Wound infection with Bacteroides fragilis: A case report
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Bacteroides fragilis is an anaerobic organism which can cause abdominal infections, abscesses, skin and soft tissue infection, and sepsis with high degree of mortality. We present a case of intra-abdominal wound infection after penetrating wound injury caused by B.fragilis. Early diagnosis and treatment has been been critical in the prevention of morbidity and mortality associated with the infection.
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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
The manuscript has an interesting and important topic, however, it is rather superficially written and with many errors, especially in taxonomy. A substantial revision should be attempted to improve the manuscript. Authors should specify what their own contribution to the topic is, what is new, and what is the message of the manuscript. 1. Line 32: change microbiome to microbiota. 2. Line 33: Current taxonomy should be complied with and actual bacterial names should be used. It is not only Bacteroides genus. At present, Bacteroides fragilis group [BFG] include Bacteroides, Parabacteroides and Phocaeicola species. 3. Line 58: Authors should not use the trade names of the antibiotics. The generic name is important; in this case it is not Monocef but ceftriaxone. 4. Lines 61-62: the words "Blood", …
Comments to Author
The manuscript has an interesting and important topic, however, it is rather superficially written and with many errors, especially in taxonomy. A substantial revision should be attempted to improve the manuscript. Authors should specify what their own contribution to the topic is, what is new, and what is the message of the manuscript. 1. Line 32: change microbiome to microbiota. 2. Line 33: Current taxonomy should be complied with and actual bacterial names should be used. It is not only Bacteroides genus. At present, Bacteroides fragilis group [BFG] include Bacteroides, Parabacteroides and Phocaeicola species. 3. Line 58: Authors should not use the trade names of the antibiotics. The generic name is important; in this case it is not Monocef but ceftriaxone. 4. Lines 61-62: the words "Blood", "Haemin", "Vitamin" and "Anaerobic" should be written in small letters. 5. Figures: some of the figures such as Figure 3 and Figure 4 can be removed. 6. Line 109: Authors should not use the trade names of the antibiotics. The generic name is important. 7. Line 115: the names of the genera should be written in italics. 8. Lines 139-143: There are numerous errors in the sentence: a. Gram-positive anaerobic cocci encompass different genera. The most common GPAC causing infections in humans and especially abdominal infections should be mentioned; b. Microaerophilic streptococci should not be with a capital letter and should not be in italics; c. At present, Propionibacterium acnes is Cutibacterium acnes and has three subspecies. d. This data should be corrected and appropriate references should be added. 9. Line 151: Bacteroides fragilis should be in italics. 10. MALDI-TOF MS is mentioned in the text but should be described in details (name, provider, score value). 11. Table 1: More recent publications (references) should be found and included. 12. Lines 160-161: The other antibiotics which are given for treating B.fragilis infections are β-lactams, carbapenems, clindamycin, Fluoroquinolones". Most beta-lactams are not appropriate to treat BFG infections. The authors should emphasize this and enumerate the inappropriate beta-lactam antibiotics. Fluoroquinolones are not drugs of choice for BFG infections either. 13. Line 164: the genes associated with BFG resistance to antibiotics are very important and should be listed in the text. 14. References: there are many references published >10 years ago. Most of them can be replaced by newer references.
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
The description of this case sufficiently provided relevant patient medical history and diagnoses resulting in the decision making processes for treatment with positive outcome. The presentation is well-structured and flows well regarding the longitudinal data from initial clinical presentation to resolution of the intra-abdominal infection and subsequent discharge of the patient. There may be additional value added for the reader if an explanation is included that outlines why the post-operative administration of Monocef and Amikacin was not sufficient in preventing B. fragilis infection, specifically. Line 159 describes Metronidazole as the preferred treatment choice for Bacteroides spp. after mentioning in Line 120-122 that there is a high frequency of this particular pathogen causing infection …
Comments to Author
The description of this case sufficiently provided relevant patient medical history and diagnoses resulting in the decision making processes for treatment with positive outcome. The presentation is well-structured and flows well regarding the longitudinal data from initial clinical presentation to resolution of the intra-abdominal infection and subsequent discharge of the patient. There may be additional value added for the reader if an explanation is included that outlines why the post-operative administration of Monocef and Amikacin was not sufficient in preventing B. fragilis infection, specifically. Line 159 describes Metronidazole as the preferred treatment choice for Bacteroides spp. after mentioning in Line 120-122 that there is a high frequency of this particular pathogen causing infection in bowel perforations cases. The laboratory diagnostic data is thorough and informative. For further clarity - How was the sensitivity determined? Is there a specific MIC value for Metronidazole sensitivity? Figure 2. appears to show 1 or 2 colonies growing close to the diffusion disc. As different institutions have varying protocols for sensitivity testing in the clinical lab, it is prudent to outline a standard protocol that was used for the antibiotic sensitivity results. Not all institutions have MALDI-TOF or RT-qPCR assays for rapid TAT's. Line 150 mentions lack of routine anaerobic culture in the clinical lab. This is not always the case. Some labs have anaerobic cultures as part of the SOP for wound cultures. So, it may also be beneficial to the clinical lab professional readers to see the biochemical assay results in a supplemental table. There are a number of simple grammatical errors that need to be revised to ensure clear communication for the final draft. Overall, the case study is informative and comprehensively outlined. However, it may add value to the reader if some more information about the treatment choice differential was included.
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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