Yokenella regensburgei urinary tract infection in an immunocompetent patient: a case report
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Yokenella regensburgei , belonging to the order Enterobacterales , is a rare and emerging human pathogen reported to cause both superficial and invasive infections. The 13 case reports in the literature worldwide highlight blood, bone and wound infections. To our knowledge this is the first case description of Y. regensburgei causing a urinary tract infection in a 69-year-old immunocompetent patient which was isolated in two separate specimens and identified using matrix-assisted laser desorption ionization time-of-flight MS. It was found to be susceptible to most antimicrobials but resistant to penicillin, amoxicillin-clavulanate, cefoxitin and colistin. Inducible chromosomal ampC resistance was demonstrated on disc approximation testing, and bla YOC-1 class C beta-lactamase, beta lactamase superfamily and MBL fold metallo-hydrolase genes were found on whole genome sequencing.
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I am pleased to tell you that your article has now been accepted for publication in Access Microbiology.
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Thank you for revising your manuscript in line with reviewer comments. I would like to give you the opportunity to incorporate into your manuscript your responses to reviewer 1's comments listed 3,4,5 in your response to reviewer table. The report will be more informative and useful to future cases with these comments in the main text e.g. I might be misleading to state the patient had no significant history, when there was a history of UTI and this information can only be found in the response to reviewers. In addition, please also upload the photo of the signed consent into the file inventory.
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The work presented is clear and the arguments well formed. This study would be a valuable contribution to the existing literature. The reviewers have highlighted minor concerns with the work presented. Please ensure that you address their comments. The reviewers found your case report interesting and valuable and have suggested some minor amendments to improve the manuscript. Please address all reviewer comments in a revised manuscript.
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Comments to Author
The case description was thorough with details especially in identification of the organism and antimicrobial susceptibility testing. The case was straight forward, but as it was a rare pathogen, it was worth sharing among colleagues, especially being the first documented case of causing UTI. Literature review was meticulous and summaries of each case was very useful. Discussion was detailed and compared with previous literatures. Overall, it was a great case report. As a minor amendment, I would like the author to include the dosage and detailed route of cefaperazone-sulbactam given and mention other blood investigations results if performed such as CRP/ESR or procalcitonin and full blood count: these to correlate the positive microbiology result with patient's systemic response and parameters.
Comments to Author
The case description was thorough with details especially in identification of the organism and antimicrobial susceptibility testing. The case was straight forward, but as it was a rare pathogen, it was worth sharing among colleagues, especially being the first documented case of causing UTI. Literature review was meticulous and summaries of each case was very useful. Discussion was detailed and compared with previous literatures. Overall, it was a great case report. As a minor amendment, I would like the author to include the dosage and detailed route of cefaperazone-sulbactam given and mention other blood investigations results if performed such as CRP/ESR or procalcitonin and full blood count: these to correlate the positive microbiology result with patient's systemic response and parameters.
Please rate the quality of the presentation and structure of the manuscript
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
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Comments to Author
For accurate identification, Why identification was not confirmed at molecular level e.g. 16S rRNA and gyrB gene sequencing. 16S rRNA gene sequencing is preferential over MALDI-TOF MS for definitive species identification. Clarify MALDI-TOF MS identification score in methodology and mention their limitations in discussion section. Scheduled identification and species characterization. Urine samples best to be cultivated on CLED agar media Lack of full Description of colony character and morphology of gram-stained film Update the references.
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, …
Comments to Author
For accurate identification, Why identification was not confirmed at molecular level e.g. 16S rRNA and gyrB gene sequencing. 16S rRNA gene sequencing is preferential over MALDI-TOF MS for definitive species identification. Clarify MALDI-TOF MS identification score in methodology and mention their limitations in discussion section. Scheduled identification and species characterization. Urine samples best to be cultivated on CLED agar media Lack of full Description of colony character and morphology of gram-stained film Update the references.
Please rate the quality of the presentation and structure of the manuscript
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
Dear Authors, Kindly find my comments below. 1. Description of the case(s): Need more details for instance( Did the patient have a previous history of UTI)?, Did the infection appear before or after suprapubic? Do you think that the suprapubic had a role for causing infection? 2. Presentation of results: Fig 1 for Antibiotics, ament title for inhibitory activity of antibiotic 3. Kindly mention to the Incubation temperature
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 …
Comments to Author
Dear Authors, Kindly find my comments below. 1. Description of the case(s): Need more details for instance( Did the patient have a previous history of UTI)?, Did the infection appear before or after suprapubic? Do you think that the suprapubic had a role for causing infection? 2. Presentation of results: Fig 1 for Antibiotics, ament title for inhibitory activity of antibiotic 3. Kindly mention to the Incubation temperature
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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