Water and foodborne bacterial pathogens isolated from hospitalized children are extensively resistance against commonly used Penicillin-type antibiotics in developing countries
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Diarrheal diseases pose a significant risk to children under the age of five, ranking as the second leading cause of death within this demographic. This threat is exacerbated by the emergence of multidrug-resistant enteric bacteria, contributing to the ongoing global health crisis. This study aims to identify prevalent bacteria responsible for diarrhea and evaluate their susceptibility to antibiotics in children under five receiving medical attention at a model Kenyan hospital; Muhoroni County Hospital. Varied approaches comprising biochemical analyses, microbial monitoring and susceptibility testing were conducted using conventional antibiotics on carefully collected patients’ samples to assess respective trends. Enteric bacterial pathogens were identified in 43 out of 196 samples (21.9%), with Escherichia coli constituting 25 out of 43 (58.1%), Shigella spp. accounting for 11 out of 43 (25.6%), and Salmonella spp. making up 7 out of 43 (16.3%). All isolated E. coli, Shigella spp., and Salmonella spp. demonstrated susceptibility to Ceftriaxone. Notably, 14 out of 25 (56%), E. coli isolates and 13 out of 25 (52%) E. coli isolates, 11 out of 11 (100%) and 10 out of 11(91%) Shigella spp. isolates, and finally 6 out of 7 (86%) and 5 out of 7(71%) Salmonella spp. showed resistance to Amoxicillin and Ampicillin respectively, commonly prescribed drugs for children under five years. The findings underscore the prevalence of enteric bacterial pathogens contributing to diarrhea in children under five, emphasizing the urgent need for targeted interventions. Furthermore, the observed resistance to commonly prescribed antibiotics highlights the imperative for ongoing surveillance and development of alternative treatment strategies to address the evolving landscape of antimicrobial resistance in pediatric healthcare.
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We have now received expert reviewer comments for your paper, and based on these comments and my assessment, I am sorry to inform you that your manuscript is not suitable for publication in Access Microbiology
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Comments to Author
The researchers have conducted extensive study on the bacteria isolated from stool samples of diseased children, there identification , associated factors with disease and the antimicrobial susceptibility patterns. They have addressed the given comments to a reasonable extent. However, the overall conclusion derived from the research and its significance to the clinical practice is unclear. For example, isolation of E coli from stool samples of patients , without the further strain identification, has no clinical significance since E coli can present in stools of a normal person. Since the viral studies have not been performed , we cant exactly exclude a viral etiology for diarrhea while presence f E coli is may not have a clinical significance. Some of the given references are more than 15 years …
Comments to Author
The researchers have conducted extensive study on the bacteria isolated from stool samples of diseased children, there identification , associated factors with disease and the antimicrobial susceptibility patterns. They have addressed the given comments to a reasonable extent. However, the overall conclusion derived from the research and its significance to the clinical practice is unclear. For example, isolation of E coli from stool samples of patients , without the further strain identification, has no clinical significance since E coli can present in stools of a normal person. Since the viral studies have not been performed , we cant exactly exclude a viral etiology for diarrhea while presence f E coli is may not have a clinical significance. Some of the given references are more than 15 years old, which may lead to out dated information. The title is misleading as it mentions as 'developing countries, but the study was conduced only in one hospital setting of a single country. Typing errors are still there . Since all these bacteria are feco-orally transmitted the significance of Table 3.3 in this study is not clear. A
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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The reviewers have highlighted major concerns with the work presented. Please ensure that you address their comments.
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Comments to Author
* The researchers have conducted an extensive study , but the presentation of methodology, results and discussion seems very disorganized. * The data were collected in 2016, ( ie 7 years back) the the epidemiology and organism profile and the antibiotic sensitivity patterns may have changed to significant level by now .Therefore the sentence 'The investigation highlights an urgent need for effective surveillance on bacterial pathogenicity among children below 5 years, antimicrobial stewardship, and alternative treatment strategies to combat the growing threat of multidrug resistant enteric bacteria in this vulnerable population.' become invalid. * The inclusive criteria is 'children who were seeking medical care in the hospital who had experienced three or more episodes of diarrhea, with or without …
Comments to Author
* The researchers have conducted an extensive study , but the presentation of methodology, results and discussion seems very disorganized. * The data were collected in 2016, ( ie 7 years back) the the epidemiology and organism profile and the antibiotic sensitivity patterns may have changed to significant level by now .Therefore the sentence 'The investigation highlights an urgent need for effective surveillance on bacterial pathogenicity among children below 5 years, antimicrobial stewardship, and alternative treatment strategies to combat the growing threat of multidrug resistant enteric bacteria in this vulnerable population.' become invalid. * The inclusive criteria is 'children who were seeking medical care in the hospital who had experienced three or more episodes of diarrhea, with or without vomiting, within a 24-hour period' - but usually the antibiotics are not prescribed for such short term diarrheal illness , therefore, checking ABST making recommendations based on that has less validity in my opinion * Maintain uniformity in writing subtitles - some are italicized, some are not * Line 133: you have mentioned as '(insert reference)' ! - No references inserted * Line 141 : What is MAC agar ? * Please re-organize the results section.The results of different components the study are scattered in a very unorganized manner. * Table 3.1 gives KIA test results- but the methodology has no mentioning on using KIA * Please re organize the discussion * Including the mechanism of action of antibiotics in the discussion seems irrelevant and unnecessary *I would suggest to include the other common etiologies of childhood diarrhoea in the introduction and the discussion ( Eg: Viral causes are the most common)
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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The reviewers have highlighted major concerns with the work presented. Please ensure that you address their comments. You have not addressed the reviewers’ comments sufficiently after revision.
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Comments to Author
To authors The following manuscript deals with an important public health issue; particularly, for developing countries. The authors have successfully identified an area, but unfortunately, the manuscript lacks important elements and has serious issues as explained in detail. Perhaps, if these can be fixed, not sure. I made diligent efforts and spent a great deal of time to help authors improve their manuscript to the standard of the journal but unfortunately, I'm forced to indicate that no much cooperation was shown. Responses were very brief quite often joining my comments for different Lines together and mentioning just a phrase or short sentence such as "this is done", this clear", this is correct", which might even imply they think it was already clear. No specific indication that they have done …
Comments to Author
To authors The following manuscript deals with an important public health issue; particularly, for developing countries. The authors have successfully identified an area, but unfortunately, the manuscript lacks important elements and has serious issues as explained in detail. Perhaps, if these can be fixed, not sure. I made diligent efforts and spent a great deal of time to help authors improve their manuscript to the standard of the journal but unfortunately, I'm forced to indicate that no much cooperation was shown. Responses were very brief quite often joining my comments for different Lines together and mentioning just a phrase or short sentence such as "this is done", this clear", this is correct", which might even imply they think it was already clear. No specific indication that they have done that part and how they responded to. The manuscript has problems in major sections and structures as explained below starting with a poor and flawed Abstract, as explained below: The manuscript ACMI-D-23-00061Title: (water and foodborne pathogens isolated from children in a hospital system reveal 2 extensive resistance against commonly used Penicillin-type antibiotics) deals with an important area in a clinical public health issue; however, there are significant issues. Title: what is meant by hospital system?, Abstract is not well written, needs attention Line 20; which one viral, bacterial, non infectious, please be specific, it is very vague "second to what? Leading cause of death is very well known for kids and different in different geographics Line 24 under five children seeking? Revise the sentence Line 26 required? Please fix Line 27, conventional antibiotics? What is meant? Isn't there a pediatric protocol? Is this an adult hospital? Why conventional, this should have been modified long ago. Based on emerging resistant strains, many antibiotic treatment protocols were revised, and there is a specific protocol for children. Line 27-28 is not clear, what is the n=? is 63.8 total children in 196? Revise. If you did stat analysis, numbers should be written as n=? Line 29, how many total isolates obtained, indicating just % makes it difficult to understand; the 21.9% is taken from a total isolates, I think, or you're considering total patients, …so, only 21% is bacterial enteritis/diarrhea, the rest of causes? Don't you think this is not significantly high enough? this is not clear or justify Line 30 italize species names Line 31, it is surprising to see Salmonella less!, need to justify in discussion Line 32 -34, this is not well stated; susceptible to only one?, what protocol is used?, if so then you should mention multidrug or extensively drug resistance…which should concern L33 All isolated E. coli, Shigella spp., and Salmonella spp. exhibited susceptibility to Ceftriaxone. Which species, so, only one antibiotic works, are they all equally susceptible. Authors do not make these important points clear L34 35: Notably, 14 (56%) and 13 (52%) of E. coli isolates demonstrated resistance to Amoxicillin 35 and Ampicillin, respectively. What about others, this is not a complete pattern This whole manuscript is mostly based on this results: "All isolated E. coli, Shigella spp., and Salmonella spp. exhibited susceptibility to Ceftriaxone. 34 Notably, 14 (56%) and 13 (52%) of E. coli isolates demonstrated resistance to Amoxicillin 35 and Ampicillin, respectively" I tried to mitigate the manuscript to see if authors can improve, but it seems no much of the advises and great efforts made for them has been taken seriously. For instance, in this result they claim extensively resistant, but do not show these important criteria for the terms they used: 1. The battery of drugs used were not enough for the known array of therapies 2. They show only one drug as susceptible 3. The term "extensively" is a standard assigned only after application of "Resistance definition for resistance" to a list of standard categories of drugs in a specific protocol 4. There is not protocol specifically used for pediatrics 5. They show resistance only for E. coli, and call extensive, even for this species around 50% were resistant, not enough to categorize as extensively. 6. These points do not support the concluding remarks at the end of Abstract Introduction (please correct these, and may be update refs if preferably) The first paragraph is more descriptive, it should review rates, frequencies, and the importance of this research which comes in the next paragraph. No much change is made in this, the first paragraph should open eyes on what is more significant instead of description we all know. The second paragraph has a couple of review on this topic, not much in the region. L60 72: The authors worked on bacteria, and review viral reports, refs 8 and 9 are over decades old and 8 is on viral infection. The authors mentioned types of E. coli (EPEC, ETEC), but the type that is zoonotic in nature and transmits from animal is EHEC, no mention about it, and they do not isolate or even briefly work on any. Now, is it hospital system, zoonotic, community associated, no description of the type of infection transmission routes. Line 49 60, these refs (1, 6) are about a decade old, info might be ok, this might help: https://www.who.int/data/gho/data/themes/topics/topic-details/GHO/child-mortality-and-causes-of-death Material and Method This is still confusing; you indicated retrospectively then it seems like this was stored for seven years. How this represents todays situation after 7 years of storage? There is not enough detail. Please refer to earlier review comments for details. Most of the response were not step wise, not detailed, only a couple of sentences saying "this is done, this is made, this is correct, …etc does not indicate they were taken care after review and could imply that they were ok. The reviewer spend a great deal of time trying to help improve this manuscript but it seems not much cooperation was shown. The manuscript has serious issues.
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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Comments to Author
Revised version of manuscript meets my expectation and looks good to publish
Please rate the manuscript for methodological rigour
Satisfactory
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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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). Please provide more detail in the Methods section and ensure that software is consistently cited and its version and parameters included.
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Comments to Author
The authors reported an original article on the water and foodborne pathogens isolated from children in a hospital system reveal extensive resistance against commonly used Penicillin-type antibiotics. Also, they revealed concerning distribution of antibiotic resistance of bacteria in under 5 children. Overall, the manuscript requires major revision before it can be finally considered for publication: 1. This version of the manuscript suffers from some grammatical and spelling errors that must be corrected over the main body text. 2. What is the novelty of this study that distinguish it from the previous studies? 3. A lot of studies reported same results. What are your important findings that can distinguish your study from previously published studies in this field? 4. Did you measure your parameters …
Comments to Author
The authors reported an original article on the water and foodborne pathogens isolated from children in a hospital system reveal extensive resistance against commonly used Penicillin-type antibiotics. Also, they revealed concerning distribution of antibiotic resistance of bacteria in under 5 children. Overall, the manuscript requires major revision before it can be finally considered for publication: 1. This version of the manuscript suffers from some grammatical and spelling errors that must be corrected over the main body text. 2. What is the novelty of this study that distinguish it from the previous studies? 3. A lot of studies reported same results. What are your important findings that can distinguish your study from previously published studies in this field? 4. Did you measure your parameters in duplicate? 5. What are inclusion and exclusion criteria? 6. What is the limitation of this study? 7. Please add a starting paragraph to the discussion section to briefly introduce the topic, your goals, and hypothesis, and a short summary of what you did in this work. Many readers start reading the manuscript from the discussion and it should be understandable. 8. It would recommend publishing this valuable data in local journals.
Please rate the manuscript for methodological rigour
Poor
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
To authors: The manuscript ACMI-D-23-00061Title: (water and foodborne pathogens isolated from children in a hospital system reveal 2 extensive resistance against commonly used Penicillin-type antibiotics) deals with an important area in a clinical public health issue; however, there are significant issues. Title: what is meant by hospital system?, Abstract is not well written, needs attention Line 20; which one viral, bacterial, non infectious, please be specific, it is very vague "second to what? Leading cause of death is very well known for kids and different in different geographics Line 24 under five children seeking? Revise the sentence Line 26 required? Please fix Line 27, conventional antibiotics? What is meant? Isn't there a pediatric protocol? Is this an adult hospital? Why conventional, …
Comments to Author
To authors: The manuscript ACMI-D-23-00061Title: (water and foodborne pathogens isolated from children in a hospital system reveal 2 extensive resistance against commonly used Penicillin-type antibiotics) deals with an important area in a clinical public health issue; however, there are significant issues. Title: what is meant by hospital system?, Abstract is not well written, needs attention Line 20; which one viral, bacterial, non infectious, please be specific, it is very vague "second to what? Leading cause of death is very well known for kids and different in different geographics Line 24 under five children seeking? Revise the sentence Line 26 required? Please fix Line 27, conventional antibiotics? What is meant? Isn't there a pediatric protocol? Is this an adult hospital? Why conventional, this should have been modified long ago Line 27-28 is not clear, what is the n=? is 63.8 total children in 196? Revise Line 29, how many total isolates obtained, indicating just % makes it difficult to understand; the 21.9% is taken from a total isolates, I think, or you're considering total patients, …so, only 21% is bacterial enteritis/diarrhea, the rest of causes? Don't you think this is not significantly high enough? this is not clear or justify Line 30 italize species names Line 31, it is surprising to see Salmonella less!, need to justify in discussion Line 32 -34, this is not well stated; susceptible to only one?, what protocol is used?, if so then you should mention multidrug or extensively drug resistance…which should concern Introduction (please correct these, and may be update refs if preferrabley) The first paragraph is more descriptive, it should review rates, frequencies, and the importance of this research which comes in the next paragraph Line 43, please rewrite this Line 49 60, these refs (1, 6) are about a decade old, info might be ok, this might help: https://www.who.int/data/gho/data/themes/topics/topic-details/GHO/child-mortality-and-causes-of-death Line 73, identifying would not lessen incidences, I think what is meant is surveillance and developing strategic planning accordingly, revise 75 76, to be more specific, you may want to distinguish between disease management in patients, and accurate diagnosis …because only stool and microscopy would be limited if you describe as "enteropathogenic E. coli" that is a strain with specific virulence. Your country is known to have a bit of advanced diagnostics, if not available to you, we advise revise the sentence to make it reasonable, this is important work. Line 79 what factors you mean, mention some Line 86, how you aim to compare before knowing if there are any, revise, …identify potential presence and frequencies of …. And …. Material and Method Not well organized, cross section what time frame? Given only in Abstract. See below also Line 92, you aim to identify and characterize (experimental?), and then here you say it is descriptive! (observational, cross section)?, please state what is it about, this is a major issue in the design. Not sure what is meant by "focusing on isolation and characterization" Weren't you worked on specific timeframe, cross section, but carried out all experiments? Or you collected records of work routinely done by hospital in that time frame? Please clarify Line 97, it seems you're only dealing with specimens, not children, clarify. Are you diagnosing or management patients? Or isolating from specimens … meaning is this only lab work or lab and clinical .. important Line 99, now here you state "data collection", what data, records of already done work, then please revise your method language Line 99 - 102, is this field collection or in the hospital? Big difference if they're in the hospital as indicated, then how would you know family status at home? there are part of lab work for specific pathogens, and there is a kind of public health epidemiology element, the question is are you interviewing the same families that showed those pathogens? Or a general population sample? Then how would you related those factors to those specific pathogens, so many factors lead to diarrhoea, can also be parasitic, viral, fungal. …etc. What is needed here is to make a case and justify why you do this, otherwise the readers would a bit confused as to how this relates. 109: why did you limit isolation only to fermenters and non fermenters by the use of MacConkey? Have you had known they're there?, and then you proceed to isolate Salmonella from specimens on selenite!, isn't it wise to first suspect Salmonella then confirm? 118 to 120, good idea to use refs bacteria 120 biochemical tests look ok but please revise experimental progress before this point, 142, there is a known resistance to some of your antimicrobials, is this what is prescribed in your area? What is the recommended protocol now, this is crucial 152, so you used the questionnaire in the hospital, then how did you confirm efficiency by doing so?, isn't it a question based? 156, in whole manuscript, some words in capital some small….make it consistent Results (any ABI output would help) Line 174, now here 196 are isolates, in abstract they're described as children, did you then isolate one from each child, clarify Line 195, out of 196 (100% showed signs) children, only 43 were enteric diarrhoea, don't you think other agents/factors are more likely to cause diarrhea, what is the significance of this considering it very common for so young kids to have diarrhea. Are you aiming for a public health related diarrhea or age-specific diarrhea, what is the significance of age here, it only speaks against you. In the whole result, I just worry why use associations of symptoms to bacterial species identified, when you can simple just test and see, what is the relevance of this. If you have specifically identified an agent from a sample, then that's it, all the symptoms must belong to it, they all have very similar signs, associations won't tell much. Preferably, you could do strain testing from a nearby refs lab or facility. Discussion Discussion is an exaggeration at Six (6) pages, of simple findings 340 the first paragraph not necessary, focus on the work 357 only by Gram stain? Not sure, you didn't find any Salmonella serotypes differentiated? Typhimurium enteritidis, ..etc Refs are over a decade, you'll find many new refs 387 388 not clear, what do you mean should be much lower as …. 518, it is critical that you clearly state (Approved) if you have obtained ethical approval, it is simply stated (sought)
Please rate the manuscript for methodological rigour
Poor
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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