A cross-sectional study in critically ill patients affected by COVID-19 in an intensive care unit: would Acinetobacter baumannii resistant to carbapenems be the biggest villain?
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Aim: to describe cases of infection of Acinetobacter baumannii (A. baumannii ) in critically ill patients affected by COVID-19, admitted to an intensive care unit (ICU), using dexamethasone. Methodology: cross-sectional study conducted on patients admitted to the intensive care unit COVID-19 survey among hospitalized patients from November 2020 to March 2021. Setting: large hospital, reference for caring for patients with COVID-19 in Bahia (Brazil). Patients: a convenience sample of 22 patients admitted to the COVID ICU signed the consent form agreeing to participate in the study. Three patients were excluded for having decided to participate without signing the form. Results: of the 22 patients listed, 45 % (10) had blood infection or mechanical ventilation-associated pneumonia by A. baumannii in blood cultures and/or tracheal aspirate secretion. We observed that there is a moderate correlation between the length of stay and infection by A. baumannii (Spearman’s ρ; 0.592; p -value<0.005) and a strong correlation between the number of days on mechanical ventilation and infection by these bacteria (Spearman’s ρ; 0.740; p -value<0.001). This percentage is higher than the value of 0.62 % of infection by A. baumannii in this ICU in the same period of the year before COVID-19 ( p -value<0.0001). Conclusions: hospitals that receive patients with COVID-19 may be vulnerable to outbreaks of multi-drug resistant organisms, such as A. baumannii . It is worth reflecting on the care and operational practices in handling these patients, especially in isolation and restriction measures for those from other nosocomial areas.
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The work presented is clear and the arguments well formed.
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Comments to Author
1. Methodological rigor, reproducibility and availability of underlying data: The case series is small but well described. As pointed out by the authors, WGS would have been required to identify possible sources of colonization - either pre-admission or post admission. 2. Presentation of results: Good descriptive of the patient cohort against a historical control group. Some linkage of clinical findings with outcomes given - creatinine levels correlated strongly with outcome in colonized patients and moderately with non-colonized patients. Antibiotic histories for each patient could be considered. The changes described associated with the hospital response to COVID in this ICU clearly impacted the acquisition of CRAB. This may have wider implications for patients on MV but would require a …
Comments to Author
1. Methodological rigor, reproducibility and availability of underlying data: The case series is small but well described. As pointed out by the authors, WGS would have been required to identify possible sources of colonization - either pre-admission or post admission. 2. Presentation of results: Good descriptive of the patient cohort against a historical control group. Some linkage of clinical findings with outcomes given - creatinine levels correlated strongly with outcome in colonized patients and moderately with non-colonized patients. Antibiotic histories for each patient could be considered. The changes described associated with the hospital response to COVID in this ICU clearly impacted the acquisition of CRAB. This may have wider implications for patients on MV but would require a better understanding of the potential mechanism(s) of colonization. This would need more data availability for analysis - in particular sequence based data - which was recognized as a weakness.. 3. How the style and organization of the paper communicates and represents key findings The rationale, clinical findings and a discussion of their implications is logically presented. 4. Literature analysis or discussion A series of similar cases presented and reviewed. 5. Any other relevant comments As pointed out by the authors, WGS would have been required to identify possible sources of colonization - either pre-admission or post admission. The changes described associated with the hospital response to COVID in this ICU clearly impacted the acquisition of CRAB. This may have wider implications for patients on MV but would require a better understanding of the potential mechanism(s) of colonization. This would need more data availability for analysis - in particular sequence based data. A strong learning point from this analysis is the recognition that WGS is still not regarded / available as a basic aspect of a modern microbiology infrastructure. This needs increasingly highlighted by journals publishing this type of manuscript as its absence leaves significant questions unanswered. Some general points: L53 needs updated as there are treatment options now available The CRAB mnemonic is used inconsistently
Please rate the manuscript for methodological rigour
Good
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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The reviewers have highlighted major concerns with the work presented. Please ensure that you address their comments. The language used is poor, which can cause ambiguity at times. Please carefully rewrite it. We offer a discounted translation service, Editage (https://www.editage.com/; see https://www.microbiologyresearch.org/prepare-an-article#13 for more information).
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Comments to Author
This is a cross-sectional study conducted on patients admitted to the intensive care unit COVID-19 of a COVID reference hospital in Salvador, Bahia, Brazil. The study show that there is a moderate correlation between the length of stay and infection by A. baumannii (Spearman's ρ; 0.592; p-value) and a strong correlation between the number of days on mechanical ventilation and colonization by A. baumannii (Spearman's ρ; 0.740; p-value) The objectives and methods are well defined. And the results presented are clear. The discussion could include other paper published with Brazilian data to compare with the finds of present study. The title of Table 1 needs to be modified. I suggest "patients' demographic and laboratory" The authors did not inform the limitations related to the small number of …
Comments to Author
This is a cross-sectional study conducted on patients admitted to the intensive care unit COVID-19 of a COVID reference hospital in Salvador, Bahia, Brazil. The study show that there is a moderate correlation between the length of stay and infection by A. baumannii (Spearman's ρ; 0.592; p-value) and a strong correlation between the number of days on mechanical ventilation and colonization by A. baumannii (Spearman's ρ; 0.740; p-value) The objectives and methods are well defined. And the results presented are clear. The discussion could include other paper published with Brazilian data to compare with the finds of present study. The title of Table 1 needs to be modified. I suggest "patients' demographic and laboratory" The authors did not inform the limitations related to the small number of participants included in this case series, which could make it difficult to extrapolate the findings. Minor amendment.
Please rate the manuscript for methodological rigour
Good
Please rate the quality of the presentation and structure of the manuscript
Very good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
-
Comments to Author
1. Methodological rigour, reproducibility and availability of underlying data: Important aspect of the current COVIC-19 pandemic which usefully points to the need for more informative in ICU setting. The inclusion of infected, colonized and coinfected introduces confounders difficult to control for in the analysis. Some terminology needs expanded e.g. what are invasive therapies. 2. Presentation of results L106 - was the comparable period 1 year before similar in patient conditions of those admitted to icu - perhaps described in the Methods or Discussion. L107 - is it LOS in ICU or LOS in hospital L109 - 112: The results section merges here into a referenced discussion - each section should be kept separate, and the Results section used for documenting the study results. The order of presentation …
Comments to Author
1. Methodological rigour, reproducibility and availability of underlying data: Important aspect of the current COVIC-19 pandemic which usefully points to the need for more informative in ICU setting. The inclusion of infected, colonized and coinfected introduces confounders difficult to control for in the analysis. Some terminology needs expanded e.g. what are invasive therapies. 2. Presentation of results L106 - was the comparable period 1 year before similar in patient conditions of those admitted to icu - perhaps described in the Methods or Discussion. L107 - is it LOS in ICU or LOS in hospital L109 - 112: The results section merges here into a referenced discussion - each section should be kept separate, and the Results section used for documenting the study results. The order of presentation is out of synch as after this discussion the patient profiles are then introduced. L115 - what is the outcome described L118 - . How was the impact of additional coinfections handled to avoid confounding impact on outcomes. L120 - describing the patient cohort would be best done in the methods section. L133 is part discussion part results merged 3. How the style and organization of the paper communicates and represents key findings I found the manuscript content lay out somewhat difficult to follow with some overlap between the sections. L86 - Fusion of the virus name (SARS-CoV-2) with the clinical condition COVID-19 should be avoided. 4. Literature analysis or discussion Well discussed 5. Any other relevant comments: The English should be reviewed by a native speaker.
Please rate the manuscript for methodological rigour
Poor
Please rate the quality of the presentation and structure of the manuscript
Poor
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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