Unusually isolated Staphylococcus arlettae in intra-oral sutures - Case series
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Introduction. The human oral cavity comprises various niches such as teeth, gingiva, tongue, soft and hard palate, and various dental prostheses, all inhabited by different bacterial species. Although more than 600 taxa belong to the oral cavity, identifying Staphylococcus arlettae , an incompletely understood bacterium, has been rare.
Methods. Three patients who underwent periodontal flap surgeries were reported with the incidental finding of S. arlettae associated with the intra-oral sutures placed. Environmental sampling was performed, to establish the exact source of this bacterium.
Results. Staphylococcus arlettae was isolated in three patients’ intra-oral sutures. All environmental samples were negative for the presence of the bacterium.
Conclusion . To this date, no studies have identified such an occurrence of Staphylococcus arlettae with intra-oral sutures. Its identification in association with foreign materials, such as sutures, can be considered a potential for surgical site infections and requires further investigation.
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Thank you for making the small amendments required.
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Thank you for addressing some of the reviewers comments. The manuscript is in a good state and is suitable for publication as it is, but I would like some minor edits to be done before sending it through for final publication please. 1. Line 39- please add "however" in between They are *however* among the most..... 2. Line 52/53- the authors state "Here, we have isolated a S. arlettae strain", but you have isolated multiple strains- the AMR data indicate that the isolations from each patient are not the one strain. Please amend the sentence. 3. Line 181- I don't think the manuscript referenced in ref No.18 can really be described as a recent observation of fimbriae-like structures- it was published in 1996. Please amend the sentence. 4. Lines 200-202- it is still not clear what role genome sequencing would play in "prove the …
Thank you for addressing some of the reviewers comments. The manuscript is in a good state and is suitable for publication as it is, but I would like some minor edits to be done before sending it through for final publication please. 1. Line 39- please add "however" in between They are *however* among the most..... 2. Line 52/53- the authors state "Here, we have isolated a S. arlettae strain", but you have isolated multiple strains- the AMR data indicate that the isolations from each patient are not the one strain. Please amend the sentence. 3. Line 181- I don't think the manuscript referenced in ref No.18 can really be described as a recent observation of fimbriae-like structures- it was published in 1996. Please amend the sentence. 4. Lines 200-202- it is still not clear what role genome sequencing would play in "prove the pathogenicity of this bacterium in regard to the oral environment". I would change the sentence to say "However, further studies are required to demonstrate the pathogenic potential of this bacterium in regard to the oral environment." Other than those minor things, it is good to go.
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The two peer review reports for this manuscript both recommend minor revisions before it can be accepted. Please can you address all reviewer comments below. Both reviewers have flagged the need for careful proof reading of your manuscript, so please pay close attention to this and ensure these issues are addressed throughout the manuscript, not just in the few instances that the reviewers have specified.
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Comments to Author
Dear Authors, The case series was interesting, but more information are require. Please refer to my comments below; 1. Please recheck sentence structures such as full stops, hyphens etc. 2. What is NAM in figure 1. PGLA in figure 2 3. Sub-Numbering can be added in figure 1 to make it clearer. 4. What is D in figure 2? 5. Please state which patient has discomfort for up to 4 days, as readers can relate it to the photo given and would be interesting if authors could compare the clinical appearance and other related information between the three patients such as comorbidities in table 1 etc and discussed them. 6. It is unclear whether chlorhexidine was prescribed to the patient and if it was, please state to which patient. As its relation to figure 2 was unclear. 7. The information related to the …
Comments to Author
Dear Authors, The case series was interesting, but more information are require. Please refer to my comments below; 1. Please recheck sentence structures such as full stops, hyphens etc. 2. What is NAM in figure 1. PGLA in figure 2 3. Sub-Numbering can be added in figure 1 to make it clearer. 4. What is D in figure 2? 5. Please state which patient has discomfort for up to 4 days, as readers can relate it to the photo given and would be interesting if authors could compare the clinical appearance and other related information between the three patients such as comorbidities in table 1 etc and discussed them. 6. It is unclear whether chlorhexidine was prescribed to the patient and if it was, please state to which patient. As its relation to figure 2 was unclear. 7. The information related to the resorbable suture was lack of discussion, please add related studies. 8. It would also be interesting if the authors could discuss the antibiotic's results.
Please rate the quality of the presentation and structure of the manuscript
Satisfactory
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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Comments to Author
[Delete this text before submitting your review. Please include comments to the author here, and include the below sections, where possible. All comments here will be posted publicly online alongside the article once the Editor has made a decision.] 1. Description of the case(s) The article titled "Unusually isolated Staphylococcus arlettae in intra-oral sutures- Case series" describes the isolation and identification of a coagulase negative Staphylococcal species in clinical samples. S. arlettae is rarely found in a clinical setting and has not been studied to the same degree as similar Staphylococcal species, so less is known about its environmental preferances. The study gives a succinct methodology and identification, as well as discussion about where the organism may be located in the clinical …
Comments to Author
[Delete this text before submitting your review. Please include comments to the author here, and include the below sections, where possible. All comments here will be posted publicly online alongside the article once the Editor has made a decision.] 1. Description of the case(s) The article titled "Unusually isolated Staphylococcus arlettae in intra-oral sutures- Case series" describes the isolation and identification of a coagulase negative Staphylococcal species in clinical samples. S. arlettae is rarely found in a clinical setting and has not been studied to the same degree as similar Staphylococcal species, so less is known about its environmental preferances. The study gives a succinct methodology and identification, as well as discussion about where the organism may be located in the clinical setting. 2. Presentation of results The results followed the methods and were succinctly presented. 3. How the style and organization of the paper communicates and represents key findings The style and organization of the paper were done well and communicated to the audience what they needed to know about the results. 4. Literature analysis or discussion The literature analysis was mostly good. It would help the authors case to cite a reference(s) about S. arlettae being teh cause of disease. The Discussion starts with talking about the virulence factors that S. arlettae does and doesn't possess, but then goes on to debate whether it is a commensal or not. Being associated with a disease in one immunocompromised individual is not the same as being consider virulent, at best it is an opportunistic pathogen. The same case could be made for S. epidermidis, that is is a commensal that can be an opportunistic pathogen, and that the organism is able to cause disease by exploiting innate physiology and not virulence factors that are specific to a host. Line 207-209: What benefit would whole genome sequencing do to prove pathogenicity if there is no normal disease state? The final paragraph of the discussion seems out of place in recommending a remedy when no further studies were performed to show that burden of S. arlettae in sutures is reduced when treated with Chlorhexidine. In particular, you just spent time making an argument that S. arlettae seems to have a preferred environmental niche that may indicate it would be harder to remove from man-made substances like sutures. In the conclusion, one again, S. arlettae were not shown to be the sole cause of bacteremia. 5. Any other relevant comments My recommendation is to accept with minor revisions. There are a few concerning items in the discussion and conclusions, but are minor. In addition, the manuscript would benefit from significant proof-reading for grammatical errors. The items elow need attention: Line 39-40: "However, currently, they are among…" "however" or "currently", not both Line 52: It would be good to cite a case of S. arlettae in blood of cardiovasular disease patient Line 127 & 128: "in vitro" should be italicized Fig2: Caption for part "D" is missing. Line 168: Should be "epidermidis" not "epidermis" Line 186: Formatting- double comma Line 187: sp. Fibriae-like Line 221: "in situ" should be italicized Table 1-Last row: italicize bacteria names Access Microbiology uses Vancouver citation style, it would make the paper easier to review if this was done ahead of time.
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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