One year experience of Achromobacter bacteremia at a tertiary care hospital in Northern India
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Introduction. Achromobacter is a Gram-negative, motile, obligate aerobic and non-fermentative bacterium. It is an emerging pathogen in the hospital environment as it is frequently found in various solutions.
Hypothesis/Gap Statement. Information about the incidence and risk factors of Achromobacter bacteremia from India is limited.
Aim. We conducted this study to identify the risk factors and underlying conditions predisposing to bacteremia by Achromobacter spp. and analyse the antibiotic resistance pattern of the isolates.
Methodology. We performed a retrospective observational study where automated blood cultures positive for Achromobacter spp. were assessed for clinical characteristics and antibiotic susceptibility patterns from January 2022 to December 2022 in the microbiology laboratory of a tertiary care centre in Northern India.
Results. A total of 14 cases (14/2435, 0.57 %) of Achromobacter spp. were identified from bloodstream infections in one year. The mean age of the patients was 37.59±23.17 years with a male predominance (8/14, 57.1 %). All patients were managed on intravenous antibiotics and intravenous access as peripheral line catheters and only 5(5/14, 35.7 %) patients were managed on central line catheters. The isolates were found highly susceptible to ticarcillin-clavulanic acid (14/14, 100.0 %) followed by fluoroquinolones (12/14, 85.72 %) and trimethoprim-sulphamethoxazole (12/14, 85.72 %). Only 57.14 % (8/14, 57.14 %) of the patients were susceptible to piperacillin-tazobactam. The all-cause 40 day mortality was observed in 35.7 % (5/14, 35.7 %) with two deaths that were directly attributable to sepsis.
Conclusion. This study provides insight into the incidence of Achromobacter bacteremia at our centre and the necessary antibiotic therapy to combat it.
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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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I see the revised version of this manuscript is suitable for publication in Access Microbiology.
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
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The reviewers have highlighted minor concerns with the work presented. Please ensure that you address their comments.
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Comments to Author
1. Methodological rigour, reproducibility and availability of underlying data. The methodology is well presented, even though, the study design needs to be more defined and contextualized. The data underlying the findings have been made available by the authors. 2. Presentation of results The results are well captured. 3. How the style and organization of the paper communicates and represents key findings The manuscript has been presented in an intelligent fashion and written in standard English. The data supports conclusions. 4. Any other relevant comments - Consider revising the entire manuscript to delete repetitions and correct minor grammatical errors e.g., line 47, line 228…etc. - Under inclusion criteria, what was the rationale for assuming that isolates collected after 48 hours of …
Comments to Author
1. Methodological rigour, reproducibility and availability of underlying data. The methodology is well presented, even though, the study design needs to be more defined and contextualized. The data underlying the findings have been made available by the authors. 2. Presentation of results The results are well captured. 3. How the style and organization of the paper communicates and represents key findings The manuscript has been presented in an intelligent fashion and written in standard English. The data supports conclusions. 4. Any other relevant comments - Consider revising the entire manuscript to delete repetitions and correct minor grammatical errors e.g., line 47, line 228…etc. - Under inclusion criteria, what was the rationale for assuming that isolates collected after 48 hours of admission were of nosocomial origin? Kindly justify. - What is the external validity of your research findings? - Were all positive blood cultures (for the true pathogens) within the one year of study period considered for analysis? If not, which sampling techniques was used to come up with the 14 cases? - Is there specific age bracket that is more vulnerable to infection with Achromobacter bacteria? Kindly justify the age choice for your study population. - This finding… "Carbapenems administration (p-value= 0.038) was more significantly associated with patients that died. Procalcitonin levels (p-value= 0.05) were found to be significantly raised in patients who died" needs to be explained under the discussion section
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?
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. The incidence of Achromobacter bacteremia requires multicenters study, as the authors mentioned in the limitations section. 2. Also, the authors didn't mention the incidence in their center. 3.Were the cases single infections with Achromobacter spp. only or mixed with other species?. If were mixed infections, please mention, commonly mixed with what?. 4.The authors didn't mention, did the cases admitted to the hospital with Achromobacter infection or acquired it during the hospital stay?. 5.For the conflicts of interest section: Please acknowledge their is no conflicts of interest. 6. For the consent of publication section: How????????? All individuals have given consent to participate in the study. & the author mentioned in the methods section: Informed consent was …
Comments to Author
1. The incidence of Achromobacter bacteremia requires multicenters study, as the authors mentioned in the limitations section. 2. Also, the authors didn't mention the incidence in their center. 3.Were the cases single infections with Achromobacter spp. only or mixed with other species?. If were mixed infections, please mention, commonly mixed with what?. 4.The authors didn't mention, did the cases admitted to the hospital with Achromobacter infection or acquired it during the hospital stay?. 5.For the conflicts of interest section: Please acknowledge their is no conflicts of interest. 6. For the consent of publication section: How????????? All individuals have given consent to participate in the study. & the author mentioned in the methods section: Informed consent was waived off given our study is retrospective. ??????????????????? 7. Please update the references.
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?
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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