Characteristics of Chryseobacterium bacteremia, associated risk factors and their antibiotic susceptibility pattern at a university hospital: a descriptive, retrospective study
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Introduction. Chryseobacterium species are emerging bacteria capable of causing nosocomial infections in immunocompromised patients or patients with indwelling medical devices.
Hypothesis/ Gap statement. Information about the incidence of Chryseobacterium bacteremia from worldwide literature is limited.
Aim. We aimed to recognize the clinical characteristics, frequency of distribution of different Chryseobacterium species isolates, and their antimicrobial susceptibility profile from bloodstream infections.
Methods. We performed a retrospective cohort study to identify all isolates of Chryseobacterium species from bloodstream infection from January 2018 to November 2022 at a university hospital in North India.
Results. We identified 42 non-duplicate isolates of Chryseobacterium species from bloodstream infection in the duration of our study. Mean age of the patients was 48.35±16.63 years. Men (22/42, 52.2 %) were more commonly affected in comparison to women (20/42, 47.6 %) but the difference was not significant. The most common species identified was C. indologenes (40/42, 95.24 %) followed by C. gleum (2/42, 4.76 %). The co-morbidities commonly encountered in our study were chronic kidney disease (21/42, 50.0 %) followed by diabetes mellitus (12/42, 28.6 %) and chronic obstructive pulmonary disease (8/42, 19.05 %). All patients had intravenous access to medications or fluid management via a central or peripheral line and mechanical ventilation was observed in 39 (39/42, 92.86 %) patients. All the isolates were susceptible to minocycline (100 %), followed by doxycycline (97.6 %) and trimethoprim-sulfamethoxazole (95.2 %).
Conclusion. Chryseobacterium species are capable of causing pneumonia, bacteremia and urinary tract infection in immunocompromised patients. Early diagnosis and prompt treatment with appropriate antibiotics can prevent progression to septicemia.
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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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Comments to Author
1. Methodological rigour, reproducibility and availability of underlying data Additional information were added following the reviewers' recommendation 2. Presentation of results Revision were done and additional information added following the reviewers' recommendation 3. How the style and organization of the paper communicates and represents key findings As the mentioned in my 1st review, most of the key findings had been presented in concise manner 4. Literature analysis or discussion The authors had made the discussion more comprehensive 5. Any other relevant comments Some of the antibiotics names had their first character being capitalized, while others were not. This might need to be standardized: - line 76: "Tigecycline", "Colistin" - small "t" and "c" - line 83: "Macrolide" - small "m"
Comments to Author
1. Methodological rigour, reproducibility and availability of underlying data Additional information were added following the reviewers' recommendation 2. Presentation of results Revision were done and additional information added following the reviewers' recommendation 3. How the style and organization of the paper communicates and represents key findings As the mentioned in my 1st review, most of the key findings had been presented in concise manner 4. Literature analysis or discussion The authors had made the discussion more comprehensive 5. Any other relevant comments Some of the antibiotics names had their first character being capitalized, while others were not. This might need to be standardized: - line 76: "Tigecycline", "Colistin" - small "t" and "c" - line 83: "Macrolide" - small "m" - line 126: Cefoperazone-sulbactam - small "c" - line 261: "Piperacillin" - small "p" Same for line 160: "Gall bladder" - small "g"
Please rate the manuscript for methodological rigour
Very 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
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This study would be a valuable contribution to the existing literature. This is a study that would be of interest to the field and community. The reviewers have highlighted minor concerns with the work presented. Please ensure that you address their comments.
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Comments to Author
Dear Sir/ Madam, Please find my humble comments and suggestions below. 1. Methodological rigour, reproducibility and availability of underlying data: - under the section "Data Collection": Since this study collected data retrospectively over 5 years period, suggest to state the sources where the laboratory data and clinical information were retrieved retrospectively from, such as from Laboratory Information System (LIS), written worksheet, patient's medical records, or any others, etc. - under the section "Antimicrobial Susceptibility Testing": as we understand that at this point, for Chryseobacterium species, there is no interpretation breakpoints for both disc diffusion zone diameter and minimum inhibitory concentration (MIC), neither in CLSI or EUCAST guideline, which are the two most …
Comments to Author
Dear Sir/ Madam, Please find my humble comments and suggestions below. 1. Methodological rigour, reproducibility and availability of underlying data: - under the section "Data Collection": Since this study collected data retrospectively over 5 years period, suggest to state the sources where the laboratory data and clinical information were retrieved retrospectively from, such as from Laboratory Information System (LIS), written worksheet, patient's medical records, or any others, etc. - under the section "Antimicrobial Susceptibility Testing": as we understand that at this point, for Chryseobacterium species, there is no interpretation breakpoints for both disc diffusion zone diameter and minimum inhibitory concentration (MIC), neither in CLSI or EUCAST guideline, which are the two most commonly used guideline in clinical microbiology laboratories worldwide. It is likely that various laboratories are interpreting the disc diffusion or MIC values using some kinds of presumptive interpretation, such as referring to the interpretation breakpoints of other organisms in similar categories. For the antibiotic susceptibility tests results reported in this retrospective study, how the disc inhibition zone diameter and/ or MIC value were interpreted in the authors' laboratory, means how the zone diameter/ MIC values obtained being concluded as "Sensitive" or "Resistant", were not being described. As in the "conclusion" section, line 258-259, the authors gave recommendation on the suitable antibiotic option to treat infection caused by this organism, based on the sensitivity test finding that 100% of Chryseobacterium isolates in the authors' institution are sensitive to minocycline, hence it is important to describe the methodology of how the authors' laboratory interpret minocycline MIC or zone of inhibition as "sensitive". 2. Presentation of results: - Table 1 (Predisposing risk factors in patients with Chryseobacterium spp. bacteremia): some of the abbreviations were not being listed. Row 9 (GIT) and row 10 (CVS), if these are referred to as "gastrointestinal tract" and "cardiovascular system", these are the human body's anatomical region or functional system, these are not underlying medical illness which predisposing patients to infections. Suggest specifically outline the types of gastrointestinal pathology and cardiovascular system disease that the patients are having. - Figure 1 (Antimicrobial susceptibility profile of Chryseobacterium spp.): as mentioned in the methodology section earlier, the authors described that both KB disc diffusion and VITEK 2 AST were being used to performed the antibiotic susceptibility on the Chryseobacterium spp. Suggest to present the MIC values done by VITEK AST card. As for this scenario where there is no interpretation breakpoints in reference guideline, and if the laboratories are doing presumptive interpretation on the susceptibility test results, interpretation based on MIC values will be more accurate compared to disc diffusion. - For the report on antibiotic therapy received by the patients with Chryseobacterium spp., instead of mentioning only the types of antibiotic agents being administered, the presentation could be made more complete by also mentioning the mode of drug administration (such as oral or intravenous) and the duration of antibiotics, if not the dosage regime (understand that this manuscript may not having collaboration with Infectious Disease physicians or clinical pharmacist). As the authors also commented about the patients' outcome and gave recommendation on the suitable antibiotic option for treating infection caused by this organism, hence the prospective readers will be interested to know the mode of administration and duration of antibiotics given, especially in cases with successful treatment. 3. How the style and organization of the paper communicates and represents key findings: Most of the important key findings were outlined in concise manner. 4. Literature analysis or discussion: If the authors are clinical microbiologists and/ or microbiology laboratory personnel, the limitations also includes lack of standardization in interpretation breakpoints for susceptibility testing (both disc diameter and MIC) for Chryseobacterium, in addition to not performing broth microdilution (BMD). 5. Any other relevant comments Thank you
Please rate the manuscript for methodological rigour
Satisfactory
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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Comments to Author
Topic: I suggest it should be modified as the study did not not describe the characteristics of Chryseobacterium species but rather cases where (associated) the pathogen was isolated. Lines 112-113: Do you mean to say positive blood culture from samples collected within 48 hours of admission? Authors may recast statement Lines 117-126: Since no interpretation guidelines for antimicrobial susceptibility currently exist for the pathogen, what was the basis used to categorize isolates as resistant or susceptible to each antimicrobial agent tested. Lines 182-184: Could the high rate of meropenem resistance you reported be attributed to the use of the drug as the empirical choice for treatment in the hospital
Please rate the manuscript for methodological rigour
Good
Please …
Comments to Author
Topic: I suggest it should be modified as the study did not not describe the characteristics of Chryseobacterium species but rather cases where (associated) the pathogen was isolated. Lines 112-113: Do you mean to say positive blood culture from samples collected within 48 hours of admission? Authors may recast statement Lines 117-126: Since no interpretation guidelines for antimicrobial susceptibility currently exist for the pathogen, what was the basis used to categorize isolates as resistant or susceptible to each antimicrobial agent tested. Lines 182-184: Could the high rate of meropenem resistance you reported be attributed to the use of the drug as the empirical choice for treatment in the hospital
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
The current study deals with the "Clinical and microbiological characteristics of Chryseobacterium species isolates from bloodstream infections from a university hospital: a descriptive, retrospective study". Isolates identified and characterized by conventional and MALDI-TOF MS methods and antibiotic susceptibility pattern. The results of this study are interesting and of great importance in respect to the clinical microbiology. However I have several comments which need addressing: 1-A native English speaker should review the manuscript and check all the grammatical errors. Although I have corrected many grammatical errors throughout the manuscript, further proofreading is required. 2- Introduction-line 80 :The name of genes must be written italics throughout the text. 3-line 90- it should be …
Comments to Author
The current study deals with the "Clinical and microbiological characteristics of Chryseobacterium species isolates from bloodstream infections from a university hospital: a descriptive, retrospective study". Isolates identified and characterized by conventional and MALDI-TOF MS methods and antibiotic susceptibility pattern. The results of this study are interesting and of great importance in respect to the clinical microbiology. However I have several comments which need addressing: 1-A native English speaker should review the manuscript and check all the grammatical errors. Although I have corrected many grammatical errors throughout the manuscript, further proofreading is required. 2- Introduction-line 80 :The name of genes must be written italics throughout the text. 3-line 90- it should be written..."and" 4-materials and methods: line 97- Please clarify that did you find any isolate with the taxonomic name Flavobacterium (the previous name of this genus) in the study. If yes, was included in the study? 5-data collection- line 105: blood 6-line 113-For the first time, it is better not to write only abbreviations (BSI) and write in complete 7-line 118- Was the MIC of the isolates determined by the Vitek-2 system? Please clarify. 8-line 119- It is better to write...."antibiotic susceptibility testing (AST)" 9-line 120- "spp." should not be written italics 10-Line 120- Please delete the phrase " antimicrobial susceptibility testing" 11-line 123- Please delete "piperacillin-tazobactam" 12-line 126-Please clarify exactly that, based on the which criteria in the CLSI guideline, the AST results were interpreted via the disc diffusion method. 13-line 128- the use 14-line 129-Please add a dot at the end of the sentence. 15-results-line 136-It is better to write:... In our study, a total of 42 isolates (Chryseobacterium indologenes, n = 40 (%=?); and Chryseobacterium gleum, n = 2 (%=?) were identified from bloodstream infections during the course of five years study period. 16-line 137-If possible, please provide information on MALDI-TOF MS results in the results section. 17-line 139-critical 18-line 140- anesthesia 19-line 140- emergency 20-line 143- Please replace "on" with "or" 21-line 143- Please delete the phrase "clinical diagnosis" 22-line 150-151: Based on the recommendation for line 136, it it better to delete the sentence. 23-line 152-153- In this study, only isolates recovered from the bloodstream infections were included in the study and there was no data about the prevalence of bacteria in another clinical specimen. So, in my opinion, it is better to move this sentence (line 152-153) to the discussion section and discuss this issue based on the results of previous studies. 24-line 155-157: In this section, only 19 cases from 30 cases with co-infections were mentioned with exact name of species. Please mention exact number / percentage for each species. 25-results: Please provide information on the prevalence of these 42 cases of Chryseobacterium infections by year during this 5-year study period in the form of a graph. 26-line 158- Please rewrite the sentence:..." Treatment of all patients with bloodstream infections was empirically started on broad-spectrum antibiotics." 27-line 159-160: Please rewrite the sentence:..."The most common antibiotic prescribed in inpatient wards was meropenem-cilastine in... 28-line 164-cefoperazone (lowercase letter) 29-line 167- According to figure 1, you did not report any isolate with an intermediate pattern to antibiotics. Please mention this in the results section. 30-line 168- were 31-line 170- mortality rate 32-line 170-171-Rewrite the sentence so that the word "Table 2" is placed in parentheses at the end of the sentence. 33-line 170- Please delete the number "54.76%" in the parenthesis. 34-results-line 176- Please state the p-value for the risk factors or refer to the table. 35- line 176- It is better to write "duration of hospitalization" instead of "length of hospital stay" 36-line 182- Bacteremia Should not be written in italics. 37-line 182- ..."Due to handful of patients..."This sentence is ambiguous. Please clarify the exact number and the antibiotic regimen of patients who survived. 38-Discussion- line 197-Please add more similar studies from other regions of the world and discuss your results and others. 39-line 199-Please delete the word "our". 40-line 199- it is better to write..."were hospitalized in the critical care unit" instead of " came from critical care unit" 41-line 209- Please add more similar studies from other regions of the world and discuss your results and others. 42-line 210- "was" should not be written in italics 43-line 213- Please add more similar studies from other regions of the world and discuss your results and others. 44-line 219- Please add space between "to" and "minocycline" 45-line 223- cefoperazone 46-line 225- it should be written AST instead of antibiotic susceptibility testing 47-line 226- Please rewrite the sentence "isolates by broth microdilution...." 48-lines 229, 233, 235, 249: it should be written "susceptible" instead of "sensitive" 49-line 224- Chryseobacterium should be written in italics. 50-Please update the references. Out of 21 references, only 4 were from 2019 and after. 51-The taxonomic name of the species must be written in italics. Please correct this in the reference section. 52-It is better to delete table 1 and transfer the information from table 1 to table 2. Please add the p-value for these risk factors and add it to table 2. Please add CVS and GIT in the abbreviations section and write "history of" instead of H/O. Finally, please remove "table 1" and correct the number of table 2 throughout the manuscript. 53-In my opinion, the graph could not represent exact information about the AST. Please delete figure 1 and present the data of AST as a table and mention the number/% of isolates susceptible, intermediate or resistant to each antibiotic. 54-If information is available, please add the number/ % of survived and dead patients with co-infection in the table 2. 55-Table 2- survived(n=19) 56-Table 2-Of 19 surviving patients with bacteremia, 73.7% did not receive appropriate antibiotics. Of 23 dead patients, in comparison with surviving patients, a higher number of them received suitable antibiotics. According to the literature review, please discuss possible reasons for surviving patients.
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
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