
g
e
n
s
i
so
l
a
t
e
d
f
r
o
m
o
b
s
t
e
t
r
i
c
s
a
n
d
g
y
n
a
e
c
o
l
o
g
y
p
a
t
i
e
n
t
s
i
n
a
t
e
r
t
i
a
r
y
c
a
r
e
h
o
s
p
i
t
a
l
,
”
I
n
t
e
rn
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
R
e
p
r
o
d
u
c
t
i
o
n
,
C
o
n
t
ra
c
e
p
t
i
o
n
,
O
b
s
t
e
t
ri
c
s
a
n
d
G
y
n
e
c
o
l
o
g
y
,
v
o
l
.
1
2
,
n
o
.
6
,
p
p
.
1
6
0
4
–
1
6
0
9
,
2
0
2
3
,
d
o
i
:
1
0
.
1
8
2
0
3
/
2
3
2
0
-
1
7
7
0
.
i
j
r
c
o
g
2
0
2
3
1
5
2
2
.
[
3
]
R
.
T.
B
a
b
a
,
M
.
R
.
A
d
e
d
a
y
o
,
S
.
A
w
e
,
a
n
d
M
.
I
.
B
a
l
e
,
“
A
n
t
i
m
i
c
r
o
b
i
a
l
s
u
sc
e
p
t
i
b
i
l
i
t
y
o
f
u
r
i
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B
I
O
G
RAP
H
I
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S O
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AUTH
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RS
K
.
Mu
r
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sh
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with
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p
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rtme
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with
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S
h
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c
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c
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tac
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m
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:
jav
a
g
a
lsa
th
ish
3
7
@
g
m
a
il
.
c
o
m
.
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